Background:Different barrier membranes and augmentation techniques are used in oral surgery to recover lost bone structures with varied success. Recently, a combination between bone graft materials and Platelet-Rich-Fibrin (PRF) is implemented in the periodontology and implantology.Aim: The aim of this case report was to assess the possibility for augmentation of the alveolar ridge in the frontal region of the upper jaw, utilizing a combination of bone graft material, injectable platelet-rich-fibrin (i-PRF) and advanced platelet-rich fibrin (A-PRF).Materials and methods:An 18 year-old male with expulsion of tooth 11 and partial fracture of the alveolar ridge was treated with augmentation of the alveolar ridge using bone graft material, injectable platelet–rich-fibrin(i-PRF) and advanced platelet-rich-fibrin (A-PRF). Clinical results were reviewed 4 months after the augmentation and a dental implant was placed.Results:The postoperative period was uneventful. The control CBCT scan showed good organization of new bone allowing placement of a dental implant.Conclusion:The successful clinical and radiographic results of the case suggest that using A-PRF and i-PRF can be beneficial for bone augmentation of the alveolar ridge before implant placement.

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Objective: Postoperative pain control after extraction of impacted mandibular third molars is important for patients because of the effect of pain symptoms on the healing process and quality of life. The objective of this study is to make a quantitative and qualitative assessment of the postoperative pain in patients to whom preemptive analgesia was administered.Material and Methods: This is a randomised, placebo-controlled study in 80 patients who underwent surgical removal of impacted mandibular third molars. The patients were divided into three groups -with the preemptive administration of placebo, metamizole sodium and nimesulide. The short form of the McGill Pain Questionnaire (SF-MPQ) and the Visual Analogue Scale (VAS) were used for assessment and analysis of postoperative pain.Results: For the first 24 hours after molar extraction the comparison of the values of the various pain components showed a superior effect of the preemptive analgesia with nimesulide for the alleviation of sensory and total pain compared to metamizole sodium and placebo. In all three groups, pain intensity was highest at postoperative hour 6.Conclusion: Preemptive use of NSAIDs in the extraction of impacted mandibular third molars reduces the perception of postoperative pain and its intensity.

Introduction: In surgical procedures, tissue damage results in the release of a number of bioactive substances. Calcitonin gene-related peptide (CGRP) is a peptide released from sensory nerves, which determines its role in pain sensation. Its distribution in tissues deter­mines its role as a primary afferent neurotransmitter. Aim: To determine the effect of CGRP on postoperative pain and reactive inflammatory process after surgical removal of impacted mandibular third molars, as well as the factors that have influence upon the perception of pain. Materials and methods: Forty patients with bilaterally impacted mandibular third molars were included in the study. Venous blood samples were collected before and 24 hours after the surgical procedure in order to test their serum levels of CGRP and procalcitonin. Two weeks later the procedure was repeated. The difficulty of the surgical procedure, its duration and complications were assessed in all patients. Results: The influence of some of the studied factors upon postoperative pain was established. Differences in the sensation of pain between the two sexes were found when comparing pain intensity reported by the patients. Significant difference between pain inten­sity after the 1st and 2nd surgical procedures (6 hours) was found in females (Z=2.63, p=0.009;), whereas in males the difference was observed at 24 hours (Z=1.99; p=0.047). Regarding the existence of sex-related association, а significant, strong positive correlation between CGRP levels after the 1st and 2nd surgical procedures (24 hours) was found in males (rxy=0.78; p=0.004), whereas in females this correlation was also significant, although moderately significant (rxy=0.44; p=0.020). CGRP levels at the first and second extractions were generally similar in males, and not as much in females. We proved significantly moderate positive association between CGRP and pulse levels measured before the second surgery (rxy=0.37, p=0.021). Conclusion: The results of our study suggest a significant role of CGRP in reactive (neurogenic) inflammation.

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AIM: To assess the incidence of mandibular second molar impaction and the treatment methods for this condition. MATERIALS AND METHODS: A retrospective review of the cases of patients diagnosed with impaction of mandibular molars at the Department of Oral Surgery of the Faculty of Dental Medicine -Plovdiv during the past 11 years was performed.RESULTS: 962 patients with impaction of mandibular molars were operated on in the analyzed period. This diagnosis is relatively rare in second mandibular molars and represents 0.94% of all cases. Most often, diagnosis is based on clinical evidence of missing molars and on panoramic radiographs. In the cases described by us, only surgical treatment was used. CONCLUSION:The treatment of this condition is a challenge which requires an individual approach to each case and an assessment to determine what treatment approach is to be used -surgical or orthodontic.

The aim of this study is to determine the change in IL-6 serum levels in patients undergoing preemptive analgesia and surgical removal of an impacted mandibular third molar. Study Design: This is a prospective, doubleblind, placebo-controlled study in 80 patients who had an atypical extraction of an impacted mandibular third molar. Results: After surgical removal of impacted mandibular third molars, elevated levels of IL-6 in the early postoperative period were found, and the highest level was 14 pg/ml. Conclusion: Postoperative IL-6 levels rise regardless of the medication used for preemptive analgesia. In the group treated with nimesulide, a trend to reducing IL-6 levels was observed, but further study in a larger number of patients is needed.