Romanian Journal of Oral Rehabilitation - Amazon S3s3.amazonaws.com/zanran_storage/ Journal of Oral Rehabilitation Vol. 2, No. 3, July 2010 3 FOREWORD The Day of Moldavian Prophylaxy

Romanian Journal of Oral Rehabilitation

Vol. 2, No. 3, July 2010

1

Romanian Journal

of Oral Rehabilitation

Vol. 2, No. 3, July 2010

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


Vol. 2, No. 3, July 2010

2

CUPRINS

FOREWARD (Prof. Univ. Dr. Norina Forna)

3

POSTTHERAPEUTIC FEEDBACK EVALUATION IN ORAL REHABILITATION

Sami Sandhaus, Norina Forna

4

THE EPIDEMIOLOGY OF THE SAGITTAL DISORDERS AT THE LEVEL OF THE SKELETAL

BASIS CORRELATED WITH THEIR VERTICAL DISORDERS ON A GROUP OF PATIENTS OF

BUCHAREST

R. Stanciu, Anca Temelcea, Ileana Simion, Valentina Dorobăţ

7

ANATOMIC AND ANTHROPOLOGICAL CONSIDERATIONS OF NEUROCRANIUM

Anca Indrei, Gr. D. Mihalache, Gr. Mihalache

11

CHILD PHYSICAL ABUSE FROM THE PERSPECTIVE OF PEDIATRIC DENTISTRY

Savin Carmen, Bălan Adriana, Petcu Ana, Maxim A., Earar K., Bălan Gh.

17

THE MECHANICAL BEHAVIOR OF THE AESTHETIC MATERIALS IN VENEERED PROSTHETIC

CONSTRUCTIONS

Diana Diaconu, Monica Tatarciuc, Anca Viţalariu, St. Panaite

21

THE ROLE AND IMPORTANCE OF THE CARIES DETECTORS DYES IN EARLY DIAGNOSIS

AND TREATMENT OF DENTAL CARIES

Pancu Galina, Stoleriu Simona, Andrian Sorin, Gheorghe Angela, Topoliceanu Claudiu, Pancu Ion,

Lăcătuşu Ştefan

26

PERIODONTAL CHANGES IN CONJUNCT PROSTHESES

Valeria Pendefunda, Arina Ciocan-Pendefunda, Carmen Pîrlia

29

RADIODENSITOMETRIC STUDY REGARDING CONSERVATIVE ENDODONTIC THERAPY IN

PERIAPICAL LESIONS

Sãlceanu Mihaela, Donciu Cristi, Maria Vataman, Radu Vataman

35

PRE-EXTRACTIONAL VALUE OF THE INTERNATIONAL NORMALIZED RATIO IN

IDENTIFICATION OF THE HEMORRHAGIC AND THROMBOEMBOLIC RISK IN PATIENTS

UNDERGOING ORAL ANTICOAGULANT TREATMENT

Oleg Zănoagă, Valentin Topalo, Ion Corcimaru, Dumitru Sîrbu, Ilie Suharschi

40

ASSESSMENT OF ORO-DENTAL HEALTH STATUS USING THE CAO AND EGOHID INDEXES AT

THE YOUNG PEOPLE

Ioan Dănilă, Iulia Saveanu, Carina Balcos

50

THE DAY OF PROPHYLAXY, JUNE, 9, 2010

55


Vol. 2, No. 3, July 2010

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FOREWORD

The Day of Moldavian Prophylaxy in Dental

Medicine is already a traditional manifestation. This

year the topic is “Evaluation of the Oral Status at Rural

and Monastic Population and Rehabilitation

Possiiities”, which extends the population health

assessment to the villages in the county of Iasi.

The Symposium dedicated to oral pathology

prevention methods reunites both conferences held by

representative personalities in the field and

representative companies which promote prophylaxy products. An important

aspect is the Prophylaxy Caravan organizing special places for the oral health

evaluation as well of information , promotion, and distribution of free samples

of prophylaxy products in the county of Iasi and in the monastic community.

The assessment results is particularly important for the future dissemination of

prophylaxy methods and identification of incipient stages in oral pathology.

Prof. Univ. Dr Norina Forna

The President of Romanian Society ofOral Rehabilitation


Vol. 2, No. 3, July 2010

4

POSTTHERAPEUTIC FEEDBACK EVALUATION IN ORAL

REHABILITATION Sami Sandhaus

1, Norina Forna

2

1. Forum Odontologicum International, Lausanne, SWITZERLAND

2. ―Gr. T. Popa‖ University of Medicine and Pharmacy Iasi

Faculty of Dental Medicine

Clinic and Therapy of Extended Partial Edentation

Abstract:

Objectives: The goal of this study was to assess the subjective post-therapeutic feedback for a group of patients

in order to evaluate the possibility of including in the analysis structure of expert system psycho-behavioral

parameters.

Methods: 135 patients diagnosed with class I and II Kennedy edentation, aged between 40 and 89 years old,

where clinically examined. All patients filled in structured questionnaires focused on psycho-behavioral

parameters.

Results: Prosthetic treatment in oral rehabilitation improves subjective perception of facial aesthetic (66,86%

total and moderate accord), psychological status (71,14% total and moderate accord) and of the social relations

(77,47% total, moderate and low accord) but it is not subjective associated with the improving of general health

(55,49% disagreement).

Conclusions: We can establish statistical support correlation between psycho-behavioral parameters and

therapeutic solutions applied in oral rehabilitation, correlation that can be later quantified and use in the

development of an expert system.

Key words: psycho-behavioral parameters, posttherapeutic feedback, expert systems.

INTRODUCTION

Establishing a treatment plan in oral

rehabilitation involves particularization of

general information concerning clinic,

paraclinical and technological aspects of

removable partial dentures realization and

also a synthesis of clinical, social and

psychological parameters of the patient.

After this complex evaluation, medical

approach of the case leads to a diagnostic

and choosing optimal therapeutic solution,

choice based on practical and theoretical

background of the practitioner. The chosen

solution will guide all the stages of the

treatment, local and generally, so in the

end the stomatognat system to be able to

sustain the prosthetic device in optimal

conditions.

AIMS AND OBJECTIVES

This study aims to analyze subjective

post-therapeutic feedback of patients

diagnosed with Kennedy class I and II

edentation, treated with three therapeutic

solutions: acrylic prosthesis, composite

prosthesis and implanto-prosthetic

rehabilitation. The final objective is to

analyze the possibility to insert psycho-

behavioral parameters in the analysis

structure of an expert system for oral

rehabilitation.

MATERIAL AND METHOD

Our research analyzed the way in

which therapeutic solutions applied to a

group of patients diagnosed with maxillary

and/or mandibullary partial edentation,

Kennedy class I and II modified the

subjective perception of some personal

psycho-behavioral characteristics.

The study has a descriptive design and

includes 135 patients with ages between

40 and 89 years old which has addressed

to Interdentis Medical Center from Pascani

between 01.11.2007 and 01.11.2008. The

patients were divided in three groups

according to the applied treatment

solutions, respectively classic acrylic

solution, composite prosthetic devices and

implanto-prosthetic rehabilitation. We


Vol. 2, No. 3, July 2010

5

estimated the size of the representative

group in order to have statistically

significant results and the examination

protocol was approved by the Clinic and

Therapy of Extended Partial Edentation

Discipline form Dental Faculty of U.M.F.

"Gr. T. Popa", Iasi. The patients included

in our research were investigated and the

results were statistically analyzed.

Clinical examination allowed an

evaluation of the patients’ subjective

perception regarding the way in which

prosthetic treatment modified their facial

esthetic, psychological status, social

relations and general health.

Statistically research has been realized

by creating a database which was

computer analyzed using SPSS 15.00

software that provided an interpretation of

the statistical analysis.

RESULTS

Fig. 1 - Age distribution of patients Fig. 2 - Sex distribution of patients

Fig. 3 - Living area distribution of patients Fig. 4 - Education distribution of patients

We can see that majority of the

patients from study group are aged

between 40 and 59 years old (68,90%) and

sex distribution is relatively equal between

male and female (55,31% female and

respectively 44,69% male). Living area

show that most of the subjects came urban

area, 57,69% have a city address and only

42,09% are coming from rural areas.

Educational level distribution puts the

majority of the patients in the groups of

high school and university degree (46,55%

and respectively 24,95%)

Fig. 5 - Affirmation "Prosthetic treatment improved my facial esthetic"

44,69%

24,21%

20,67%

10,43% 40-50 years

51-60 years

61-70 years

over 71 years

44,69%

55,31%male

female

57,91%

42,09%

urban

rural

13,97%

14,53%

46,55%

24,95%

primary classes

8 classes

highschool

college

3,17% 4,28%

7,45%

36,69%18,25%

30,17%total disagreement

slight disagreement

moderate disagreement

moderate agreement

slight agreement

total agreement

0

500 80457

7,26%20,86%

27,37%22,53%

12,10%

9,87%total disagreement

slight disagreement


moderate agreement

slight agreement

total agreement

0

100

200

300

disagreement agreement

298239


Vol. 2, No. 3, July 2010

6

Fig. 6 - Affirmation "Prosthetic treatment improved my general health"

Fig. 7 - Affirmation "Prosthetic treatment improved my psychological status"

Fig. 8 - Affirmation "Prosthetic treatment improved my social relations"

DISCUSSIONS

Without determining directly the

course of the treatment, psycho-behavioral

parameters influence the choice of the

final therapeutic solution, case

management and medium and long term

prognostic for the case.

Subjective post-therapeutic feedback

may represent an orientation element in

pretreatment psycho-behavioral

assessment of the patient and in the

process of choosing the final prosthetic

solution

CONCLUSIONS

1. 85,10% of patients consider that

prosthetic treatment improved their facial

esthetic (66,86% total and moderate

accord).


prosthetic treatment improved their

psychological status (71,14% total and

moderate accord).


prosthetic treatment improved their social

relations (total, moderate and low accord).

4. Improvement of the general health is not

associated with prosthetic treatment

(55,49% total, moderate and low

disagreement).

5. We can statistically support the

establishment of correlations between

patient's psycho-behavioral parameters and

applied therapeutic solutions, correlations

that can be later used in development of an

expert system for oral rehabilitation.

REFERENCES 1. N. Forna, Burlui V. - Clinical guidelines and principles in the therapy of partial extended edentation -

editura Apollonia, Iași, 2001

2. Collen M.F. - A vision of health care and informatics - American Journal of Medical Informatic

Association, 2008

3. Reichert A., Sadan B.A., Bengtsson S. - Design of an oral health information system based upon a

computer based dental record - Jerusalem, Israel, 1993.

7,26%

45,81%

16,39%

25,33% 5,21%total disagreement

slight disagreement


moderate agreement

slight agreement

total agreement

0

200

400

600


67

470

3,17% 7,26%

12,10%

29,05%22,91%

25,51%

total disagreement

slight disagreement


moderate agreement

slight agreement

total agreement

0

200

400

600


121

416


Vol. 2, No. 3, July 2010

7

THE EPIDEMIOLOGY OF THE SAGITTAL DISORDERS AT THE

LEVEL OF THE SKELETAL BASIS CORRELATED WITH THEIR

VERTICAL DISORDERS ON A GROUP OF PATIENTS OF

BUCHAREST R. Stanciu

1, Anca Temelcea

2, Ileana Simion, Valentina Dorobăţ

3

1 The University of Medicine and Pharmacy „Carol Davila‖ Bucharest, Faculty of Dental Medicine,

Orthodontics and Dento-facial Orthopedics Clinic 2 The University of Medicine and Pharmacy „Carol Davila‖ Bucharest, Faculty of Dental Medicine,

Orthodontics and Dento-facial Orthopedics Clinic 3 The University of Medicine and Pharmacy „Gr. T. Popa‖ Iaşi, Faculty of Dental Medicine

Abstract: The development disorders of the maxillary and mandibular skeletal basis in a sagittal and vertical

plan correlate and create a clinical image with an impressive variability. Even if the proportions on each

development model are less important, their association determines an important treatment necessity.

Key words: class II/2 malocclusion, hyperdivergent development, hypodivergence development

PURPOSE: determining the prevalence of

the epidemiology for Class II/2

malocclusion in a survey.

OBJECTIVES:

- establishing the prevalence of the

modifications occured on the basis in

Class II/2 malocclusion;

- studying the reported phenomenon in

relation to the age and sex group;

- introducing the early therapeutic

measures for the population.

WORK METHOD:

The research is based on the data

collected from a group of 268 patients,

aged between 4 and 16 years, 126 boys

and 142 girls.

The data were registered in the

diagnosis report sheet and in that of the

epidemiological examination, where the

main purposes were:

- the level of the general psycho-somatic

development;

- the clinical facial examination, the

position of the lower cranial floor of the

face compared to the middle one, the facial

typology, normal, hypo-/hyper-divergent,

thus realizing a three-dimensional

analysis;

- the dimensional equilibrium between the

anterior and the posterior floors of the

face;

- thus obtaining enough information in

order to establish the equilibrium existence

or the lack of equilibrium at the level of

the maxilar basis and implicitly the

necessity to continue the investigations in

order to assess the need for an orthodontic

treatment.

The dental analysis focused on the

occlusion of the three dimensions of the

space, a fact which allowed the group’s

division into two, with dental and

maxillary abnormalities, classified in the

three Angle classes (Class I, Class II/1,

Class II/2, Class III) and dental and

maxillary abnormalities.

The gathering of the dental and facial

data allowed us to perform an overall

assessment of the health status of the

population and to establish the needs for

treatment.

The epidemiological sheets were

stored in the information database; the

statistic processing was performed

according to the SPSS 16.0 system.


Vol. 2, No. 3, July 2010

8

Diagram no.1 The position of the lower cranial

floor compared to the middle floor in boys

Diagram no.2 The position of the anterior cranial

floor compared to the middle floor in girls

RESULTS AND DISCUSSIONS

1. The study of the position of the

lower cranial floor compared to the

middle cranial floor In boys, the retroposition of the lower

floor is established at the age of 6-12

years; the biggest proportion, of almost

20%, occurring in the interval 6-8 years,

while for the interval 8-12 years, decreases

at almost 10% (diagram no.1).

The mandibular prognathism affects

the peoples from the same interval, but

with much lower values compared to the

mandibular retrognatia.

We notice the fact that at the age

below 6 years, a normal position of the

mandibula is present, a phenomenon

which we will encounter at the group of

12-14 years (diagram no.1).

In girls, the mandibular retrognathism

reaches values certainly larger at the age of

6-8 years, and decreases more than half in

the interval 8-10 years, in order to reach

values of 25% in the interval 12-14 years.

The mandibular prognathism occurs in

the interval 6-8 years and significantly

decreases at the age of 8-10 years (diagram

no.2).

The differences between sexes are

given by the frequency of the cases with

mandibular retrognathism, which is larger

in girls at the observation terminal age

comprised in the survey (12-14 years).

As a synthesis of the relation

between the maxillary and the mandibula,

at the cranial basis, respectively of the

maxillary, we can state that: in the age

interval comprised in our step (6-14 years),

boys of 12-14 years are mostly affected by

the maxillary prognathism (in a proportion

of 100%, and of 50% in girls), while girls

are more affected by mandibular

retrognatia rather than boys (girls 25%,

boys 0%).

