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The introduction of CAD/CAM technology in dentistry opened the way for the use of numerous materials for prosthetic restorations: dental alloys, ceramic masses, zirconia, PMMA, etc. One of the materials suitable for CAD/CAM technology is zirconia, used either ceramic-plated or full-contour, through its mechanical and optical properties. Zirconia, proves to be a real competitor for dental alloys used in porcelain fused to metal technology, with great results on posterior and frontal areas of dental arches. Prosthetic restorations made of zirconia in transit areas (including canines and premolars) exemplify the perfect combination between mechanical resistance and aesthetics of this material.

In dental practice, the fidelity of a model is given by the quality and type of material used, the technique by which it is made, and last but not least by the experience and skill of the dental technician. But, the emergence of CAD-CAM technology has led to a major change in the stages of making the working model, through the development of the virtual model. Thus, the purpose of this material is to perform a comparative study between several techniques for obtaining sectional working models, with or without pins, compared to the virtual model obtained by CAD-CAM technique.

Dental veneers made of ceramic masses are considered on conservative solution for patients that require an enhancement of shape, shade, dimension and/or position of anterior teeth. Ceramic veneers are successfully used on large scale to hide tooth discoloration, to correct the position and minor defects of teeth, without removing significant quantities of hard tissues.

Prosthetic rehabilitation of the maxillary front teeth is an extremely laborious problem for the dental team, consisting of the dentist and the dental technician. If for the physiognomic component the most recommended materials are the ceramic masses, for the resistance substrate there are several variants. Conventional technologies using dental alloys and modern ones involving the use of zirconium dioxide can be used successfully in performing fixed prosthetic restorations in the maxillary frontal area, both options having both advantages and disadvantages, as we will describe in this material.

Stroke is the second leading cause of death worldwide. The global incidence of stroke has increased in recent years, although low and middle-income countries have been heavily affected. Because of the complicated and diversified physical and emotional disruption, stroke survivors are likely to face a variety of difficulties in daily life activities. Because of the wide impact of a stroke on all body structures and functions, there is no gold standard instrument to evaluate impairment and all elements of recovery after a stroke, and there is no single scale that can capture all the effects of a stroke. The International Classification of Impairments, Disability, and Handicaps (ICIDH) categorized the consequences of the diseases into three categories: impairment, disability, and handicap. Using the biopsychosocial model in 2001 WHO defines and classifies disability by using International Classification of Functioning Disability and Health (ICF). The ICF divides the impairment into three categories: body function and structure, activity, and participation. This article aims to review the most important tools that are reliable and valid in assessing the disability left after a stroke: The National Institute of Health Stroke Scale (NIHSS), Barthel index (BI), The modified Rankin scale (mRS), Instrumental activities of daily living (IADL), Glasgow outcome scale (GOS), The Functional Independence Measure (FIM), The World Health Organization Disability Assessment Schedule (WHODAS 2.0). The WHODAS 2.0 questionnaire is validated in several countries and it would be useful to be validated, also, in our country.

Communication between the clinical department (dental office) and the technical department (dental laboratory) is one of the topics that often comes to the mind of every dental technician or dentist. This communication can be done by different methods as a type of inter-compartment communication, but diagnostic wax-up, along with Digital Smile Design and mock-up, is not only one of the most effective, but also one of the clearest and precise ways of transmitting information from the dental technician to the dentist, and implicitly to the patient, but also vice versa.

The Resistance was a reaffirmation of France's independence and individuality, as well as a struggle to regain freedom and, above all, national integrity. In fact, many historians appreciate that the French Resistance could have achieved more if it had been more effectively integrated into Allied plans and strategies. Thus, in this material we tried to present some short biographies of dentists who worked in the French Resistance against the German occupation troops, some of them even paying with their lives for the courage they showed.

Background. Osteoporosis is a frequent comorbidity among patients with inflammatory rheumatic diseases, due to the impact of their therapies, the hish systemic inflammation and the large scale use of glucocorticoid treatment. Use of DXA and REMS. Dual X-ray Absorbtiometry (DXA) is the “gold standard” for detecting patients with low bone mineral density (BMD), using Z and T scores to define the thresholds for diagnosis of osteopaenia and osteoporosis, but this method has proven many disadvantages in time, especially in patients with inflammatory rheumatic diseases, those diagnosed with a disease in the spectrum of spondylarthritides. Therefore, in the last years, a new method of evaluating bone mineral density (BMD) was developed and benefited from numerous efficiency studies: REMS (Radiofrequency Echographic Multi-Spectrometry). The basis of the method is its ability to identify and analyze native unfiltered ultrasound waves that reflect from the bone surface of the vertebra and femoral neck, the so-called echographic radiofrequency (RF) waves. The analysis of all RF waves spectra allows both a quantitative as well as a qualitative assessment of the bone, thus effectively obtaining estimates of bone resistance and evaluating fracture risk through indirect analysis of bone architecture. Conclusions. The studies concluded that REMS is a method at least as good as DXA in detecting patients with osteoporosis by applying the definitions of the World Health Organization (WHO), and also discovered many advantages of the REMS method, probably the biggest advantages being the ability of this ultrasound method of evaluating bone fragility independent of BMD by introducing the Fragility Score (FS) and the possibility of using the ultrasound method in identifying bone demineralization and fragility in pregnant women. Furthermore, numerous studies begin to recognize the usefulness of REMS in diagnosis and evolution of patients with osteoporosis and inflammatory rheumatic diseases. Discussions. A new concept that should be considered is the fact that REMS could potentially more accurately evaluate BMD and bone fragility through the FS in patients with diseases from the spectrum of spondilarthritides (especially those with ankylosing spondylitis and psoriatic arthritis).

The most common types of crystal arthropathies are gout and calcium pyrophosphate deposition (CPPD) disease. Serum urate levels are influenced by a combination of genetic factors and the environment. There are studies estimating the heritability of urate ranging from 45% to 73%. Approximately 3% of the variance in serum urate level is explained by the locus SLC2A9. Among the Caucasian population, 10% of all gout cases may be largely attributable to locus ABCG2. Loss or reduction function of ABCG2 halves the kidney’s ability to secrete uric acid. Gain-of-function mutations in ENPP1 gene may be involved in the development of CPPD disease. Loss-of-function mutations in ANKH leads to excess calcium hydroxyapatite formation. Conclusions: There is reason to believe that studying susceptibility genes for the crystal arthropathies will contribute to our understanding of the complexity of inheritance of these disorders. At present many other genes involved in crystal arthropathies are being investigated, and we hope that soon, novel therapeutic targets will be found.

