Objective: Calprotectin is a calcium binding heterocomplex protein which appear to have regulatory functions in the inflammatory process. Epithelial cells which expressing calprotectin are more resistant to bacterial invasion . In acute phase inflammatory reactions calprotectin is detectable in elevated levels. The aim of the present study is to detect the calprotectin level in saliva in patients with periodontal disease (chronic and aggressive periodontitis and gingivitis) and to follow calprotectin level during azithromycin treatment. Methods and materials: In nine healthy patients without systemic disease and malignancy whole unstimulated saliva was investigated. Salivary calprotectin levels were measured by enzyme-linked-immunosorbent using a commercial kit (ELISA Hycult Biotech). Azithromycin treatment was taken as 500 mg (2 x 250 mg tabls.) once daily at 10.00 am for 4 consecutive days. Results: At baseline Day levels of calprotectin ranged between 1.45 and 2.97; median 2.19. On Day 5 (first day after azithromycin treatment) the salivary calprotectin levels decreased in 6 of the patients. The measured values at Day 10 were more similar to those at Day 5, than those at Day zero. This was confirmed by the values of the average median of calprotectin. Conclusion: We present the first study with the application of antibiotic and measurement the calprotectin levels before, during and after azithromycin intake with no side effects reported. Measuring calprotectin levels could benefit the monitoring of antibiotic treatment efficacy in patients with gingivitis and periodontitis.

Aim: The aim of the presented study is to compare the effectiveness of the diagnosis with a dental microscope, laser fluorescence (DIAGNOcam) and X-ray examination in proximal caries diagnosis. Material and methods: Thirty-eight adult patients were examined. They were first examined with a dental mirror and a probe, under magnification 6.4 times. After that a diagnosis with DIAGNOcam was performed. Bitewing X-ray images were administered. The data from the three diagnostic methods was compared using SPSS 16 package of Windows. The lesions that were diagnosed as involving dentin were then excavated which served as a confirmation of the diagnosis. Results: The results of the study showed that dentinal lesions were detected with a high degree of correlation with all three diagnostic methods. The visual examination seriously underestimated lesions involving only enamel. In these cases there was a good correlation between laser fluorescence and X-ray data. Conclusions: Based on the conducted study we could conclude that the diagnosis of proximal caries with DIAGNOcam is equivalent to X-ray, both being more accurate in cases with early lesions, compared to visual diagnosis.

Knowing the injury mechanisms is of extreme importance for correct diagnostic evaluation. Specific injury models can be related to exactly determine trauma mechanisms. Understanding the way of injury may be a key to solving the occult injuries. Thus, some life threatening injuries may be diagnosed without present clinical symptoms at the moment of examination. Purpose: The aim of our study is to analyse the risk factors for arising of associated maxillofacial trauma injuries (AMFI) Material and methods: A total of 352 traumatic patients were retrospectively and prospectively examined for the period 05. 2005 - 12. 2011, treated at the Department of Oral and maxillofacial surgery at the St. Anna University Hospital, Sofia, whereas AMFI were determined in 129 patients Results: Our study results indicate that most often, RTA are a reason for a combined trauma at the age group of 20-29, followed by the age group of 30-39, and less in the age group of 40-49. The most often reasons for combined traumas are RTA(road traffic accident) and IPV(interpersonal violence), each of which has a relative share, significantly higher than the other reasons (x2, р<0.001). Our study results indicate that following a RTA, the most common combined trauma is CrT - 31 patients, followed by muscular skeletal system trauma - 11, equal number of eye injuries and polytrauma – 4 patients, spinal cord trauma - 1, and more than one concomitant injury - 1. When analyzing the mutual relation between aetiology and combined trauma, the most common reasons are included (RTA and thrash) as well as combined traumas (neurosurgical, MSS trauma and eye trauma). Conclusion: Data analysis in our study indicates that trauma mechanism is the most important factor that imposes the need of CT examination, especially in intoxicated and disorientated patients, as well as in unconscious patients.

The study and documentation of occlusal-articulation relationships has a high diagnostic significance in patients with bruxism and bruxomania. The study aims on the basis of registration of occlusal contacts via articulating paper and the T-Scan system to evaluate the advantages and disadvantages of both methods in occlusal diagnosis of patients with bruxism and bruxomania. Material and Methods: 40 patients with bruxism and / or bruxomania (29 women and 11 men) aged between 21 and 77 years from October 2010 to February 2014 was conducted computerized occlusal analysis using the systems T-Scan II (in 12 patients), T-Scan III (in 28 patients) and the software T-Scan III. All patients were subjected to registration of occlusal relationships in centric occlusion (CO) with articulating paper Bausch PROGRESS 100 µ and Bausch® Arti-Fol® 8 µ. Results and Discussion: In 90.0% of patients it is established unevenly distributed, irregular in size and intensity occlusal contacts. Essential factor for preventing the spontaneous bilateral closure with balanced forces is the presence of interceptive contacts and sliding occurring in the first frame of the occlusion time until the maximum intercuspation - MIP. Conclusion: Registration with articulating paper visualizes cumulative picture of the contacts in CO and interceptive contacts without being able to distinguish them in size and time of onset. Computerized occlusal analysis objectively and quantitatively determines interceptive contacts and distinguishes them from contacts in MIP and gives real meaning to the terms "strong" and "light contacts".