2. Facial typology

The vertical development of the

cranial and facial segment represents a

first class factor in the analysis of Class

II/2 malocclusion. Our investigations with

regard to the facial tipology underline the

following aspects correlated with sex and

age:

- in boys, the hypodivergence

marks rates over 10% in the 6-8 years

class, decreasing with insignificant value

in the interval 8-10 years, a decrease

which maintains for the interval 10-12

years, and in for 12-14 years, we ascertain

a massive increase of the hypodivergence,

with values over 50%.

0%

20%

40%

60%

80%

100%

< 6 years

6-8 years

8-10 years

10-12 years

12-14 years

14-16 years

> 16 years

Boysretro

normo

pro

0%

20%

40%

60%

80%

100%

< 6 years

6-8 years

8-10 years

10-12 years

12-14 years

14-16 years

> 16 years

Girlsretro

normo

pro


Vol. 2, No. 3, July 2010

9

- hyperdivergence occurs with small

values in the interval 6-8 years, increases

to 10% in the interval 8-10 years, and

slightly decreases again, with around 8%

in the interval 10-12 years.

As a conclusion, hypodivergence is

more frequent in boys than the

hyperdivergence and reaches ceiling

values at the age of 12-14 years (diagram

no.3)

In girls we can appreciate that the

phenomenon reverses (diagram no.4),

respectively the hyperdivergence is present

at the age of 6-8 years in a proportion of

over 25%, decreasing with almost 10% for

the group of 8-10 years, and in the interval

12-14 years, it marks values of almost

50%.

Hypodivergence is identified in the

interval 6-10 years with values of 10%.

Diagram no.3 Facial vertical typology in boys

Diagram no.4 The facial vertical typology in girls

As a conclusion, the girls are affected

by hyperdivergence, registering the most

significant values at the age of 12-14

years, an element which needs to be

considered in the treatment strategy

applied to the clinical case (the necessity

to be controlled and quantified based on

the complementary examinations, on the

clinical examination).

The epidemiology of the dental and

maxillary abnormalities has a large

variability, depending on: the examined

people, the geographical environment, the

social and economic factors, the age

groups, dentition - teeth and sex.

As for the types of abnormalities

identified by us in investigated group,

these will be scheduled as follows, in the

prevalence order: Class I Angle

abnormalities – 43,63%, Class II-

abnormalities – 32,7 and Class III

abnormalities 3,2%; the type of dental and

maxillary abnormalities class found in our

research, exist in the most part of the

researches performed on people, in our

country10

as well as in other parts of the

world.

CONCLUSIONS

The data obtained in our study

regarding this group of children, allow us

to draw the following conclusions:

- the clinical examination can provide a

wide range of data, which might allow us

to give a clinical diagnosis of Class II/2

malocclusion;

- based on the results obtained in the

epidemiological examination, we found a

prevalence of Class II/2 malocclusion of

9%;

0%

20%

40%

60%

80%

100%

< 6 years

6-8 years

8-10 years

10-12 years

12-14 years

14-16 years

> 16 years

Boyshipodiv

normodiv

hyperdiv

0%

20%

40%

60%

80%

100%

< 6 years

6-8 years

8-10 years

10-12 years

12-14 years

14-16 years

> 16 years

Girlshipodiv

normodiv

hyperdiv


Vol. 2, No. 3, July 2010

10

- the prevalence of Class II/2 malocclusion

established differences depending on the

sex and age group;

- our research underlines the need for the

trials on people, extended to larger groups

of persons and for a long-term follow-up,

based on the complementary examinations

(trial; models, teleradiographies) of small

groups of subjects, in order to obtain more

clear data;

- the treatment strategies must take into

account the insertion of the early

orthodontic therapy, correlated with sex

and the age group.

REFERENCES 1. DOROBĂŢ, V. şi colab.: Epidemiologia anomaliilor dento-maxilare la vârsta de 7 ani. Rev. Ortod. şi ODF

1(2): 2-7,2000.

2. HEIKINHEIMO, K.: Need of Orthodontic treatment and prevalence of cranio-mandibular dysfunction in

Finnish Children Turku – Finland, 1989.

3. HELM, S.: Malocclusion in Danish Children with adolescent dentition. An epidemiologic study. Am J

Orthod, 54:352-66, 1968.

4. PROFFIT, W.R., FIELDS, H.W. JR, SARVER, D.M.: Contemporary Orthodontics. Mosby, 2007.

5. STANCIU, D., DOROBĂŢ V., BRATU E., ŞERBĂNESCU, A. ŞI COLAB. - Proiect CEEX nr. 87/2006.

6. STANCIU, D., SCÂNTEI-DOROBĂŢ, V.: Ortodonţie. Editura Medicală Bucureşti, 1991.


Vol. 2, No. 3, July 2010

11

ANATOMIC AND ANTHROPOLOGICAL CONSIDERATIONS OF

NEUROCRANIUM Anca Indrei, Gr. D. Mihalache, Gr. Mihalache

―Gr.T.Popa‖ University of Medicine and Pharmacy Iaşi

School of Dental Medicine

Discipline of Anatomy and Embryology Abstract: The neurocranium, the part of the skull enclosing the brain, plays a significant role in the skeleton.

This is the reason for which it has been the subject of many studies, that have not clarified all its anatomic but,

most of all, anthropological aspects. Material and method: Our research is based on the study of 60 skulls from

the collection belonging to ―Ion Iancu‖ Institute of Anatomy and to Iaşi Institute of Anthropology. 30 skulls

dated from the 1st century (15 male skulls and 15 female skulls) and 30 from the 20

th century (also, 15 male

skulls and 15 female skulls). We grouped these skulls by age, resulting thus 12 sub-categories.

We studied the braincase bones of each skull, noticing first of all any potential variations. We also measured the

maximum cranial length and width of each skull, and we determined the cephalic index, and the cranial

capacity. Results: Our study revealed several variations of the neurocranium bones, and the anthropometric

values showed that most of the investigated skulls from the 1st century were dolichocephalic and mesocephalic

in the 20th

century. We should also mention that the skulls from the 20th

century had an increased cranial

capacity than those from the 1st century.

Key words: neurocranium, cephalic index, cranial capacity.

INTRODUCTION

The neurocranium, the part of the

skull enclosing the brain, plays a

significant role in the skeleton. This is the

reason for which it has been the subject of

many studies, that have not clarified all its

anatomic but, most of all, anthropological

aspects.

MATERIAL AND METHOD

Our research is based on the study of

60 skulls from the collection belonging to

―Ion Iancu‖ Institute of Anatomy and to

Iaşi Institute of Anthropology. 30 skulls

dated from the 1st century (15 male skulls

and 15 female skulls) and 30 from the 20th

century (also, 15 male skulls and 15

female skulls). We grouped these skulls by

age (under 30 years age, between 30 and

60 years age and over 60 years age),

resulting thus 12 sub-categories.

We studied the braincase bones of

each skull, noticing first of all any

potential variations (1).

We measured the maximal cranial

length (summit of glabella to furthest

occipital point) and the maximal cranial

breath of each skull (greatest breath, at

right angles to median plane). We

determined the cranial index (breath/

length ratio). After the cranial index, the

skulls may be dolichocephalic (the index

up to 74,9), mesocephalic (the index

between 75 and 79,9) and brachycephalic

(the index over 80).

We measured too, the cranial capacity

using the following formulae:

Males: 0.000337 (L-11) (B-11) (H-11)

+ 406.01cc

Females: 0.000400 (L-11) (B-11) (H-

11) + 206.60 cc

In these formulae L and B are

maximal cranial length and breadth and H

is the auricular height, measured to the

vertex from the external acoustic meatus

(2). All measurements are in millimeters.


The bones of the neurocranium

presented numerous variations.

The frontal bone and the parietal bone

were the most constant bones presenting

no major variations from the normal

bones.

The ethmoid bone presented in one

case (skull nr. 17 – figure 1) the presence


Vol. 2, No. 3, July 2010

12

of the accessory nasal concha of Santorini

(3).

The sphenoid bone presented the most

variations (4,5). Three skulls presented

middle clinoid processes. We present in

figure 2 such a case.

We also noted the presence in one

case of the ossified ligament of Civinini

(6). We present in figure 3 the skull 18

with this variation.

The temporal bone presented in one

case (figure 4) the persistence of the suture

between the squamous part and the

mastoid part (7).

A rare case is the presence of a

vermian bone at the level of the occipito-

temporo-parietal suture (8). This case is

presented in figure 5.

Figure 1. The accessory nasal concha of Santorini.

Figure 2. Middle clinoid processes in skull nr. 31.

Figure 3. Ossified ligament of Civinini.


Vol. 2, No. 3, July 2010

13

Figure 4. The persistence of the suture between the squamous part and the mastoid part –

skull 42.

Figure 5. Vermian bone at the level of the occipito-temporo-parietal suture.

The skulls from the first century presented the following dimensions:

The first subcategory – female skulls from the first century (under 30 years old):

Skull Length (mm) Breath (mm) Auricular

height (mm)

Cranial Index Cranial

capacity (cc)

1. 180 148 109 82,2 1129,19

2. 181 137 110 75,6 1054,83

3. 184 136 111 73,9 1071,6

4. 186 138 110 74,1 1086,71

5. 188 139 111 73,9 1112,84

The second subcategory – female skulls from the first century (between 30 and 60 years old):


height (mm)


capacity (cc)

6. 185 147 111 79,4 1153,1

7. 186 138 114 74,1 1122,27

8. 184 139 116 75,5 1136,64

9. 187 139 112 74,3 1116,73

10. 189 140 115 74,0 1161,81


Vol. 2, No. 3, July 2010

14

The third subcategory – female skulls from the first century (over 60 years old):


height (mm)


capacity (cc)

11. 182 141 112 77,4 1104,69

12. 185 149 115 80,5 1205,49

13. 178 148 114 83,1 1149,21

14. 189 141 113 74,6 1150,71

15. 186 139 111 74,7 1102,61

The fourth subcategory – male skulls from the first century (under 30 years old):


height (mm)


capacity (cc)

16. 189 145 115 76,7 1375,38

17. 190 140 113 73,6 1277,46

18. 188 141 114 75,0 1282,92

19. 187 139 115 74,3 1272,88

20. 185 138 116 74,5 1256,34

The fifth subcategory – male skulls from the first century (between 30 and 60 years old):


height (mm)


capacity (cc)

21. 191 147 118 76,9 1375,17

22. 194 145 116 74,7 1429,78

23. 188 140 113 74,4 1267,72

24. 189 141 115 74,6 1287,87

25. 186 142 114 76,3 1279,68

The sixth subcategory – male skulls from the first century (over 60 years old):


height (mm)


capacity (cc)

26. 188 151 117 80,3 1377,88

27. 182 139 116 76,3 1256,35

28. 186 138 119 74,1 1294,12

29. 185 140 118 75,6 1294,64

30. 189 141 120 74,6 1339,24

The skulls of the 20-th century presented the following results:

The 7-th subcategory – female skulls from the 20-th century (under 30 years old):


height (mm)


capacity (cc)

31. 187 148 116 79,1 1219,30

32. 191 147 119 76,9 1404,96

33. 189 143 114 75,6 1206,24

34. 188 146 115 77,6 1200,63

35. 192 146 116 76,0 1232,87


Vol. 2, No. 3, July 2010

15

The 8-th subcategory – female skulls from the 20-th century (between 30 years and 60 years

old):


height (mm)


capacity (cc)

36. 188 146 116 77,6 1210,19

37. 193 148 116 76,6 1253,82

38. 197 147 118 74,6 1289,26

39. 195 149 117 76,4 1283,22

40. 199 152 120 76,3 1362,34

The 9-th subcategory – female skulls from the 20-th century (over 60 years old):


height (mm)


capacity (cc)

41. 191 150 118 78,5 1277,45

42. 196 151 116 77,0 1294,40

43. 204 152 119 74,5 1382,20

44. 202 154 117 76,2 1473,92

45. 201 149 119 74,1 1339,30

The 10-th subcategory – male skulls from the 20-th century (under 30 years old):


height (mm)


capacity (cc)

46. 185 144 118 77,8 1322,20

47. 188 146 120 77,6 1369,69

48. 193 151 121 78,2 1443,04

49. 200 155 122 77,5 1523,77

50. 203 160 121 78,8 1570,35

The 11-th subcategory – male skulls from the 20-th century (between 30 and 60 years old):


height (mm)


capacity (cc)

51. 201 148 119 73,6 1446,16

52. 202 143 118 70,7 1404,15

53. 204 154 121 75,4 1529,28

54. 203 155 122 76,3 1541,51

55. 206 156 121 75,7 1556,80

The 12-th subcategory – male skulls from the 20-th century (over 60 years old):


height (mm)


capacity (cc)

56. 203 151 122 74,3 1500,02

57. 205 154 121 75,1 1535,10

58. 201 152 122 75,6 1552,60

59. 199 153 119 76,8 1472,78

60. 200 155 120 77,5 1503,63


Vol. 2, No. 3, July 2010

16

CONCLUSIONS

Our study revealed several variations

of the neurocranium bones – the most

variable bone being the sphenoid bone.

The anthropometric values showed

that most of the investigated skulls from

the 1st century were dolichocephalic and

mesocephalic in the 20th

century.

We should also mention that the skulls

from the 20th

century had an increased

cranial capacity than those from the 1st

century.

REFERENCES 1. Rouviere H, Delmas A. Anatomie humaine. Tome 1 - Tete et cou. Paris: Masson, 2002, 39–90.

2. Williams PL, Warwick R. Dyson M, Bannister LH. Gray's Anatomy. 37th

ed. Edinburgh: Churchill

Livingstone, 1989, 371-398.

3. Ashton EH, Moore WJ. Cranial shape in the hominidea - exploratory considerations. J Anat 1980; 131:

744-745.

4. Berry AC. Factors affecting the incidence of non - metrical skeletal variants. J Anat 1975; 120: 519-535.

5. Indrei A, Mihalache GrD. Neurocraniul – elemente de curs. Iaşi: Casa de Editură ―Venus‖, 2002, 25–84.

6. Kinman J. Surgical aspects of the anatomy of the sphenoidal sinuses and the sella turcica. J Anat 1977;

124: 541-553.

7. Solter M, Panjana D. Variations in shape and dimensions of sigmoid groove, venous portion of jugular

foramen, jugular fossa, condylar and mastoid foramina classified by age, sex and body size. Z Anat Entw

Gesch 1973; 140: 319-335.

8. Olivier G. Biometry of the human occipital bone. J Anat 1975; 120: 507-518.


Vol. 2, No. 3, July 2010

17

CHILD PHYSICAL ABUSE FROM THE PERSPECTIVE OF

PEDIATRIC DENTISTRY Savin Carmen

1, Bălan Adriana

1, Petcu Ana

1, Maxim A.

1, Earar K.

2, Bălan Gh.

3

1 Pediatric Dentistry Department, Faculty of Dental Medicine, Iasi „Gr.T. Popa‖ University

of Medicine and Pharmacy 2 Dentist, Iasi „Sara Dent‖ Dental Office

3 Student, Iasi „Gr.T. Popa‖ University of Medicine and Pharmacy

Abstract: Child physical abuse is a complex problem, of great topical interest, a severe social problem, with

direct implications on the dento-somato-facial harmony and on the psycho-mental and intellectual development

of the child.

