Right after teeth extraction in posterior regions, there is a following process that consists of physiological resorption and nonfunctional atrophy of the remained alveolar bone ridge. That also impacts the quality on the quality and quantity of the remained bone tissue, what later makes the implant incorporation and the prosthetic restoration much harder and complicated than usual it is. In the posterior region of the upper jaw additional complication of the prosthetic restoration process causes the existing of paranasal sinus that is located right in the body of the upper jaw maxilla. It’s post extraction pneumatization reduces the height of bone tissue what causes difficulties in dental implants placement. The aim of this survey is to evaluate the clinical outcome and the efficiency of the most often used sinus lifting techniques. Were analyzed totally 78 published studies that were done in the last 12 years. The study is made on narrative review of published articles that were investigating the related subject. Research was done by using the most common data bases: NCBI (US National Library of Medicine), Emedicine, PubMEd, Webmd. By using the open method for sinus lifting there needs to be formed lateral window in the bone tissue first by elevating the mucoperiosteal flap on the vestibular surface of the maxillary alveolar ridge and after that creating iatrogenic fenestration on the cortical lamina without perforating the sinus membrane. After the sinus membrane is being separated, the following step is augmentation. For this step are used four different types of bone substituent: autogenous, allogeneic, xenogeneic bone graft and synthetic alloplastic materials. The closed method for sinus lifting is performed after previous created place for the future implant in the residual alveolar bone ridge in the maxilla, after that with special instruments a perforation is being made in the bone floor of the maxillary sinus and carefully elevating the sinus membrane up for a few millimeters. In the created space a bone graft material is being placed and at the same time a dental implant is being applied. From the gathered results, both of the techniques are considered to be effective, in all of the followed cases the implant placements were successful with high rate of postoperative osseointegration, the healing period was without complications and also successful. There was no prosthetic failure in any case. From this survey the final conclusion is that both of the techniques are successful when it comes to sinus lifting. Very important is to have a qualitative imaging like computed tomography or roentgen before placing the implants to be able to estimate the bone volume and height. If the residual bone height is less than 5 mm the survival rate of the future implants is not guaranteed.

In patients with head and neck cancer, the most common issue after radiation treatment is xerostomia and the consequences of that, which are affecting the quality of everyday life of the patient. Subjectively xerostomia is manifested as dryness in the oral cavity, followed with obstructed chewing and swallowing of the food.Mostly it happens because of the death of the cells in the gland that are supposed to be dividing, caused by the radiation. To improve patients' life after treatment, IMRT approach has been considered to be a better solution for the gland tissue sparing during the radiation treatment, therefore, to decrease the severity and the intensity of the following xerostomia.The IMRT technique allows the chosen dose of radiation to be applied specifically on the tissue where it is supposed to be, sparing the surrounding healthy parts from the unnecessary radiation.The aim of this study was to evaluate the influence of the Intensity Modulated Radiation therapy (IMRT), with different intensity and dosage, on the function of salivary glands.For this study were analyzed total number of 87 surveys, 41 of them were used for detail analysis. This study is based on narrative review on published articles written in English language, reporting results related to the use of Intensity modulated radiation therapy treatment in patients with head and neck cancer.The gathered results have shown that the function of the salivary glands after radiation treatment can be in many cases protected during the treatment, or even restored to some level, therefore the resulting xerostomia can be reduced and its' following negative effects affecting the patients' life could be minimized by using the improved technique IMRT.In many studies the evaluated levels of xerostomia have been found to be significantly lower in the groups of patients treated with IMRT technique, compared with the other group of patients treated with conventional radiation therapy. Also, a big influence has the dosage of the radiation beams, on what depends on the outcome of the salivation function in patients treated with radiation therapy.

Radiation therapy is widely used approach in treatment of head and neck cancer, unfortunately it leaves consequences that are influencing the patients’ life in a negative way. During and after the treatment with ionizing irradiation it affects not only the malignant area that is being treated, but also the surrounding tissues and organs that are located near the region that is targeted (oral mucosa, jaw bones, teeth, salivary glands, surrounding muscles and the temporomandibular joints), leaving changes in their structure and functions. Many of the patients that are treated, have not been prepared optimally for the radiation treatment, what also affects the post operative condition of their tissues and organs that are located nearby to the radiation treated area. The aim of this study was to define the most common postradiation complications in patients with head and neck cancer and to evaluate the efficiency of the solutions that are used to manage them. For this study were analyzed in details 37 published articles on the studied topic, the research was done online using the data bases NCBI, Cochrane Library, Medline, PubMed and Webmd. The inclusion criteria were: studies made in vivo; studies written in English; case reports on head and neck cancer patients; surveys on patients after radiation therapy; studies on patients with intraoral complications from after radiation therapy. Results showed that radiation induced complications in the head and neck cancer patients can be classified in three groups as early, intermediate and late changes. The most common changes were found in the tissues (mucosa, skin, subcutaneous connective tissues, salivary glands, the bone tissues and the teeth), resulting with: hyposalivation (xerostomia), mucositis, opportunistic infections, radiation caries, dysphagia, altered taste and difficulties with the chewing and swallowing. Many studies have shown that the percent of damage on the oral mucosa is strongly related to the radiation dose and the type of ionizing irradiation that patients are being treated with. Treatment consists of application of lubricants; usage of substitutes for saliva; and stimulants for the saliva production, with preparations like pilocarpine and cevimeline, and electro stimulation. The loss of the taste after the treatment can be partial or total. Mostly affected are the sour and bitter tastes, rarely the sweet and the salty taste, and very rare is total loss on all of the flavors. Fortunately in most of the studied cases has been show that the changes in the taste were reversible after a period of time, in some cases a few months and in others it can happen even up to a few years until it reaches total recovery. It is crucial to implement more solutions and to find new ways to manage the complications that follow after the irradiation, so the quality of the life in these patients can be spared in any possible way. Using the new approaches such as IMRT and VMAT on these patients, could also improve their condition after the treatment, and reduced dosage of the irradiation also could be tested and implemented if it is possible.

