Purpose: The aim of the presented in vitro study was to evaluate the effectiveness of the device DIAGNOcam and the laser fluorescence device DIAGNOdent for early diagnosis of occlusal caries and to compare it with three traditional methods – visual and tactile, dye and radiographic examination. Material and methods: The sample consisted of 60 extracted human teeth. Three clinicians diagnosed independently the presence or absence of early occlusal surface caries with the visible tactile method,DIAGNOcam andDIAGNOdent. Then X-rays were taken and the dentists viewed them separately, without magnification.Fuchsine was applied for 30 sec. and then washed under running water for 20 min. Places where dye was present were registered. Statistical analysis was performed with SPSS package of Windows. Results: The results showed high level of correspondence between the authors for all the diagnostic methods. Concerning different methods applied for caries diagnosis there was a correlation between the methods, but it was diverging for the different methods. No correlation between radiographic exam and data obtained with DIAGNOdent and dye staining was observed. Conclusions: Based on the obtained results we may conclude that the least sensitive method for fissure caries diagnosis was the dye staining, followed by the radiographic exam. The results, obtained by DIAGNOdent and DIAGNOcam were very close, but DIAGNOcams’ data was better correlating with the clinical results.DIAGNOcam procedure can be judged as equivalent in the detection of occlusal dentine lesions when compared to clinical results.

Purpose: The aim of the presented study was to determine the incidence of secondary root caries lesions in patients referred for treatment in the Faculty of Dental Medicine – Sofia. Material/Methods: The subjects who took part in the study were patients referred for treatment of caries lesions in the Faculty of Dental Medicine, Sofia. They were interviewed for smoking, presence of systematic diseases and medications and debris and plaque were removed from natural teeth prior to examination. Dental examination was carried out with a dental mirror and a probe. Decayed, missed and filled teeth (DMFT) were recorded. Root caries lesions, restorations of those lesions and secondary caries lesions were recorded separately. Results: A total number of 603 patients were examined. The frequency of appearance of root caries in the investigated population was 33.5% (202 patients). The whole number of root caries lesions was 857. Three hundred forty three (41.4%) of those lesions were restored. Presence of secondary caries lesions was observed in 138 cases (39.1%). Conclusions: Based on the data obtained from the presented study it may be concluded that most of the root caries lesions remain untreated (58.8%). Secondary carious was diagnosed in 39.1% of the root caries restorations. The patients with secondary caries lesions presented with higher incidence of concomitant diseases and lower incidence of smoking.

Literature data have reported that certain Gram-negative anaerobe bacteria from the subgingival environment are important etiological agents of chronic periodontal disease. Based on published criteria identifying periodontal pathogens, major evidences has been shown for: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia; moderate evidences for: Prevotella intermedia, Peptostreptococcus /Micromonas/ micros, Fusobacterium nucleatum, Eubacterium nodatum, Campylobacter rectus, and spirochetes (Treponema denticola). Microbiological data has been suggested by several studies as a useful indicator of disease progression, selection of an adjunctive antimicrobial administration, healing assessment and disease recurrence. The results of this study demonstrate statistically significant correlation between periodontal attachment loss and the prevalence of Porphyromonas gingivalis, Tannerella forsythia and Peptostreptococcus (Micromonas) micros in deep periodontal pockets of severe chronic periodontitis patients.

