Functional appliances are key to success in early orthodontic therapy. Their application is most useful in the period of a pre-puberty and pubertal growth spurt, in order to achieve facial aesthetics and improve the patient's health. The aim of treatment with functional appliances is to act on the muscles and ligaments, thereby influencing the movement and growth of the lower jaw forward, when it comes to the distal bite. The devices are used to correct malocclusions in all three spatial planes: sagittal, vertical, and transferal. In the sagittal dimension, the distal bite is corrected and Angle class I occlusion is established. In the transferal dimension, appliances are used to expand the dental arches. In the vertical dimension, appliances are used to correct an open or deep bite. Most often, mobile functional appliances are used, which consist of special upper and lower parts, such as the Twin block and the "M" block. Other types of functional devices have been used for many years, they consist of one part and their disadvantage is discomfort for patients and the impossibility of use in the presence of septal deviation or any other airway obstruction (activator and all its modifications, as well as Bionator). Recently, fixed functional appliances are also used, the advantage of which is that they do not depend on the cooperation of the patient and that they hold the mandible in an anterior position for 24 hours, achieved on the basis of an adequately taken construction bite. Their application is not conditioned by the puberty growth spurt but can be used by post-adolescents and young adults. In the production of functional appliances, the most important thing is to take a good construction bite, which determines how the muscle power will be transferred to the tissues, teeth, and jawbone. They determine the course of treatment and its duration. Muscle activation is performed in sagittal, transverse, and vertical directions, individually for each patient depending on the type of device.

Introduction. The most common form of leishmaniasis is cutaneous leishmaniasis. It presents with cutaneous lesions of the unprotected parts of the skin which leave scars later on. The causative agents are protozoae from the Leishmania species , and there are more than 20 of them. Clinical presentation and therapy depend on the type of leishmaniasis. The vectors of leishmaniosis are flies from the Phlebotomus species, and the source of infection is people and animals. Case report. A patient used to work in Iraq. Due to skin lesions that persisted for three months and suspicion of cutaneous leishmaniosis, he was sent by an infectious disease specialist from General hospital, Pancevo to the Public Health Institute of Serbia - PHIS. Lesions were localized on the hands, in the form of plaques with central ulcerations. There were similar cases among his colleagues. Microscopic examination of the skin samples, Giemza stained, showed intracellular amastigote Leishmania. The patient spent two months in the Clinic for infectious and tropical diseases. He was treated with fluconazole and liposomal amphotericin B and discharged with crusts on his hands. Clinical presentation, epidemiologic data, and microbiological diagnosis are very important for the diagnosis of cutaneous leishmaniasis.

Introduction. Success in endodontic treatment depends upon the clinician's knowledge and ability to recognize and diagnose the presence of anatomical and morphological variations of the root and canal system. Mandibular canines are usually recognized as having one root and one root canal. In spite of the low incidence of mandibular canines with one root and two canals, their appearance should not be neglected due to the fact that the presence of a second canal in these teeth leads to difficulties in endodontic treatment. The aim of this case report is to describe mandibular canine with two root canals. Case presentation. 45-year-old patient presented for medical care due to the pain in a lower right canine. Clinical and radiographic examination revealed composite filling and caries with periapical radiolucent area and sensitivity to percussion in the mandibular right canine. By careful evaluation of the diagnostic radiology, it was observed that the mandibular canine had two canals. The patient was diagnosed with acute apical periodontitis and root canal therapy was given following the standard protocols. Conclusion. Although the prevalence of two canals in mandibular canine is low, the clinician should always be mindful of variations in the number of canals for appropriate therapeutic management.

Introduction. The success of endodontic treatment depends on the adequate biomechanical preparation and obturation of the entire root canal system. The untreated or poorly debrided/obturated root canals are among the most frequent causes of endodontic treatment failure. The endodontic treatment of maxillary molar has the highest failure rates due to the complexity of their root canal anatomy. The aim of the study is to present the endodontic treatment of maxillary second molar with two roots and two canals. Case report. The clinical case report presents the endodontic treatment of maxillary second molar with two roots and two canals in a patient, aged 32 years. After the analysis of preoperative diagnostic radiograph, opening the pulp chamber and access cavity preparation, two canal orifices were localized. After the biomechanical preparation, root canals were obturated with the Gutta-percha points and sealer during the same visit. Conclusion. Although maxillary second molar most commonly varies in terms of the number of root canals in the buccal roots, less common variations in anatomical and morphological traits, such as the presence of two roots and two canals, should be considered during endodontic treatment.