The physical rehabilitation of patients with cardiovascular pathology is poorly studied and developed in our country, especially in patients with heart failure. There are studies in the literature that confirm that a decrease in the grasping force of the hand is associated with an increase in morbidity and mortality. The physical deconditioning of patients with heart failure can be assessed with the help of the Amadeo robot, which is a device capable of measuring the flexion and extension force of the hand in kilograms. Material and methods. We prospectively analyzed a group of 44 patients diagnosed with heart failure class II-III NYHA who were hospitalized between June 17 and July 15, 2019 in the Cardiology Department of Elias Hospital. We evaluated the grasping force of the hand of patients with heart failure using the Amadeo robot. The Amadeo robot is a device used in the rehabilitation of stroke patients, which can measure the flexion and extension force of the hand using sensors attached to the hand and fingers. Results. By evaluating patients with heart failure using the Amadeo robot, the average value of the hand extension force was 2.364 kg at admission and 2.264 kg at discharge. The flex-ion force of the hand was 6.78 kg at admission and 7.361 kg at discharge. Patients enrolled in the study who had valvulopathies, atrial fibrillation and diabetes had a lower value of the extension force of the hand compared to patients with heart failure who did not have these pathologies. Patients with valvulopathies, high blood pressure, and ischemic heart disease also had a lower flexion strength than those without these diseases. Conclusions. It is known that the grasping force of the hand is an important indicator in assessing the fragility status of patients. Patients with heart failure are frail patients with multiple comorbidities in which physical deconditioning acts as a negative prognostic factor on morbidity, mortality, and increased hospitalization rates. Thus, the physical rehabilitation of patients with heart failure is essential for increasing the quality of life and also for decreasing morbidity and mortality and the rate of hospitalization.

Physical rehabilitation programs for patients with heart failure (HF) are underdeveloped in our country. In order to establish the correct rehabilitation plan, the first step is to evaluate the patient’s functional capacity. G-Walk is a simple and effective test in assessing functional capacity. The aim of the study is to analyze the correlation between the results obtained in Timed Up and Go (TUG) and walking speed test and the prognosis of patients with heart failure. Material and methods. We prospectively analyzed a group of 44 patients with heart failure class II-III NYHA hospitalized in the Cardiology Department of Elias Hospital between June 17 and July 15, 2019.We evaluated the functional mobility of the patients with heart failure with the G-Walk device that contains a wireless sensor. The G-Walk device represents a gait analysis system, performing – according to a protocol – 2 tests: Walk (patient’s walking speed) and TUG (measures balance and mobility). Results. After analyzing the walking speed, the patients were divided into 2 groups: those with a speed 0.8 m/s. Out of 44 patients, 21 patients had a walking speed < 0.8 m/s and 23 patients had a walking speed > 0.8 m/s. It was seen that patients with lower walking speed (V < 0.8 m/s) versus patients with better walking speed (V > 0.8 m/s) were older, had a lower body weight, a lower blood pressure value, a lower value of the oxygen saturation, a lower value of sodium and a higher blood glucose value. After analyzing the value of the TUG test, patients were divided into 2 groups: patients with a TUG test duration < 15 seconds and patients with a TUG test duration > 15 seconds. Thus, out of 44 patients studied, 19 patients had a TUG value < 15 seconds and 25 patients had a TUG value over 15 seconds. It was observed that patients with a higher TUG value (> 15 seconds) versus patients with normal TUG value (< 15 seconds) were older, had a higher creatinine value and a higher blood glucose value. Conclusions. It has been shown that a low value of walking speed and mobility is associated with increased morbidity and mortality of all causes in elderly patients with cardiovascular disease. The physical rehabilitation of patients with heart failure is very important for improving the quality of life.

Introduction. An important role in the appearance of acute or chronic infections is played by bacterial biofilms that contain several bacterial species and that develop preferentially on inert surfaces, dead tissues and medical devices. Purpose. In this material we tried to make an interesting study, regarding the adhesion capacity of microbial biofilms characteristic of the oral cavity of human subjects on the surface of materials used for industrial scale manufacturing of dental implants: titanium and zirconium dioxide (Zirconia). Material and methods. For this study were used plates of Ti4 and zirconia, on which adhesion of different bacterial strains belonging to the species Enterobacter cloacae, Klebsiella oxytoca and Klebsiella pneumonia were tested. Results and discussions. A rather high microbial load was observed on both types of materials for all types of bacterial strains studied. For certain types of strains, a lower colonization was noted in the case of zirconium dioxide compared to Ti4 surfaces. Conclusions. Although Zirconia has been reported to have a lower susceptibility to bacterial adhesion, our study contradicts this aspect specified in the literature. Both titanium and zirconium dioxide are promptly colonized by existing bacteria on the teeth left in the oral cavity.

The First World War was and is considered the most terrible conflagration of all time. Thus, over 65,000,000 soldiers made up the corps of land armies, naval and air forces, combat armies that participated in the conduct of military operations during the First World War. About 8,500,000 people died and more than 21,000,000 were injured. France was one of the countries most affected by this war, its medical services, including dentistry and oral and maxillofacial surgery, being completely obsolete. Thus, in this material, we tried to describe some important figures of French oral and maxillofacial dentistry and surgery, which were active in French civil and military hospitals during the First World War (1914-1918).

Sedentary behavior, both professional, occupational, and leisure, recreational, is one of the major risk factors for cardio-metabolic health and premature mortality. But, we find this sedentary behavior in many of the existing professional activities in 2021, among which are the professional activities with a medical profile in the field of dentistry: specific activities of the dental office (and here we discuss dentists and dental nurses) and activities specific to the dental technique laboratory (in this case, we are talking about dental technicians).

Introduction. Titanium and the alloys that contain this element became in the last decade of the twentieth century almost irreplaceable materials in many biomedical fields, including dentistry. Purpose. The purpose of this study is to test and evaluate the cyto- and genotoxicity of Ti4 and Ti-6Al-4V, to obtain biomaterials with antimicrobial properties, compatible with the human body. Material and method. Ti4 and Ti-4Al-6V in powder form were analyzed using cell proliferation analysis and micronucleus test. Two concentrations of 1.5 mg/ml and 3 mg/ml were tested for each type of sample. Results and discussions. For both materials tested in the two concentrations, the presence of micronuclei was observed, but within normal limits. Conclusions. Although the variations are within normal limits, it should be noted that for Ti-6Al-4V the incidence was higher at both concentrations than in the case of Ti4.

