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NOTES:

*Articles are cited according to Uniform Requirements by International Committee of Medical Journal Editors - ICMJE and NLM Style Guide for Authors, Editors and Publishers

Bill JS, Watted N. Contemporary Aspects of Orthognatic Surgery. Acta Stomatol Croat. 2004;38(4):263.

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Title in English:	Contemporary Aspects of Orthognatic Surgery
Title in Croatian:	Suvremeni pogledi na ortognatsku kirurgiju
Type of Article:	congress abstract
MeSH:	ORTHODONTICS + methods
Abstract:	Orthognathic surgery within the past half decade has become a standard procedure in cranio-maxillo- facial surgery. Based upon the elementary works by Obwegeser introducing the sagittal split ramus osteotomy in the early 50is, today this procedure has become the gold standard in mandibular orthognathic procedures worldwide. The introduction of devices to ensure the centric condyle position throughout the entire surgery by Luhr in the early 80ies gives another impact to modern understanding on complete functional rehabilitation after dysgnathia.Even though the LeFort-I-Osteotomy was already introduced by Wassmund in the 20is it took almost another 50 years before this procedure became accepted in surgery, mainly based on the fear of severe bleeding that may occur during surgery. By introducing a compund condyle positioning device to ensure the exact condyle position throughout both procedures of maxillary and mandibular osteotomy respectively, during combined bimaxillary osteotomies, as well as the targeted use of distraction devices, today we are able to solve even the severest dysgnathia problems.At the Department of Cranio-Maxillo-Facial Surgery of the University of Würzburg, during the past two decades and far more than 2000 orthognathic surgery cases, we are trying to present a broad overview of the development of the latest surgical techniques and clinical results.This progress is not possible without the primary and consistent treatment by a specifically skilled orthodontist during primary treatment including the interdisciplinary indication for surgery, the orthognathic preparation of the patient as well as the postoperative treatment.Therefore special emphasis will be put on the orthognathic treatment, as well as on technical prerequisites for the surgical procedure.

Virag M. Differenial Diagnosis of Malinant Tumours of the Maxillofacial Region. Acta Stomatol Croat. 2004;38(4):264.

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Knežević G. Differential Diagnostics and Assessment of Cystic Translucencies of the Jaw. Acta Stomatol Croat. 2004;38(4):264-5.

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Title in English:	Differential Diagnostics and Assessment of Cystic Translucencies of the Jaw
Title in Croatian:	Diferencijalna dijagnostika i procjena cističnih prozirnosti čeljusti
Type of Article:	congress abstract
MeSH:	JAW CYSTS
Abstract:	Cystic translucencies of the jaws are more or less clearly circumscribed, oval or round, solitary or multiple translucencies in the bone with straight or wavy edges. As they are most frequently caused by cysts diagnosis of such lesions is usually simple. Occasionally pathological lesions are hidden behind such conditions, creating diagnostic difficulties, and consequently adequate knowledge and experience are required for diagnosis, and at the same time awareness that a mistake is occasionally possible. Namely, the correct diagnosis enables the correct choice of surgical treatment or choice of some other method of treatment, depending on the nature of the lesion. Pathological lesions which create translucency may be: odontogenic or nonodontogenic cysts, pseudocysts, odontogenic tumours without calcified tissue, gigantocellular jaw lesions, ectopic position of the salivary gland tissue, benign nonodontogenic tumours, such as desomoplastic fibroma, hemangioma or neurinoma, localised forms of histiocytosis X, osseous lesions in certain syndromes, some diseases of organic systems, and even primary malignant tumours of the jaws or metastases of other malignant tumours of the body. Restricted translucency in the jaws can be induced by dental germs prior to their calcification, variation in the trabecular structure of spongy bones and focally osteoporotic bone defects, impaired bone healing after tooth extraction, including so-called paraffinoma or myospherulosis, connective healing of the bone cavity after surgical procedures and finally translucencies which are the result of the anatomic structure of the jaws.The object of the lecture is to warn of the diversity of radiographic idiosyncrasies by showing examples of typical and atypical X-rays, particularly the specificity of radiographic findings which predict aggressive growth of formations or greater tissue potential.

Uglešić V, Jokić D, Knežević P, Gašparović S. Orthognathic Surgery - Functional or Aesthetic Surgery. Acta Stomatol Croat. 2004;38(4):265.

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Biočina-Lukenda D, Pirkić A, Cekić-Arambašin A. C-ERB-2 as a Biomarker for Premalignant Potential of Oral Lichen Ruber. Acta Stomatol Croat. 2004;38(4):265-6.

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Title in English:	C-ERB-2 as a Biomarker for Premalignant Potential of Oral Lichen Ruber
Title in Croatian:	C-erbB-2 kao biomarker premalignog potencijala OLR-a
Type of Article:	congress abstract
MeSH:	LICHEN PLANUS, ORAL + diagnosis
Abstract:	The object of this investigation was to estimate the possible premalignant potential of lesions of oral lichen ruber (OLR) by determining the intensity of expression of tissue antigen c-erbB-2 in relation to the clinical form and clinical status of the lesion. Comparison of the tissue expression of antigen cerbB- 2 was carried out between erosive (LRE) and planus form (LRP) oral lichen, and comparison according to the intensity of inflammation and hyperceratous lesions.The investigation included 30 patients with clinical and histopathological diagnosis of OLR. The results obtained were compared with a control group comprising 15 patients with a diagnosis of oral leukoplakia (OL), verified as leukoplakia simplex. Tissue antigen c-erbB-2 was demonstrated by APAAP and LSAB immunohistochemical methods, following prior analysis of biopsy samples in a microwave oven. The reaction showed specific mosaicism, in both intensity and topography occurrence. Positive reaction to this tissue antigen was observed, primarily in the spinous layer of cells of the oral epithelia, while negative reaction occurred in the basal layer of cells. The reaction was intensively positive in the tonofibrile cells of the spinous layer. No difference was observed in the intensity of the reaction to this tissue antigen between erosive and planus form of oral lichen. The intensity of the reaction to tissue antigen c-erbB-2 did not correlate with the intensity of the inflammation, although it positively correlated with the intensity of the hyperkeratose lesion.It can be said that expression of tissue antigen c-erbB-2 in ORL lesions was changed, which indicates their changed nature and specific premalignant potential.

Vučičević-Boras V, Čikeš N, Lukač J, Virag M, Cekić-Arambašin A. Salivary and Serous Values of Interleukin 6 and Basic Growth Factor of Fibroblasts in Patients with Planocellular Carcinoma. Acta Stomatol Croat. 2004;38(4):266-7.

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Alajbeg I [Ivan], Ivanković S, Jurin M, Pirkić A, Alajbeg-Žilić I, Cekić-Arambašin A. The Effect of Nonaromatic Naphthalane on Mice Oral Planocellular Carcinoma - a Pilot Study. Acta Stomatol Croat. 2004;38(4):267-8.

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Title in English:	The Effect of Nonaromatic Naphthalane on Mice Oral Planocellular Carcinoma - a Pilot Study
Title in Croatian:	Učinak nearomatskog naftalana na mišji oralni planocelularni karcinom - pilot studija
Type of Article:	congress abstract
MeSH:	CARCINOMA, SQUAMOUS CELL
Abstract:	Nonaromatic naphthalane (NAVS) is a specific fraction of Croatian oil, extremely rich in steranes from which the aromatic system is removed. Steranes are attributed with bioactivity similar to steroid hormones, modulators of tumour growth. Encouraged by the results of earlier in vitro and in vivo studies on the inhibitory effect of NAVS on the growth of planocellular carcinoma, we carried out a study on its effect on oral planocellular carcinoma (OPCC) in mice.Aims: 1) To test the validity of the simple experimental model OPCC, 2) to test possible antiproliferative effect of NAVS on the above model by monitoring tumour growth, 3) to test the antineoangiogenic effect of NAVS to explain the possible antiproliferative effect, and to estimate the possibility of crisis reactivity of anti-human immunohistochemical markers with mice tissue. A suspension of 100 μl s 105 SCC VII cell was inoculated intraorally under the buccal mucous membrane in 48 syngeneic C3H mice. Seven days after inoculation the animals were divided in six equal groups and the mice, depending on the group, were intratumorously injected with 100 μl of the following substances: paraffin oil (PO) as a negative control, NAVS (in one group 7 days, and in the second group 14 days, after inoculation of the tumour), 1.25 dihydroxyergotamine (1.25-D3) as a positive control, and a combination of NAVS with 1.25 D3 and PO with 1.25- D3. Tumour growth was monitored weekly by measuring with callipers. The animals were sacrificed 1, 2, 3 and 4 week after application of the tested substance. Histological specimens of explanted tumours were stained with hematoxylin-eozine, and immunohistochemically with anti-CD34 antibodies for estimation of tumour neoangiogenesis. Compared with the PO group, tumour growth and angiogenesis were decreased in the 1.25-D3 and NAVS groups. NAVS probably reduced growth by OPCC inhibition of vascular proliferation, needed for tumour growth.