Many of medicaments used historically in root canal treatment have been shown to be cytotoxic. Paraformaldehid agents (such as Toxavit and Depulpin) are used to devitalize inflamed pulp when local anesthesia is ineffective. The misuse of pulp devitalizing agents may cause damage to gingiva and alveolar bone. This case report demonstrates complications arising after application of paraformaldehyde containing paste, necrosis of the gingiva and alveolar cortical bone, which resulted in great loss of supporting bone. Surgical intervention was required wherein necrotic bone was removed and bone defect was filled with xenograft of bovine origin. After three months endodontic treatment was performed. After the treatment, the patient?s complaints were resolved. The use of paraformaldehyde-based agents during endodontic therapy requires special caution.

Introduction/Objective. Malocclusions are one of the most frequent disorders in dentistry, and pose a risk for the onset of caries and periodontal diseases. Fixed orthodontic treatment solves the problem of malocclusions; however, it requires simultaneous cooperation of the patients, parents, and dentists involved. The objective of this study is to examine the effects of fixed orthodontic therapy on the Streptococcus mutans and Lactobacillus spp. bacteria in saliva, the pH value, and buffering capacity of saliva. Methods. The research was carried out at the Faculty of Medicine in Foca, Department of Dentistry. The study included 100 respondents, aged 13 to 17 years. The respondents were divided into two groups: the study group (respondents wearing fixed braces) and the control group (respondents not subjected to fixed braces therapy). Saliva samples were taken from the respondents four, 12, and 18 weeks after the start of the orthodontic therapy. The study used the bacteria caries risk test (CRT) and CRT buffer (Ivoclar Vivadent). Results. The study showed an increased number of bacteria in saliva of the respondents during all three follow-up periods (χ2 test, p = 0.001). The largest numbers of the Streptococcus mutans and Lactobacillus spp. bacteria were found in week 12 of the therapy. Saliva pH value and buffering capacity of saliva increased statistically significantly in week 12 of the therapy (χ2 test, p = 0.001). Conclusion. Oral conditions in patients changed during the fixed orthodontic therapy: the number of bacteria increased, the pH value and buffering capacity of saliva changed. It was necessary to use preventive measures in order to avoid complications during the fixed orthodontic appliances therapy.

Uvod. Uspeh endodontskog tretmana zavisi od adekvatne biomehanickeobrade i opturacije celokupnog sistema kanala korena. Najcesci uzrok neuspehaendodontskog tretmana su netretirani, neadekvatno obrađeni iliopturisani kanali korena. Najveci broj neuspelih endodontskih tretmanazabeležen je nakon endodontske terapije maksilarnih molara, zbog kompleksnegrađe korenskog i kanalnog sistema. Cilj rada je da se prikaže endodontskaterapija maksilarnog drugog molara sa dva korena i dva kanala.Prikaz bolesnika. U radu je prikazana endodontska terapija maksilarnogdrugog molara sa dva korena i dva kanala kod pacijenta starosti 32 godine.Nakon analize preoperativnog radiograma, trepanacije pulpne komorei formiranja pristupnog kaviteta, lokalizovana su dva otvora korenskihkanala. Sprovedena je biomehanicka obrada, nakon cega su u istoj posetikanali definitivno opturisani gutaperka poenima i silerom.Zakljucak. Iako maksilarni drugi molari najcesce poseduju varijacije u pogledubroja korenskih kanala u bukalnim korenovima, prilikom endodontsketerapije treba imati na umu i postojanje ređih anatomo-morfoloskihvarijacija, kao sto je prisustvo dva korena i dva kanala.

INTRODUCTION Italian and Serbian Health authorities performed an in-depth Gap Assessment of the Serbian microbiology system in the function of communicable disease surveillance using a methodology adapted to context and information needs. METHODS There were two study phases: a capacity based survey and an equipment mapping survey. Invited participants included national health authorities, heads of national reference laboratories and of public/private diagnostic laboratories in Serbia. Findings were analysed preliminarily and identified gaps were discussed, prioritized and validated through two ad hoc workshops involving all concerned institutions. RESULTS The Gap Assessment was performed between September and December 2017. The overall response rate was 69% for phase one and 74% for phase two. Identified gaps were assessed as highly relevant during the project workshops. DISCUSSION Gaps and priorities were highlighted, validated, and studied with a suitable level of detail to develop a concrete action-plan. The same methodological approach could be used to monitor progress in Serbia as well as in other EU candidate countries.