Edward Hartley Angle was an eminent American scientist, dentist, great inventor, being rightly considered to be the father of modern orthodontics. The great American scientist was the author of an impressive number of patents (46) and was the coordinator of 7 editions of some impressive orthodontic treatises. Thus, in this material, important data from the biography of Dr. Edward Hartley Angle.

Introduction. Peri-implantitis is a condition of the tissues adjacent to dental implants, which can occur in patients with implant-prosthetic restorations, following inadequate prophylactic measures. However, these peri-implants, untreated or improperly treated, can lead over time to quite severe complications, which can quickly turn into emergencies of low, medium or increased intensity in the usual dental care. Purpose. Peri-implantitis is not a major dental emergency, but ignoring and/or treating it incorrectly can lead to complications that are considered major in dentistry. That is why we tried through this study to verify the knowledge related to peri-implantitis as well as the complications that may arise from the nontreatment of these diseases, among the practitioners involved in this field. Material and method. The study was conducted with the help of 37 specialists involved in implantprosthetic treatments, aged between 37 and 53 years, using a 7-point questionnaire. Results and discussions. The results show the concern of specialists in the field of oral implantology regarding peri-implantitis, as well as the complications arising from them. Conclusions. Knowing the causes but also the complications arising from peri-implantitis are very important for the creating preventive programs, which with a reduced effort bring the long-term success of implant supported restorations.

Introduction. In order to achieve the goals of oral implantology, it is of great importance to obtain tissue integration (bone and epithelial) of dental implants. Bone integration has the role of rigidly fixing the dental implant at the level of the supporting bone, while ensuring the transfer of masticatory forces to the neighboring bone, while the soft tissues integration has the role of creating a barrier around these medical devices, with the role of protecting the underlying bone and preventing the access of microorganisms. Purpose. In this material we wanted to perform a statistical analysis on the gingival integration and osseointegration of dental implants in the oral cavity. Material and method. The analysis was performed on a number of 21 patients with a total of 97 dental implants, approximately one year after the prosthetic loading of the implants. The analysis was based on bleeding index, gingival index but also on the depth of the peri-implant canal and bone resorption around the implant. Results and discussions. Most of the implants analyzed showed no signs of inflammation. A small number (less than 30%) showed incipient signs of inflammation, falling within the data in the literature. Conclusions. Early detection of tissue changes around the implant and proper treatment will reduce the risk of more serious injuries and implant failure.

Objectives. The purpose of this paper is to assess the frequency of ultrasonography detected enthesitis in spondyloarthritis (SpA) patients as well as it’s correlation to reported pain and disease activity. Methods. 80 SpA patients were evaluated clinically (medical history, clinical examination, inflammatory markers, clinical and composite indices) and using musculoskeletal ultrasonography (MSUS). The conducted evaluation focused on 16 entheseal sites for each patient, reaching a total of 1280 entheses. The medical history form included questions regarding present or past spontaneous pain and the clinical examination, which evaluated entheseal pain upon pressure (digital pressure on the enthesis overlying skin). Two Esaote My Lab machines with 6-12/8-18 MHz linear probes were used. One clinician/ultrasonographer performed all evaluations, in order to avoid interobserver variability. Results. Using musculoskeletal ultrasonography, up to 54.68% of the asymptomatic entheses in patients with axial/peripheral SpA were found with either GS and/or PD abnormalities. The tendons with the highest rates of ultrasound detected entesitis were the Achilles, followed by the quadriceps, both in gray scale (GS) (76.25%, 56.25% respectively) and power Doppler (PD) (24.4%, 20% respectively), while the least affected were the proximal patellar (20.65% GS, 8.15% PD) and flexor tendons (19.4% GS, 9.4% PD). Conclusions. Although it has a leading role in the pathogenesis of SpA, enthesitis is partially overlooked in everyday practice. This paper highlights the high percentages of both GS and PD entheseal abnormalities, both in peripheral and axial SpA. The low correlation between reported peripheral pain, especially in axial SpA, and MSUS signs of enthesitis proves the need for an imagistic enthesitis score in the diagnostic process, in order to establish the full extent of the disease and to personalize the treatment, considering the high and rising range of therapies to choose from.

Edward Hartley Angle was an eminent American scientist, dentist, great inventor, being rightly considered to be the father of modern orthodontics. The great American scientist was the author of an impressive number of patents (46) and was the coordinator of 7 editions of some impressive Orthodontic Treatises. Thus, in this material, which we structured in 2 distinct parts, we tried to present as concisely as possible the most important data from the biography of Dr. Edward Hartley Angle.

Objective. In this study, we aim to evaluate the frequency of enthesitis in psoriatic arthritis (PsA), using musculoskeletal ultrasonography (MSUS) and to determine to what extent it is correlated to clinical spontanous or provoked pain, disease activity and biologic inflammatory markers. Methods. 320 entheses, belonging to 20 PsA patients, were evaluated clinically and MSUS. For each patient, the medical history form included questions regarding spontaneous pain, targeted to 16 entheseal sites. Then, a thorough enthesis clinical exam was performed, evaluatig pain upon pressure (digital pressure on the enthesis overlying skin). Two Esaote My Lab machines were used, with 6-12/8-18 MHz linear probes. All evaluations were performed by the same clinician/ultrasonographer. Results. The Achilles, followed by the quadriceps tendons were the most affected by MSUS-detected enthesitis, both in gray scale (GS) (100%, 75% respectively) and power Doppler (PD) (40%, 35% respectively), while the proximal patellar tendon (35% GS, 25% PD), the plantar fascia (40% GS, 25% PD) and the flexor tendons (45% GS, 25% PD) were the least affected. Ultrasound abnormalities were found in up to 68.4% of the asymptomatic entheses, with high variation between the entheseal sites. The number of ultrasound-detected enthesitis for each patient was significantly correlated with the patient’s global assessment for DAPSA and also with the CRP levels, in this lot of patients with high disease activity. Conclusions. In PsA, the entheses involvement is a central feature, underscored in this study by the high percentages of both GS and PD abnormalities, even in the least affected entheseal sites. There is a low correlation between clinical symptoms and imaging signs of enthesitis in PsA, which proves the need for an imagistic enthesitis score in the diagnostic process, in order to establish the full extent of the disease and a more personalised therapeutic plan.