Kobler P, Virag M, Seiwerth S, Manojlović S. Mucoepidermoid Carcinoma of the Small Salivary Glands. Acta Stomatol Croat. 2004;38(4):268-9.

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Title in English:	Mucoepidermoid Carcinoma of the Small Salivary Glands
Title in Croatian:	Mukoepidermoidni karcinom male žlijezde slinovnice
Type of Article:	congress abstract
MeSH:	CARCINOMA, MUCOEPIDERMOID SALIVARY GLANDS
Abstract:	The mucous membrane of the oral cavity, covered with multilayered squamous epithelium, is a source of benign and malignant lesions, from simple fibroma to carcinoma of the oral cavity. Because of accessibility of the pathological lesions dental practitioners can, by a routine clinical examination, with no additional diagnostic methods, diagnose and refer the patient to an oral or maxillofacial surgeon. For early detection and treatment of different formations it is most important for the patient to be referred promptly to the surgeon, so that minor surgical procedures can be performed, which can lead to cure. Pathological processes of deeper layers also manifest on the mucous membrane. Mucosal cysts, benign and malignant tumours can develop in the small salivary glands of all parts of the oral cavity. Tumours of the salivary glands comprise around 3% of the tumours in the body. In other words they are relatively rare. However, it is important to realise that 10 to 20% of all the above tumours occur inthe small glands, most frequently on the palate. Equally important is the data that the relative incidence of malignant tumours increases, as the size of the glands in which they develop decrease.Case presentationA 21-year-old male patient was admitted for examination because of a painless formation on the hard palate, at the level of the molar, 2 cm in diameter, with wide base, exulcerous surface and thickened edges. From the case history it was learnt that he had not had subjective problems for around 2 years. Six weeks prior to admittance the growth/formation exulcerated and he felt fluid coming from it. A biopsy was performed which showed mucoepidermoid carcinoma, a malignant neoplasm of the small salivary glands that can occur at any age, although it is more frequent in children. The tumour was removed with an electro-scalpel, and the histopathological finding confirmed the diagnosis and revealed grade 1 malignancy (G-1). Such types of tumours rarely recur and metastasise, and according to data from the literature the degree of recovery within five years amounts to 90%. Malignomas of the small salivary glands are frequently difficult to clinically mutually differentiate, and they may resemble benign pleomorphic adenomas. Prompt examination and specialist treatment, followed by prompt biopsy and surgical procedure increases the chances of recovery.

Ivasović Z, Krmpotić M, Milenović A, Katanec D. All that Can be Hidden Behind the Clinical Appearance of Odontogenic Abscesses. Oversight or Error? - Presentation of Two Cases. Acta Stomatol Croat. 2004;38(4):270.

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Title in English:	All that Can be Hidden Behind the Clinical Appearance of Odontogenic Abscesses. Oversight or Error? - Presentation of Two Cases
Title in Croatian:	Što se sve može sakriti iza kliničke slike odontogenih apscesa. Previd ili pogrješka? - prikaz dvaju slučaja
Type of Article:	congress abstract
MeSH:	ABSCESS
Abstract:	The aim of this study was to show the importance of a detailed clinical examination, diagnostic analysis and good knowledge of the pathology of the oral cavity, in order to avoid erroneous treatment and loss of precious time.The first patient, R. J., a 36-year-old man, was admitted to the ENT Department of the General Hospital, Karlovac, because of a perimandibular swelling and trismuss of the right side of the face. Because an odontogenic abscess was suspected extraoral incision was performed on two occasions. After the arrival of an oral surgeon to the hospital and examination of the oral cavity the patient was transferred to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava. During an intraoral examination an ulcer was detected beneath the tongue on the right side and a massive infiltrate of almost the whole of the anterior two thirds of the tongue. Immovable metastasis was detected by palpation in regions two and three, 50 millimetres in size. After consultation at an oncological Meeting irradiation only was indicated. A check-up six months later showed partial regression of the disease.The second patient, K. J., a 33 year-old man, came to the Out-patient Department of Oral Surgery with suspected palatinal abscess of the upper left molar. The upper left six was trepanated and the suspect abscess incidirated twice. For a period of six months no regression occurred and consequently the patient was sent to the Clinical Department of Oral and Maxillofacial Surgery, University Hospital Dubrava, where cytopuncture, biopsy, CT of the maxilla were performed which confirmed mucoepidermoid carcinoma of the hard palate. After preoperative preparation partial resection of the upper jaw was performed. Therapy is presently in course.These two cases indicate the need to know the causative agents of swellings in the area of the head and neck, and if odontogenic inflammation is the case it quickly responds to appropriate therapy.

Knežević G. Surgical Procedures in the Treatment of Large Osseous Cavities of the Jaws. Acta Stomatol Croat. 2004;38(4):271.

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Title in English:	Surgical Procedures in the Treatment of Large Osseous Cavities of the Jaws
Title in Croatian:	Kirurški postupci u liječenju velikih koštanih šupljina čeljusti
Type of Article:	congress abstract
MeSH:	JAW CYSTS
Abstract:	The problem of the choice of surgical procedure in the treatment of large osseous cavities which remain after the removal of benign pathological lesions of the jaws implies the need to prevent possible recurrences of local invasive lesions by the surgical procedure and to ensure organisation of the blood clot and restoration of the bone without infection. This was the reason for the appearance of several different surgical procedures that developed throughout history. The treatment of large osseous cavities by Partsch II method with intraoral postoperative suction and Partsch II method with decortication of one side of the jaw will be presented, and the results after filling the bone defect with resorbable granulate tricalcic phosphate (BioResorb, Oraltronics), and the results of treatment by biphase surgical procedure. From the results of clinical investigations it can be concluded that each of the above methods produces good results, when applied in correctly chosen indications. The application of intraoral suction is safe and the cheapest method for the largest osseous defects, particularly if at the same time decortication of one osseous wall is performed. The application of alloplastic resorbable material is safer than the application of nonresorbable materials, and healing is completed without complications within a period of six months. Biphase surgical procedure in the treatment of odontoma of the jaws is unique in the literature. The abandoned methods of marsupialisation are again being revived after experimental investigations showed changes in the virility of the epithelia of such treated odontogenic keratocysts, which from the literature and daily practice are known to be extremely prone to recurrence, and therefore in modern pathology today they are classified as odontogenic tumours.

Grgurević J. Biphase Treatment of Large Mandibular Cysts - Case Presentation. Acta Stomatol Croat. 2004;38(4):272-3.

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Title in English:	Biphase Treatment of Large Mandibular Cysts - Case Presentation
Title in Croatian:	Dvofazno liječenje velike ciste donje čeljusti - prikaz slučaja
Type of Article:	congress abstract
MeSH:	JAW CYSTS
Abstract:	A young female patient, aged 28 years, was admitted to the Out patient Department of the Clinical Department of Oral Surgery in May of this year. She was referred to us by an oral surgeon because of a large cyst in the mandible. The patient brought with her an orthopantograph which showed a large multilocular translucency in the mandible on the right side, which extended from the area of the second premolar up to the incisura semilunaris on the ramus of mandible. We performed another orthopantograph on which the translucency did not differ essentially from that on the orthopantograph which the patient had brought. Because of the swelling of the lower edge of the jaw and multilocular translucency we were unsure as to the nature of the pathological lesion. To help us decide on which operative procedure to use we sent the patient for a CT of the mandible. However the finding failed to dispel our uncertainty, in spite of the fact that we felt almost convinced that it was a cyst and not a cystic tumour. However, before finally deciding on which operation to perform we took a piece of tissue, under local anaesthesia, from the osseous cavity for biopsy which confirmed our suspicion that it was a keratocyst. As it was an exceptionally large cyst and because of the danger of mandibular fracture in the case of complete removal of the buccal corticalis, we decided to use the biphase technique. The plan was to carry out decompression of the cyst in the first phase by opening the calotte on the most prominent part of the cyst from the buccal side and construct an obturator. This method enables regeneration of the thinned bone. The obturator is worn continuously and is not reduced. The patient has a check-up by the dentist at least twice a week, who rinses the cavity in the bone with 3% hydrogen peroxide and physiological solution. As soon as the clinical and radiographic findings show that the cyst has decreased and that the bony defect has healed we plan to carry out the second phase of treatment, in which the cyst will be completely removed and the remaining bone defect primarily closed. The X-rays performed 6 weeks and 3 months after the operation show good recovery of the bone and significantly decreased cystic cavity. Continuation of treatment is planned in approximately one month. The results obtained show the justification of such an approach in the treatment of large cysts.

Sokler K. The Need for Standardisation of Procedures in the Treatment of Odontogenic Keratocysts. Acta Stomatol Croat. 2004;38(4):273-4.

