I. Radev

Private practice for maxillofacial and oral surgery

Distraction osteogenesis (DO) gives an opportunity to provide needed volume of bone and soft tissues for the normal function and rehabilitation of the masticatory apparatus.
In the poster is shown a case of patient treated with DO of the maxillary alveolar crest with subsequent insertion of dental implants and fixed bridge prosthesis.

Aim: To estimate the opportunity DO to be used in daily out-patient practice as well as a method whit good prognosis to provide the needed volume of tissues for the rehabilitation of the masticatory apparatus.

Materials and methods: 55 y.o.w. with alveolar crest atrophy in the region of 25 – 28 teeth needs rehabilitation with dental implants. Teeth have being extracted years ago. Attempts are made for sinus lift and vertical bone-block plastic. We took a decision for vertical DO of the alveolar crest with intraoral distractor with subsequent inserting of dental implants and bridge prosthesis.

Results and discussion: after an osteotomy, placing the distractor and waiting for a week, in a period of 10 days is achieved needed distraction of the bony fragment. After five months period of bone consolidation the distractor is removed and two dental implants are inserted. After osteointegration period of three months bridge prosthesis was made.

Conclusions: DO is applicable as well in out-patient practice of doctors with surgical skills. It is a promising procedure and despite of high traumatic level can be used in motivated patients to provided needed volume of hard and soft tissues.



Dinkova А., Vladimirova-Kitova L.*, Daskalov H.

Medical UniversityPlovdiv, Faculty of Dental Medicine, Department of Oral Surgery

Medical University – Plovdiv, Clinic of Cardiology

The risk of excessive bleeding often prompts physicians to interrupt the antiplatelet agents as Acetilsalicilic acid before dental extractions which puts patients at risk of adverse thrombotic events.

Aim of this study is to evaluate the risk of bleeding during dental extractions in patients with continued antiplatelet therapy with ASA.

Material and methods: The study included 68 patients aged between 42 and 90 years, 31 men and 27 women, receiving Acetilsalicilic acid (100 mg)once daily. Patients underwent tooth extraction under local anaesthesia as no more than 3 teeth in 1 visit were extracted. Local haemostasis with gelatine sponge and/or suturing was used to control potential haemorrhage. Postoperative bleeding was observed on the 2nd, 24th, 48th hour and 7th day.

Results: Mild bleeding was observed most frequently in the first 30 minutes, successfully managed by local haemostasis. No major haemorrhage requiring emergency or more than local haemostasis occurred. No statistically significant difference in bleeding between the control and the working group was found.

Conclusion: Single and multiple dental extractions in patients receiving low dose Acetylsalicylic acid can be safely performed without discontinuation of the therapy with provided appropriate local haemostasis.

Keywords: antiplatelet, bleeding, tooth extraction, local haemostasis



Dinkova A., Vladimirova-Kitova L.*, Deneva T.**

Medical University – Plovdiv, Faculty of Dental Medicine, Department of Oral Surgery

* Medical University – Plovdiv, Clinic of Cardiology

** Medical University – Plovdiv, Department of Clinical Laboratory

Anticoagulant therapy is widely used for treatment and prevention of arterial and venous thrombosis. The most widely used oral anticoagulant in Bulgaria is Sintrom (acenocoumarol). As other vitamin K antagonists it requires frequent laboratory monitoring of PT/INR for dose adjustment. To facilitate this control in the early 90s were introduced POC (Point of care) devices for INR/PT measurement at the moment. Some earlier studies have shown statistically significant differences between values from laboratory and POC meters, because of which the accuracy of these meters remain still controversial.

Aim of this study was to evaluate the results of INR on the CoaguChek XS meter relative to laboratory results.

Material and methods: INR values of 40 patients, receiving acenocumarol (Sintrom) were measured by laboratory coagulometer CS Sysmex 2000i and by CoaguChek XS POC analyser. The accuracy of the CoaguChek XS was determined by comparing the INR value with laboratory by linear regression analysis. Bland-Altman plot was used to assess the agreement between the monitor and laboratory values of INR.

Results: An excellent correlation between INR values obtained by CoaguChek XS and the laboratory method was found. Bland Altman plot demonstrated great agreement between INR values obtained by the two methods.

Conclusion: CoaguChek XS analyzer is precise and reliable devise for INR measurement, compared with laboratory results. Therefore, it has the potential to become part of the daily practice of physicians, including dentists treating patients receiving VKA.

Keywords: coagulation analyzer, point-of-care testing, prothrombin time, INR


Dinkova А., Daskalov H., Petrov P.*

Medical University – Plovdiv, Faculty of Dental Medicine, Department of Oral Surgery

* Medical University – Plovdiv, Department of Maxillofacial Surgery

Cardiovascular diseases are the leading cause of mortality and disability worldwide. Main place in the treatment and prophylaxis of these diseases and their complications occupies antiplatelet and anticoagulation therapy. Routine practice in the past was interruption of antiplatelet and anticoagulant medication before dental extraction. Today most authors and dental associations recommend maintaining therapeutic levels of antithrombotic drugs in single or multiple teeth extractions due to the fact that the risk of serious embolic complications outweighs the risk of bleeding.