The technique with socket shield is used like not total extraction therapy which is based on preserving segment from one of the sides on the root from the tooth that is going to be extracted. The main use of this technique is in cases for implant placement that is combined with grafting bone. The goal of this technique is to preserve as much as possible tissue from the periodontal ligament and also to spare the gingival tissue from unnecessary damaging during the therapy. Indications for this technique are : 1. To support and to preserve buccofacial bone part of extraction socket in cases that require immediate implants.2. Socket shield technique is indicated in cases with vertical fractures of teeth that are without any pathology of the pulpal tissue, where the bone tissue sparing and also attractive look are a main goal.3. To preserve the papilla between the placed dental implants. In spite of that to have a full success of this therapy is required to have enough bone tissue that will allow stability of the future implant and also absence of any kind of infection. The advantages from application of this technique are many, such as prevention from resorption of the lamellar bone, high aesthetics results, improved primary stability of the future implant, minimal invasiveness during the procedure, prevention from forming a connective tissue with the implant, low cost compared with other procedures etc. There are also disadvantages such as possibility of displacement of the buccal lamellar bone. The purpose of this study is to analyze the efficiency of this socket shield approach in immediate implant treatment. This study was based on Narrative review on published surveys, using PubMed, Medscape, Webmd, Mdconsult, Emedicine data bases. The preservation of the whole attachment apparatus of the tooth to maintain complete preservation of the alveolar bone tissue, makes the socket shield approach a very good technique that results with high level efficiency. The clinical outcomes from different studies is believed for this technique to be the best approach for alveolar ridge sparing in the future and also to use as less material as possible.

In cases with periapical lesions, there are two types of treatment modalities: noninvasive and invasive. The first one noninvasive is also known as nonsurgical or endodontic treatment. The second one – invasive method is surgical approach. In some cases, there is a need for combination of both aproaches. In everydays clinical treatment, the first choice is less invasive method and has better outcomes. Treatment of some periapical lesions (like cysts) are a theme of discussion and we do not have best option to treat them. The patient should make the definitive decision about the treatment. The doctor should inform him about the advantages and disadvantages of endodontic-noninvasive and surgical-invasive procedure. The therapeutic modalities for these pathologies are a wide range of treatment from endodontic treatment to different surgical options. We like to find out and present the best way about healing the periapical lesion. We wanted to know whenever surgical or non-surgical approach is better, and if using them might improve healing of those pathologies. The aim was clear and to reach it, we make an electronic search of medical and dental literature. We searched the following electronic databases: PubMed and Embase Ovid. Inclusion and exclusion criteria were used to reach the aim of this review study. We place restriction about language (only those articles that are written on English) and publication date (articles that are not older than 2010 year). We excluded duplicate article. We searched the references of the studies that we included for those review. We searched by hand the reference list of the studies and journals in the fields of endodontics and oral surgery. Every periapical lesion should firstly begin with good performed endodontic treatment. In some cases, there is a need for surgical approach of periapical pathologies because the endodontic treatment is not successful. Some cases might fail because of multipurpose factors such as: foreign body reaction, the size of the periapical lesion, biofilm, oral health and oral hygiene. A surgical approach is an option in cases when periapical lesion is large. Marsupialization might be the adequate option of treatment for those lesions in some cases. In cases with postoperative periapical lesion there is a need for surgical retrograde treatment. The procedure can be performed with hand endodontic instruments to make mechanical treatment of the root canal especially the part that is untreated. The advantages, disadvantages and modalities of treatment of periapical lesions are discussed in this review. According to these review there is no evidence that the first approach leads to better results compared to the second approach. This conclusion is based on electronic research of the literature database and clinical trials. There are several options for treatment to eliminate the clinical problems of periapical lesions but furder research is necessary. This review article is about the benefits of both approaches, and to determinate the best treatment modalities of cases with periapical pathologies, healing and postoperative quality of dental life.