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Title in English:	The Need for Standardisation of Procedures in the Treatment of Odontogenic Keratocysts
Title in Croatian:	Nužnost standardizacije postupaka u liječenju odontogenih keratocista
Type of Article:	congress abstract
MeSH:	ODONTOGENIC CYSTS
Abstract:	Odontogenic keratocysts comprise approximately 10% of all odontogenic cysts of the jaws and occur as solitary lesions or within the framework of Gorlin- Goltz's syndrome, frequently in the mandible in the area of the angulus and ramus. According to Stoeling, they can be classified radiographically as unilocular, multilocular with osseous trabecules, multilocular without trabecules and those with wavy edges. The following are reported as possible causes of recurrence (3%-62%), the thin capsule and its incomplete scaling during the surgical procedure, satellite cysts, the presence of parakeratinisation, “dropping down” of epithelial cells etc. Thirty odontogenic cysts were found in a clinical sample of the Clinic of Maxillofacial and Oral Surgery, University Hospital Dubrava, Zagreb, of which 12 recurred once and 3 several times, which amounts to 50%. Thus the incidence of recurrence in this sample was equal to the values of recurrence in ameloblastoma (50 - 90%). The behaviour of odontogenic keratocysts is therefore similar to the behaviour of ameloblastomas, which is sufficient reason for caution in the method of treatment. The following is recommended:• Odontogenic keratocyst should be considered an odontogenic tumour with tendency to recurrence, because in the latest classification it is included under the term keratinising cystic odontogenic tumour.• Cases of osseous translucency with the above radiographic characteristics, resembling odontogenic keratocystic prior to or during the operation should be histopathologically checked.• Cases of cystic lesions in Gorlin-Goltz's syndrome, even without prior histopathological verification, should be considered odontogenic keratocysts and thus treated, and patients continually monitored because of the constant possibility of new cysts forming.• During the operation carefully denucleate the capsule and later whiten the bone with 3% hydrogen peroxide in order to see possible remains of the capsule and all places of eroded or perforated bone, and also undermined sites should be revealed and polished with a burr until the surface is smooth.• Healing of the osseous cavity should be ensured by one of the usual methods (Partsch II+ decortication (Brosch), Partsch II+ postoperative suction).• Marsupialisation should be applied in cases of exceptionally large cysts for drainage and eventual reduction of the osseous cavity, or in the case of patients with health risk, who are a risk for operation under general anaesthesia. Because of the determined changes in virility of the epithelia of marsupialized keratocysts wider application of the method is possible.• Postoperatively the patient should be clinically and radiographically monitored until complete healing of the bone, from two to fifteen years after the operation. In cases with signs of recurrence surgical intervention should be immediate, in order to avoid uncontrolled expansion of the formation/mass.

Filipović-Zore I, Milenović A, Ivasović Z, Šiljeg J. Uncommon Metastasis of Melanoma of the Face After Sixteen Years - Case Presentation. Acta Stomatol Croat. 2004;38(4):274-5.

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Filipović-Zore I, Milenović A, Ivasović Z, Šiljeg J. Uncommon Clinical Appearance and Localisation of Carcinoma of the Upper Lip - Case Presentation. Acta Stomatol Croat. 2004;38(4):275-6.

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Title in English:	Uncommon Clinical Appearance and Localisation of Carcinoma of the Upper Lip - Case Presentation
Title in Croatian:	Neobična klinička slika i lokalizacija karcinoma gornje usnice - prikaz slučaja
Type of Article:	congress abstract
MeSH:	CARCINOMA LIP
Abstract:	The study presents the uncommon clinical appearance and localisation of carcinoma of the upper lip.A 74-year-old female patient was referred to the Outpatient Department of Oral Medicine because of a purulent infiltrate in the upper lip which was thought to be an insect bite. She was referred to the Outpatient Department of Oral Surgery where an incision was performed and drainage, and piogenic granuloma diagnosed. As the lesion had not healed after two months, but on the contrary had become harder and more visible, both vestibularly and labially, an excision was planned. In the meantime, however, the patient had attended the Clinic of Dermatovenerology because of basocellular lesions on the face, and during excision of the facial lesions a surface biopsy was performed from the skin side of the lip, and the PHD finding showed planocellular carcinoma. At the Clinic of Dermatovenerology the patient was recommended to undergo radiotherapy of the lesions. However, the patient returned to the Out-patient Department of Oral Surgery. Because of the suspicion that the biopsy had been too superficial and because of the possibility of eventual confusion with a mioblastoma, complete excision of the lesion was performed and an identical PHD finding was obtained of planocellular carcinoma. The patient was then transferred to the Department of Maxillofacial Surgery, University Hospital Dubrava, where an extended excision was performed, and the PHD confirmed that the lesion had been completely excised in the previous procedure.

Škrobot R, Macan D. Epidural Spinal Abscess After Extraction of a Tooth - a Rare but Possibly Fatal Complication. Acta Stomatol Croat. 2004;38(4):276-7.

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Title in English:	Epidural Spinal Abscess After Extraction of a Tooth - a Rare but Possibly Fatal Complication
Title in Croatian:	Epiduralni spinalni apsces nakon vađenja zuba - rijetka, ali moguće fatalna komplikacija
Type of Article:	congress abstract
MeSH:	ABSCESS TOOTH EXTRACTION + adverse effects
Abstract:	The complications of an odontogenic abscess are well known, and difficulty swallowing in the case of a submandibular or pterygomandibular abscess is a serious and a valuable sign. However, the majority of physicians are unaware that a stiff and painful neck can indicate complications of odontogenic infection. In fact it is one of the first, and at the same time the main symptom in epidural spinal abscess. Only a few cases have been presented in the literature of patients treated with such an abscess.The specificity of an epidural spinal abscess is that it occurs in a very small number of patients (0.2 to 1.2 in 10000 patients), abruptly or a few days or a week after infection, anywhere in the body and most often in immunocompromised patients.The main symptoms are:1. Pain in the spine within 24 hours, which increases within three days of the operation.2. Stiffness gradually increases.3. Reduced control of the bladder and intestines.4. Rapid progression toward paralysis.As stiffness of the neck is the earliest sign of epidural spinal abscess it should not be treated lightly, because of the possibility of a lethal cause of such an abscess, particularly when a patient arrives with signs of acute torticolis, after a recent operation in connection with the teeth and oral cavity.We contemplated such pathology in two patients admitted to the Clinic of Maxillofacial and Oral Surgery, University Hospital Dubrava, and retained for treatment and observation.

Kobler P, Borčić J, Filipović-Zore I, Nola M, Sertić D. Occurrence of Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation. Acta Stomatol Croat. 2004;38(4):277-8.

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Title in English:	Occurrence of Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation
Title in Croatian:	Pojava non-Hodgkin limfoma u usnoj šupljin - prikaz slučaja
Type of Article:	congress abstract
MeSH:	LYMPHOMA, NON-HODGKIN
Abstract:	Non-Hodgkin lymphomas (NHL) are a heterogenetic group of lymphoproliferative neoplasms, characterised by the occurrence of malignantly changed lymphocytes in a lymph node, and rarely primary in other organs. The disease most frequently manifests with painlessly enlarged lymph nodes, which in the gastrointestinal and urinary tract may cause compression. Infiltration of the bone marrow causes insufficiency of myelopoiesis, resulting in anaemia, trombocytopenia and neutropenia. Classification of the disease is based on PHD and peripheral blood findings.Extranodular disease occurs most frequently in the gastrointestinal tract, and also often occurs in the sinuses, thyroid gland, salivary glands, breasts, kidneys and lungs. Approximately 25% of extranodular lymphomas first occur on the head and neck in the so called Waldeyer's ring, although primary lymphomas of the oral cavity are rare.We present the case of a 63-year-old man with primary occurrence of NHL on the gingiva. The suspect lesion in the oral cavity was noticed during extraction of an inflamed root in the upper jaw. The lesion was located in the immediate vicinity of odontogenic inflammation, although it was not connected with it, and thus a specimen was taken for biopsy. The radiographic finding did not show anything specific. PHD finding of the lesion showed necrosis, bleeding and polymorphonuclear inflamed infiltrate and a tumorous mass with atypical lymphocyte cells. After a further examination by a haematopathologist NHL was confirmed with a high degree of B-cell malignancy. Immunohistochemistry confirmed giant cell NHL, B immunophenotype, and the patient's condition was defined as NHL II E.

Kuna T, John O, Kobler P, Filipović-Zore I. A Finding of Diffuse Cellular Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation Dg: Diffuse Giant Cell Non-Hodgkin lymphoma B-immunophenotype. Acta Stomatol Croat. 2004;38(4):278-9.