Aim of this survey was to establish the opinion of the dental practitioners in Bulgaria on the approach according dental extractions in patients on antiplatelet or anticoagulant therapy.

Material and method: In the survey were interviewed 301 dentists regarding their approach to dental extractions in patients taking aspirin, clopidogrel (Plavix, Trombex) or acenocoumarol (Sintrom).

Results: A large number of dentists interrupt undue platelet therapy to their patients, exposing them to risk of thromboembolic complications.

Conclusion: The dental doctors with extensive work experience and oral surgeons are sufficiently informed about possible thrombotic complications.

Keywords: dentists, antiplatelet agents, anticoagulants, tooth extraction


Petrov P.*, Daskalov Hr.**, Dinkova A.**

*Department of Maxillofacial Surgery

**Department of Oral Surgery

Faculty of Dental Medicine, Medical University Plovdiv

Wound sections resulting from high-energy laser treatment of premalignant oral lesions have a specific healing process.

Aim of this study was to follow up the dynamics of wound healing in patients with oral leukoplakia submitted to Er-YAG laser treatment.

Materials and methods: Observed in this study were 36 wounds resulting from surgical treatment of patients that were histologically proven with oral leukoplakia, without presence of cell displasia. Laser ablation technique was applied using vapolarization. The rate of wound healing was taken each 3rd, 7th and 14th postoperative day. Indications were followed up for pain, infection, sensory disturbance symptoms and appearance of healing in the treated area.

Results: The wound healing run smoothly. There was no presence of pain and sensory disturbance. Feeding and comfort of the patients were recovered immediately after the procedure.

Cunclusion: Wounds resulting from Er-YAG laser treatment of oral leukoplakia are healing without pain and without complications. This method gives excellent comfort to patients combined with good quality healing outcomes.

Keywords: oral leukoplakia, Er-YAG laser, ablation


Pomakova A.

Medical University – Varna, Faculty of Dental Medicine, Department of Pediatric Dentistry

The role of the frequent use of sweetened medicines as a risk factor in the etiology of dental caries in children is well known. The cariogenic sugars in homeopathic preparations and their role as a risk factor is a topic, which is still not discussed.

Aim: To assess the awareness of dentists on the role of homeopathic medicines as a risk factor in the etiology of dental caries.

Materials and methods: A questionnaire was distributed among 100 dentists from several cities in Bulgaria. It consists of 11 questions, followed by several possible answers. The questions are related to the awareness of dentists about the composition of homeopathic preparations, their role as a risk factor in the etiology of dental caries in children and the need for prevention by their frequent use. Collected data were subjected to statistical analysis and displayed in summary form.

Results: More than half of the respondents are aware of the role of sugar-containing drugs as a factor in the etiology of dental caries in childhood, but do not relate homeopathic preparations to them. More than 50% of the respondents do not recommend additional preventive measures to their pediatric patients, which report a frequent intake of homeopathy.

Conclusion: There is a need for additional education of dentists in Bulgaria to raise their awareness about the possible role of homeopathic medicines as a risk factor in the etiology of dental caries among children.

Keywords: homeopathy, caries, etiology, awareness

7. Non-extraction treatment of a Class II-2 patient using rapid maxillary expander – case report

M. Stoilova, G. Stoilov

Medical University Plovdiv, Faculty of Dental Medicine, Department of Orthodontics

Hyrax – type orthodontic appliance fixed with bands on the first premolars and molars result in rapid maxillary expansion. When non-extraction treatment of class II-2 patients is needed, it is necessary to evaluate if the use of this type of appliance can help correction of the discrepancy.

Aim: The aim of the presented clinical case of a patient with permanent dentition, was to evaluate the transversal changes after rapid maxillary arch expansion with rapid expander (RME) during the initial phase of the orthodontic treatment.

Material and methods: An 14-year-old female patient with permanent dentition was examined in the Department of Orthodontics of the Faculty of Dental Medicine in Plovdiv. Biometric analysis of orthodontic models indicated transversal discrepancy measuring maxillary interpremolar and molar widths, maxillary retrusion, conical lateral incisor (21) , deep and distal bite. For correction of the skeletal and dentoalveolar deviations is used rapid maxillary expander. Changes in transversal parameters are measured by Pont’s method analysis. In this study we used norm values established by Linder and Hart.

Results: Using rapid palatal expander we achieved opening of the midpalatal suture and transversal increase of maxillary arch width simultaneously in interpremolar and molar region and intercanine distance expansion, obtaining additional gap between the central incisors( diastema).

Conclusion: Based on the results , it can be concluded that the use of bonded RME in upper dental arch achieves expansion in tranversal dimention. This correction provides the proper conditions for accurate dental alignment of the present teeth in the maxilla.