Background: Because of their main characteristics: transparency, opalescence and color density, the tooth structures are extremely difficult to restore by means of completely inconspicuous restorations of the natural tooth tissue characteristics. The aim is to show successful aesthetic restoration of III Class dental lesions in upper incisors by means of high quality composites. Materials and method: A female patient visited the clinic being not satisfied with the esthetics of her front teeth. The intraoral examination showed previous restorations and carious lesions in 12, 11, 21, 22. After defining the tooth color a silicone key was made. The treatment was performed under anesthesia, the existing restorations were removed and the carious lesions in teeth 11, 12, 21, 22 were treated with restorations using Vanini edge preparation. The teeth were restored by means of stratification technique. After etching and rinsing, bonding was applied for 20 sec. and then polymerized. After fixing the silicone key enamel shade was applied and then dentine shades UD2, UD3, UD4 of 0.5mm thickness each. The polymerization was done layer by layer. Applied were 10 to 15 layers in total. The composite material was preheated in oven up to 55. Teeth 21 and 22 are restored with Enamel Plus HRi (Micerium). Results and Discussion: Excellent aesthetics is achieved with composite material. They have enamel and dentine shades and allow high quality aesthetics. The polishing is excellent in Enamel Plus HRi (Micerium) which is typical for this type of composite. The result of the carious lesion treatment in this patient is real improvement of the dental appearance of her anterior incisors. Conclusion: Materials show excellent aesthetic results due to their characteristics and the stratification technique used.

The exact determination of vertical dimension of occlusion is of great significance for the recreation of the functional, esthetical and prophylactic biological factors for the edentulous patients. Authors aim was to establish the change in mm of the vertical dimension of occlusion by patients with different duration of full dentures treatment. Materials and methods: 75 patients (44 women and 31 men) aged from 56 to 82 years, wearing complete dentures for 3 to10 years, were included in our investigation. On all patients’ plaster casts were made baseplates from photopolymerizing baseplates (TRIAD VLC Custom, Dentsply De trey) and occlusal rims from temperature resisting pink wax (Modern Pink No3 Wax, Heraeus Kulzer, GmbH & Co.KG). The numbers of measurements of the physiologic rest position for every patient were 10. After calculating the average value of measurements the result was minimized with 2.5 mm thus giving the vertical dimension of occlusion (VDO) for the new denture treatment. Results and discussion: By 49 patients (65, 33%) the difference between the VDO with the old dentures and the new treatment was from 2 to 3.99 mm. By 17 patients (22, 67%) that difference was from 4-5.99 mm and by 9 patients (12%) - from 6-8 mm. By all the patients the VDO had to be increased with 2-6 mm by the new treatment.

Literature data relate certain Gram-negative anaerobe microorganisms with advanced destructive periodontal lesion. There are some references which reported higher levels of periodontal pathogens by the red and orange complex in deep periodontal pockets. The aim of this study is to determine the presence of most important periodontal pathogens and Candida spp. in deep periodontal pockets in patients with severe chronic periodontitis. The results of this study indicate the presence of high levels of periodontal pathogens in a strong connection with periodontal disease in deep periodontal pockets of patients studied.

In the present study we aimed to optimize the thermal imaging method for evaluation of skin patch test reactions in dental clinical allergology. A total of 30 patients without a history of allergic diseases were included in the study - 12 men and 18 women, age 21 - 32 years. Skin patch testing was performed with a set of 20 standardized allergens. The thermographic investigations were performed with the FlirT620 infrared camera with a temperature resolution of 0,06°C. Thermograms were analysed using the Flir Reporter Professional software 2013. The statistical analysis of the results revealed an average correlation between the clinical evaluation of the results according to the cheme of ICDRG and the thermal image diagnostic (rphi = 0.538, p = 0.001). Absolute matching of clinical and thermal image results was observed only for the negative ones. For the clinically positive skin patch results matching with thermal image method was observed in 60.7% of the cases. Optimization of thermal imaging as a method for evaluation of skin patch test results could serve as a safe, accurate and non-invasive method, especially to distinguish weak (+), doubtful and irritant reactions, although not standardized criteria to distinguish these reactions have been elaborated yet. Crucial factor for the accurate interpretation of results is the precise diagnosing performed by well-trained physicians in this area, with clinical relevance, to minimize the role of subjective factors.

The understanding of the pathogenesis of periodontitis makes various progresses in the last decades. Today it is well known that the synthesis of high levels of pro-inflammatory mediators from gingival tissues in response to periodontal pathogens results in destruction of soft and hard periodontal tissues and clinical expression of periodontal disease. The occurrence of increased IL-6, IL-1β, TNFα and PGE2 levels in GCF or gingival tissue is capable to indicate risk of progression of destruction in specific periodontal site. Detection of gene expression of numerous major cytokines in high levels in gingival tissues and crevicular fluid may be indicator for activity of periodontitis and provides the rationale for the additional periodontal therapy. The current conception of the pathogenesis of periodontitis suggests that additional host modulation approach may inhibit the production of pro-inflammatory mediators in periodontal tissues and thus may enhance the treatment result.