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Title in English:	A Finding of Diffuse Cellular Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation Dg: Diffuse Giant Cell Non-Hodgkin lymphoma B-immunophenotype
Title in Croatian:	Nalaz difuznog staničnog NHL-a u ustima - prikaz sučaja Dg: Difuzni velikostanični non-Hodgkin limfom B-imunofenotipa
Type of Article:	congress abstract
MeSH:	LYMPHOMA, NON-HODGKIN
Abstract:	Definition: Non-Hodgkin lymphomas (NHL) are a heterogenetic group of lymphoproliferative neoplasms characterised by the occurrence of malignantly changed lymphocytes in a lymph node, and rarely primary in other organs.The heterogenicity of the disease is interpreted in the diverse clinical manifestations of the disease, diverse laboratory parameters, histological finding, immunological origin of the malignant cells, reaction to therapy and disease prognosis. The disease is most frequently interpreted by painless enlarged lymph nodes, and more rarely with disturbances in other organic systems due to lymphomic infiltration of organs. Diffuse giant cell NHL B-immunophenotype belongs to the group of lymphomas of moderate degree of malignancy. It occurs in middle-aged and older age groups, usually with disseminated lymph nodes, and up to 70% of patients have infiltration of the bone marrow by lymphoid cells. Diffuse lymphomas of giant cells are very often localised and infiltration of the gastrointestinal tract and central nervous system is a frequent occurrence.In this study we describe the method of diagnosing diffuse giant cell NHL B-immunophenotype, which was detected after inadequate healing of postextraction alveola.The patient was admitted because of a swelling and growth from the post-extraction alveola in the area of the lower left wisdom tooth and anaesthesia of the chin. The tooth was extracted because of pain in the tooth and gingiva. The patient informed us that approximately 6 months ago he had felt “tingling” on the left side of the chin. At that time he was treated with laser therapy by a specialist in oral medicine, after which partial improvement occurred. However anaesthesia of the area, pain and swelling recurred, and it was decided to perform extraction of the lower wisdom tooth. The patient was treated in this Department initially with cochleation and antibiotics. Improvement occurred one week after treatment. However, after the remission pain and swelling recurred. A detailed history was taken and it was learnt that a few months beforehand, during an operation for an inguinal hernia, a problem had occurred with coagulation, and renal enzymes were raised and hepatitis suspected. A biopsy was then taken in our Department and sent for PHD. Palpable lymph nodes were not found in the area of the head and neck. During analysis of the first biopsy the result was suspect for malignant lymphoma and the patient was sent for further treatment by a haematopathologist, where a further biopsy was taken. The finding showed diffuse giant-cell Non-Hodgkin lymphoma B-immunophenotype. The patient is presently undergoing treatment in the Clinical Department of Haematology, and after appropriate therapy the disease is in remission.

Švajhler T, Šiljeg J, Filipović-Zore I, Krhen J. Assessment of the Success of Raising the Floor of the Sinus for Insertion of a Dental Implant - Case Presentation. Acta Stomatol Croat. 2004;38(4):280-1.

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Title in English:	Assessment of the Success of Raising the Floor of the Sinus for Insertion of a Dental Implant - Case Presentation
Title in Croatian:	Procjena uspješnosti podizanja dna sinusa za inserciju dentalnog usadka - prikaz slučaja
Type of Article:	congress abstract
MeSH:	ORAL SURGICAL PROCEDURES MAXILLARY SINUS
Abstract:	Loss of a large number of teeth in the lateral segment of the maxilla, either on one side or both, represents a challenging therapeutic procedure. Today the demands of the patient have increased with regard to fixed prosthetic treatment for lateral segments of edentia.Although lateral edentia can more easily be solved by a partial prosthesis or a cantilever bridge, dental implantology is now one of the solutions in the daily practice of the dentist. One of the most frequent problems in solving distal edentia of the maxilla by the use of dental implants is connected with the anatomic relations between the maxillary sinus and alveolar prolongation of the maxilla, i.e. the socalled deep recess of the maxillary sinus, or even the result of severe atrophy of the alveolar prolongation. Such situations do not facilitate insertion and good stabilisation of dental implants, and thus they narrow indications for fixed prosthetic work. With the development of dental implantology during the 1980s, a possible solution for this problem arose, by an operation to raise the floor of the sinus, which today is known as “sinuslifting”. Prospectively, operation techniques are diverse, as are also the different materials used in these operations. Sinuslifting is in fact a reconstructive surgical procedure, which with osteal implants or osteal restorations achieves the formation of bone on the floor of the maxillary sinus in the alveolar recess, where the dental implant will later be inserted. Today's technique is briefly described as the opening of the lateral osteal wall of the maxillary sinus, and this osseous fragment is twisted towards the interior of the sinus cavity and the resulting area (caudal third) filled with augmentation material. If there is sufficient height of the bone in the area of the floor of the sinus (4-5 mm) the implant can be carried out at the same time as sinuslifting, to ensure safe primary stabilisation of the dental implant.We present the case of a 33-year old patient with sinuslifting in the right segment of the maxilla, as preparation for dental implant. The patient already has osseointegrated implants in area 46 and 37.

Krmpotić M. Medical and Financial Aspects of Surgical-Prosthetic Therapy of the Atrophic Mandible-Vestibuloplastics vs. Implantology. Acta Stomatol Croat. 2004;38(4):281.

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Grgurević J, Grgurević J. Analysis of Vestibuloplastics in a Thirty-Year Period (from 1975 to 2004). Acta Stomatol Croat. 2004;38(4):281-2.

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Title in English:	Analysis of Vestibuloplastics in a Thirty-Year Period (from 1975 to 2004)
Title in Croatian:	Raščlamba vestibuloplastika u tridesetogodišnjem razdoblju (od 1975. do 2004. godine)
Type of Article:	congress abstract
MeSH:	ALVEOLOPLASTY
Abstract:	By analysing case histories and operative protocol of the Department of Maxillofacial and Oral Surgery from 1975 to 2004 we have attempted to follow the progress of pre-prosthetic surgery over a thirty-year period.On the assumption that vestibuloplastics are the criteria for development of the oral surgical profession and education of the dentist and prosthetic specialists who are in a position to decide on the correct indication for pre-prosthetic surgical procedure, we have attempted to determine how the circumstances in dental medicine have changed over the thirty years.It may be presumed that the number of patients referred for pre prosthetic surgical procedure has decreased over the last few years because of the increased number of inserted implants and increasing number of available implantological systems on our market. On the other hand the increased number of patients operated on due to malignant diseases of the oral cavity and jaws need some kind of preprosthetic surgical procedure in order to successfully prosthetically be rehabilitated.During the 1970s when the late Professor Ivo Miπe dominated oral surgery, the majority of patients were operated on by his operative method. After his death his close co-workers, who had visited many important European clinics and schools introduced new operative techniques and methods which today comprise the largest number of treatment methods.The results obtained show a definite fall in the number of operations over the last two years, which need not necessarily mean that the number of indications for pre-prosthetic surgical procedure has decreased and that such patients are treated in another way, e.g. by the insertion of an implant, because there were several years in the thirty year period during which there was a distinct decrease in the number of pre-prosthetic surgical procedures, for which there is no logical explanation. Finally it can be said that vestibuloplastics are still the key indicator of the situation in oral surgery and in dental medicine in general.

Kojundžić T, Kojundžić TM. Transdental Implants in the Case of Wider Indications for Apicotomy of the Median Upper Incisor. Acta Stomatol Croat. 2004;38(4):282-3.

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Knežević G, Perić B. The Tooth in the Maxillary Sinus as a Complication During Extraction of the Upper Wisdom Tooth. Acta Stomatol Croat. 2004;38(4):283-4.

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Title in English:	The Tooth in the Maxillary Sinus as a Complication During Extraction of the Upper Wisdom Tooth
Title in Croatian:	Zub u maksilarnome sinusu kao komplikacija tijekom vađenja gornjeg umnjaka
Type of Article:	congress abstract
MeSH:	TOOTH EXTRACTION + adverse effects MAXILLARY SINUS MOLAR, THIRD
Abstract:	All textbooks on oral surgery mention the pushing of the tooth root or the whole tooth into the maxillary sinus as one of the possible complications during tooth extraction. While the first complication is relatively frequent and oral surgeons come across it almost every day, pushing of the whole tooth into the maxillary sinus is an uncommon complication. Two cases of the wisdom tooth in the maxillary sinus were admitted last year for treatment in the Clinical Department of Oral Surgery. Both cases were complications which occurred during alveotomy of upper impacted wisdom teeth. In both cases the teeth had slid into the sinus during work with Bein's elevator. The patients were hospitalised and after the necessary analyses extirpation of the teeth was performed under general anaesthesia by an approach through the facial wall. After removal of the teeth tamponade of the floor of the sinus was done with Jodoform gauze, which was carried out in the mouth in the frontal part of the cut and removed on the third day after the operation. After removal of the sutures the patients were monitored until objective and subjective problems ceased. The examples are presented in order to warn that complications which are commonly thought of as only occurring in books, can happen to each of us. With this in mind we recommend the careful use of forceps only in cases when it is possible to grasp the tooth through the equator of its crown, and with some reservation instead of Bein's lever we recommend any of the elevators which are normally used in the mandible for extracting the roots of multi-rooted teeth.

Gašparović S, Milić M, Goranović T, Butorac-Rakvin L. Anaesthesia in Dental Medicine. Acta Stomatol Croat. 2004;38(4):284-5.