Aim. To highlight the oro-maxillo-facial signs of physical abuse and the role of the pediatric dentists in

identifying and evaluating this signs of physical abuse.

Material and Method. The study was carried out on a sample of 299 abused subjects (218 boys and 81 girls)

aged between 6-18 y.o. from Iasi rural and urban area. The data were analyzed and statistically processed and

the results were synthesized with the help of a descriptive and correlative study.

Results. The physical abuse has serious consequences in oro-dento-facial area, that consists especially in soft

tissue lesions – 62.11%, dento-periodontal trauma (fractures, luxations, concussions, avulsions) – 19.47%,

mandible fractures – 7.89% facial massif fractures – 7.89% and temporo-mandibular joint lesions - 2.63%.

Conclusion. Pediatric dentist should to be legally qualified and morally entitled to report to report when s/he

suspects any physical abuse against the child.

Key words: child, physical abuse, pediatric dentist.

INTRODUCTION Child physical abuse is a complex

highly topical issue, a serious social

problem that has direct implications on the

dental, somatic and facial harmony and

over the psycho-mental and intellectual

development of the child and the adult he

will become.

Analyzing the data from the

specialized literature regarding the

psychical, mental and behavioral evolution

of the child, from birth to teenage, and the

determining pre-and post-natal

circumstances, it was ascertained that one

of the factors that may disturb variably the

normal development, is child abuse and

neglect [1]. Kempe W. and col. (1962)

introduced in the specialized medical

literature the notion ―syndrome of the

beaten child‖, and Elerstein states that

―child abuse causes more physical and

psychological morbidity than most child

diseases.‖

Health Canada defines child abuse as

any maltreatment enforced by a parent,

guardian, caretaker or any other person

onto a child that results in hitting or

traumatizing emotionally or psychically

the child. Physical abuse is the most

frequent form of abuse and the easiest

form to notice by the dentist, due to the

prevailing location of lesions (over 50%)

[2, 3, 4, 5] on the cephalic extremity, on

the orofacial soft parts, on the facial

massive bone, on the dental and

periodontal units, mandible etc.

Specialized studies show that in Great

Britain, every year at least 1 child out of

1000 (under 4 years old) is a victim of

violence, while in the United States and in

Canada 47 children out of 1000 are

physically abused.

Dentists should be aware that physical

abuse involves in more than half of the

cases (65%) (Becker and col. 1978,

daFonseca and col.1992, Jesse, 1995),

manifestations in the mouth and on the

head (i.e. bleeding of the face skin,

excoriations, dental fractures, dental-

alveolar fractures, lesions of the lip, gum,

mandible fractures) that may provide clues


Vol. 2, No. 3, July 2010

18

as to the time of the abuse, its nature or the

identity of the aggressor.

The aim of this study is to outline the

orofacial manifestations of the physical

abuse of the child and to emphasize the

important part played by the pediatric

dentists in identification and correct

assessment of these signs and in reporting

the various child abuse forms.

MATERIAL AND METHOD

This paper is an integrative part of a

longitudinal study on the medical legal

aspects of oro-facial and dento-periodontal

traumas of the child and the teenager. The

study was conducted on a group of 299

subjects (218 boys, 81 girls), aged between

6 and 18 year old, from the urban and the

rural environment of Iasi county, that were

referred to the Service of Forensic

Medicine in the Polyclinic no.1 of Iasi.

The distribution of subjects per sexes and

environments of origin are shown in fig.1

and fig.2.

Fig. 1 Distribution of subjects per sexes Fig. 2 Distribution of subjects per

and origin environment origin environment

The data (number of traumas, etiology

of the trauma, type of orofacial traumatic

lesion, type of odonto-periodontal lesion

and so on) obtained from all legal medical

certificates were statistically analyzed and

processed and the results were synthesized

by means of a descriptive and correlative

study.


It was ascertained an alarming rate of

cases of oro-facial traumas produced via

physical abuse, compared to other cases

(car crashes, rapes) (fig.3), and their

prevalence at the age stage 13 to 18 years

(table 1), which suggests a higher rate of

oro-facial traumatic lesions at this age

stage in comparison to other age stages,

data comparable with those in the

specialized literature [2, 6].

0

50

100

150

200

250 218

81boys

girls

0

20

40

60

80

100

120

140

urban rural

91

127

3645

boys

girls


Vol. 2, No. 3, July 2010

19

Fig. 3 Etiology of orofacial traumas

Age 6-12 years 13-18 years

Etiology Physical abuse Physical abuse

Number of

subjects

15.05% (45 subjects) 84.95% (254 subjects)

Table 1 - Distribution of subjects per age stages

Child abuse has major consequences

in the oro-facial area, which consisted

generally in lesions of soft tissues

(contusions and ecchymoses, bites) -

62.11%, dento-periodontal traumas

(fractures, dislocations, conccusions,

avulsions and so on) – 19.47%, mandible

fractures – 7.89%, fractures of the facial

massive bone – 7.89% and lesions of ATM

– 2.63% (fig5). It was ascertained that in

comparison to other types of lesions,

dental fractures were at a higher rate –

49%, and as to the topography of the

dento-periodontal traumas, they were

prevailingly located at the level of the

central incisors – 74%.

Fig. 5 Distribution of the lesion type on the orofacial area

We may say that it is highly necessary

to make a minute extra and extra oral

examination in all cases that the dentist

suspects or believes are child abuse cases.

Some authors [7] consider the oral cavity

as being a target of the physical abuse

because of its significance and role in

ensuring important functions, such as

communication or nutrition.

All pediatric dentists should know

how to recognize the signs and symptoms

of child abuse and to be aware of the laws

which requires them to report such cases to

the authorities, because the timely

recognition of such a problem leads to

0

10

20

30

40

50

60

70

80

phys.abuse rape car crash

70,3%

11% 18,7%

soft tiss.les.d-per.tr.

dento-parod

fract mas fac ATMles.


Vol. 2, No. 3, July 2010

20

taking effective intervention measures,

beneficial on the short, medium and long

term, if we consider that most of the times

these children are subject both to physical

abuse and to the emotional abuse, as they

live in fear, they lack confidence in

themselves and have no self-respect.

CONCLUSIONS It is required a holistic approach of

child health and social work for the child,

with the true involvement of all the

decision-makers. As most then half the

lesions resulting from physical abuse are

located in the orofacial area, pediatric

dentists have the moral and ethic

obligation to report child abuse that they

see in their dental practices. The pediatric

dentists should be legally habilitated and

morally entitled to report to competent

authorities that they suspect any child

abuse, as this is a complex issue with

multiple legal-medical and psychological-

behavioral implications.

REFERENCES 1. Maxim A., Balan A., Pasareanu M., Nica M., Stomatologie comportamentala pediatrica, Ed. Contact

International, Iasi 1998, pp 91-97.

2. Stavrianos C., Stavrianou I., Kafas P., Mastagas D., The Responsibility of Dentists in Identifying and

Reporting Child Abuse, The Internet Journal of Law, Healthcare and Ethics 2007, volume 5, number 1.

3. Ambrose JB., Orofacial signs of child abuse and neglect: a dental perspective, Pediatrician 1989; 16:188-

92.

4. American Academy of Pediatrics Committee on Child Abuse and Neglect and the American Academy of

Pediatric Dentistry, Guideline on oral and dental aspects of child abuse and neglect, adopted 1999, revised

2005, vol.3, no.7.

5. Balan A., Maxim A., Pedodontie traumaele dento-parodontale, Ed. Junimea Iasi, 2001, pp192-202.

6. Needleman HL. Orofacial trauma in child abuse: Types, prevalence, management, and the dental

profession’s involvement, Pediatr Dent 1986;8(Spec Iss 1):71-80.

7. Wooley E: Significance of skeletal lesions in infants resembling those of traumatic origin. JAMA, 1955;

158:539.

8. Welbury R, Gregg T., Managing dental trauma in practice, Quintessence publishing Co.Ltd. London 2006,

pp 99-109

9. Welbury RR, Macaskill S.G., Murphy JM., Evans DJ., Weightman KE., Jackson MC., Crawford MA.,

General Dental Practitioners’perception of their role within child protection: a qualitative study, European

Journal of Paediatric Dentistry, 2003; 2:1-7.

10. Tsang A., Sweet D. Detecting Child Abuse and Neglect —Are Dentists Doing Enough?, J Can Dent Assoc

1999; 65:387-91

11. Mouden LD, Bross DC. Legal issues affecting dentistry’s role in preventing child abuse and neglect. J Am

Dent Assoc 1995;126:1173-80.

12. Misawa S., Feature: Child Abuse and what Dentists can do. Forensic Odontology Today, J.F.O.C., 2001; 5;

1.

13. Kenney J.P., Spencer E.D., Child Abuse and Neglect. In Bowers CM, Bell GL (ed). Manual of Forensic

Odontology, ASFO, 1995, pp 191-193.

14. Vadiakas G, Roberts MW, Dilley DC. Child abuse and neglect: Ethical issues for dentistry. J Mass Dent

Soc 1991;40:13-5.


Vol. 2, No. 3, July 2010

21

THE MECHANICAL BEHAVIOR OF THE AESTHETIC MATERIALS

IN VENEERED PROSTHETIC CONSTRUCTIONS Diana Diaconu, Monica Tatarciuc, Anca Viţalariu, St. Panaite

Abstract:

Introduction. The researches in dental materials aria improve the mechanical and biological properties of the

veneered prosthetic constructions. The veneered bridges combine the strength of the metallic restorations with

cosmetic effect of the ceramic or polymeric component.

Materials and methods. The aim of our study is to compare the mechanical and technological parameters of

three aesthetic materials: Solidex (Shofu) and SR Adoro (Ivoclar) resins and Vintage Halo (Shofu) ceramic. The

research investigate the characteristics in making the design of the metall frame, the specific conditioning of the

bonding surface and the methods in application of the aesthetic component, varying with the nature of the

material.

Results and discussions. The knowledge of the technological procedures achieves higher mechanical

performance of fixed veneered constructions. The analyse of those three materials demonstrate that ceramic

component has a greater resistance. Making a comparison between the two types of composites, the SR Adoro

resin has higher mechanical performance, because the double cure method determine a compact and

homogenous structure, consequently, superior performance.

Conclusions. The knowledge of the characteristics of the technological steps allowed to choose an adequate

aesthetic material for fixed veneered bridges, with best mechanical resistance and higher longevity.

Key words: veneered bridges, resin composite, ceramic, mechanical behavior.

INTRODUCTION

The main thrust of the development

work on metalo-nonmetalic prosthetic

construction is to find an aesthetic

veneering material that offers optimal

physical properties, excellent

physiognomy and optimal flexibility. The

veneered bridges combine the strength of

the metallic restorations with cosmetic

effect of ceramic or polymeric component.

The nature of the veneering material has a

direct influence to the design of the metal

frameworkl, to the specific conditioning of

the bonding surface and, implicit, to the

mechanical parameters of the bridges.

MATERIAL AND METHODS

In our work we want to demonstrate,

that the technologigal steps have a huge

influence to the biomechanical behavior of

the bridges, with direct impact on their

clinical performance and longevity.

The purpose was to compare and

analyse three aesthetic veneering

materials: composit resins SR Adoro

(Ivoclar) and Solidex (Shofu), and the

ceramic Vintage Halo (Shofu).

After the construction and

conditioning of the metallic framework

and the edification of the physiognomic

component it was analysed the

deformation behaviour and the fracture

resistance of the fixed prosthetic

construction.

SR Adoro is a microfilled composit

veneering system with high loading of

inorganic microfillers, in nanoscale range.

The matrix, based on urethane

dimethacrylate, give more toughness,

endowning the material with excellent

physical properies and a high resistance to

wear.

The framework is realised so the

dimension concede a stable metal

component and a durable relation between

metal and composite. After finishing, the

framework is blasted with Al2O3 particles,

at 2 barr pressure. It tis basically to apply

retention beads, to provide mechanical

retention, in addition to the chemical bond

-with SR Link. (fig.1)


Vol. 2, No. 3, July 2010

22

Fig. 1 Mechanical retentions beads

The individual SR Adoro pastes are

applied according to the layering diagram.

The aesthetic component is build up step

by step and each segment is precure for 20

sec.(fig.2) The final polymerization is in

Lumamat 100 furnace and the material is

light and heat cured.(fig.3)

Fig. 2 Precuring with Targis Quick Fig. 3 Final curing in Lumamat 100

After the last finishing procedures the

bridge has an optimal aesthetic aspect.

The Solidex resin is also a new

composit material with 53% inorganic

component, 21% organic matrix and 1%

catalysts. The metal substructure is

prepared in the same way: finishing,

blasting with Al2O3; the retention of the

aesthetic component is also mechanical

and chemical. After casting, the retention

beads may be reduced by half of theirsize,

to preserve enough retention surface; the

mechanical retention produce an irregular

surface. The chemical retention, with

Solibond (a silan layer) increase the bond

strength between metal and veneering

composite. Each ledge of the resin

component is light cured.(fig.4)

Fig. 4 Light curing of the composite layers


Vol. 2, No. 3, July 2010

23

It is crucial to adhere to the

recomanded curring depths and maximum

layer thickness of the individual materials

when carrying out the layering procedure.

(Park Y.J.1999)

After polymerization, the bridge is

finished and polished with rotative

instruments and is prepared to be fixed in

the oral cavity.

The ceramic Vintage Halo, the third

material in our study, is a felspatic

porcelain, with a high mechanical

resistance, optical properties similar with

the natural teeth and the wear near to the

enamel.

In the constructions of the metallo-

ceramic bridge, the technological steps are

the same: the design and the fabricate of

the framework, the conditioning of the

metal surface and the apply of the aesthetic

component.

The difference is that the metal

substructure, in metallo-ceramic

constructions do not have macroretentions,

because the metallo-nonmetalic bonding is

strictly chemical.(fig.5)

The framework, smooth and clean, is

conditioned by oxidation and the next step

is to build up the ceramic component,

following each technological step.(fig.6)

Fig. 5 The conditioned metall framework Fig. 6 The apply of the ceramic component


It is crucial to know the technological

peculiarities of the prosthetic materials.

The specifically design of the metal

framework influence the resistance and the

retention of the aesthetic component.

The conditioning of the metal surface

increases the bonding strength between

metal and the veneering element. The

metallic nonmetallic relation is important

for the longevity of fixed prosthetic

constructions.( Dale B,1993, Waknine S,

2001)

Our mechanical studies reveal that the

nature of the material, the technological

steps in the building up of the

physiognomic component, the strength of

the interface bonding, influence the

mechanical resistance, the clinical

behavior and, of course, the longevity.

Analyzing the two types of composite

resins, we observe that SR Adoro material

has a higher fracture resistance than that of

Solidex resin. The values of the load

failure are not significantly statistic

different, but clinically, SR Adoro

composite has a better mechanical

resistance. (Kynomoto Y 1998).