Modern dentistry demands an interdisciplinary approach in solving severe clinical cases. For a successful prosthetic treatment a number of prior manipulations are required. Rehabilitation of the oral cavity includes professional oral hygiene, repeated treatments of poorly filled root canals and removal of persistent teeth and roots. However, to achieve better conditions for prosthesis, special methods before the procedures are preferred. These methods include the more invasive periodontics and surgical techniques as well as the less invasive orthodontics techniques.

The resorption of the lateral incisors after ectopic eruption of the permanent canines is one of the most common complications and may be detected in all cases of seriously altered route of eruption. The case presented is of a 10-year old boy with permanent dentition and extracted upper lateral incisors as a result of a severe degree of resorption of their roots due to improper eruption of the canines. This article aims at establishing that early detection and prompt preventive measures will lead to avoiding the critical complications arising out of the impacted canines and will preserve the morphological and functional integrity of the incisors and the dentition.

Introduction: There are cases in the endodontic treatment which are a real challenge. There are teeth with taurodontism and radix entomolaris. Patients usually lose their teeth because these anatomical features are less familiar. Purpose: The aim of this study is to investigate several cases with taurodontism and radix entomolaris. Material and methods: Two cases with taurodontism and one with radix entomolaris that are described in the following article. Careful exploration of the grooves between all orifices with magnification, use of ultrasonic irrigation; and a modified filling technique are of particular use. Results: Results are observed after several years. In performing a root canal treatment on such teeth, one should appreciate the complexity of the root canal system, canal obliteration and configuration, and the potential for additional root canal systems. Conclusions: Knowledge of the phenomenon of taurodontism and radix entomolaris will improve the medical practice of the general dental practitioner.

The article summarizes the most common as well as the most severe complications due to outdated prosthetic restorations. It is based on 38 clinical cases, examined at Faculty of Dental Medicine - Varna. The conclusions outline the mistakes which cause such dramatic results and the leading role of the dental clinician in considering the treatment prosthetic plan.

Introduction: Traumatic ulcers in the oral mucosa are extremely painful and can cause severe troubles in talking and eating. Their treatment can be quite prolonged. The present paper aimed at exploring the therapeutic potential of low energy laser irradiation (LELI) in treating oral mucosa traumatic ulcers and propose methods of stimulation of their healing using a laser with an appropriate wavelength and frequency of irradiation, appropriate dose and number of procedures. Material and methods: Thirty patients were recruited in the study. They were allocated into three groups: group 1 (a study group) – these patients received red laser irradiation with a wavelength of 658 nm; group 2 (a study group) – these had infrared laser irradiation with a wavelength of 904 nm; group 3 (a control group) – these patients were treated with granofurin and solcoseryl. With the technique we used the laser tip was placed at a distance from the irradiated area (0.5 cm2) with the fiber optic emitting in the red spectrum (658 nm) or the infra-red spectrum (904 nm). A diode laser was used in the study. We irradiated the area of the traumatic ulcer and the surrounding mucosa 0.5 to 1 cm in diameter. The applied dose was 1 – 2 J/cm2. The treatment procedure was repeated once daily until the symptoms disappeared. Results: We found that pain was rapidly managed with the treatment and epithelization of the ulcers was accelerated. Conclusions: LELI is an effective and easy-to-use modality to treat traumatic ulcers that obviates the use of drugs.

The aim of this study was to evaluate adolescents’ acceptance and pain perception of Er-YAG laser preparation in comparison to conventional mechanical preparation. Material and methods: Forty four adolescents between the age of 16 and 18 years with bilateral matched pairs of carious permanent molars participated in this study. In each patient one of the 2 cavities was prepared conventionally, the other with the Er-YAG laser. All cavities were restored with light-cured composite resin following the application of acid etch and a bonding agent. The patients were instructed to rate pain (sensitivity) during treatment according to visual analogue scale and to decide which method they would prefer for their future caries treatment. Results: The patients rated lower pain perception during laser treatment. It was found that 86.36 % of the adolescents indicated that they would prefer the Er:YAG laser preparation for further caries treatment. Conclusion: The application of the Er-YAG laser for carious tissue removal, compared to conventional mechanical preparation, is perceived as more comfortable and the adolescents prefer it for a future treatment.