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Title in English:	Anaesthesia in Dental Medicine
Title in Croatian:	Anestezija u stomatologiji
Type of Article:	congress abstract
MeSH:	ANESTHESIA, DENTAL
Abstract:	Introduction. The majority of dental procedures are carried out under local anaesthesia (90%). Reasons for this are the simple preparation of the patient, out-patient treatment and rare complications. However, there are patients and conditions for which such procedures are impossible to perform under local anaesthesia.Aim. The aim of this study was to determine the indications and complications of general anaesthesia in dental patients.Materials and methods. We analysed 864 patients during a period from 2001 to 2004 in the University Hospital Dubrava, in whom dental operations were performed. In preoperative preparation patients require laboratory findings, ECG, case history and paediatric or internist examination. They are premedicated with atropine and midazola intramuscularly, and the type of anaesthesia determined according to the type of operation, age and general condition of the patient.Results. During the period from 2001 to 2004 864 patients were analysed in the University Hospital Dubrava, in whom an operation was performed. Indications for general anaesthesia were children, mentally retarded persons and those with inflamed soft tissues of the oral cavity. Teeth extractions were performed under inhalation anaesthesia on a mask (692), and patients with multiple dental repairs were intubated (172). During anaesthesia blood pressure, ECG, peripheral saturation with oxygen and CO2 concentration was measured. The patients were monitored for 6 hours after the operation, after which they were released from hospital if there were no complications.Complications were rare: laryngo and bronchospasm in 3 patients, arrhythmia in 5, nausea and vomiting in 6, and postoperational excitation occurred in 3 patients.Conclusion. Children and mentally retarded persons were the most frequent indications for general anaesthesia in dental medicine. Complications occurred in 17 patients (1.8%) which is an acceptable risk for this type of operation.

Sandev S, Knežević G. Comparative Analysis of Possible Complications During Oralsurgical Operations Under General Endotracheal and Short Inhalation Anaesthesia. Acta Stomatol Croat. 2004;38(4):285-6.

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Title in English:	Comparative Analysis of Possible Complications During Oralsurgical Operations Under General Endotracheal and Short Inhalation Anaesthesia
Title in Croatian:	Usporedba raščlamba mogućih komplikacija tijekom oralnokirurških zahvata u općoj endotrahealnoj i kratkotrajnoj inhalacijskoj anesteziji
Type of Article:	congress abstract
MeSH:	ANESTHESIA, DENTAL + adverse effects ORAL SURGICAL PROCEDURES
Abstract:	The object of the study was to investigate the numerous possible complications during oralsurgical procedures in two groups of patients. The patients in the first group were treated under general brief inhalation anaesthesia, i.e. inhalation sedation, while the patients in the second group were treated under general inhalation anaesthesia with intubation. The results of monitoring the parameters of general physiological status and local complications during work were recorded in a previously prepared questionnaire. We determined greater frequency of raised blood pressure, rapid pulse, low oxygenation, fractured teeth during extraction, increased bleeding during and after the procedure, breathing difficulties due to blood and secretion in the respiratory tract, the presence of a foreign body in the respiratory tract, and bruising of the soft tissues of the oral cavity in the group of patients treated under inhalation sedation. Vomiting after the operation was frequently registered in the group of patients under general inhalation anaesthesia with intubation, which is a consequence of the longer duration and greater depth of anaesthesia. The results of the investigation, compared with the experience and investigations in the available literature, indicate the need for a more cautious approach to inhalation sedation and the need for further more comprehensive investigations in this field.The investigation showed that during brief inhalation anaesthesia general and local complications can be expected which may threaten the health of the patient.Every more serious complication during work with the application of short inhalation anaesthesia requires the cessation of work and plan for intubation of the patient in order for the operation to be concluded, e.g. fracture of the root which cannot be removed. There were no such examples in the examined sample, although data exists on the same in the Clinical Department of Oral Surgery.

Žagar D, Gašparović S. Systemic Side-Effects of Local Anaestheics in Dental Medicine. Acta Stomatol Croat. 2004;38(4):286-7.

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Title in English:	Systemic Side-Effects of Local Anaestheics in Dental Medicine
Title in Croatian:	Sustavne nuspojave lokalnih anestetika u stomatologiji
Type of Article:	congress abstract
MeSH:	ANESTHESIA, DENTAL + adverse effects
Abstract:	Systematic side effects are the consequences of non-selective pharmacodynamic interactions of local anaesthetic with tissues and organs outside the oral cavity.The aim of the study was to give a short review of systematic side effects, their pathophysiology, clinical appearance and therapy, which the dentist should apply in the dental surgery until the arrival of urgent medical help.We classified systematic side-effects into: psychogenic reactions, toxic reactions, reactions to vasoconstrictors and reactions of hypersensitivity.The most frequent clinical presentation of psychogenic reaction is syncope, a consequence of vasovagal reactions or hyperventilation. The condition requires the cessation of the dental operation and placing the patient in Trendelenburg's position.Toxic reactions occur when the concentration of anaesthetic in the blood exceeds the minimal toxic concentration. They can occur in the case of overdosing and intravascular application of the anaesthetic. Toxicity can be interpreted in the central nervous and cardiovascular system. Involvement of the cardiovascular system can be seen in AV block of different degrees or asystolia, which requires resuscitation.Toxic reactions in CNS are interpreted as excitation or depression. The most serious presentations of excitation are clonic-tonic cramps, which are halted by intravenous application of diazepam. Respiratory depression requires mechanical ventilation of the patient.Reaction to vasoconstrictors is the result of the stimulation of adrenergic receptors in the cardiovascular system, and symptoms are transient raised frequency of cardiac and blood pressure, and also arrhythmia. In the case of mild symptoms the patient should be sedated and kept under observation, and in the case of significantly raised blood pressure medication therapy applied.Reactions of hypersensitivity may be local or systematic. Local reactions involve changes on the skin and mucous membrane such as erythema and urticaria, and they require intramuscular application of an antihistaminic. Systematic hypersensitivity includes laryngo broncho spasm with a fall in blood pressure. The therapy choice is intravenous application of adrenaline, antihistaminic and corticosteroids and ventilation of the patient with 100% oxygen.Algorithm of clinical procedure is proposed for easier differential diagnosis and therapy.

Zajc I, Franolić M. Application of Hyperbaric Oxygenation in Oral Surgery. Acta Stomatol Croat. 2004;38(4):287-8.

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Title in English:	Application of Hyperbaric Oxygenation in Oral Surgery
Title in Croatian:	Primjena hiperbarične oksigenacije u oralnoj kirurgiji
Type of Article:	congress abstract
MeSH:	SURGERY, ORAL + methods HYPERBARIC OXYGENATION
Abstract:	As a method of treatment hyperbaric oxygenation also has its application in oral surgery. Inhalation of pure oxygen under increased pressure leads to multiply increased amount of oxygen in the tissues. In this way hypoxy is removed which regularly occurs in numerous pathological conditions as the cause or consequence. A whole series of physiological mechanisms are normalised and improved. Perfusion of tissue and microcirculation are improved because of the reodynamic effect and neoangiogenesis. Metabolic activity is improved to subcelular level. HBO regulates local and general immunity. It acts antibacterially, particularly to anaerobes, which is of great importance in the case of oral infection. Furthermore, it also acts synergistically with antibiotics in cases of infection with resistant micro-organisms.HBO can be applied in oral surgery in the treatment of acute and chronic inflammations of soft tissues and jaws, and also in the case of irradiated patients with tumours. It is important as a preventive prior to various operations and in the case of immunocompromised, chronic patients (diabetes, liver, kidneys etc.). It is particularly important prior to operations on bones (extraction, reconstruction of defects, implants etc.).As contraindications are few, side-effects practically negligible, and usefulness with regard to health and cost benefit incomparably greater, it can be concluded that HBO therapy is a very important, powerful and modern means of treatment, which has recently become available in the University Hospital “Dubrava”.

Knezović Zlatarić D, Čelebić A, Filipović-Zore I. Oral Rehabilitation of a Patient with Restricted Opening of the Mouth Caused by a Combat Injury of the Soft and Hard Tissue of the Maxilla. Acta Stomatol Croat. 2004;38(4):288.

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Rebić J, Knezović-Zlatarić D, Sušić M, Filipović-Zore I. Assessment of the Density of Mandibular Bones in Rowers, Depending on Body Mass Index. Acta Stomatol Croat. 2004;38(4):288-9.