The double mechanism in

polymerization- heat and light- determine

for the SR Adoro material a more

homogenous, more dense structure and

less wear. (Lutz F 1999)

As concerns ceramics, Vita Hallo

material has a significantly higher fracture

resistance.(fig7)


Vol. 2, No. 3, July 2010

24

Composite resin

Ceramic material

Fig.7 The comparable behavior of the fracture resistance

The behavior in deformation, at a

loading similar with masticator forces, was

also different, comparing the two

categories of materials. (Giezendanner P

1991)

The ceramic modulus of elasticity is

similar to the enamel and the modulus of

elasticity of the composite resin is similar

to the dentine. (tab.I)

TABLE I

Values of the modulus of elasticity

Material Modulus of elasticity(GPa)

Enamel 50-80

Dentine 15-20

Ceramic 50-80

Composite 10-18

After we calculate the minimal and

maximal deformation for ceramic and

composite, at a loading values comparable

with the masticator forces, we observe that

composite resins has a higher deformation

and a smaller loading resistance in

comparing with ceramic material ( tab II)

TABLE II

Comparative values of the minimal and maximal deformation

Material Minimal

deformation

Maximal

deformation

Composite resin 0,200 0,266

Ceramic 0,080 0,050

CONCLUSIONS

Our mechanical studies reveal that the

nature of the material, the technological

steps in the build up of the physiognomic

component, the strength of the interface

bonding, have a huge influence to the

mechanical resistance, the clinical

behavior and, of course, to the longevity.

SR Adoro material has a higher

fracture resistance than that of Solidex


Vol. 2, No. 3, July 2010

25

resin. The double mechanism in

polymerization- heat and light- determine

for the SR Adoro material a more

homogenous, more dense structure and a

less wear.

The ceramic material has a higher

fracture resistance and a reduce

deformation at the masticator loading.

(Esquivel-Upsaw Josephine 2001, Kato H.,

1996). The knowledge of the technological

procedures achieves higher mechanical

performance of fixed veneered

constructions. The analyses of those three

materials demonstrate that ceramic

component has greater resistance. Making

a comparison between the two types of

composites, the Adoro resin has higher

mechanical performance, because the

double cure method determine a compact

and homogenous structure, consequently,

superior performance.

The knowledge of the characteristics

of the technological steps allowed to

choose an adequate aesthetic material for

fixed veneered bridges, with best

mechanical resistance and higher

longevity.

REFERENCES 1. Dale B., A clinical approach to techniques and materials, Esthetic Dentistry, Leo & Febiger, Philadelphia,

1993, 210-292.

2. Esquivel-Upsaw Josephine, Anusavice K, Reig Megan,Yang M., Lee R., Fracture resistance of all ceramic

and metalo-ceramic inlays , The Journal of Prosthodontics, 2001, (14)2, 26-35.

3. Giezendanner P., Die Anfertigung von Kompositinlays aus Klinischer und zahntechnischer Sicht,

Quintesenz Zahntech.,1991, (17), 407-420.

4. Kato H., Matsumura H., Tanaka T., Atsuta M., Bond strength and durability of porcelain bonding system, J

.Prosthet. Dent., 1996, (75 ), 163-168.

5. Kynomoto Y.,Torii M., Fotoelastic analysis of polymerization contraction stress in resin composite

restorations , J. Dent., 1998, (26), 165-172.

6. Lutz F. ,Phillips R.W., Roulet J., F., Setcos J.C., Varying chewing forces versus wear of composite and

opposing enamel, Journal of Dental Resorations, 1999, (4). 35-44.

7. Park Y.J., Chal K.H., Rawls H.R., Development of a new photoinitiation system for dental light cure

composite resines, Dental Material,1999, (15), 120-127.

8. Waknine S., Conqueste D.F., A new universal dental composite restaurative system, Esthetic Dentistry,

Update, (2), 2001, 256-273.


Vol. 2, No. 3, July 2010

26

THE ROLE AND IMPORTANCE OF THE CARIES DETECTORS DYES

IN EARLY DIAGNOSIS AND TREATMENT OF DENTAL CARIES Pancu Galina

1, Stoleriu Simona

2, Andrian Sorin

3, Gheorghe Angela

4, Topoliceanu

Claudiu5, Pancu Ion

6, Lăcătuşu Ştefan

7

1,2,34,5,7 Departament Restorative Dentistry-Cariology ,

Faculty of Dental Medicine 6

Private Dentistry Medilife, Iassy, România.

Abstract: Despite the progresses of the modern dentistry, the carious disease is still affecting a large number of

peoples. The caries detectors would be helpful for diagnosis of early enamel caries as well as dentinal caries.

The study focused on the role of caries detectors on objective criteria of assessment of the caries preparation, the

early diagnosis of the incipient caries as well as monitorisation of the remineralising processes. The study used

product Color-test of the Vladmiva (Rusia): solution and gel. The study was performed on 25 patients age 15-38

with medium and high level of cariogenic status. The statistical results show the practical importance of the

caries detectors for the conservative treatment of the dental caries, with different degree of penetration in dental

tissues. It also allows the monitorisation of the success of the non-invasive or minimal invasive treatment. The

use of the caries detectors allows minimal preparation of the dental issues, accordingly to modern principles of

the actual dentistry.

Key words: incipient caries, caries detectors, remineralisation therapy.

INTRODUCTION

Although many dentists know modern

principles of dental caries therapy, the use

of dental caries indicators is very limited

in current practice. Today is more

important that restorative dentistry to stand

on minimal invasive approach, without

idle sacrifices of healty dental tissues. The

role of the research is to highlight dental

caries in incipient stages, with caries

detectors dyes and to monitor their

evolution after remineralisation therapy.

MATERIALS AND METHODS

The caries detector dyes Color-test

(Vladmiva, Rusia) is used in study. The

diagnostic and monitorisation of the

incipient dental caries were made through

Borovschii-Axamit method. This method

allows us to assess depth and surface of

demineralisation area. In study were

included 36 patients and 65

demineralisation focuses (white-spot).

These demineralisation areas were divided

in 4 lots: lot 1- 18 teeth (10 patients) with

remineralisation therapy by fluor gel; lot

2- 15 teeth (8 patients) with

remineralisation therapy by calcium,

phosphat and fluor; lot 3- 17 teeth (12

patients) with remineralisation therapy by

calcium-phosphat gel; lot 4 (6 patients)- 15

teeth without remineralisation therapy

(witness lot). The patients were

monitorised for 12 months, with

assessment periodes at 6 and 12 months.

RESULTS

The evolutions of the caries detector

dyes intensity and of the demineralisation

surfaces in the four lots are synthesised in

tables I and II.


Vol. 2, No. 3, July 2010

27

TABLE I.

The evolution of the caries detector dyes

LOT 1 –

F

(Average

values)

LOT 2 –

CaFP

(Average

values)

LOT 3 –

CaP

(Average

values)

LOT 4 –

witnes

(Average

values

Initial 6,06 5,87 5,59 6,80

First

application

4,94

Decreasing

18,34%

4,40

Decreasing

24,99%

2,71

Decreasing

51,56%

After 2

weeks

4,72

Decreasing

22,00%

1,20

Decreasing

79,50%

3,06

Decreasing

45,25%

6,80

Increasing

0,00%

After 6

months

3,72

Decreasing

38,50%

3,07

Decreasing

47,70%

3,47

Decreasing

37,88%

7,07

Increasing

3,92%

After 12

months

1,78

Decreasing

70,59%

2,40

Decreasing

59,06%

1,47

Decreasing

73,66%

7,80

Increasing

14,71%

TABLE II.

Total surfaces of the demineralisation areas

LOT 1 – F

Total

values

LOT 2 –

CaFP

Total

values

LOT 3 –

CaP

Total

values

LOT 4

witness

Total

values

Total

surfaces

(mm2)

54.50 48.20 51,80 46,90

Total

surfaces-

6 months

46.90

Decreasing

13.94%

41,70

Decreasing

13,49%

48,90

Decreasing

5,60%

51,70

Increasing

10,23%

Total

surfaces–

after 12

months

42.30

Decreasing

22.39%

37,60

Decreasing

21,99%

43,40

Decreasing

16,22%

58,90

Increasing

25,59%

The results regarding depth of the

demineralisation focuses (colour

intensity) were different related to the four

lots. For lot 1 (F) the results consisted in

significant decreasing of colour intensity

with 17,2% after first application, with

20,8% after 2 weeks, with 28,7% after 1

month and with 70,5% (after 6 months).

For lot 2 (CaPF) the results consisted in

colour intensity decreasing with 27% after

first application, with 81% after 2 weeks,

with 45,6% after 1 month and with 53,7%


Vol. 2, No. 3, July 2010

28

after 6 months. For lot 3 (CaP) the results

consisted in colour intensity decreasing

with 48,7% after first application, with

37,9% after 2 weeks, with 24,3% after 1

month and small increasing after 6 months.

For lot 4 (witness lot) the results consisted

in colour intensity increasing with 3,92%

after 6 months and with 14,71% after 12

months.

The results regarding surfaces of the

demineralisation focuses (colour

intensity) were different related to the four

lots. For lot 1 (F) the results consisted in

significant decreasing from 54,50 mm to

42,30 mm (decreasing with 22,39%), for

lot 2 (CaPF) the results consisted in

decreasing from 48,20 mm to 37,60 mm

(decreasing 21,99%), for lot 3 (CaP) the

results consisted in decreasing from 51,80

mm to 43,40 mm (decreasing with

16,22%), and for lot 4 there is a increasing

with 25,59% of the total demineralisation

surface.

DISCUSSIONS

Caries detector dyes are useful for

early detection of the incipient dental

caries in pits, fissures and smooth dental

surfaces (Lăcătuşu Şt.., Ismail AI). The

retention of the caries detector dyes allows

precise assessment of the depth and

surface for demineralisation areas, through

assessment of the colour intensity and use

of a graph paper (Ржанов Е.А. şi colab.).

The caries detector dyes are an useful

instrument for detection of secondary

dental caries and fissures or microfractures

(Andrian S., Cureachina N.V.). The

scientific progress of the modern dentistry

allows more effective caries detector dyes

that can be visible in special spectrum. In

fact, these caries detector dyes make

possible a less invasive treatment (Andrian

S., Ржанов Е.А.).

CONCLUSIONS

The caries detector dyes are extremely

useful in early detection of incipient dental

caries located in pits, fissures and smooth

dental surfaces.

REFERENCES 1. Andrian Sorin Tratamentul minim invaziv al cariei dentare , Editura, Princeps Edit, Iaşi 2002, pag. 94-95.

2. Andrian Sorin, Lăcătuşu Ştefan., Caria dentară, protocoale şi tehnici. Ed. Apollonia, Iaşi, 1999.

3. Cureachina N.V., Savelieva N. A. Profilaxia stomatologică. Mascva, Izdatelistvo Mediţinscaia cniga,

2005, pag. 35-55,104.

4. Ismail AI. Clinical diagnosis of precavitated carious lesions. Community Dental Oral Epidemiol

1997;25:13-23

5. Lăcătuşu ŞT., Dănilă I, Ghiorghe A, Iovan G, Pendefunda V, Solomon S. Caria fisurală: diagnostic,

aspecte morfopatologice. Rez.Com. Ses. Şt. ―30 de ani de Învăţământ stomatologic ieşean‖, Iaşi, 1.03.1996,

100, 3-4, 193

6. Ржанов Е.А. Минимально-инвазивное лечение кариеса зубов. // Клиническая стоматология. – 2005,

№1 – с. 24-27.


Vol. 2, No. 3, July 2010

29

PERIODONTAL CHANGES IN CONJUNCT PROSTHESES Valeria Pendefunda, Arina Ciocan-Pendefunda, Carmen Pîrlia

E.P.R. Department- Dental prosthesis

Dentistry Medicine Faculty, U.M.F. ―Gr.T. Popa‖ Iasi

Abstract:

Introduction. The treatment of reduced partially edentulous patients with gnatprosthetic bridges, linked to the

organic substructure, determines on the gum’s tissue many adaptive changes, related to the following factors:

previous state of sulcular epithelium, quality of the finishing edges of the microprostheses, material from which

the bridge is made, definitive cementing materials, etc.

The aim of our study is to assess the impact of the fixed prostheses upon the periodontal health.

Material and method. The study includes 112 patients (54 males and 58 females) with ages between 20-60

years. The evaluation was made on 282 conjunct prostheses. The statistical processing was made by the program

STATISTIC (dedicated to medical research) and specific tests as ANOVA, Spjotvol/Stoline, Pearson, CHI –

square (2), Fisher, Spearman, etc.

Results. Periodontal changes appeared in 44.64% of cases. This aspect was correlated with different

particularities of the prosthetic device. These can be taken into consideration as potential risk factors for

periodontal changes. The study of periodontal health, related to the material that was used, showed a low

prevalence in metal ceramic bridges (14.3%) and metal composite bridges (8.9%). Periodontal changes are more

important in case of high amplitude and older bridges, and they are influenced by the material and the quality of

their finishing. Although, there is a correlation between oral hygiene and periodontal changes of the prosthetic

bridges patients.

Conclusions. Results show a close relation between periodontal changes and: the amplitude and age of the

prosthetic bridges, quality of the finishing edges of the microprostheses, surface texture, axial and transversal

adjustment and the materials used for the bridge and final cementation.

Key words: periodontal dieses, dental – periodontal joint, iatrogenic.

INTRODUCTION

The treatment of partially reduced

edentulous patients with gnatprosthetic

bridges, linked to the organic substructure,

determines on the gum’s tissue many

adaptive changes.

A very important observation,

regarding the prosthetic treatment of

partially reduced edentulous patients, is

that there is the highest iatrogenic risk.

Only small mistakes (just a few

millimeters) in the adaptation of prosthetic

field and the manufacturing of the bridges

may lead to dental pulp damages,

pathological functions and periodontotic

teeth, determining further teeth losses.

The aim of our study is to assess the

impact of the fixed prostheses upon the

periodontal health.

MATERIAL AND METHOD

The study includes 112 patients (54

males and 58 females) with ages between

20-60 years. The evaluation was made on

282 conjunct prostheses by clinical and

paraclinical exams, mainly X-rays. The

clinical evaluation of bridges includes the

following parameters: the age and material

of the bridge, the amplitude, axial and

transversal adaptation, prophylactic

modeling and periodontal modifications:

gum retraction, periodontal bags, teeth

mobility, bleeding index and hygiene

status.

The statistical processing was made

by the program STATISTIC (dedicated to

medical research). We used also many

other specific tests, such as: ANOVA,

Scheffé, Spjotvol/Stoline, correlation tests

for quantitative and qualitative data, such

as: Pearson, CHI – square (2), Mantel-

Haenszel, Fisher, Spearman, Kendall tau,

Gamma.


Vol. 2, No. 3, July 2010

30

Lot’s structure according to sex

The study lot presented a

homogeneous distribution regarding the

sex of the patients, 51.79% were females

and 48.21% were men (fig. 1).

Fig. 1 Case distribution regarding the sex

Regarding the age, there was a high

presence of 20 – 30 years old patients

(62.5 %). A small presence had older

patients, over 50 years (8.9 %) (Tab. I).

Age in the sample No. cases %

20< age <=25 40 35.71%

25< age <=30 36 32.14%

30< age <=35 10 8.93%

35< age <=40 6 5.36%

40< age <=45 6 5.36%

45< age <=50 4 3.57%

50< age <=55 2 1.78%

55< age <=60 8 7.14%

Total 112

Tab. I Case distribution regarding the age


The treatment of partially reduced

edentulous patients with gnatprosthetic

bridges, linked to the organic substructure,

determines on the gum’s tissue many

adaptive changes. The tissue reaction

depends on: previous gum status, quality

of the finishing edges of the

microprostheses, surface texture, axial and

transversal adjustment and the materials

used for the bridge and final cementation.