Introduction. Peri-implantitis is a non-specific inflammation, induced or maintained in the host tissues. Peri-implantitis usually presents a succession of specific symptoms, such as: bleeding on palpation, mobility of the dental implant, pain, increased depth of the pockets located around dental implants. Purpose. Thus, in this material we wanted to carry out a review of the main notions, both theoretical and practical, which characterize the diseases of surrounding tissues of dental implant called peri-implantitis. Material and method. For this study, we used 31 practitioners from Bucharest who frequently perform implant-prosthetic rehabilitation treatments, based on a questionnaire consisting of 6 questions. Results and discussions. The doctors included in the study showed that they have a thorough training in the field of implant-prosthetic restorations and of course in the diagnosis and treatment of peri-implantitis. Conclusions. In-depth knowledge of the notions related to peri-implantitis leads to an early diagnosis, favoring the rapid application of a treatment that prevents the occurrence of subsequent complications.

Introduction. By follow-up care process is meant an individualized curative-prophylactic active medical method, which supervises, at the initiative of the doctor, categories of healthy persons - exposed to risk factors - or categories of sick persons suffering from certain conditions. Purpose. In this study, we will refer to the theoretical and practical aspects regarding the necessity of follow-up care in children patients (preschool children, pupils), adolescents and young people, an operation that must be performed by the doctors with specialization and/or competence in pediatric dentistry, by the doctors with specialization in orthodontics and dentofacial orthopedics, by the school doctors, as well as by the simple dental doctors, who perform very regular pediatric dentistry maneuvers. Material and method. This study was conducted with the help of 23 pedodontists or pediatric dentists in Bucharest. Results and discussions. The answers obtained by applying the questionnaire created a clear image of the follow-up care system currently existing in Bucharest. Conclusions. The follow-up care in pediatric dentistry is the most useful active dental care, and in order to have an increased efficiency it is necessary that it is extremely well organized and controlled.

Introduction. In general, implant-prosthetic restorations, whether they are fixed or mobile, and regardless of their location (maxillary or mandibular), imply slightly different design and conceiving criteria, compared to the conventional prosthetic restorations already known. Purpose. In this material we tried to present some general and particular aspects regarding the design and manufacture of fixed implant-prosthetic restorations. Material and method. The study took place between September and December 2019 with the help of 31 dentists from Bucharest. Results and discussions. Following the application of the questionnaire, we were able to outline some aspects, frequently encountered in practice, by dentists who perform implant-prosthetic restorations related to occlusal balancing and the forces that appear at the level of implant restorations. Conclusions. The correct analysis and evaluation of the occlusal contacts and forces, leads to an increase in the life expectancy of prosthetic work as well as of their support (dental or implant).

Introduction. Atherosclerosis represents the process of stiffening of the arterial wall and includes arterial changes secondary to atherosclerosis, as well as physiological changes, reducing vascular elasticity in the elderly. However, the importance of knowing the pathology of atherosclerosis is mandatory among dentists, given the high frequency of patients with atherosclerotic lesions. Purpose. Through this study we tried to familiarize dentists on the therapeutic behavior towards patients with atherosclerosis but also the risks arising from it. Material and method. 87 practitioners from Romania helped to carry out this study between September and November 2018. Results and discussions. A clear picture emerged regarding the changes and manifestations in patients with atherosclerosis by dental practitioners as well as the attitude to be adopted in the case of treatments for such patients. Conclusions. Knowing the pathology of patients at cardiovascular risk as well as the therapy to be applied for them, is a must for dentists given the growing number of patients and the pathology with different stages of evolution.

ntroduction. Infectious risk in orthodontic practice is a real risk and involves problems both for the medical team of orthodontics and dental-facial orthopedics and for patients. Purpose. In this material we tried to highlight both the microbial load taken from the level of metal breaches Existing in the oral cavity but also the effect of mouthwashes with wide commercial use, on the different categories of germs isolated from these surfaces. Material and method. Microbial harvesting was carried out at different stages of the consultation and periodic examination in order to establish the effect that different substances have on reducing microbial load. Results and discussion. The results obtained for each stage and study group are graphically exemplified for a better understanding of the studied problem. Conclusions. The efficiency of the substances for removing the bacterial load is considerable but the replacement of disinfectants due to their toxicity and aggressiveness must be considered.

Introduction. A special role in the occurrence of acute or chronic infections is the microbial biofilms, which contain several microbial species and which develop mainly on inert surfaces. Purpose. The objective of this research is to obtain scientific information on microbial biofilms relevant to human health, in order to identify and improve the prophylactic and therapeutic methods of the infections caused by them. Material and method. This research focuses on the study of the microbial plaque attached to the dental surfaces, from patients wearing fixed dental appliances. The study was performed on a number of 39 patients wearing fixed orthodontic appliances. Results and discussion. Several types of microbial strains have been identified – Burkholderia cepacia, Pseudomonas aeruginosa, Serratia liquefaciens, Enterobacter cloacae, Eikenella corodens, Lactobacillus sp., Bacteroides sp., Candida albicans etc. Conclusion. The identification of the microbial strains isolated from the dental plaque revealed a great diversity of the aerobic and aerobic facultative anaerobic microbial species, which supports the hypothesis of the nonspecific bacterial plaque, involved in the etiology of periodontal diseases.

Introduction. Reliable and rigorous, the new techniques and procedures of oral implantology have rapidly evolved, having an important place in the therapeutic plan elaboration, for the prosthetic restoration of different forms of edentation, especially single tooth edentation. Purpose. Through this study we want to implement among the dental professionals, some notions of theoretical and practical character, regarding certain therapeutic implant-prosthetic flows for restoring single tooth edentations regardless of location. Material and method. The study was carried out with the help of an 8-point questionnaire, applied to a study group composed of 45 dentists in Romania. Resultsand discussion. The results of this study create a clear picture of how physicians know and apply the concepts related to implant supported prosthetic rehabilitation. Conclusion. Implant-prosthetic rehabilitation of single tooth edentations is a safe treatment method, with few surgical complications and minimal bone loss, an aspect that also results from the answers of the doctors participating in the study.