The aim of the study is to compare success rates for ultrasonic removal or bypassing endodontic instruments, fractured below the curve of root canals. Methods: 45 clinical cases – 30 MB and 5 ML root canals of mandibular molars, as well as 8 MB, 2 DB root canals of maxillary molars were selected from the authors’ private practice. 18 of the fragments are stainless steel files, 6 are rotary Ni-Ti files and 21 – lentulos. Fragments, to which visual access could be achieved by safe straightening of the root canal (26) were treated ultrasonically under dental microscope (OPMI Pico, Carl Zeiss) with magnification 10x and 16x. Bypass is chosen for fragments (19) without visibility. Results: Ultrasonic group: 22 of 26 fragments (84,61%) were totally removed, and full working length was consequently reached in 69,23% of the cases (18 fragments). Four fragments (15,38%) separated additionally from the vibrations and could not be totally ultrasonically removed. Bypass group: only 7 of 19 fragments (36,84%) could be successfully bypassed. Conclusions: Ultrasonic technique for broken instruments removal is significantly more successful than bypassing. Straight visible access to the fragment under dental microscope is crucial for successful fragments retrieval.

The objective of this study is to establish the possibilities of the infrared laser with (λ) 904 for treatment of bone resorptionof bone implants in the process of osseointegration. Material and methods: The osseointegration process of 167 implants was radiologically evaluated between the first and the second surgical stage. In nine was established bone resorption reaching the implant screw. For the treatment was used infrared laser with (λ) 904 nm. Six procedures were performed, every other day, with a dose of 3-4 J/ cm2. Results: The x-ray tests done about three months after the treatment showed restoration of the bone resorption. Conclusion: In diagnosed bone resorption of implants in process of osseointegration, the application of infrared lasertherapy with (λ) 904 nm, with protocol of six sessions every other day, with dose 3-4 J/ cm2 per session, recovers the bone structure.

Background: The ability to self-assess is a critical skill that all health professionals must be able to do, in order to achieve competence. This is essential for the doctors of dental medicine. During their education and practice they apply different clinical and para-clinical procedures. The aim is to evaluate the students' self-assessment skills during the education of clinic and preclinic of prosthetic dentistry. Material and methods: After the completion of certain work - preparation for full veneer crown, a questionnaire was provided to each student in preclinical course (n=30) and clinical course (n=30) for self-evaluation. The questionnaire involved: axial reduction, occlusal reduction, facial and lingual reduction, smoothing and finishing. The answers were based on the standard for the university grading scale. Than, the same questionnaire was fulfilled by the assistant professor without seeing students' self-evaluation. Results and Discussion: Results have been reported in percentages. 100% respond rate has been achieved. The students from the preclinical course tend to overestimate their performance (50%). The students from the clinical course tend to submit overall lower grades than the faculty evaluation (25%). Conclusions: The students from clinics have better self-assessment skills. The discrepancy was most pronounced in the junior students. The different evaluations (self-assessment and assistant professor's) help students to improve their understanding of certain principles and improve the teaching effectiveness of education of prosthetic dentistry.

Background: Successful endodontic treatment requires effective biomechanical preparation of the root canals and three-dimensional obturation of the root canal system. This can be achieved only by knowing and identifying the variations in the root canal system of the endodontically treated teeth. The Aim: The aim of this article is to present cases of endodontic treatment of maxillary first premolar with three root canals – different types. Material and Methods: Five clinical cases of successful endodontic treatment of patients with maxillary first premolar and three root canals are described. Result and Discussion: It is noted that good endodontic practice requires good knowledge of dental anatomy and possible variations, accurate X-ray images, as well as use of magnifying equipment. Conclusion: Knowledge of dental anatomy is fundamental for good endodontic practice.