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Title in English:	Assessment of the Density of Mandibular Bones in Rowers, Depending on Body Mass Index
Title in Croatian:	Procjena gustoće mandibularne kosti u veslača ovisno o indeksu mase tijela
Type of Article:	congress abstract
MeSH:	BONE DENSITY SPORTS MEDICINE
Abstract:	The forces of muscular exertion which develop during daily physical exercise stimulate the process of bone formation in the areas of the insertions of the exerted muscles, resulting in the strengthening of bone, in terms of increased mineral component of the bone and increase in its density.The object of this study was to assess the density of mandibular bones in a group of active rowers, compare the measured values with values obtained in a control group and to examine whether there is statistically significant difference in the total sample, depending on the different body mass index of the subjects.Eight active rowers took part in the study and seven subjects in a control group. An orthopantomogram was performed in all subjects and the values of density measured on them were expressed in equivalent thickness of the copper calibration pin.In all points measured from the right and left sides of the angulus mandible mandibular density in rowers was higher than the same in the control group. Furthermore, in all points measured from the right and left side of the angulus mandible mandibular density in the group with higher values of body mass index was higher than the same in the group with lower values of body mass index. No statistically significant difference was recorded (p>0.05).Increased physical activity inevitably leads to thickening of bone structure in the areas of the insertions of the exerted group of muscles and in order to compensate for the effect of the forces of exertion on surrounding tissue.

Ćabov T, Macan D, Husedžinović I, Bošnjak D, Škrlin-Šubić J. The Effect of Chlorhexidine on Oral Bacterial Colonisation and Development of Nosocomial Infections in Life Threatened Patients. Acta Stomatol Croat. 2004;38(4):289-90.

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Title in English:	The Effect of Chlorhexidine on Oral Bacterial Colonisation and Development of Nosocomial Infections in Life Threatened Patients
Title in Croatian:	Učinak klorheksidina na oralnu bakterijsku kolonizaciju i razvoj nozokomijalnih infekcija u životno ugroženih bolesnika
Type of Article:	congress abstract
MeSH:	CHLORHEXIDINE CROSS INFECTION
Abstract:	Aims: To record the effect of decontamination of dental plaque and buccal mucous membrane by antiseptics on the colonisation of potential pathogenic nosocomial bacteria and development of nosocomial infections in patients in the Department of Intensive Care.Type: A double blind prospective comparative study based on a randomly selected sample.Location: Department of Intensive Care with 12 beds in the University Hospital Dubrava.Subjects: Patients admitted one after the other in the Department of Intensive Care with a disease which indicated at least three days of treatment. Edentulous patients were excluded from the study.Therapy: After randomly selecting the patients, the group was treated with 0.2% gel chlorhexidine, three times daily for the duration of their stay in the Department. Standard measures of oral hygiene and placebo gel were applied in a control group.Specific measurements: Dental status was taken by means of caries index; the amount of plaque was determined by means of semi quantitative plaque index. Samples of bacteria were taken of dental plaque, buccal mucous membrane, nasal and tracheal aspirate and blood on the first, third and sixth day and thereafter every three days until the patient's release from the Department of Intensive Treatment.Results: Sixty patients participated in the study: 30 who received therapy and 30 in a control group (mean age: 54.5±5.5 years, Simplified Acute Physiological Score II: 29±13.5 points). On admittance to hospital there were no significant differences between the two groups with regard to clinical and dental data. Average value of the caries index amounted to 19.5±5.5, and plaque index 1.7±0.62. On the day of admittance potentially pathogenic nosocomial bacteria were isolated from the area of dental plaque and buccal mucous membrane in 63% of patients. In relation to the control group the amount of transcolonisation of bacteria in the region of the bronchi was significantly reduced (19/7 patients, p=0.002), as also was the incidence of the development of nosocomial infections (26.7%/6.7%, p=0.041). These results were consistent with the significant preventive effect of antiseptic decontamination with 75% relatively reduced risk. There was a trend toward a decrease in the values of plaque index, colonisation of potential pathogenic bacteria and the duration of stay in the Department of Intensive Care.Conclusions: Decontamination of dental plaque and buccal mucous membrane by antiseptics, 0.2% gel chlorhexidine, reduced oral bacterial colonisation, and can reduce the incidence of the development of nosocomial infections in life threatened patients.

Brajdić D, Macan D. Treatment of Acute Odontogenic Inflamation in National Health Care. Acta Stomatol Croat. 2004;38(4):291-2.

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Title in English:	Treatment of Acute Odontogenic Inflamation in National Health Care
Title in Croatian:	Liječenje akutne odontogene upale u primarnoj zdravstvenoj zaštiti
Type of Article:	congress abstract
MeSH:	INFECTION DELIVERY OF HEALTH CARE
Abstract:	Acute odontogenic inflammation is the most frequent disease because of which patients come to the Out-Patient Clinic of Oral Surgery. In the majority of cases help can, and should, be ensured in the dental surgeries of National Health clinics.The object of our investigation was to determine how and in what way, some dentists treat acute odontogenic infections and why they refer patients with acute odontogenic swelling to the Out-Patient Clinic of Oral Surgery.We arrived at the following data by prospectively completing a questionnaire for 38 patients, selected at random, who had come to the Out-Patient Clinic of Oral Surgery, Clinic for Maxillofacial and Oral Surgery, University Hospital Dubrava, because of swellings of odontogenic aetiology.Of these patients, 79% were referred by dentists, 13% general practitioners and 8% came on their own initiative. Two-thirds of the patients were referred by female dentists, mean age 38 years, while the remaining patients were referred by male dentists, mean age 41 years. Female dentists most frequently prescribe only antibiotics, 60% in our questionnaire, and 20% refer patients without any therapy at all or after trepanation and prescribed antibiotics. In the same way in 40% of cases male dentists refer patients without any therapy at all or only prescribed antibiotics, and only 20% perform trepanation and prescribe antibiotics. The oldest dentists, mean age 43 years, do not carry out any therapy at all, and antibiotics are only prescribed by those aged around 39 years, and trepanation of the tooth and antibiotics are prescribed by the youngest dentists, mean age 34 years. The most frequent explanation for referring patients to our Out-Patient Department are: “cannot do any work because of the swelling”, allergy to medications, “cannot give an injection because of the swelling” and “does not have the instruments”. One third of the patients did not receive any kind of therapy prior to being referred to our Department. Trepanation and antibiotics were performed in only 18% of cases. In this investigation the most frequent method of treatment was the application of antibiotics (53%). Not one intraoral incision was performed prior to being referred to our Department. We performed intraoral incision in two-thirds of the patients and only 13% were justifiably referred to our Department because extraoral incision had been performed, i.e. three in out-patient departments and two in hospital.The results of this questionnaire indicate the unacceptable attitude of some dentists towards treatment of acute odontogenic swellings. Thus, there is clearly a need for more intense undergraduate teaching and permanent training of the national health dentist on the problem of treating acute odontogenic inflammation, and for raising the quality of national health dental care with the object of reducing the occurrence of odontogenic inflammations and their complications, and the need for hospitalisation of such patients.

Kobler P, John O, Petričević I. Gingival Hyperplasion Caused by Medications. Acta Stomatol Croat. 2004;38(4):292-3.

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Title in English:	Gingival Hyperplasion Caused by Medications
Title in Croatian:	Hiperplazija gingive uzrokovana lijekovima
Type of Article:	congress abstract
MeSH:	GINGIVAL HYPERPLASIA + etiology
Abstract:	Gingival hyperplasia is the enlargement of gingiva due to increased extracellular matrix of gingival connective tissue. If may be hereditary, idiopathic, and can occur during pregnancy. It is a secondary occurrence in leukaemia, diffuse lymphoma (malt lymphoma) and within the complex of certain syndromes. It is important to know that such a clinical status can be caused by different medications. More than 20 types of medications can induce these lesions, such as antiepileptics, immunosuppressives and blockers of calcium canals. Hyperplastic lesions occur most frequently 2-3 months after initial application of the medication, and depend on the dose and duration of taking the medication. A predisposing factor for the development of hyperplasia is poor hygiene of the oral cavity.The object of this study was to acquaint the oral surgeon and dental physician with the types of medications that can cause gingival hyperplasia, other causes and the need for multidisciplinary cooperation during treatment.Case presentationA 70-year old patient was referred to the Department by his dentist because of increased size of the gingiva in both jaws, for which surgical procedure was requested. From the case history we learnt that the initial changes on the labial gingiva of the incisor had been observed two years beforehand, and that greater changes had occurred 6 months ago. The patient had been a hypertonic for many years, was a diabetic, and had received antihypertensive therapy for 12 years. For the last seven years he had taken Logimax forte, a combination of β-blockers and antagonist Ca. Apart from hyperplasia a layer of supragingival calculus could be seen. In cooperation with the internist the therapy was changed and the patient was referred to a periodontist. Surgical operation was unnecessary due to the fact that after abandoning the above combination of antihypertensive medications complete regression of the hyperplastic gingival lesions occurred.

Filipović-Zore I, Grgurević J. Do We Know Everything about Radioosteonecrosis?. Acta Stomatol Croat. 2004;38(4):293-4.