Introduction. Prosthetic restoration of single tooth edentation produced by the loss of the permanent first molar (6-year molar), regardless of its location (maxillary or mandibular), represents a challenge for any dentist. Purpose. In this study we tried to present some theoretical and practical aspects regarding the advantages of implant-prosthetic rehabilitation, regarding the advantages of implant-prosthetic rehabilitation compared to the classic prosthetic rehabilitation, for the restoration of the 6-year molar single tooth edentation, taking into account both the opinions of the dentists and the preferences of the patients. Material and method. The study was conducted between April 15 and June 30, 2018 on a group of 39 dentists, based on a questionnaire with 8 questions. Results and discussion. The results obtained from the analysis of the answers given to the 8 questions, have been exposed in a varied iconography for easier understanding. Conclusion. The most important aspect of this study is that most practitioners have recommended fixed prosthetic restorations on implant support, because of their superior advantages, compared with fixed prosthetic restorations with aggregation on the teeth bordering the edentulous breach.

Gingival integration, also known as epithelio-conjunctive integration, together with bone integration, is one of the main processes involved in the tissue integration of dental implants. Unfortunately, many practitioners treat this gingival integration with great superficiality, considering it to be an insignificant factor in this highly complex process of tissue integration of dental implants. Purpose. In this study, we intend to define very precisely the concept of "gingival integration" or "epithelial-conjunctive integration" and to introduce it as a specialized term in the basic vocabulary of implantologists. Material and method. A questionnaire based on 5 questions was used to carry out this study. The study group was composed of 64 implantologist (all subjects are holders of a degree after following a competence program in oral implantology in Bucharest). The study was conducted between October 2015 and November 2018. Results and discussions. The responses of the 64 practitioners have been analyzed and structured for a simple understanding, being extremely important for future research directions. Conclusions. Following the analysis of the results of this study we consider that the concept of "gingival integration" of dental implants requires more attention from practitioners, which will be reflected in the long-term success of dental implants.

Introduction. Most patients over 40 years old who present for specific treatments in the dental offices have at least one general condition. Specialized research has shown that atherosclerosis is more common in patients with periodontal disease, which suggests that periodontal and cardiovascular disease may have similar causes. Purpose. Given the close connection between the two conditions, we have tried to draw the attention of patients to the importance of the prophylactic maneuvers performed by him or by specialized personnel and we also want to emphasize the importance of the dental hygienist in this process. Material and method. In order to carry out this study, a questionnaire with predetermined answers was used, applied to 57 patients with ischemic cardiomyopathy and who presented for specialized treatments in dental offices. Results and discussions. The answers really reflect how the patients understood the connection between the two conditions and how they perform the oral and dental hygiene. Conclusions. Given that many of the respondents do not perform the hygiene procedures correctly or incompletely, there is a need for a medical staff to discuss with patients to educate them on the importance and the way of hygiene and to perform the oral and dental hygiene procedures, in short the dental hygienist.

Data on the functional three-dimensional positioning of the future restoration are important for planning a prosthetic guided insertion of the dental implants. Errors can occur in the digital and analogous process of analysis, design and production of the surgical guides, possibilities of minimizing them being vital for obtaining a predictable surgical and prosthetic process.

Introduction. Any new class of materials almost always brings with it a new processing technology, regardless of the field in which it is operated. If this technology is not fully respected, all the benefits and performance of the material can be compromised. Purpose. In this material we tried not only a familiarization of the dental technicians, but rather their awareness regarding the polymerization processes, which intervene in various technologies for creating prosthetic restorations of any kind. Material and method. For this study, 53 dental technicians, who have completed various forms of schooling, answered 10 questions related to the different forms of polymerization used in the dental technology. Results and discussions. The answers obtained give us an image regarding the knowledge of the practitioners in this field, but also the way in which the theoretical knowledge is verified in practice by the daily experience of the respondents. Conclusion. There is a variation in the accumulated knowledge, a variation that can be based both on the studies followed by each participant in the study and on how they use the materials discussed in this article in daily practice.

Dental medicine is an extremely complex medical field, comprising several specialties (orthodontics and dentofacial orthopedics, prosthodontics, dental surgery, endodontics etc.), which in most cases also require the assistance of a dental nurse. Purpose. In this paper, we have tried to present a number of very interesting ergonomic aspects in the dental office, which aim at simplifying work at this level. Material and method. This study was conducted between May and July 2018 using a questionaire applied to a number of 69 dental practitioners from Bucharest. Results and discussions. Results obtained in this study give us an image about how current dental practitioners understand ergonomics in daily practice. Conlclusions. All the aspects discussed in this study have an important role in the ergonomy of daily activity of a dental office. More important is that the majority of dentists involved in the stuty understand and apply the ergonomic concepts underlined by this study.

The development of the dento-maxillary system from the very beginning to the age of 12 implies a multitude of changes in the structure of this system. In the age of growth a sequence of deviations from the morphology and function of the dento-maxillary system appear. Purpose. In this paper, we have approached certain aspects of both theoretical and practical aspects that may intervene in the formation and development of dento-maxillary system in preschool age (up to 6 years). Material and methods. 75 dental practitioners from of different specialities from Bucharest were involved in this study between April 15 and May 20, 2018. To carry out a relevant survey a 6 items questionaire was used. Result and discussions. The results obtained were structured for a better understanding and to have a clear view for further study directions. Conlcusions. The dentist have the most important role in detecting disturbances that may have a negative effect on formation and development of dento-maxillary system and also is the one who guide prophylactic actions of preschool age children to avoid negative effect on dento-maxillary system.

Implant-prosthetic rehabilitation (both the surgical step of inserting dental implants and also the stage of creating the implant-supported prosthetic restorations) in smokers patients poses particular problems not only for the medical team but also for the patients (and here we refer in particular to the average number of cigarettes smoked daily). Purpose. In this paper we have attempted to present a multitude of factors both theoretical and practical, which can intervene in the implant-prosthetic rehabilitation of heavy smoker patients. Material and method. The study was conducted between April 2018 and November 2018 by applying a questionnaire with 6 questions. The 31 subjects enrolled in the study were aged between 29 to 67years old, specialists and/or primary doctors of general dentistry, dental prosthodontics or dental surgery. Results and discussions. Centralized results have been processed to provide a clearer picture of the current attitude towards heavy smokers for oral rehabilitation with the implant-supported restorations. Conclusions. The insertion of dental implants and subsequent creation of implant-supported restorations are not an interdiction for heavy smokers (up to 60 cigarettes a day) but requires the involvement of both the medical team and especially the patients in the follow-up care period to increase long-term success of dental implants and prosthetic restorations made thereon.