Periodontal changes were assessed

according the case particularities, and

appeared in 44.64% of cases. This was

correlated to different particularities of the

prosthetic bridge and which can be

considered potential risk factors for the

appearance of periodontal changes.

Correlations in periodontal changes.

The material vs. periodontal changes.

There is a significant correlation (tab. II)

between the material and periodontal

changes, especially for metalacrylic and

metallic bridges (fig. 2).

male48,21%

female51,79%


Vol. 2, No. 3, July 2010

31

Fig. 2 Case distribution regarding the material

Chi-square 2 df

p

95% confidence interval

Chi-square - 2 10.60880 df=3 0.01404

ML Chi-square 10.71584 df=3 0.01337

Correlation coefficient

(Spearman Rank R) 0.591549 0.01142

Tab. II Estimated parameters in the correlation between material and periodontal changes

The highest frequency in the study lot

had metalceramic bridges (39.3%),

followed by metalcomposite (28.6%),

metalacrylic (21.4%) and metallic bridges

(10.7%).

The amplitude of prosthetic bridge vs.

periodontal changes

The study showed that periodontal

changes occurred especially in 3 (12.5%)

and 4 (14.3%) elements bridges (fig. 3).

Fig. 3 Case distribution regarding the amplitude

of prosthetic bridge vs. periodontal changes

25

14,3

19,6

8,9

7,1

14,3

3,6

7,1

0 10 20 30 40 50 60

no periodontal disease

periodontal disease

Material used vs. periodontal diseasemetallo-ceramic metallo-composit

metallo-acrylic metallic cast

32,1

3,6

10,7

5,4

1,80

1,87,1

8,9

12,514,3

01,8

00

5

10

15

20

25

30

35

1 2 3 4 5 6 11

Prosthesis size vs. periodontal disease


periodontal disease


Vol. 2, No. 3, July 2010

32

The study demonstrated a significant

correlation between the prosthetic bridge

amplitude and periodontal changes. In one

element bridges the changes occurred only

in 7.1% of cases. In 3 and 4 elements

bridges the changes increased significantly

(r=0.51, p=0.001, 95%CI).

The age of prosthetic bridge vs.

periodontal changes

The medium values of the age of

prosthetic bridges depending on the

changes were 10.4 months in the cases

without modifications, and 51.5 months in

the cases with periodontal changes (tab.

III).

Periodontal

disease

Mean

Prosthesis age

Mean

Dev.std Er. std Min Max Q25 Median Q75 -95% +95%

Absent 10.4 2.4 18.4 31.4 4.0 0.2 240.0 1.0 3.0 7.0

Present 51.5 30.3 72.8 74.7 10.6 1.5 300.0 12.0 24.0 36.0

Total 28.8 17.8 39.7 58.6 5.5 0.2 300.0 2.0 7.5 24.0

Tab. III The age of prosthetic bridge vs. periodontal changes

Prosthesis age F (95% confidence interval) p

ANOVA test 15.42233 0.000150

Tab. IV Test for comparison of the medium values of the age of prosthetic bridges depending

on the periodontal changes

Results of ANOVA test demonstrate

significant differences between the

medium values of the age of prosthetic

bridges and the presence or absence of

periodontal changes (p=0.00015, 95%CI)

(tab. IV).

The anatomical restoration of

prosthetic bridge vs. periodontal

changes

The anatomical restoration of the

tooth leaded to an absence of periodontal

changes in 67.4% of cases. Contrary,

84.6% of cases without anatomical

restoration presented periodontal

modifications (fig. 4).


Vol. 2, No. 3, July 2010

33

Fig. 4 Case distribution regarding the anatomical restoration of prosthetic

bridge vs. periodontal changes

Estimated value 95% Confidence interval

Minim Maxim

Chance parameters

Odds ratio (OR) 11.39 3.27 43.5

Risk parameters

Relative risk (RR) 2.6 1.84 3.67

STATISTICAL TEST Chi-pătrat

Chi - squared (χ2) 21.89

p – significance level 0.0000029

Correlation coefficient 0.838

Tab. V Estimated chance and risk parameters depending on the

periodontal modifications in the bridges without anatomical restoration

The lack of anatomical restoration of

the teeth was taken into consideration as a

risk factor for the contingent table (tab. V).

Starting from here we calculated the

chance and risk parameters depending on

the periodontal changes. From this study

we can notice that the chance ratio for

periodontal changes is 11.39 (OR=11.39),

which is a high risk for the patients with

prosthetic bridges that do not respect the

tooth anatomy to present periodontal

changes (11.3 times higher then cases with

anatomical restorative bridges). This

parameter can increase up to a highest of

43.5 (OR=43.5).

The results show that any

modification (rough edges of

microprostheses, retentive spaces between

margins and organic substructure) of the

gum, which has a high predisposition to

bacterial plaque, promotes quantitative and

qualitative changes of the plaque. The

modification of the plaque’s ecology

determines a local inflammation and a fast

depth and surface spreading of bacteria.

The presence in the bridges and cements of

toxic and irritating materials will maintain

and amplify the already existing

inflammation.

CONCLUSIONS

The periodontal changes are in close

relationship with: amplitude and age of the

prosthetic bridges, quality of the finishing

32,6

84,6

67,4

15,4

0

10

20

30

40

50

60

70

80

90

doesn't respect the teeth morphology respect the teeth morphology

The teeth's anatomic shape vs. periodontal disease

periodontal disease



Vol. 2, No. 3, July 2010

34

edges of the microprostheses, surface

texture axial and transversal adjustment

and the materials used for the bridge and

final cementation. These parameters are

risk factors which will determine

important periodontal modifications.

REFERENCES 1. Carranza F.A., Glickman’s

Clinical Periodontology 7/e, HBJ I.E.Saunders Philadelphia 1990, 403-420.

2. Burlui V., Norina Forna, Gabriela Ifteni., Clinica şi Terapia Edentaţiei Parţiale Intercalate Reduse, Ed.

Appolonia Iaşi 2001, 50-55.

3. Bratu D., Nussbaum R., Bazele clinice şi tehnice ale protezării fixe, Ed.Signata Timişoara 2001, 592-617.

4. Blanchard J.P., Lauverjat Y., Limites prothetiques et environnement gingival. Les Chaier de Prothese

1996, 94, 45-50.

5. Shillingburg H.T., Jacobi R., Brackett S.E., Les préparations en prothèse fixée. Principes et applications

cliniques, Ed.CdP,Paris 1988, 45-57.

6. Silness J., Fixed prosthodontics and periodontal health. Dent. Clin.North Am.1980, 24: 317.

7. Gűnay H., Tschernitschek H., Geurtsen W., Ligne de fintion des préparations et de sante parodontale –

Etude clinique prospective sur 2 ans. Parodontie et. Dentisterie Restauratrice 2000, 20, 173-181.

8. Ayad M.F., Rosensiel S.F., Salama M., Influence of tooth surface roughness and type of cement on

retention of complete cast crowns J.Prosthet Dent 1997,77,116-121.

9. Vataman R., Noţiuni de profilaxie parodontală, I.M.F. Iaşi 1982.

10. Brian S. Everitt, Modern Meddical Statistics, Oxford University Press Inc. New York, 2003.


Vol. 2, No. 3, July 2010

35

RADIODENSITOMETRIC STUDY REGARDING CONSERVATIVE

ENDODONTIC THERAPY IN PERIAPICAL LESIONS 1Sãlceanu Mihaela,

2Donciu Cristi,

3Maria Vataman,

4Radu Vataman

1 Assistent, Discipline of Endodontics, Department of Odontology and Parodontology,

School of Dental Medicine, „Gr.T.Popa‖ University of Medicine and Pharmacy, Iasi,

Romania 2 Tehnical University of Iasi, Romania

3 Professor, Discipline of Endodontics, Department of Odontology and Parodontology,

School of Dental Medicine, „Gr.T.Popa‖ University of Medicine and Pharmacy, Iasi,

Romania

4 Professor, School of Dental Medicine, „Gr.T.Popa‖ University of Medicine and Pharmacy,

Iasi, Romania

Abstract:

Introduction. Our study aimed to assess periapical healing processes using a quantitative method based on

radiodensitometry.

Material and methods. The evolution of periapical lesions in a study group of 10 patients taken in conservative

endodontical therapy was monitorised through radiographs taken at baseline, after 12 months and after 24

months. The radiographs were scanned at 300 dpi resolution with an automated level of bright and contrast.

Modification of bone density and periapical lesion size were assessed using radiodensitometry.

Results and discussions. Radiodensitometry indicated objectively the increase of bone density and decrease of

periapical radiotransparencies size that were correlated with time interval and preoperator diagnostic.

Conclusions. Radiodensitometry can be useful for an objective cuantification of endododontic therapy success

in chronic periapical periodontitis..

Keywords: periapical lesions, endodontic therapy, bone density, size, radiodensitometry

INTRODUCTION

The conventional radiographic

examen is an important tool in

contemporary dentistry related to

diagnostic and monitoring of healing

processes of periapical lesions post-

nonsurgical treatment. Post-treatment

monitoring of healing processess is based

on radiographic criteria of success or

failure. The absence of changes in

periapical radiotransparency diameter or

increase of periapical lesion diameter

represent signs of failure treatment.

However conventional radiographs taken

at different time intervals can present

different contrasts, bright levels and scales

because of the different angles of

incidence and different properties of the

films./1/ To reduce the error possibilities,

dentists use a category of indices, named

PAI (Periapical Index), on a scale that

includes clinical situations from healthy

periapical bone to severe chronic apical

periodontitis. That is why, in some cases

that present discrete healing processes,

conventional radiography can lead to

diagnostic errors. Digital radiovisiography

allows an objective assessment of stages of

periapical healing because of the

reproductibility and possibilities of

objective measurement but this method is

not a routine practice for most dentists

because of the high costs. As alternative

technique to improve diagnostic

performances were proposed optical

densitometry or processing of digitized

serial radiographs /2/ Also images

processing can offer objective indicators

for a number of medical applications/3/

AIM

Our study aimed to present

possibilities of radiodensitometry in

monitorising the evolution of periapical


Vol. 2, No. 3, July 2010

36

status at patients with periapical lesions

treated through conservative endodontic

therapy.

MATERIAL AND METHODS

Study group included 12 patients with

age ranging between 19 and 34 years, with

bicusps and molars with severe periapical

lesions (PAI 4-5) treated endodontically

and monitorised for 24 months. Working

protocol followed conventional stages

used in periapical lesions treatment.

NaOCl 2,5% and EDTA 17% were

solutions used as root canals irrigants,

Rockle’s solutions was used as antiseptic,

and calcium hydroxide was used as

intracanalar medication for 14-30 days.

Radicular obturations were processed

using lateral condensing technique and

Endoflas sealer (Sanlor), a sealer with

powerful antibacterial and remineralising

properties (calcium hydroxide, eugenol,

iodoform). Following endodontic

treatment, periapical lesions presented

visible positive evolution for all teeth

taken in study. Conventional periapical

radiographs were taken baseline, at 12

months and 24 months. The radiographs

were scanned at 300 dpi resolution with an

automated level of bright and contrast. To

avoid subjective analyzing of healing

processes, conventional radiographs were

processed through radiodensitometric

method. The implemented processing

algorithm uses as source the digitized

image of the classic radiographies or the

image obtained in digital format. The main

instrument, in realizing the interpreting

analysis for the bone tissue’s renewal, is

the histogram function. Only those pixels

having a value that falls in this range are

taken into account by the histogram

calculation. In order to objectively

interpret the process of bone tissue’s

renewal, it is defined a global index of

renewal. The global index of renewal (GI)

represents an objective evaluation of the

bone tissue’s renewal, being defined as the

ratio between the global luminous intensity

of a geometric area (ROI –Region of

interest) of affected tissue and the

luminous intensity of the same geometric

area of healthy tissue. The software

instrument is represented by LabView 8.2.

Imaging processing was realized through

virtual instrumentation techniques in order

to calculates and displays the value of the

global index of renewal and the average

value of the gray level, specific to the

healthy bone tissue. Taking into

consideration that the determination of the

ROI area is realized with certain

subjectivism, to calculate the final

evaluation value (GI) it was introduced the

reporting of the ROI to the same area with

the reference gray hue of the healthy

tissue. So, the total number of pixels, as

ROI area, is not a parameter that will

interfere in the calculation of the global

index of renewal. To interpret the

evolution of the bone tissue’s renewal of a

patient it were taken into consideration

three radiographies taken during 24

months interval of monitoring.


We selected three representative cases

of chronic periapical lesions with visible

gradual evolution that was quantified

through radiodensitometric methods.

Case 1. Patient B.A, age 31. Patient

presented at 3.5. a periapical granuloma

with PAI 5. Periapical lesion was treated

following conservative endodontic

treatment as described below. Control

radiographs were taken at 12 months and

24 months. Figure 1 presents periapical

status of 3.5. periapical area at baseline.

Figures 2-3 present processed

conventional radiographs and values for

Global index of bone renewal. We see an

increase of GIR from 77% at 12 months

post-treatment to 81% at 24 months post-

treatment.


Vol. 2, No. 3, July 2010

37

Fig.1. Radiographic aspect at baseline (3.5.)

Case 2. Patient C.A, age 28. Patient

presented at 3.6. difuse periapical osteitis

with PAI 5. Periapical lesion was treated




24 months. Figure 4 presents radiographic

aspect of 3.6. periapical area at baseline.

Figures 5-6 present processed

conventional radiographs and values for

Global index of bone renewal. We see an

increase of GIR from 64% (12 months

post-treatment) to 80% at 24 months post-

treatment.


Fig. 3. Stage 3 of investigation

Fig. 2. Stage 2 of investigation


Vol. 2, No. 3, July 2010

38

Fig.5. Stage 2 of investigation (12 months post-treatment)

Fig.6. Stage 3 of investigation (24 months post-treatment)

Case 3. Patient D.D., age 26. Patient

presented at 3.5. periapical granuloma with

PAI 5. Periapical lesion was treated




24 months. Figure 1 presents processed

conventional radiographs 3.5 and values

for Global index of bone renewal. We see

an increase of GIR from 51% at 12 months

post-treatment to 66% to 24 months post-

treatment.


Fig. 8 Stage 2 of investigation (12 months post-treatment)


Vol. 2, No. 3, July 2010

39

Fig. 9 Stage 3 of investigation (24 months post-treatment)

For all radiographs sets taken in study

index GIR presented a gradual increase

value indicating the existence of

remineralisation processes of bone tissues.

GIR changes express the periapical healing

processes observed on conventional

radiographs. Our results sustain favourable

conclusions of similar studies focused on

possibilities of improving diagnostic and

monitoring of periapical lesions evolution

through methods of imaging processing

and radiodensitometry /4-8/.

CONCLUSIONS

The evolution of the periapical healing

processes can be objectively quantified

through radiodensitometry. The various

values of bone remineralisation degree,

detected in the selected cases, indicate the

different individual reactions influenced

by systemic status, reactivity of immune

system, phosphate and calcium

metabolism and type and extension of

chronic periapical lesions.