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Title in English:	Do We Know Everything about Radioosteonecrosis?
Title in Croatian:	Znamo li sve o radi o osteonekrozi?
Type of Article:	congress abstract
MeSH:	OSTEORADIONECROSIS
Abstract:	According to data of the World Health Organisation, malignant diseases, apart from cardiovascular diseases, are the most prevalent diseases of today.As one form of therapy for malignancy radiation in 63% of patients has the primary task of destroying tumour cells, while minimally damaging the surrounding tissue.The greatest and most dangerous complication in radiotherapy of the head and neck is without doubt osteoradionecrosis (ORN). It occurs most frequently when the dose of radiation is more than 60 Gy or in the case of patients who receive combined radio and chemo-therapy. ORN occurs in 5-22% of such irradiated patients. ORN can occur spontaneously, although in 60% of cases it occurs as a response to tissue injury, usually after tooth extraction, but also after other manipulations in the oral cavity. Because of the radiation the bone becomes acellular, avascular and hypoxic, and clinically can be interpreted as the occurrence of ulceration, mucous membrane necrosis and exposure of necrotic bone, with pain and eventual paresthesia. Predilective sites are the posterior parts of the mandible. For diagnosis of ORN, apart from a medical examination, orthopantomogram, computerised tomography and magnetic resonance are needed. In the future SPECT (single-photon emission computed tomography) will have an important role.Clinical indicators in the therapy of ORN are first and foremost a good preventive programme and periradiational care of the patient undergoing radiation, and in the case that changes do occur surgical therapy is needed, therapy with hydrobaric oxygen (HBO), and the use of Marx's protocol. Presentation of numerous examples from our practice shows how many clinical indicators are implemented.

Bergovec L, Brajdić D, Macan D. Mucocele. Acta Stomatol Croat. 2004;38(4):294-5.

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Title in English:	Mucocele
Title in Croatian:	Mukokele
Type of Article:	congress abstract
MeSH:	MUCOCELE
Abstract:	In the Out-Patient Department of Oral Surgery we daily come across salivary cysts which we treat surgically - by scaling or marsupialisation.We considered that it would be helpful to analyse these changes clinically, histopathologically and pathogenetically.There are two types of salivary cysts: retention cysts (histologically a salivary gland with dilated secretory canals lined with large cells with honeycomb cytoplasm) and extravasation cysts (a hollow mass filled with cellular detritus and bacteria, coated with cylindrical and stratified epithelia).Mucocele are coated with a lining of granulation tissue and contain eozinophyllic hyaline material. They occur throughout the whole of the mucous membrane of the oral cavity, although the majority are on the lower lip. They most frequently occur because of mechanical injury to the secretory canals of the small salivary glands and retention. They are approximately 1.5 cm in diameter. They cause slight cyanosis of the area and bluish-white surface which occurs as a result of the narrowing of the blood vessels and thin walls of the mucocele.We retrospectively analysed histopathological findings with a clinical diagnosis “mucocele” during the period 1 January 1995 to 31 December 2000. During that period a total number of 9047 people were operated. Of 1358 findings sent for histopathological analysis (PHD), 89 were clinically diagnosed as mucocele. Of these 89 lesions in only 72 cases was the diagnosis of mucocele confirmed histopathologically. Differences in gender did not essentially have an effect on the occurrence of mucocele, and according to the results of the investigation we found that although mucocele occurs in all age groups, it is more frequent in younger people during the second and third decade of life. In our investigation mucocele were largely located on the lower lip, 83.3%. Other mucocele were located in the sublingual space, on the mucous membrane of the cheek and in the vestibulum of the oral cavity. According to the histopathological description we concluded that 23 mucocele were of retention type and two extravasation lesions.

Kopić V, Perić B, Macan D. Frenulectomy - When and Why?. Acta Stomatol Croat. 2004;38(4):295-6.

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Title in English:	Frenulectomy - When and Why?
Title in Croatian:	Frenulektomije - kada i zašto?
Type of Article:	congress abstract
MeSH:	ORAL SURGICAL PROCEDURES LIP
Abstract:	Data from the literature are often diametrically contradictory with regard to the need to carry out a surgical procedure in the case of a persistent frenulum, either when it is a case of its direct connection with the diastema median or not.Opinions vary on the most suitable time to perform the operation, or on the chronology of the intervention of the surgeon or orthodontist. The majority of authors agree that the operation is necessary but that there is no need for urgency. Some authors consider that one should wait until the eruption of the permanent molar, while others warn of the possibility of spontaneous closing of the diastema at the time of the eruption of the second permanent molar. According to reports in the literature the frequency of tectolabial frenulum in children is 7.3%, and in adults only 1.3%, which indicates that early surgical treatment is unjustified.Our investigation shows consistent data, because the greatest incidence of frenulectomia (80%) occurred up to the age of 20 years. Of all the sites affected by a hypertrophic frenulum, 90% were in the area of the upper lip. The connection between age and the localisation indicates orthodontic indication, of just the diastema median. Most diastema close during eruption of the lateral incisors, but if the diastema persists, and is accompanied by hypertrophic frenulum, the possibility of later spontaneous closing is slight. Thus the operative procedure can be carried out without waiting for the eruption of the canines.All operations for removal of abnormally developed frenulum comprise incision, excision or transposition of tissue in the region of the frenulum, i.e. a combination of all three procedures. The operative methods most frequently recommended because of the satisfactory postoperative result, speed of procedure and simple technique are “V” excision and horizontal incision of the interdental tissue and part of the papilla incisiva. After such surgical treatment it is possible to carry out corticotomy in the area if necessary.The aim of this study was to present indications for frenulectomy, with special reference to the time of the surgical procedure.

Begović AE, Macan D, Bolfek I. Epulis - Clinical Appearance and Histopathological Analysis. Acta Stomatol Croat. 2004;38(4):296-7.

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Title in English:	Epulis - Clinical Appearance and Histopathological Analysis
Title in Croatian:	Epulis - klinička slika i patohistološka raščlamba
Type of Article:	congress abstract
MeSH:	GINGIVAL DISEASES + pathology
Abstract:	Epulis is a benign lesion on the gingiva whose external appearance resembles a tumour, while histologically it looks more like a transitional form of an inflammatory process. It occurs in several histological forms: Epulis gigantocellularis, Epulis granulomatosa, Epulis fibromatosa, congenital epulis, epulis gravidarum, Epulis haemangiomatosa, Epulis fissuratum, papilarna hyperplasia, piogeno granulom and irritative fibroma.Epulis occurs twice as often in women than in men, and slightly more frequently in the upper jaw, and conformity of clinical and histopathological diagnoses is 48%.Clinical and histopathological diagnoses were analysed during a period of six years in order to obtain insight into the frequency of epulis as the described term among the clinical diagnoses. Such a collection of different processes under one name, which emerged on the basis of localisation, without histopathological confirmation, does not offer the correct information on the percentage in which it occurs in clinical practice. Histopathological analysis is used as the most important method for differentiating epulis from other similar conditions on the gingiva. The importance of epulis is that it is a relatively frequent formation, under whose similar clinical appearance can be different histopathological material, and verification of this material on the part of the pathologist, provides the surgeon with justification for performing the operation.From the foregoing it follows that the introduction of precise terms for such pathological lesions and their correct histopathological analysis would greatly contribute to correct diagnosis, and consequently the application of appropriate therapy.

Baranović M, Macan D. Alveotomy of the Wisdom Tooth: Indications and Cotraindications in Theory and Practice. Acta Stomatol Croat. 2004;38(4):297-8.

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Title in English:	Alveotomy of the Wisdom Tooth: Indications and Cotraindications in Theory and Practice
Title in Croatian:	Alveotomija umnjaka: indikacije i kontraindikacije u teoriji i praksi
Type of Article:	congress abstract
MeSH:	ORAL SURGICAL PROCEDURES MOLAR, THIRD
Abstract:	In 1979 the National Institute of Health reached agreement on indications and contraindications for extraction of the wisdom tooth. In situations where there are indications special attention should be paid to the general health of the patient and local factors.The following are considered strict indications. Frequent pericoronitis, abscesses, pulpal and periapical pathology, caries, periodontal diseases, cystic and tumorous lesions and external resorption of the second molar, caused by the wisdom tooth.Other indications are: autogeneic transplantation on the site of the first molar, fracture lines on the site of the wisdom tooth, specific medical situations such as cardiac valvular disease or radiotherapy, when there is a risk of infection etc.Contraindications for extraction of the wisdom tooth are: normal eruption and justified function in dentition, deep implication without local and systemic disturbance, potential disruption of the integrity of neighbouring structures by alveolectomy, unacceptable risk for the health of the patient, and the age of the patient.Correct diagnosis must be preceded by case history, clinical extraoral and intraoral examination, and radiographic treatment, i.e. orthopantomographic recording.The correct decision depends on a large number of factors, and if the anatomic structures allow, eruption should be awaited and special attention paid to the age of the patient.The aim of this investigation was to present the reasons for which alveoletomy of wisdom teeth can be performed in the dental surgery.

Jukić J, Škrinjarić I, Škrinjarić K, Ulovec Z. Value of Oro-Dental and Physical Minor Anomalies in the Discrimination of Children with Developmental Disorders/Impaired Development. Acta Stomatol Croat. 2004;38(4):299-311.