The lifespan of a fixed implant supported restoration is influenced by several factors: the medical team's experience, the superior technical and material endowment, the experience of the dental laboratory, but also maintaining a proper hygiene by the patient. Purpose. In this study, we insisted on the responsibility that rehabilitated patients through implant supported restorations should assume. Material and method. The study was conducted between March 2016 and March 2018 on a group of 73 patients rehabilitated by fixed implant supported restorations using a questionnaire consisting of 7 questions. Results and discussions. Maintaining a high degree of hygiene by regular or professional means of implant-prosthetic restorations leads to prolonging their life span. For this, it is necessary on the one hand for the medical team to make pertinent, logical, sufficient and easy to understand recommendations for all patients and on the other hand for the patients to implement the part of the recommendation that directly targets them. Conclusions. The recommendations of the medical team on oral hygiene after fixed implant supported restorations should be done in a language that is appropriate and easy to understand by patients. To the same extent, the recommendations must be assimilated and respected by patients, as a significant component in maintaining good hygiene in fixed implant supported restorations is the patient.

Implant-supported restorations are being used increasingly by dentists to treat maxillary or mandibular total edentulous patients in parallel with the old methods involving acrylic full dentures. Purpose. In this study, we attempted to perform an assessment of satisfaction degree in elderly total edentulous patients who were carriers of acrylic full dentures and were subsequently rehabilitated using cement retained implant-supported restorations. Material and method. The study was conducted using a 5-point questionnaire, applied to a study group of 39 patients aged between 67 and 77 years between April 2014 and June 2018. Results and discussions. The results provide information on how the edentulous condition is perceived, as well as the classical and modern treatment modalities. Conclusions. The treatment of the edentulous condition by fixed implant-supported prosthesis should be regarded as an alternative from the beginning of the treatment.

Immune checkpoint inhibitors are used with increasing regularity in metastatic disease. Anti-CTLA4 (ipilimumab) anti-PD1 (pembrolizumab, nivolumab) or anti-PD-L1(avelumab, atezolizumab) are approved for use in metastatic melanoma, non-small cell lung cancer, renal cell carcinoma and other malignancies. Despite their advantages, their immune adverse reactions are important. This paper is a review current literature regarding rheumatologic adverse reactions that follow ICI treatment. Their frequency is not high but it is important to correctly diagnose and treat them. Most of the adverse reactions are mild and moderate. The treatment for immune related adverse events (IRAEs) is currently not supported by a sufficient amount of studies. The best treatment option is therefore based on the rheumatologist experience.

The convulsive syndrome in eclampsia and epilepsy is often a major complication in obstetrics. If eclampsia is a pathology of gestation, epilepsy is a pre-existing pathology of pregnancy. Epilepsy can be aggravated by the presence of preeclampsia and eclampsia in both terms of fetal-placental units, frequency of convulsions. Obstetrical behaviour at birth by caesarean surgery or vaginal delivery with or without applying forceps should be chosen so as not to delay maternal and fetal prognosis. Epileptic patients have a higher risk of developing complications in pregnancy, by increasing maternal morbidity due to seizures, coma, birth bleeding or caesarean section, pelvi-genic hematoma, infections. The extraction of the fetuses was performed by caesarean surgery and forceps application. The immediate maternal and fetal, vital and functional prognosis was good. We recommended ablation in epileptic patients and administration of anticonvulsant treatment. The objective of the paper is represented by the study of the neuro-convulsive syndrome in eclampsia, epilepsy and in the association of the preeclampsia – epilepsy, the difference between the three entities and the therapeutic medical and obstetrical attitude for a good materno-fetal prognostic.

Purpose. The adhesion ability of microorganisms present in the oral microbial plaque is a certainty for solid surfaces at this level (including coronal restorations, classical prosthetic restorations and implantsupported restorations fixed and mobile, orthodontic appliances). Therefore, in this study, we have attempted to demonstrate the ability of these microorganisms from the oral cavity to adhere on the surface of some common impression materials used in implant-prosthetic rehabilitation. Material and method. The study was conducted on the main impression materials used in implant supported prosthetic restorations as well as in dental medicine: irreversible hydrocolloids, zinc oxide eugenol pastes, polyethers, condensation and addition silicones. The study was conducted between June and July 2017. Results and discussions. With the help of microorganisms isolated from the 87 patients, an inoculation of standard samples of impression materials was performed. Verification of adherence was achieved at different time intervals, the results being significant. Conclusions. For the tested materials, it was noted that the degree of adhesion was either influenced by the products incorporated in the base substance or by the secondary products resulted from chemical setting of material.

Purpose. Starting from a very recent event on the market of disinfectants, where for many years very diluted disinfectant products were marketed in Romania, the antimicrobial activity being non-existent, we tried, on the basis of simple experiments, to study the antimicrobial efficiency of the active substances of some common products used on impression materials in implant-prosthetic rehabilitation, but also in classical dental prosthetics and in orthodontics and dentofacial orthopedics, products approved and used in the European Union. Material and method. 7 decontamination and/or disinfectant products were tested for qualitative screening for the sensitivity to different microbial strains as well as for quantitative testing of antimicrobial activity. Results and discussions. The study results for the two objectives are influenced by the active substances of the tested products. Conclusions. Decontamination of dental impressions must also become a certainty in implant-prosthetic rehabilitation, in classical dental prosthetics and in orthodontics and dentofacial orthopedics even if this work is disregarded and ignored by many practitioners.