Purpose: Manufacturers have introduced instruments made with new alloys and with reciprocating motion trying to improve the fracture resistance of rotary NiTi files. The aim of this study was to compare instrument life of WaveOne and One Shape single-file techniques used for the instrumentation of artificial curved canals after a glide path creation. Material/methods: Canal preparation was performed on 100 Endo-Training Block simulators divided in two equal groups, depending on the file used. Average lifespan and cumulative survival at the time of WaveOne files (Dentsply Maillefer) with reciprocating rotation and One Shape files (Micro Mega) with continuous rotation, after a glide path creation, were tested. All shaping instruments worked till fracture occurred. During mechanical instrumentation each file was coated with Glyde™ (Dentsply Maillefer) to act as a lubricant, and copious irrigation with 5.25% NaOCl was carried out. Results: Twelve shaping files were used in canals’ preparation, after their initial enlargement, and ten of them broke: 2 WaveOne files and 8 One Shape files. The average lifespan of one WaveOne file was 17.50±2.12 canals and of one One Shape file–4.63±1.30 canals. The difference was statistically significant (p<0.001). The WaveOne instruments presented a significantly longer survival than the One Shape files (р<0.05). Conclusions: Within the limits of this study, the WaveOne files showed significantly higher resistance to fracture compared with the One Shape files. Instrumentation with files with reciprocal motion increases significantly instruments life and makes them safer during shaping of root canals.

Purpose: The aim of the presented in vitro study was to evaluate the effectiveness of the laser fluorescent device DIAGNOdent in measuring changes in the level of mineralization of intact enamel surfaces etched for different time intervals and intact dentin etched for 30 sec. Material and methods: The study was performed on extracted human teeth. DIAGNOcam was used to measure the values of laser fluorescence of intact enamel and dentinal surfaces. Then the samples were treated with 37% H2PO3 etchant for 5, 30 and 60 sec for enamel surfaces and 30 sec for dentinal. Teeth were rinsed, dried and measured again with DIAGNOdent. Statistical analysis was done using statistical software SPSS 16.0 (SPSS Inc.). Results: After etching the enamel surfaces for 5, 30 and 60 seconds an average increase of 0,5 (0.62-1.1) was detected. The detected average values of increase of laser fluorescence for the enamel were 0.5 for 5 sec. ethching, 0.62 for 30 sec and 1.1 for 60 sec. The average increase for dentine was 0.26. Conclusions: Based on the limitations of the conducted study it may be concluded that changes in the degree of mineralization of tooth structures can be detected by using DIAGNOdent. Enamel etching for 5 sec and 30 sec lead to a comparative degree of change in the laser fluorescence. The obtained values after 60 sec. of etching revealed an almost double increase. The measured changes in enamel after etching are better pronounced than that in dentin.

Hyperactivity of melanocytes is the reason for dark colour of gingiva, which is absolutely benign condition with only esthetic disadvantage, for people with gummy smilemostly. Depigmentation is a procedure of removing or reducing of gingival hyperpigmentation. The purpose of the research is to investigate the advantage of using Er:YAG laser than liquid nitrogen in case of gingival depigmentation. That’s why two alternative methods are used: laser ablation with an Er:YAG laser and cryosurgical procedure of tissue destruction by fast freezing with liquid nitrogen (-196º C).Laser assisted gingival depigmentation is a single step procedure, with fast healing process. There is difficult control of penetration and risk for excessive tissue destruction after prolonged freezing in the cryosurgical procedure.

The aim of this in vitro study was to establish and compare the amount of debris and irrigant extruded apically after root canal preparation with two rotary systems (K3 and RaCe). Methods: Two groups of 24 extracted teeth with single canals were used. In group 1 (12 teeth) the root canals were instrumented using nickel-titanium K3 rotary instruments and “crown-down” technique. In group 2 (12 teeth) the root canals were instrumented using nickel-titanium RaCe rotary instruments and “crown-down” technique. Debris and irrigant extruded from the apical foramen were collected into pre–weighed vials (using Myers and Montgomery technique) and the amounts were determined. Time taken for each instrumentation technique was also determined. The data was input and processed using the statistical software package SPSS 17.0.1. Results: The amount of the debris extruded through apical foramen in group 1 (K3 files) was 0,225 mg and in group 2 (RaCe files) was 0,213 mg. The volume of the extruded irrigant was 0,247 ml in group 1 and 0,238 ml in group 2. Time taken for instrumentation was 8.3 min by RaCe files and 8.7 min by K3 files. The difference in the amount of debris and irrigant produced among two groups was not significant. Conclusions: It was concluded that the RaCe system induces less extruded debris and irrigant through the apical foramen, than the K3 system. The difference between two groups was not significant..

Introduction: The patients with C-shaped configuration of the root canal system are definitely a problem in the everyday dental practice. The C-shaped configuration of the root canal can be seen in the mandibular and maxillary molars. The treatment of these teeth is very difficult. Purpose: To trace the treatment of clinical cases with C-shaped configuration of the root canal system. Material and methods: There are some different cases that are described with a C-shaped configuration of the root canal system with one, two, three and four separate root canals. Careful exploration of the floor of the pulp chamber, inspection with magnification, use of ultrasonic irrigation and a modified filling technique are of particular use. Results and Discussion: Clinical cases of a C-shaped pulp chamber and root canal system shows that this root canal aberration occurs in a wide variety and variability with a single root canal up to two, three and four separate root canals. The diameter of the root canal themselves also varies from very wide to such with a small diameter. Conclusions: Knowledge of the different anatomical variations will improve the endododntic practice of the general dental practitioners.