The purpose of the study is to compare microleakage after root end resection of the two materials (MTA and Biodentine) for two different apical cavity preparation using the method of penetration of dye - 0, 2 % Rodamine B. Materials and Methods: Forty-eight extracted single-rooted human teeth were used in this study. The resection was made at 3 mm from the root tip with a high speed diamond bur at an angle of 90 degree to the long axis of the tooth. For the retrofilling, ProRoot MTA and Biodentine were used. The teeth were divided into 5 groups: 1st group (10 teeth) – the apical cavity was prepared with stainless steel fissure bur #10 at 3 mm depth in the root canal parallel to the long axis of the tooth and is filled retrograde with MTA. 3rd group (10 teeth) - retrofilling with Biodentine. 2 nd group (10 teeth) - with a round bur apical cavity was prepared with a concave shape and cavity along the root canal with a depth of 3 mm and retrograde obturation with MTA. 4th group (10 teeth) - retrofilling with Biodentine. 5th group (8 teeth) - control group - with preparation of the cavity after resection without retrofilling. The outer surface of the root is covered with two layers of varnish, with the exception of the apical 3 mm then immersed in 0.2% Rodamine B for 72 h. The degree of penetration of the dye is measured in millimeters. Results: Relative highest median value of penetration of the dye in mm is in the control group. MTA group has a higher value in mm versus the Biodentine. The apical preparation with a concave shape and cavity along the root canal with a depth of 3 mm after apicoectomy is important to reduce apical microleakage. Conclusion: Different apical cavity preparations in both types of material have led to the microleakage dye, but to varying degrees.

Introduction: Dental caries continues to affect a large percentage of children and currently advises that if diagnosed at an early stage can be reversed with minimally invasive treatments. There a large number of methods for early diagnostics. Purpose: The aim of the presented in vitro study was to evaluate the effectiveness of the laser fluorescent device DIAGNOdent pen in measuring changes in the level of mineralization of intact deciduous teeth enamel surfaces etched for different intervals and of intact dentin etched for 30 seconds. Material and methods: The study was performed on extracted children teeth. DIAGNOdent was used to measure the values of laser fluorescence of intact enamel and dentinal surfaces. Samples were treated with 37% H2PO3 etched for 5 sec., 30 sec. and 60 sec. for enamel surfaces and 30 sec. for dentinal. Teeth were rinsed, dried and measured again with DIAGNOdent. Results: After etching the enamel surfaces for 5 sec., 30 sec. and 60 sec. an average increase of 1.55 (0.85-2.2) was detected. The detected average values of increase of laser fluorescence for the enamel were 0.85 for 5 sec. ethching; 1.6 for 30 sec. and 2.2 for 60 sec. The average increase in the dentine was 3.5. Conclusions: Based on the limitations of the conducted study it may be concluded that the changes in the degree of mineralization of deciduous tooth structures can be detected by DIAGNOdent. Enamel etching for 5 sec., 30 sec. and 60 sec. lead to a comparative degree of change in the laser fluorescence. The obtained values after 30 sec. of etching revealed almost a double increase compared to 5 sec. etching and 3-fold for those at the 60 sec. The measured changes after etching in the dentin were better expressed than those in the enamel.

Introduction: Maxillary central incisors usually have one root with one root canal. The cases with two root canals are extremely rare. Purpose: The aim was to present an unusual case of a maxillary first incisor with two root canals and the methods of treatment. Material and methods: The 48-year old patient had a painful swelling above the first maxillary incisor. The diagnosis was Periodontitis chronica granulomatosa diffusa exacerbata. After exploration of the pulp chamber, the inspection with an operating microscope was found two root canals. The lesion was covered to periapical and the part of marginal periodontium. The decision was taken of combined endodontic and surgery treatment. Results and discussion: After 7-year follow-up, there was a healing of the lesions and no recurrence. Conclusions: The combined endodontic and surgery treatment was successful choice for preservation of the tooth.