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Title in English:	Value of Oro-Dental and Physical Minor Anomalies in the Discrimination of Children with Developmental Disorders/Impaired Development
Title in Croatian:	Vrijednost orodentalnih i tjelesnih minor anomalija u diskriminaciji djece sa smetnjama u razvoju
Type of Article:	original scientific paper
MeSH:	MAXILLOFACIAL ABNORMALITIES DEVELOPMENTAL DISABILITIES CHILD TOOTH ABNORMALITIES
Abstract:	The incidence of oral and physical minor anomalies is higher in children with developmental disorders compared with healthy children. The aim of this study was to determine the possibility of discriminating children with developmental disorders from healthy children on the basis of oro-dental and physical minor anomalies. The study was performed on a sample of 303 children with developmental disorders (DD) and a control group of 303 healthy children (HC). The sample of children with developmental disorders comprised 176 mentally retarded children (MR), 70 children with impaired hearing (IH) (partially deaf and deaf), and 57 children with impaired vision (IV) (partially blind and blind). The control group consisted of 303 healthy children of the same age and sex. Multivariate discriminate analysis was performed in the manifest space of 18 oro-dental and physical minor anomalies. The initial space of 18 original variables was reduced to three discriminative functions. Clear discrimination and great distance was determined between the centroids of the control group and the groups of children with developmental disorders. The first two discriminate variables are significant for discrimination between the groups, and they explain 95.7% of the total variance. The first variable contains 87.2% of the information and is defined by oro-dental and toe anomalies. The second variable explains 8.5% of the total variability, and is defined by dental and auricle anomalies. The third function, which is not significant, contains just 4.3% of the total variability. The discriminate functions obtained enable clear discrimination between the three groups of children with developmental disorders, but not clear mutual discrimination of individual entities within the groups of children with developmental disorders.

Filipović J, Jukić S, Miletić I, Pavelić B, Malčić A, Anić I. Patients Attitude to Rubber Dam Use. Acta Stomatol Croat. 2004;38(4):313-22.

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Title in English:	Patients Attitude to Rubber Dam Use
Title in Croatian:	Stajalište pacijenata prema uporabi koferdama
Type of Article:	original scientific paper
MeSH:	RUBBER DAMS + adverse effects
Abstract:	The purpose of the study was to assess the patient’s attitude towards the use of a rubber dam and to determine whether any clinical factors influence it. After receiving endodontic treatment under a rubber dam, patients were asked to complete an anonymous questionnaire. They were divided into 2 groups: Group 1 - operators were final-year dental students at the School of Dental Medicine University of Zagreb and Group 2 - operators were (dentists) dental specialists and resident dentists at the Department of Restorative Dentistry and Endodontics, School of Dental Medicine University of Zagreb. The data were statistically analysed by descriptive statistics and Pearson chi square and variance analysis. The majority of the patients (69.1%) in both groups would prefer rubber dam use at their next appointment and consider it pleasant and comfortable to wear (58.2%). Dentists did not explain the reason for the use of the rubber dam to 40.0% of the patients, but when they did, all but two patients understood the explanation. The time required for placing the rubber dam without the assistant’s help was 3 minutes on average and the duration of the endodontic treatment under rubber dam was 69 minutes on average. When compared to the dental specialists students required more time to place the rubber dam and to perform endodontic treatment under it. From this study it can be concluded that patients do not have a negative attitude towards the use of a rubber dam, that the placement of a rubber dam does not take long and that operator’s experience influences the patient’s attitude.

Ćelić R, Dworkin S, Jerolimov V, Maver-Biščanin M, Bago MJ. Prevalence of Temporomancibular Disorders Diagnosis and Psychologic Status in Croatian Patients. Acta Stomatol Croat. 2004;38(4):323-39.

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Title in English:	Prevalence of Temporomancibular Disorders Diagnosis and Psychologic Status in Croatian Patients
Title in Croatian:	Pojavnost dijagnoza temporomandibularnih disfunkcija i psihološkog statusa u hrvatskih pacijenata.
Type of Article:	original scientific paper
MeSH:	TEMPOROMANDIBULAR JOINT DISORDERS + epidemiology
Abstract:	The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) uses a dual axis system for diagnosing and classifying TMD patients. The objective of the study was to explore the prevalence of different types of TMD, psychologic distress, and psychosocial dysfunction in Croatian TMD patients and to compare data between Croatian and Swedish, American and Asian TMD patients. One hundred and fifty-four consecutive patients (117 female and 37 male) referred to the Department of Prosthodontics and Department of Oral Surgery, School of Dental Medicine in Zagreb, Croatia, were included in the study. The mean age of the Croatian population was 39 ± 14.5 years. Frequency distributions and descriptive statistics were obtained through the use of SPSS statistical programe (version 10), and chisquare statistical analyses were performed (P < 0.05) to evaluate gender differences. Group I (muscle) disorder was found in 64.9% of the patients; Group II (disc displacement) disorder was found in 31.8% and 27.3% of the patients in the right and left joints, respectively; Group III (arthralgia, arthritis, arthrosis) disorder was found in 21.4% and 26% of the patients in the right and left joints, respectively. Axis II assessment of psychologic status showed that 19.5% of patients yielded severe depression scores and 27.3% yielded high nonspecific physical symptom scores (somatization). Psychosocial dysfunction was observed in 21.4% of patients based on graded chronic pain scores (Grade III and IV). Axis I and II findings of Croatian TMD patients were generally similar to their Swedish, American and Asian cohorts. In all 4 populations, women of child-bearing age represented the majority of patients. The most common type of RDC/TMD diagnoses was muscle disorders. A considerable portion of TMD patients were clinically depressed, withelevated levels of nonspecific physical symptoms. These results suggest that the RDC guidelines are valuable in helping to classify TMD patients, support the usefulness of the RDC/TMD for gathering research and clinically relevant data, allowing international and cross-cultural comparison of clinical findings.

Mehulić K, Mehulić M, Kos P, Komar D, Prskalo K. Investigation of Contact Allergies to Component and Auxiliary Prosthetic Materials. Acta Stomatol Croat. 2004;38(4):341-53.

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Title in English:	Investigation of Contact Allergies to Component and Auxiliary Prosthetic Materials
Title in Croatian:	Ispitivanje kontaktne alergije na gradivne i pomoćne protetske materijale
Type of Article:	original scientific paper
MeSH:	HYPERSENSITIVITY DENTAL MATERIALS
Abstract:	Contact allergy is a delayed reaction to sensitivity in which a localised lesion of the skin or mucous membrane occurs as a result of contact with an allergen. The fitting of a fixed, or placement of a mobile, prosthetic appliance in the oral cavity causes corrosive processes to occur on the surface of the restoration and the release of ions which, as haptens, can induce allergic reaction. The aim of this investigation was to examine the occurrence of allergies to component and auxiliary prosthetic materials by patch test in patients with lichen ruber planus, stomatitis and stomatopyrosis. Thirtytwo patients with fixed and/or mobile restorations and seven patients with one of the above diagnoses without a restoration, participated in the investigation. Testing was carried out by standard technique (patch test) with 13 allergens. The results of the investigation indicate the greater probability of a positive patch test in subjects with the aforementioned diseases and with a restoration, in relation to subjects without a restoration (P = 0.62). The probability of symptoms worsening increased with the insertion/ fitting of a fixed or placement of a mobile restoration (P = 0.019). This was particularly so in the case of restorations made of Co-Cr-Mo alloy. With the increase in the number of units of fixed restorations, or the presence of mobile restorations in both jaws, the probability of a positive patch test to cobalt chloride also increased (P = 0.05). Lichen ruber planus increased the probability of a positive patch test in the majority of cases (P = 0.05). The greatest number of positive results were for the allergens nickel, cobalt and chrome (each 17.95%) and a negative finding was obtained for dibutylphthalate and HH mix. Stomatopyrosis increased the probability that the subject would have a positive result for chrome (P = 0.019). The occurrence of a positive patch test was greater in women for all allergens (P = 0.05), apart from epoxy resin, where it was less than in the male subjects (P=0.036). Because of the greater incidence of contact allergies in the population a more detailed investigation of prosthetic materials is needed prior to their introduction into clinical practice. In the case of patients with atopic history allergological testing and immunological tests should be performed prior to prosthetic treatment.

Rajčić A, Knežević G, Vučićević-Boras V. Orofacial Pain of Non-Odontognic Cause - Retrospective Study on 100 Patients Referred to the Primary Dental Health Care. Acta Stomatol Croat. 2004;38(4):355-64.

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Knežević A, Tarle Z, Prskalo K. Ozone Treatment of Initial Lesions. Acta Stomatol Croat. 2004;38(4):365-74.

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Šegović S, Pavelić B, Jukić S, Anić I. Three-Rooted Maxillary First Premolars: Five Clinical Cases. Acta Stomatol Croat. 2004;38(4):375-80.

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