Keywords: Rapid maxillary expander, rapid expansion, transversal correction of upper dental arch


Ivan Gerdzhikov

Department of Prosthetic Dental Medicine, Faculty of Dental Medicine, Medical University Sofia

Surgical resection of a maxillary tumor often creates a large postoperative defect. Factors that affect the prognosis for successful, conventional prosthetic management of maxillary defects are the presence of teeth, amount of remaining support areas, and defect characteristics such as size, location, access, contour and available undercuts.

Aim: The aim of the described clinical case is to monitor the role which the prosthetic construction has in restoring the nutrition, speech and appearance of a patient with partial maxillectomy.

Materials and methods: For restoration in a 39-year old patient with partial maxillectomy and remaining 21, 22, 23 and 28 teeth, a bridge construction and hollow bulb model-cast obturator were fabricated. After preparing the teeth and tamponing the defect with gauze, a dual phase impression with Elite HD Putty and Elite HD Regular additive silicon was taken. The bridge construction was fixated with ICem dual-curing cement. The impression for the prosthetic’s model cast skeleton was taken with Phase plus irreversible hydrocolloid impression material. The model cast hollow bulb prosthesis following the resection was finished with Meliodent HC heat cure acrylic resin with a low level of residual monomer.

Results: The plan for fabricating a definitive postresection prosthesis that was set up and fulfilled, lead to a successful restoration of the impaired speech and masticatory function and helped restore the patient’s appearance and social contacts.

Conclusion: The application of prosthetic methods of treatment in patients with partial maxillectomy allows for a successful restoration of the impaired functions.

Keywords: maxillary resection, model cast prosthesis, obturator, resection following prosthesis, partial maxillectomy.


N. Mitova, M. Rashkova

MU – Sofia, FDM, Department of Pediatic Dentistry

The biological reactions that take place in the dentine and the pulp during operative treatment of deep dentine lesions have been a subject of research of modern-day regenerative dental medicine. The minimal-invasive treatment of caries in dentine necessitates a non-aggressive, controlled excavation.

Aim: The aim is to establish the clinical protocol for minimal invasive approach in the treatment of dentinal caries of permanent teeth in children.

Material and methods: The object of the study were 60 dentinal carious lesions of permanent teeth in 60 children who were treated by stepwise excavation controlled by fluorescence method. The applied methodology enable us to store a large volume of tooth structure and activation of protective mechanisms of pulp-dentine complex. On the basis of treatments have been established clinical protocol for the minimally invasive approach in the treatment of deep dentine caries (stepwise method).

Results: The control of the excavation by fluorescence technique (Proface) provides the ability to perform gentle excavation. Excavation down to partially infected dentin assures that a larger volume of structures can be preserved, which enables processes of internal remineralization and reactive dentinenogenesis. Such lesions are treated in two sessions. In one session can be treated dentine carious lesions with characteristics of slowly progressive, with excavation down to affected dentine (through fluorescent control).

Conclusion: In minimally invasive approach for the treatment of deep dentine caries lesions were offered two options:

1.When affected dentin – dentine carious lesions can be treated in one session

2.When partially infected dentin dentin – dentine carious lesions can be treated in two sessions.

Keywords: minimal invasive treatment, caries, excavation

10. Orthodontic-prosthetic treatment in cases of hypodontia of the upper lateral incisors

T. B. Yordanova

Medical University Sofia, Bulgaria, Faculty of Dental Medicine, Department of Orthodontics

Upper lateral incisors are widely accepted to be the second most frequent congenitally missing teeth after the lower second premolars. To correct deformities of this type, two basic clinical approaches can be used: orthodontic closure of space through mesial movement of the posterior teeth or opening enough space for subsequent prosthetic reconstruction.

Aim: To evaluate the possibility for orthodontic space opening as a preparation for subsequent prosthetic restoration of maxillary lateral incisors in skeletal class III non-growing patients.

Materials and methods: 9 non-growing patients with III skeletal class and hypodontia of the upper lateral incisors were enrolled in the study. We used a fixed appliance (braces) to treat the patients. Missing lateral incisors were replaced with single-tooth implant restorations. Approximal enamel reduction (stripping) was also necessary in the lower jaw.

Discussion: Due to the co-existing malocclusion (skeletal class III/progenia), we selected an orthodontic approach that allowed us to open up enough space and restore the number of teeth in the upper jaw. By correcting rotations of upper premolars, distal movement of upper canines and by buccal and distal inclination of upper posterior teeth we were able to create additional space in the maxillary dental arch.

Conclusion: Selecting the optimal treatment plan depends on the number and position of missing teeth, co-existing malformations, patient’s profile and also on the shape, color and condition of the neighboring teeth. Hypodontia cases usually require complex orthodontic-prosthetic approach, which is a prerequisite for achieving optimal functional and aesthetic restoration of the dentition.

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