REFERENCES 1. Gordon J.Christensen. Why switch to digital radiography? J Am Dent Assoc, Vol 135, No 10, 1437-1439.

2004

2. Heling I,Bialla-Shenkman S,Turetzky A,Horwitz J,Sela J. The outcome of teeth with periapical

periodontitis treated with nonsurgical endodontic treatment: a computerized morphometric

study.Quintessence Int 2001;32:397-400.

3. Fujimasa, I., Nakazawa, H., Miyasaka, E. Development of an image processing software for medical

thermogram analysis using a commercially available image processing system, Engineering in Medicine and

Biology Society, 1998. Proceedings of the 20th Annual International Conference of the IEEE Volume 2, 29

Oct.-1 Nov. 1998 Page(s):956 – 958

4. Nicopoulou-Karayianni K., Bragger U., Patrikiou A., Stassinakis A., Lang P. Image processing for

enhanced observer agreement in the evaluation of periapical bone changes. Int.Endod J.2002 jul; 35 (7): 615-

622

5. Orstavik D, Farrants G, Wahl T, Kerekes K. Image analysis of endodontic radiographs: digital

subtraction and quantitative densitometry. Endod Dent Traumatol. 1990 Feb;6(1):6-11

6. Orstavik D. Radiographic evaluation of apical periodontitis and endodontic treatment results: a computer

approach. Int Dent J. 1991 Apr;41(2):89-98.

7. Rózyło-Kalinowska I, Czelej-Górski J, Rózyło TK. Radiodensitometric measurements in cases of chronic

periapical changes of endodontically treated teeth. Ann Univ Mariae Curie Sklodowska [Med].

2002;57(1):98-105

8. Narcis M.Marcov, Elena-Cristina Gh.Roman. Digital radiodensitometry monitoring evolution of bone

periapical lesions posttreatment. Journal of Romanian Medical Dentistry 2008; 3 (vol.12): 73-82

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

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

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Vol. 2, No. 3, July 2010

40

PRE-EXTRACTIONAL VALUE OF THE INTERNATIONAL

NORMALIZED RATIO IN IDENTIFICATION OF THE

HEMORRHAGIC AND THROMBOEMBOLIC RISK IN PATIENTS

UNDERGOING ORAL ANTICOAGULANT TREATMENT Oleg Zănoagă

1, Valentin Topalo

1, Ion Corcimaru

2, Dumitru Sîrbu

1, Ilie Suharschi

1

State University of Medicine and Pharmacy ―Nicolae Testemiţanu‖ 1 Department of Orthopedic Dentistry, Oro-maxillo-facial Surgery and Oral Implantology

Abstract: The study comprised 38 patients undergoing antithrombotic treatment. Relying on the research which

we have carried out, we can conclude that patients who undergo unsupervised anticoagulant treatment have an

increased both hemorrhagic and thromboembolic risk. The incidence of bleeding after dental extraction in

patients undergoing antithrombotic therapy who have been extracted teeth without any prior withdrawal of these

drugs, is 30,8±10,2%. These hemorrhages, having recorded the values INR<2,4, have an insignificant intensity.

As a prophylaxis of the severe hemorrhagic and thromboembolic events the dose of the anticoagulant drug will

be modified depending on INR.

Key words: tooth extraction, bleeding after dental extraction, thromboembolism, international normalized ratio.

INTRODUCTION

Thrombolitic therapy is known to be

one of the most important 10

achievements of cardiology in the XXth

century (N.J. Mehta and I.A. Khan, 2002).

Nowadays some oral anticoagulants with

coumarinic or inandionic structure are

used. They differ by the time of their

action, active doses, effect duration [1].

Due to its advantageous pharmacological

peculiarities (it is less toxic, it has an

adequate plasmatic T1/2) warfarin has

become in the last years, in the majority of

European countries and USA, the drug of

the first choice in the prolonged therapy

with oral anticoagulants [2]. In Romania,

the only oral anticoagulant registered at

present is acenocoumarol (thrombostop)

[3]. At the same time, of all antithrombotic

drugs, acetylsalicylic acid (aspirin) has a

central place.

In the last years the indications for

treatment with oral anticoagulant drugs

have extended [4]. This is due to an

increase of the angio/and cardiosurgical

assistance rendered to population (cardiac

valve prosthesis, coronary by-pass,

valvuloplasty as well as the number of

people who are carriers of artificial cardiac

valves and valve prosthesis, with

disturbances of the cardiac rhythm etc. [5].

In 1997 there were performed 64000

valvular surgeries in the whole Europe.

Mechanic prostheses were used in 2/3 of

these cases [6]. At present 500

cardiosurgeries are annualy performed in

MSPI Center of Heart Surgery from

Chisinău.

It is known that mechanic valves are

foreign bodies for the organism which

have a high risk of infections and

thromboembolic complications. This fact

requires an anticoagulant therapy and

prophylactic antibiotic therapy during the

whole life [7]. Sometimes these patients

require to be rendered stomatological

assistance including dental extractions.

The latter can lead to hemorrhagic

complications. The hemorrhagic events are

relatively frequent in this group of patients

[1]. They are fostered by a high risk of

overdosage, linked with the individual

variations in the pharmacokinetic

behaviour, as well as interferences

connected with different pathologic

conditions or associated drugs [1,2].

According to data taken from literature,

the incidence of hemorrhages in patients

undergoing a treatment with indirect

anticoagulants varies between 5-10% [2].


Vol. 2, No. 3, July 2010

41

The rate of severe bleedings is 2,4-8,1%,

while the rate of the fatal outcomes is 0–

4,8% [2].

Thrombolitic disease represents a

major complication of the surgical patient.

The importance of this medical problem,

on the one hand is due to the increase of

frequency, on the other hand it is due to

the difficulties of intravital diagnosis and

increased lethality [8]. Anatomo-clinical

statistics of USA shows that massive

embolism is the third cause of sudden

death. About 300 thousand patients are

annualy hospitalized with profound venous

thrombosis (PVT) which causes

approximately 50 thousand deaths from

pulmonary thromboembolism (PTE). The

incidence of PVT in Europe which was

recorded in the last years, reached 160

cases at 100 thousand population. Over 80

thousand of PTE occur annualy in

France,while, at least 20 thousand deaths

are recorded.

In order to prevent occurence of

hemorrhagic and thromboembolic

accidents, patients following anticoagulant

treatment are compelled to monitor their

monthly anticoagulant effect of

coumarinic drugs [1,2,9]. With this

purpose the optimum level of oral

anticoagulant drugs is assessed by

monitoring the time of prothrombin which

is represented by the international

normalized ratio (INR) [2,9]. The

therapeutic level of anticoagulants depends

on the indication for which it was

administered. INR values range within 2,0-

4,0 [9]. The higher this coefficient is the

more marked hypocoagulation is and,

consequently, the hemorrhagic

complications are more frequent and more

dangerous. Conversely, reduction of INR

values below the therapeutic range limits

leads to increase of the risc of

thromboembolitic events occurence [9].

Management of teeth extraction in

patients under antithrombotic therapy is

disputable [10,11]. In order to prevent

hemorrhagic accidents some doctors

recommend their patients to cancel oral

antiplatelet and/or anticoagulant therapy

some days prior to operation (pre-

surgically and pre-extractionally) [12],

others recommend a compulsory

substitution with heparin during the whole

period of treatment, up to oral

anticoagulants return [13]. Other

researchers suggest to perform dental

extractions in patients undergoing

antithrombotic therapy without suspending

these remedies [14]. Thus, the dilemma

widley disputable within the last years in

the medical literature: „Is it necessary to

discontinue anticoagulant treatment in

patients who are sibjected to tooth

extractions?‖ – is still actual and any

gained experience contribute to

elaboration of an optimal treatment

management of these patients.

So, the problem of tooth extraction in

patients undergoing antithrombotic therapy

has a major practical importance and is

insufficiently approached in the medical

literature. Therefore there are

complications which occur in these cases

and varied choice of medical tactics, which

is often groundless.

PURPOSE OF STUDY

To assess the frequency of the post-

operatory hemorrhage, hemorrhagic and

thromboembolic risk in patients

undergoing antithrombotic therapy who

are subjected to dental extractions without

cancelling these drugs.

MATERIALS AND METHODS

The study comprised 38 patients under

antithrombotic therapy. They were

admitted to Oro-maxillo-facial Surgery

Department from the National Scientific

Practical Centre of Emergency Medicine

(NSPCEM) from Chişinău in April 2007 –

November 2009. Men (18) constituted

47,4 ± 8,1%, while women (20) - 52,6 ±

7,6% (p>0,05). Mean age was 54,8 ± 1,7

years (p<0,001). Of 38 patients, 26 (68,4

± 7,5%) were hospitalized in order to be

performed surgical manipulations in the

oral cavity (34 dental extractions were


Vol. 2, No. 3, July 2010

42

carried out). 12patients (31,6 ± 7,9%)

(p<0,01) – complained of hemorrhage in

the oral cavity: 8 (66,7%) had post-

extractional dental hemorrhage (PDH), 3

(25,0%) hemorrhage resulting from

periosteotomy and 1(8,3%) patient with

gingival hemorrhage.

Clinical examination was carried out

according to the traditional methods of

patients examination. The routine

parameters of general and biochemical

blood analyses, urine analysis,

coagulogram indices (prothrombin index,

fibrinogen content, time of partially

activated thromboplastin (TPAT),

thrombin time, ethanol test), panoramic

and retroalveolar radiography,

electrocardiography were examined.

To have an orientative examination of

the haemostatic system, the examined

patients were determined the bleeding time

according to Duke and blood coagulation

time according to Lee-White.

The effect of oral anticoagulants was

assessed at admission and in dynamics

through determination of INR values. Due

to its pharmacological properties, aspirin,

unlike indirect anticoagulants

(thrombostop, warfarin, fenilin) does not

require laboratory monitoring of

coagulations [2]. Despite this fact in 5

patients who were administering aspirin,

the anticoagulant effect was not estimated

through assessment of INR values.

The mathematical processing of the

study results was carried out by means of

the statistical set of programs: EXCELL

and STATISTICA. Obtained results were

presented by the respective tabels.


Our studies have reported that of 38

patients ungergoing antithrombotic

therapy, the majority of patients (21

patients or 55,3%) were administered

thrombostop, being followed by those who

were receiving warfarin (9 or 23,7%),

aspirin (5 patients or 13,1%) and fenilin (3

patients or 7,9%). The causes of

administration of antithrombotic therapy

were the following : cardiosurgical

interventions (valve prosthesis) - in 32

cases (84,2%); ischemic cardiopathies – in

4 (10,5%); thromboembolic case history –

in 1 (2,6%); thrombophlebitis of the lower

extremity – in 1 patient (2,6%).

Although multiple guides and

recommendations on thromboprophylaxis

are published, the way these

recommendations are applied into the

medical practice represents only a partially

solved problem. Studies that have

observed this aspect, suggest that

pharmacological thromboprophylaxis is

underutilized in 30-50% of patients with

thromboembolic risk [3]. This fact was

stated in the current study as well. Thus,

after anamnesis taking it was stated that of

33 patients receiving oral anticoagulant

therapy, in 11 (33,3%) patients the effect

of these drugs was not monitored.

Consequently during 2-3 months INR

values were not estimated in 6 patients,

between 4-6 months – in 3 patients and >

12 months in 2 patients.

Moreover, in the medical practice

anticoagulant therapy interruption is

frequently groundless. Thus, after history

taking it was established that of 38 patients

in 7 cases (18,4 ± 6,3%) the oral

anticoagulant therapy was cancelled one

day prior to dental extraction in order to

prevent hemorrhage occurence. In 4

(57,1%) cases the patient himself

discontinued receiving the anticoagulant,

in 2 (28,6%) cases the patients were

recommended by the dentist to discontinue

the therapy; in 1 case (14,3%) – the patient

got the indication from the family doctor.

Despite the fact that the duration of

thrombostop effect after treatment

interruption is 48-72 hours, unlike

warfarin which has a longer effect

duration (5-7 days) [1], we can state that

interruption of these drugs one day prior to

operation hasn't been justified, at least

from the theoretical point of view.

Postoperatory wound bleeding having

continued, patients required specialized

medical assistance. At the same time it


Vol. 2, No. 3, July 2010

43

should be recognized the fact that having

groundlessly interrupted the anticoagulant

therapy, these patients were exposed to a

major thromboembolic risk.

Of those 38 examined patients

positive hemorrhagic anamnesis was

revealed in 33 cases (86,8 ± 5,9%,

p<0,001). It manifested by occurence of

bruises without any marked lesions in 19

(57.6%) patients, post-extractional dental

hemorrhages in 7 (21,2%) patients,

excessive menstrual hemorrhage in 4

(12,1%) cases. Hemorrhagipar syndrome

was less frequent (9,1%), it manifested in

the anamnesis by epistaxis, hemorrhage

after periosteotomy and petechiae

hemorrhages in places where clothes were

tightly adherent to skin. Thus, clinical

manifestations of hemorrhagipar

syndrome, which previously had been

recorded (within anamnesis) in patients

following antithrombotic therapy, were

marked by multiple symptoms of

hemorrhagic character. At the same time,

the most frequent symptom (in 57,6 ±

8,6% cases) recorded in these patients was

occurrence of bruises without any evident

lesions or after insignificant traumatism. It

is necessary to mention the fact that

negative hemorrhagic anamnesis was

established in those 5 patients (13,2 ±

5,5%, p < 0,05) following antiplatelet

(acetylsalicilic acid) therapy. Perhaps, this

fact is due to different patients

sensitiveness to aspirin. In this respect, the

patients are divided into some groups

according to their sensitiveness [15]:

reactive (aspirine in dose of 0.5g

diminishes aggregation by 50-40%);

hyperreactive (aspirin inhibits the

aggregation maximally or up to 80-90%)

and areactive (antiplatelet effect is absent).

According to some sources it was

established that only 20-25% of patients

receiving antiplatelet drugs have abnormal

bleeding time (a prolonged one) [16].

Initial evaluation of the haemostatic

system was carried out through

determination of the bleeding time

according to Duke and the coagulation

time according to Lee-White. Thus, of 38

patients, 36 (94,7 ± 3,6%) patients had

bleeding time according to Duke within

the limits of normal values (2-4 minutes).

Only 2 patients (5,3 ± 3,6%) (p<0,001)

were suspected with alteration of the

primary haemostasis through increase of

the bleeding time (5 and 6 minutes), it

being subsequently confirmed by decrease

of the platelets count (58,0.10

9/l şi

84,0.10

9/l). After having estimated the

coagulation time according to Lee-White,

it was stated that in 3 patients (7,9 ± 4,3%)

the values of this test exceeded the upper

limit of the norm (>12 minutes), INR

being 4,6; 4,7 and 4,8. By means of these

two tests, initially there were suspected,

then confirmed marked disturbances in the

primary vasculo-thrombocyte haemostasis

(severe thrombocytopenia) and in the

secondary haemostasis (overdosage of

indirect anticoagulants).

In patients whose INR (at admission)

was below the therapeutic range limits (<

2), the anticoagulant dose was individually

increased (pre-extractionally as well) to

prevent thromboembolic accidents. It was

increased up to INR adjustment within the

therapeutic limits. The results obtained

from adjustment of dose of the oral

anticoagulant therapy are presented in

Tabel 1.