The inflammatory, degenerative and rheumatic diseases are triggered and evolving at osteoarticular level due to the disruption of functionality of constitutive cells and extracellular microenvironment correlated with systemic responses as synthesis of progressively degradative cytokines. Objectives. The in vitro bioactive efficacy of standardized small sea fish extract has therapeutic relevance on the strength of optimal physiological and structural biologic system rendered by primary cells isolated from human cartilage (HCH, PromoCell) unlike standardized cell lines that may have genetic and functional changes and beside the primary cells directly isolated from animal tissue that do not reproduce an authentic biological response because of metabolic stress adaptation to growing conditions in vitro. The main therapeutic targets in osteoarticular disorders are regeneration of affected cartilage and attenuation of local inflammatory processes. Materials and methods. The in vitro articular matrix reconstruction action was evaluated by molecular tests with relative quantification of gene expression (qPCR) for aggrecan, the predominant component of human cartilage, and for the enzyme responsible for degradation of aggrecan, aggrecanase (ADAMTS4) whose activities were phenotypically measured by ELISA (enzyme-linked immunosorbent assay) test. The anti-inflammatory profile was proved by techniques of quantitative evaluation of mRNA level and detection of extracellular soluble proteins by flow-cytometry (BD™ Cytometric Bead Array) for pro-inflammatory cytokines IL-6, IL-8 and gene expression for nuclear factor NF-κB. Results and discussion. The results prove the matrix regenerator effect of standardized small fish extract by stimulation at gene expression level of aggrecan synthesis in early stages of chondrocytes differentiation, directing cells to a mature functional status, as well as by inhibition of aggrecan degradation by action on gene expression and extracellular activity of ADAMTS4. The standardized small sea fish extract has an anti-inflammatory effect proven by extracellular and transcriptional inhibition of pro-inflammatory cytokines, IL-6, IL-8 and the nuclear factor NF-κB gene. Conclusions. The in vitro anti-inflammatory and regenerative action of standardized small fish extract reflects a significant therapeutic potential for osteoarticular disease sustained both through the effects at gene and phenotypic expression levels and through the reproducible characteristics of dynamics of in vivo chondrocytes evolution evidenced by primary cell lines.

Background. The musculoskeletal system is deeply involved in patients with CKD on dialysis. The studies that were done by now with regarding this subject mostly aimed the bone metabolism. So far, there is few data on the subject concerning the articular and abarticular abnormalities in dialysed patients(1). Objectives. To indentify the musculoskeletal soft tissue abnormities associated to dialysis and to evaluate whether or not they are more frequent. Also, we set ourselves to point out the importance of detecting these anomalies early in the evolution, in order to preserve the joint function and the quality of life, in a category of patients already severely affected. Materials and methods. This is a prospective study, ran on a period of 4 months. We included 55 patients ( 32 in the study group – on dialysis, 23 in the control group – late stage pre-dialysis chronic kidney disease). For each patient, we evaluated 68 joints using ultrasonography. Also, a visual analogue scale for pain was applied for each patient. Results. The findings vary from median nerve entrapment and tendon calcifications, to usual degenerative abnormalities, synovitis and tenosynovitis. The type of abnormalities does not vary between the two groups, but the percent of the affected patients was much higher in the study group. Conclusions. A great number of patients from the study group presented important articular and mostly abarticular abnormalities, sometimes with no correlation with the algofunctional symptoms.

Background. Systemic sclerosis (SSc) is a complex chronic autoimmune disease, with an unpredictable evolution and high morbidity and mortality rates. Objective. Evaluation of long-term survival and identification of prognostic factors in patients with systemic sclerosis. Methods. All patients with SSc of the EUSTAR100 center, having at least one visit between 2004 and 2016, were included. Data were analyzed for survival, cause of death, as well as for the following events defining disease worsening: increase in modified Rodnan score (mRSS) with at least 25% and 5 points (compared to baseline visit), decrease with at least 10% (compared to baseline) of predicted forced vital capacity (FVC) and predicted diffusing capacity of the lungs for carbon monoxide (DLCO), and presence of new digital ulcers (DUs). Logistic regression (LR), Cox proportional hazards regression and Kaplan-Meier survival curves were used in univariate and multivariate analysis to study survival and identify prognostic factors. Results. 137 patients were included in the study (89.1% females, mean age ± SD 56.7 ± 12.6 years, disease duration 9.7 ± 7.1 years), with a follow-up duration of up to 19 years. 96 patients had at least one follow-up visit and 66 (not including patients who died earlier than 2 years after the first presentation) had follow-up data at 2 years (± 6 months) after the first visit in the clinic. There were 19 reported deaths (13.9%), 11 attributed to SSc (of whom 8 were due to lung involvement). Risk factors for death were diffuse cutaneous subset and mRSS>14 at baseline (identified by LR adjusted for age and sex), male sex and proteinuria (Cox analysis). While in over half of the patients FVC and mRSS were stable or improved (86% and 96% respectively), and no new DUs occurred (64%), 52% of the patients presented significant worsening of DLCO during the entire follow-up. Risk factors for DLCO worsening at 2 years, by LR adjusted for sex and age, were male sex and diffuse cutaneous subset, while Cox analysis identified only male sex. The only risk factor identified for appearance of new DUs was the history of DUs at the first presentation. Conclusions. SSc often presents an unfavorable disease course, particularly due to lung involvement. Risk factors for disease worsening were male sex, diffuse cutaneous subset, and mRSS>14 at baseline. SSc-related deaths were mainly due to lung involvement, thus underlining the necessity of identifying predictive factors for lung function deterioration at the first presentation.

Bell facial paralysis association with pregnancy pathology is quite rare in practice, but reported to the cases outside gestation it is 2 times more frequent, which was why we decided to present this case. In the presented case, we note that the neurological pathology was revealed in a patient, aged 34 years and located in 34 weeks gestation with pregnancy-induced hypertension which was presented accusing facial asymmetry insidiously installed. The treatment was agreed between the obstetrician and the neurologist. Birth was conducted in normal dynamic parameters, evolving naturally with a good fetal and maternal prognosis. Further development of the peripheral facial paralysis was slowly favorable, with a partial remission 3 weeks later. A year and a half after this episode that took place during the gestation, the neurological and clinical examination revealed the persistence of a discrete facial asymmetries.