Vol. 2, No. 3, July 2010

44

INR values At admission At discharge

p n P±ES% n P±ES%

1,0 – 1,9 15 45,5 ± 8,7 - - ****

2,0 – 2,5 10 30,3 ± 7,9 28 84,8 ± 6,2 ****

2,6 – 3,0 3 9,1 ± 5,0 4 12,1 ± 5,7 *

3,1 – 3,5 1 3,0 ± 2,9 1 3,0 ± 2,9 *

3,6 – 4,0 1 3,0 ± 2,9 - - *

4,1 – 4,5 - - - - -

4,6 – 5,0 3 9,1 ± 5,0 - - *

Tabel 1. INR values at admission and discharge in patients receiving oral anticoagulant

therapy (n = 33) (* p > 0,05 **** p < 0,001)

The data from the tabel show that INR

(at admission) ≤ 1,9 was revealed in 15

patients (45,5 ± 8,7%). To reduce the risk

of occurrence of the thromboembolic

events, the anticoagulant dose was

increased up to INR adjustment to the

therapeutic range values (2,0-4,0). In 15

(45,5 ± 8,7%) cases INR was within the

therapeutic range limits and anticoagulants

dose was not modified. It was stated an

overdosage of indirect anticoagulants in 3

patients (9,1 ± 5,0%). INR values at

admission were 4.6-4.8. In patients with

overdosage, the anticoagulant dose was

reduced and subsequently kept within the

therapeutic limits. There was one

exception when the anticoagulant was

cancelled by general physician`s

indication. In the result we have

determined that after having been

administered the individual anticoagulant

dose, all the patients were discharged with

INR within the limits of 2.0-3.5, that is

within the therapeutic range limits. Thus,

thromboembolic complications have been

avoided, especially in patients hospitalized

with INR values below the therapeutic

limits.

Pre-extractional modification

(increase) of the oral anticoagulant dose in

patients with INR (at admission) below the

therapeutic range limits is reflected in the

following clinical case.

Patient C.V., aged 57 years, medical

card nr.21485, was admitted to the

Departament of OMF Surgery on

November 18, 2008 complaining of

presence of the root debris on the mandible

on the left side which periodically caused

painful sensations and discomfort; marked

general weakness. From the anamnesis –

painful dental sensations appeared 10-11

days prior to admission. The respective

teeth were endodontically treated 8 years

ago. As the patient stated and according

to the data from the medical outpatient

card in 2005 the patient had undergone a

cardiosurgical intervention (mitral valve

prosthesis) after which he received

thrombostop (2mg/day). The last check-up

of INR was done on March 15, 2007. Its

values were 2.0. Thus, it was established

that trombostop effect had not been

monitored for one year, although at

patient's discharge from MSPI Center of

Heart Surgery, the patient was

recommended by his physician to monthly

assess INR and to keep it within the limits

of 2,5-3,5. Objective examination:

symmetrical face, pale-rose colour of the


Vol. 2, No. 3, July 2010

45

skin. The regional lymphatic nodes were

not palpable. Mouth opened easily.The

endobuccal examination revealed presence

of the 35th, 36th teeth roots. They were

not tender to percussion in the axis. They

were immobile. Palpation of both slopes of

alveolar apophysis of the 35th, 36th teeth

was painless. The haemodynamic indices

at admission: AP= 110/70 mmHg, puls =

78 b/min. Bleeding time according to

Duke = 3 minutes, while the blood

coagulation time according to Lee-White =

12 minutes. The patient was consulted by

the internist. Orthopantomography

revealed presence of oval, radiotransparent

formations, with a well-defined contour

around the 35th, 36th teeth apices, with a

size of < 0,5 cm.

The diagnosis was established on the

basis of the clinical and paraclinical

examination: „Chronic granulomatous

periodontitis of the 36th, 36th teeth.

Rheumatic valvulopathy. Condition

associated with mitral valve prosthesis

(2005)‖.

Due to absence of monitoring over the

anticoagulant therapy and presence of the

major risk both hemorrhagic and

thromboembolic, venous blood was taken

at admission to assess the indices of

coagulogram. The following results were

obtained: prothrombin index = 93%;

fibrinogen = 2,4 g/l; TTPA = 37 sec.;

thrombin time = 24 sec.; ethanol test was

„negative‖; INR = 1,10. While assessing

respective indices it was observed the

increase of prothrombin index (93%) and

decrease of INR values (1.10) below the

therapeutic limits. This suggested

existence of the major risk of occurrence

of the thromboembolic events. This served

as an indication for increase of

thrombostop dose from 2 mg/day to 3

mg/day under a control in dynamics of

INR.

The results of paraclinical analyses

(general blood analysis) urine analysis,

biochemical blood analysis) were within

the limits of normal values. On November

19, 2008, at the INR level of 1.14, the

extraction of the 35th, 36th teeth roots was

carried out. Immediately the alveoli of the

extracted teeth filled post-extractionally

with blood which flowed on the bottom of

the vestibular and lingual sac. Bleeding

lasted for 30-40 sec. Its intensity was

insignificant. The formation of the blood

clot was post-extractionally assessed in the

3rd

minute after transformation of the

blood from liquid state into gel-like state

(Picture 1.A). At the same time, it was

observed that the newly formed clot was

homogenous. Being at the level of the

alveolus, the clot had a contact with the

alveolus edges. In the 10th post-

extractional minute there was observed the

appearance of a light-red gingival line at

the periphery compared with the dark-red

colour from the clot center. Thus, it was

stated that a scratchy clot had appeared.

This coincided with its „migration‖ under

the alveolar edge (Picture 1.B). Post-

operatory period lasted without any

peculiarities: at inspection of the post-

extractional wound, which was carried out

12 hours after the extraction, it was

determined the presence of retracted blood

clots (Picture 1.C). Restoration of the

gingival integrity was practically recorded

36 hours after the extraction (Picture 1.D).


Vol. 2, No. 3, July 2010

46

Picture 1. Blood clot formation and its appearance after the extraction of 35th, 36th teeth

roots in patient C.V. receiving oral anticoagulant therapy (Thrombostop).

A – Blood clot formation in the 3rd

post-extractional minute; B – Appearance of the scratchy

clot and its position under the alveolar edge; C – Appearance of the post-extractional

wound after 12 hours of extraction; D - Appearance of the post-extractional wound after 36

hours of extraction.

On November 21, 2008, after the

increase of thrombostop dose, it was stated

the restoration of INR within the

therapeutic range limits (2,84). Thus, the

patient was not subjected to risk of

occurrence of the thromboembolic

complications. The patient stated that his

general weaknes had disappeared. Perhaps,

it was due to improvement of rheological

properties of the blood after INR

adjustment to therapeutic values. On

November 22, 2008 the patient was

discharged, his general condition being

satisfactory.

From those mentioned above we can

conclude that when patients receiving oral

anticoagulant therapy have INR values

below the therapeutic range limits, the

dose of these drugs can and must be

increased (including pre-extractionally) to

prevent the thromboembolic

complications. Moreover, after assessment

of the post-extractional dental haemostasis,

the patient was found to have blood

hypercoagulation which was evaluated by:

A B

C D


Vol. 2, No. 3, July 2010

47

short bleeding duration of the post-

extractional dental wound (30-40 seconds)

opposite the mean bleeding duration in

patients with an uncompromised

haemostatic system [17] (1,2 ± 0,2

minutes);

early formation of the blood clot

(in the 3rd

post-extractional minute)

opposite the mean time of the blood clot

formation in patients with an

uncompromised haemostatic system [17]

(in the 5.2 ± 0,1 minutes).

After dental extractions (34)

performed on 26 patients under

antithrombotic therapy it was stated the

absence of BADE in the majority (18) of

cases (69,2 ± 9,1%), Of those 18 patients,

14 (77.8%) received oral anticoagulants

(thrombostop – 9 (64,3%), warfarin – 5

(35,7%)) and 4 patients (22,2%) received

antiplatelet therapy (aspirin). INR values

estimated on the day of dental extractions

in patients receiving oral anticoagulants

without BADE were within the following

limits: INR = 2,0-2,6 was established in 6

(42,9%) cases, while INR < 1,9 – in 8

(57,1%) patients.

At the same time, it was observed

absence of this contact in 30,8 ± 10,2%

patients (8), in whom bleeding continued

after 15-20 minutes. This condition was

appreciated as BADE. This was a

cappilary bleeding. Its intensity was

insignificant. Bleeding continued from the

soft tissues through the space between the

clot and the alveolus edge. Of 8 patients

with BADE, 6(75,0%) received oral

anticoagulant therapy (thrombostop – 4

(66,7%), warfarin –2 (33,3%); one patient

(12,5%) received antiplatelet therapy

(aspirin) and one patient (12,5%) –

received both oral anticoagulant

(thrombostop) and antiplatelet (aspirin)

therapy. In patients with BADE receiving

thrombostop and warfarin (7) INR values

assessed on the day of the dental

extractions were within the following

limits: INR = 2,0-2,4 was established in 5

(71,4%) cases, while INR < 1,9 – in 2

(28.6%) patients. Although it is considered

that blod coagulation increases in patients

who are below the therapeutic range limits

(INR < 2,0) [9], the analysis of the

obtained data has proved that in 2 patients

(28,6%) BADE appeared at INR values of

1,8 and 1,4. This phenomenon can be

explained by the fact that in one clinical

case apprearance of BADE was

conditioned by the simultaneous presence

in the patient of thrombocytopenia

(thrombocyte count was 84,0.10

9/l). In

another clinical case it has been

conditioned by associated antithrombotic

therapy (thrombostop and aspirin) which

significantly increases the risk of

appearance of BADE [18].

Thus the presented data show that

hemorrhagic accidents in patients

receiving oral anticoagulant therapy can

occur at any INR value. The frequency of

this post-operatory complication in

patients under antithrombotic therapy

subjected to dental extractions without

cancellation of these drugs was 30,8 ±

10,2%. It is necesary to mention that

BADE which occured at the level of INR

values <2.4 was a cappilary bleeding. Its

intensity was insignificant. According to

some studies, these hemorrhages are easily

kept under control through local

applications of human thrombin and

aminocaproic acid of 5% [19]. At the same


Vol. 2, No. 3, July 2010

48

time, it is necessary to mention that

BADE occuring in patients who have had

an overdosage of oral anticoagulants are

extremely severe and can jeopardize

people's health [9]. To prevent the severe

hemorrhagic accidents in this group of

patients, our study has proved that

overdosage with indirect anticoagulants

can be pre-extractionally assessed through

determination of both INR values and time

of the blood coagulation according to Lee-

White. Some authors mention that the

optimal value of INR for performing

dental extractions is 2.5, because this limit

reduces the risk of occurrence of both

hemorrhagic accidents and

thromboembolic events [20]. Despite this

we consider that dental extractions can be

successfully performed at the level of

individual INR values recommended to the

patients by the general physician. At the

same time we are aware of the local

haemostatic measures that should be

undertaken and are necessary in order to

control the bleeding.

Taking into consideration the increase

of frequency and high lethality of

thromboembolic complications, we think

that the decision of modifying the

anticoagulant therapy should be

deliberated after a careful consideration of

risk and benefit. In this respect, when INR

value is higher than 4.0, the dental

extraction will be delayed and the dose of

the anticoagulant will be reduced.

Conversely, when INR values are below

the therapeutic range limits, the dose of

these drugs should be increased (including

pre-extractionally) to prevent

thromboembolic complications.

CONCLUSIONS

1. Assessment of INR is a compulsory

method of pre-extractional evaluation of

the effect of oral anticoagulants.

2. Patients under unmonitored

anticoagulant therapy are exposed to an

increased risk both hemorrhagic and

thromboembolic.

3. Frequency of BADE in patients

receiving antithrombotic therapy who

undergo dental extraction without

cancellation of these drugs constitutes 30,8

± 10,2%. These hemorrhages, at INR

values < 2,4, have an insignificant

intensity.

4. As a prophylactic measure in

prevention of severe thromboembolic and

hemorrhagic accidents the dose of the

anticoagulant will be modified depending

on INR.

5. Dental extraction in these patients

can be performed without interruption of

the anticoagulant therapy by maintaining

INR within the limits of individual

therapeutic values.

REFERENCES 1. Cojocaru V., Dereglări hemostazice în stări patologice critice, Chişinău, Art-Grup Brivet, 2006.

2. Grosu A., Profilaxia accidentului vascular cerebral ischemic şi a altor complicaţii tromboembolice în

fibrilaţia atrială, Buletinul Academiei de Ştiinţe a Moldovei, Ştiinţe medicale, vol. 1, no. 5, p. 189-202,

2006.

3. Antonescu D., Gherasim L., Tulbure D., Jurcuţ R., Ghid de prevenţie a tromboembolismului venos,

Medicina Internă, vol. 5, no. 5, p. 23-39, 2007.

4. Gohlke-Bärwolf C., Zentrum H., Krozingen B., Anticoagulation in valvar heart disease: new aspects and

management during non-cardiac surgery, Heart, vol. 84, p. 567-572, 2000.

5. Ciubotaru A., Manolache Gh., Chişlaru L., Istoricul şi prezentul chirurgiei cardiovasculare în Republica

Moldova, Buletinul Academiei de Ştiinţe a Moldovei, Ştiinţe medicale, vol. 5, no. 9, p. 8-13, 2006.


Vol. 2, No. 3, July 2010

49

6. British Society of Haematology, British committee for standards in haematology guidelines on oral

anticoagulation, 3rd ed, Br J Haematol, vol. 101, p. 374-387, 1998.

7. Bucur A., Cioacă R., Urgenţe şi afecţiuni medicale în cabinetul stomatologic, note de curs, Bucureşti,

Editura Etna, p. 23, 2004.

8. Hotineanu V., Jovmir V., Ciubotaru A., Chirurgie, curs selectiv, Chişinău, Medicina, p. 214, 2008.

9. Момот А.П., Патология гемостаза, Принципы и алгоритмы клинико-лабораторной диагностики,

Санкт-Петербург, ФормаТ, с. 101-107, 2006.

10. Dunn A.S., Turpie A.G., Perioperative management of patients receiving oral anticoagulants, a systematic

review, Ar Intern Med, vol. 163, no. 8, p. 901-908, 2003.

11. Ferrieri G.B., et al., Oral surgery in patients on anticoagulant treatment without therapy interruption, J

Oral Maxillofac Surg, vol. 65, no. 6, p. 1149-1154, 2007.

12. Scher K.S., Unplanned reoperation for bleeding, Am Surg, vol. 62, no. 1, p. 52-55, 1996.

13. Hirsh J., Raschke R., Heparin and low-molecular-weight heparin, the Seventh ACCP Conference on

Antithrombotic and Thrombolytic Therapy, Chest, vol. 126, suppl. 3, p. 188S-203S, 2004.

14. Napeñas J.J. The frequency of bleeding complications after invasive dental treatment in patients receiving

single and dual antiplatelet therapy, J Am Dent Assoc, vol. 140, no. 6, p. 690-695, 2009.

15. Ghicavîi V., Sârbu S., Bacinschi N., Şcerbatiuc D. Farmacoterapia afecţiunilor stomatologice, ediţia a II-

a, revăzută şi completată, Chişinău, Tipar, p. 161-162, 2002.

16. Owens C.D., Belkin M., Thrombosis and coagulation: operative management of the anticoagulated

patient, Surg Clin North Am, vol. 85, no. 6, p. 1179-1189, 2005.

17. Zănoagă O., Evaluarea hemostazei postextracţionale dentare la pacienţii cu un sistem hemostatic

necompromis, Curierul medical, vol. 4, no. 310, p. 12-14, 2009.

18. Flaker G.C., et al., Risks and benefits of combining aspirin with anticoagulant therapy in patients with

atrial fibrillation: an exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial

fibrillation (SPORTIF) trials, Am Heart J., vol. 152, no. 5, p. 967-973, 2006.

19. Zănoagă O., Topalo V., Sîrbu D., Suharschi I., Procopenco O., Conduita în extracţia dentară la pacienţii

aflaţi sub medicaţie anticoagulantă orală, Revista medico-chirurgicală a Societăţii de Medici şi Naturalişti

din Iaşi, vol. 113, no. 2, supliment no. 2, p. 75-79, 2009.

20. Pototski M., Amenábar J.M., Dental management of patients receiving anticoagulation or antiplatelet

treatment, J Oral Sci, vol. 49, no. 4, p. 253-258, 2007.

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

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

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

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Amen%C3%A1bar%20JM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


Vol. 2, No. 3, July 2010

50

ASSESSMENT OF ORO-DENTAL HEALTH STATUS USING

THE CAO AND EGOHID INDEXES AT THE YOUNG

PEOPLE Ioan Dănilă, Iulia Saveanu, Carina Balcos

Faculty of Dentistry, ―Gr.T.Popa‖ University of Medicine and Pharmacy Iasi

Abstract: CAO and CAOS epidemiological indices provide significant information for an overview assessment

of dental health but can not make a nuanced type of carious lesions and involvement of the need for treatment.

EGOHID system of clinical assessment and restoration of carious lesions provide evidence on lesion topography

guided us on the degree of dental damage in motivating action supporting our dental health. The purpose of this

study was to evaluate the comparative in terms of dental health indices CAO, CAOS and EGOHID system.

Materials and methods: The study was conducted on a sample of 122 subjects with a mean age 23.53 years in

which data were collected on the type of carious lesion and the type of restoration. Data were collected by

clinical examination and observation files recorded according to codes. All patients in the study were informed

verbally about the purpose of the study noting their consent. Statistical data processing was performed with

SPSS 14.00 for Windows fixing the threshold of statistical significance of p ≤ 0.05. Results and discussion:

Comparative analysis of two systems of assessment revealed that significant differences p ≤ 0.05 for the system

of assessment of dental status in the system component EGOHID carious lesions, lesion assessment is

accomplished underestimated component CS of CAOS index showing an average of 4.42 (± 4.132) compared

with EGOHID-C is the index of the cavity showing an average of 10.38 (± 7.484). Conclusion: Data obtained

through evaluation of dental caries is higher, providing a concrete image of the orientation dentistry, early

diagnosis of dental caries, treatment and hence the technicallity and restorative treatments.

Key words: CAO, EGOHID, dental status.

INTRODUCTION

World Health Organization has

formulated a definition that dental caries,

prevention and prevention methods shall

constitute an integral part of restorative

treatment, clinical caries as an

evolutionary stage that grows from a

microscopic lesion that can not be

diagnosed with certainty in current clinical

means [1,2]. Switching from an early

lesion, non-cavitary, cavitary lesion to

reverse, irreversible, develops slowly, by

disrupting the balance between

demineralization and remineralization

processes in favor of demineralization [3].

Therefore diagnosis dental decay,

apparently simple, it seems practically a

difficult decision, therefore, recommended

the combination of clinical examination

with additional tests. However the

assessment of epidemiological indicators

is mostly based on clinical examinations

which induce more bias in the assessment

of early carious lesions that may be an

overestimation or underestimation of the

presence of injury for the purposes of

giving or another function code the

examiner. Therefore, refinement of codes

carious lesion should be a mandatory step

since and conduct therapeutic purposes is

different in primary, secundary and tertiary

prevention measures. CAO and CAOS

epidemiological indices provide significant

information for an overview assessment of

dental health but can not achieve a

nuanced type of carious lesions and

involvement of the need for treatment. Nor

shall a targeted, individualized treatment

strategy on prevention schemes of primary

or secondary prevention of treatment

patterns.

As the evaluation indices CAO index

of caries in all those early carious lesions

showing noncavitation remineralization

potential and non-invasive treatment we

intend to achieve a differentiated based

monitoring injury from minor changes in

tooth surfaces following with obvious

changes of enamel structure, with loss of


Vol. 2, No. 3, July 2010

51

substance or not located in dental enamel

or dentin.

EGOHID system of clinical

assessment and restoration of carious

lesions was designed to support the

collection of global oral health indicators

(EGOHID - European Global Oral Health

Index Development). This system provides

evidence on lesion topography guided us

on the degree of dental damage and costs

arising from default on it. Data provided

by EGOHID system contribute to a

strategy of primary prevention and

secondary motivating with local, national

and European decision makers [4].

EGOHID is a comprehensive

evaluation of oral health status, which

consists of several sections, namely:

identification data and background

information of subjects; Questionnaire on

dental health, dental fluorosis

questionnaires, survey on periodontal

health, determination of the presence of

oral cancer, orthodontic treatment,

prosthetic treatment.

In this study we considered part of the

questionnaire on dental health codes for

attributed type of restoration present, the

type of carious lesions developed. Codes

are assigned according to Table 1.

Table 1.

Codes for restoration and sealing Codes for tooth decay

0= without sealing and restoration 0= surface without lesion

1= partial sealing 1= slight modification of the surface, the inspection

2= sealing 2= obvious change of surface

3 = discoloration restoration 3= cavity in the enamel, dentin without evidence

4 = amalgam restoration 4= damage to the enamel-dentin junction

5 = steel crown 5= dentin cavity

6= crown , facet ceramics, gold or composite 6= extended cavity dentin

7= restoration fractured or missing

8= temporary restoration

Missing teeth

97 = the extracted teeth cause tooth decay

98 = teeth absent from other causes

99= teeth that have erupted

P = implant

MATERIAL AND METHOD

In designing and running clinical trials

have formulated the following hypotheses:

the null hypothesis was that there is no

difference between the results of dental

health evaluation by epidemiologists

indices CAO, CAOS and EGOHID

system, testable hypothesis tested was that

the systems differ them, this translated by

statistically significant differences

obtained from analysis codes on the

questionnaire on dental health.

Patient selection was done among

students of III, Faculty of Dentistry, UMF

―Gr.T.Popa‖ Iasi. Following clinical

examination were selected a number of

122 subjects with a mean age of 23.53

years, 45 male and 77 female.

Inclusion criteria of patients in the

study followed the patients: to provide

carious lesions and restorative treatment to

highlight the value index and filling

cavities. The exclusion criteria were

followed: patients who had no carious

lesions or dental restorations.


Vol. 2, No. 3, July 2010

52

Following clinical examination data

were collected on the type of carious

lesion and the type of restoration, data

were collected through clinical

examination and preparation of charts. The

study was clinical type.

All patients in the study were

informed verbally about the purpose of the

study noting the consent form. The

examination was performed in the office

of dispensary patients nr.1, outpatient

dentistry. Patients were placed in the

database according to certain codes.

Statistical data processing was done with

software for Windows SPSS14.00 settling

a threshold of statistical significance of p ≤

0.05.


Assessment component of the system

decay index EGOHID namely EGOHID-C

was performed on a tooth surface because

can exist at different codes of carious

lesions.

The results of comparative analysis of

two systems of assessment revealed that

the differences statistically significant p ≤

0.05 (Table 4) for dental status assessment

system through the component EGOHID

carious lesions, lesion assessment can be

done in CS underestimated component of

the index showing an average of 4.42

CAOS (± 4.132) (Fig. 1, Table 2)

compared with EGOHID-C (the decay

index) an average 10,38 (±7,484) (Table

3).

Fig. 1. CS component analysis (mean scores obtained).

20151050

CS

40

30

20

10

0

Fre

qu

en

cy

Mean =4.42Std. Dev. =4.132

N =122

CS


Vol. 2, No. 3, July 2010

53

Table 2. Analysis of CaO and descriptive indices CAOS

N Minimum Maximum Mean Std. Deviation

CAO 122 1 29 10,11 5,507

CD 122 0 20 3,76 3,507

AD 122 0 9 ,97 1,443

OD 121 0 19 5,49 3,608

CAOs 122 2 62 17,46 11,825

CS 122 0 20 4,42 4,132

AS 122 0 45 4,85 7,110

OS 122 0 40 8,37 7,039

Valid N (listwise) 121

Differences fall mainly in providing

code 01 which represents a slight

modification of the surface with an

average of 3.72 (± 4.005) and the award

code 02 which represents a clear change of

the surface with an average of 2.89 (±

2.785).

Component analysis OD 5.49 (±

3.608) (Table 2) compared with

EGOHID-R 5.48 (± 3.793) (Table 3)

reveals no significant differences

statistically however there is a difference

in assessment of present sealing part code

10 with an average of 0.07 (± 0.421) and

sealing all present, that code 20 with an

average of 0.24 (± 0.882) (Table 3).

Table 3. Descriptive statistical analysis of system components EGOHID

N Minimum Maximum Mean Std. Deviation

EGOHID-C 122 0 37 10,38 7,484

EGOHID-R 122 0 17 5,48 3,793

cod 01 122 0 23 3,72 4,005

cod 02 122 0 18 2,89 2,785

cod 03 122 0 13 2,39 2,671

cod 04 122 0 11 ,70 1,520

cod 05 122 0 10 ,45 1,234

cod 06 122 0 6 ,23 ,758

cod 10 122 0 4 ,07 ,421

cod 20 122 0 6 ,24 ,882

cod 30 122 0 12 4,24 3,330

cod 40 122 0 10 ,57 1,548

cod 50 122 0 5 ,07 ,477

cod 60 122 0 6 ,18 ,693

cod 70 122 0 3 ,20 ,492

cod 80 122 0 3 ,13 ,444

cod 99 122 0 4 ,48 ,938

cod98 122 ,00 3,00 ,2705 ,76100


EGOHID-C -carious lesions,

EGOHID- R-dental restorations 01 - now partly sealed, code 02 - sealed, code 03 - filling, code 04

- amalgam fillings, code 05 - crown, ceramic side, code 07 - fractured fillings or missing, code 08 -

filling temporary, code 10 - slight modification of the surface, the inspection, code 20 - obvious

change of surface, code 30 -cavity in the enamel, without dentin evidence, code 40 - lesion-enamel-

dentin junction, code 50 - dentin cavity, code 60 - extended cavity dentin


Vol. 2, No. 3, July 2010

54

Table 4.

Application of Nonparametric Chi-square test

CS EGOHID-C

Chi-

Square(a,b) 93,148 60,803

df 16 26

Asymp. Sig. ,000 ,000

a. 0 cells (,0%) have expected frequencies less than 5. The minimum expected cell frequency is 7,2.

b. 27 cells (100,0%) have expected frequencies less than 5. The minimum expected cell frequency is

4,5.

Also in the analysis proposed by

Axelsson index CCITN [5] (Caries Index

Treatment Needs Community –

Community index of treatment needs

carious lesions) achieved an average of

4.00 (Table 5) compared with an index

value CDs average of 3.76 (± 3.507). The

difference is that the clinical examination

in the index CAO were not always

recorded color changes or other changes in

the surface structure present in the form of

noncavitation injuries, while the

differential analysis of primary enamel

lesion component were inserted all early

lesions.

Table 5.

Average evaluation indices of caries index CCITN

N Minimum Maximum Mean

Std.

Deviation

CCITN 1 122 0 16 2,57 2,712

CCITN 2:1 122 0 8 ,36 1,076

CCITN 2:2 122 0 14 ,53 1,657

CCITN 3:1 122 0 12 ,43 1,408

CCITN 3:2 122 0 2 ,11 ,390


CONCLUSIONS

Comparative analysis of oro-dental

health and CAO EGOHID system provides

clinicians and especially the organizers of

health evidence on preventive or curative

approach tends dental network.

Data obtained through evaluation of

dental caries EGOHID are higher,

providing a concrete picture of the

direction of early diagnosis of dental

caries, treatment and hence the technicality

and restorative treatments.

REFERENCES 1. WORLD HEALTH ORGANISATION, Oral health survey - basic methods, 4th edition, Geneva, p.66-9,

1997.

2. HICKEL R., MANHART J., Longevity of restorations in posterior teeth and reasons for failure, J Adhes

Dent Spring, 3(1), pp. 45-64, 2001.

3. REISINE S., DOUGLASS JM., Psychosocial and behavioral issues in early childhood caries,

Community Dent Oral Epidemiology, 26 (1 Suppl), pp. 32-44, 1998.

4. http://www.egohid.eu

5. PER AXELSON, DDS, PhD, Diagnosis and Risk Prediction of Dental Caries, vol.2, 2000.

http://www.egohid.eu/


Vol. 2, No. 3, July 2010

55

THE DAY OF PROPHYLAXY, JUNE, 9, 2010

The Day of Moldavian Prophylaxy in Dental Medicine, organized by the Romanian

Dental Association for Education, The Faculty of Dental Medicine, UMF, Gr. T. Popa, Iasi,

in partnership with companies dealing with prophylaxy products used in preventing oral

pathology and its complications in Moldavia focuses on the topic ―The Evaluation of the Oral

Status of the population from rural areas and monasticism‖. There is to be assessed the

population from villages in the Iasi county with no residing dentist –Popesti, Braesti, Dagita,

Dobrovat, Gropnita and as well as from those having a dentist doctor-Rediu, Miroslava. An

important role in such events s held by the local authorities-both from the villages involved in

the study and from Iasi, as ell as by the Metropolitan Bishopric of Moldavia and Bucovina.

The event will take place on June, 9, 2010 and it focuses on two main aspects: the former

is the Symposium dedicated to oral pathology prevention methods where outstanding

specialists in the field are expected to hold conferences and representatives of the companies

promoting prophylaxy products in Moldavia are invited to participate. The Symposium is

scheduled for 9.00AM in the G E Palade auditorium of The University of Medicine and

Pharmacy Gr. T. Popa, Iasi. The Latter manifestation is the Prophylaxy Caravan (9.00am-

9.00pm) evaluating and distributing free samples of prophylaxy products in the county of Iasi

(The Theatre Park, V Alecsandri). The other places for evaluation and product distribution

are in rural and monastic communities: Neamt, Agapia, Varatec, Secu, Sihastria. The

participant companies –Colgate, Glaxo, Johnson and Johnson, Oral B will deliver free

samples and informative brochures.

The participants will come in touch with prevention methods in oral pathology and the

new products on the market used in this respect, leading to an increase in their life quality.

Univ Prof Dr Norina Forna

Dean of the Faculty of Dental Medicine Iasi


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Romanian Journal of Oral Rehabilitation - Amazon S3s3.amazonaws.com/zanran_storage/ Journal of Oral Rehabilitation Vol. 2, No. 3, July 2010 3 FOREWORD The Day of Moldavian Prophylaxy