Background. A better understanding of the role of endoplasmic reticulum degradation-enhancing alpha-mannosidase – like protein 1 (EDEM1) in endoplasmic reticulum associated degradation (ERAD) may open new therapeutic approaches in autoimmune diseases. Aim. To study ERAD and EDEM1 in the generation and assembly of MHC I and the potential role in the pathophysiology of autoimmune diseases. Materials and methods. HEK293T cell line (human embrionic kidney cells), A375 cell line (amelanotic melanoma cells) and THP-1 cell line (leukemic monocytes used both as undifferentiated and differentiated) underwent transient transfection with EDEM1 and mock transfection with pTriEx. Western blot experiments assessed the total cellular MHC I levels in cell lysates, while expression on the cellular surface was quantified by flow cytometry of fixed cells. Results were analysed using the FACS Calibur and CellQuest Pro dedicated software. Experiments were done twice with duplicate probes for the Western blot assay and triplicate probes were used for flow cytometry. GraphPad Prism was used for data analysis. Results. MHC I plasma membrane routing and expression was similar in HEK293T and A375 both in mock transfected and non-transfected cells. Western blot assay for EDEM1 transfected cells showed bands corresponding to the total MHC I that migrated at 42kDa mass in non-transfected and mock transfected Hek293T, A375 and undifferentiated THP-1 cells. Mock transfected differentiated THP-1 cells showed a reduction of total MHC I. EDEM1 transfected Hek293T, A375 and undifferentiated THP-1 cells displayed higher levels of total MHC I, while differentiated THP-1 cells showed a marked reduction. Flow cytometry assay showed significantly reduced cell surface MHC I levels in Hek293T cell line. We observed a modest reduction of MHC I complexes on the cellular surface in undifferentiated THP-1 EDEM1 transfected cells, while there was no significant change in the A375 EDEM1 transfected cell line, as well as the differentiated THP-1 EDEM1 transfected cells. Conclusion. The impact of ERAD’s EDEM1 in MHC I reduction may have an important role in autoimmune disease, making ERAD an interesting therapeutic target

Background. Semi-quantitative nailfold capillaroscopy (NFC) scoring represents a promising tool for assessing disease activity, severity and change in systemic sclerosis (SSc), however there is no consensus yet over which capillaroscopy abnormalities should be analyzed and how. Objective. Investigation of the reliability of the qualitative and semi-quantitative scoring of NFC assessment between two raters and test-retest for each rater in a SSc cohort. Methods. This is a single-center pilot study where 2 raters assessed the NFC images of 48 consecutive patients with SSc. Data were analyzed in 3 ways: 1. qualitatively by “normal”/“abnormal” category; 2. qualitatively by the following categories: “early”, “active”, “late” SSc patterns, “normal”, and unclassifiable in any pattern, and step; 3. Semi-quantitatively by calculating the mean score for capillary loss, disorganization of the microvascular array, giant capillaries, microhaemorrhages and capillary ramifications and combinations of giant capillaries and microhaemorrhages (as a surrogate for vascular activity). Disorganization and ramifications (surrogate for vascular damage) were also assessed. Variables for all steps were calculated for all fingers and for each finger. Inter-rater/intra-rater agreement was assessed by Cohen’s kappa coefficients for qualitative variables and by intraclass correlation coefficients (ICC) for mean score values of abnormalities. Results. Inter-rater reliability ranged from good to excellent agreement for mean score values of abnormalities in all fingers (ICC coefficients 0.745 to 0.897) and was excellent for activity (ICC coefficient of 0.923) and damage combinations (ICC coefficient of 0.918). Assessment of abnormalities in a qualitative manner (normal/abnormal or with capillaroscopy patterns) showed weaker inter-rater agreement than the semi-quantitative assessment (k coefficient

Background. Rheumatoid arthritis (RA) is not a contraindication to pregnancy. It is only mandatory to observe several recommendations: planning pregnancy, adapting anti-rheumatic medication and monitoring disease activity every trimester. Postpartum, RA often relapses, therefore, breastfeeding can be exposed to anti-rheumatic drugs. Only Methotrexate, Leflunomide and Cyclophosphamide are fully contraindicated during lactation. TNF inhibitors are compatible with breastfeeding, while other biological therapies are not recommended, due to the lack of data. Objectives. This study aimed to evaluate pregnancy outcomes among female patients with RA, who attended rheumatology clinics from different Romanian cities. Secondary objectives were disease course and anti-rheumatic medication post-partum, the occurrence of RA postpartum flares and the adherence to breastfeeding. Patients and methods. This is a pilot observational, multicentric study, performed between October 2012 and July 2016. We have analyzed 41 patients diagnosed with RA before conception and who had at least one pregnancy after diagnosis. We recorded the pregnancy outcome, and, regarding the postpartum period, the occurrence of disease relapse and the antirheumatic medication exposure during lactation. Results. The 41 patients had 72 pregnancies, with 39 deliveries resulting in 42 healthy infants; 30 patients chose to breastfeed. Postpartum, the disease relapsed in 23/30 patients after a mean of 9.56 weeks. Therefore, these infants were exposed to anti-rheumatic drugs during lactation (anti-inflammatory drugs, Sulphasalazine and Hydroxicloroquine). No biological therapy was administrated during breastfeeding. Conclusion. The data obtained regarding the relapse risk and breastfeeding while using antirheumatic drugs are generally within international recommendations. We need more experience to be able to manage difficult situations and to take the best decision for our female patients with RA.

Objective. Our aim was to investigate whether two ERAP2 single nucleotide polymorphisms (rs2910686 and rs2248374) influence spondyloarthritis (SpA) susceptibility in Romanians. Methods. The case control study included 139 controls and 192 SpA patients. The two polymorphisms were genotyped by real time polymerase chain reaction (RT-PCR). The association tests for allele, genotype and haplotype frequencies for each polymorphism were performed with PLINK 1.9. Results. The genotypes and allele frequencies of the two SNPs in general SpA group vs. controls showed no association except for a possible marginal one for the minor allele A of rs2248374 (p = 0.08). In HLA-B27 negative SpA cohort the minor allele (A) frequency (55.4%) of SNP rs2248374 was significantly higher than the one in HLA-B27 controls (44.5%) (p = 0.012). HLA-B27 negative carriers of minor allele A present a higher risk of developing SpA (p = 0.015). Also for the second ERAP2 gene variant investigated (rs2910686) the minor allele T frequency was significantly higher (46.5%) in HLA-B27 negative SPA patients when compared with HLA-B27 negative controls (36%) (p = 0.02). The haplotype of the minor alleles (AC) is a risk factor for HLA-B27 negative SpA (p = 0.019), while the haplotype of the major alleles (GT) is a protective one against the disease in HLA-B27 negative cohorts (p = 0.009). Conclusions. Both ERAP2 gene polymorphisms investigated, especially rs2248374, influence SpA susceptibility, but this influence is limited only to the HLA-B27 negative individuals.