Summary Diabetes mellitus is one of the most common chronic diseases which continue to increase in number and significance. It presents the third most prevalent condition among medically compromised patients referring for dental treatment. Diabetes mellitus has been defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Hyperglycemia leads to widespread multisystem damage which has an effect on oral tissue. The present article summarizes current knowledge regarding the association between diabetes mellitus and oral and dental health.

Summary Premature loss of teeth in children may lead to both functional and esthetic problems. Missing teeth in both anterior and posterior regions may cause malfunctions in mastication and proper pronunciation. If the missing teeth are not replaced, further complications may occur, including adjacent tooth migration, loss of alveolar bone, and irregular occlusion. Considering the sensitive nature of children, loss of teeth may cause the development of insecurities and low self esteem problems. Due to dynamic nature of growth in children and adolescents, prosthetic appliances must not hinder development of orofacial system, and must meet adequate esthetic and functional standards. Dental prosthetic appliances in paediatrics must be planned with respect to the special conditions that led to tooth loss or damage. Multi-disciplinary approach is needed, under constant supervision of paediatric dentist and orthodontist, as well as regular checkups with clinical and radiographical examinations.

Introduction. Orthodontic treatment is a common dental procedure in developed countries. Assessment of orthodontic treatment need is important for health services planning and population trends monitoring. The aim of this study was to assess the need for orthodontic treatment among children in Foca, Bosnia and Herzegovina. Methods. The study involved 81 students of two primary schools in the municipality of Foca, aged 11-13 years. The subjects underwent clinical examinations, the dental impressions were taken, study models were made and analyzed, and digital photographs of anterior dentition were taken too. Index of Complexity, Outcome and Need (ICON) was used to assess the need for orthodontic treatment. The number of orthodontists, which would be sufficient to meet the needs of this population of children, was estimated. Results. ICON index results showed that 56.8% of children needed orthodontic treatment. There was no statistical significance in the need for orthodontic treatment between the subjects of different gender and age. The study showed that 22.2% of boys and 34.6% of girls needed orthodontic treatment. In relation to age, 21% of eleven- and 21% of twelve-year-olds needed orthodontic treatment and 14.8% of thirteen-year-olds. The incidence of crowding was 80.2%. Crossbite was present in 23.5% of examined students, open bite in 2.5%, deep bite in 29.6% and irregular dental esthetics anterior teeth in 28.4%. Class II/1 malocclusion was found in 39.5% of children, II/2 class in 9.9%, class I in 38.3%, while class III malocclusion was found in 9.9% of examined children. Conclusion. The study shows that a large percentage of children in Foca need orthodontic treatment. Percentage of the need for orthodontic treatment is higher in comparison to most of the countries in Europe and the world. The development of prevention programs and early caries therapy can greatly reduce the need for orthodontic treatment.

SUMMARY Introduction Malocclusion is common in children and it has great influence on the quality of life of patients. The aim of this study was to determine the prevalence of malocclusion among 11-13 years old children in the municipality of Foca in Republika Srpska. Material and Methods The study included 81 respondents, 11-13 years old. It was conducted in elementary schools in the municipality of Foča. Respondents underwent clinical examination, alginate impressions of upper and lower jaws were taken and study models analyzed. To determine malocclusion (crowding, spacing, cross bite, deep bite, open bite and occlusion class as per Angle) ICON index (Index of Complexity, Outcome and Need) was used. Results The results showed that 17.3% of respondents had spacing between teeth, 80.2% crowding, 23.4% cross bite, 29.6% deep bite while open bite was present in 2.4% of patients. Occlusion II/1 class by Angle was present in 38.3% of respondents, II/2 class in 12.3% of respondents, Class I occlusion in 40.7% of respondents and III class was found in 2.4% of respondents. Conclusion There was high prevalence of malocclusion in the examined children. It is necessary to implement prevention programs, early treatment of dental caries, prevent premature tooth loss as well as measures of interceptive orthodontics in order to reduce frequency of malocclusion KRATAK SADRŽAJ Uvod Ortodontske nepravilnosti su različito, ali dosta često, zastupljene kod dece i u velikoj meri utiču na kvalitet života pacijenata. Cilj ovog rada je bio da se odredi učestalost ortodontskih nepravilnosti kod dece uzrasta 11-13 godina na području opštine Foča u Republici Srpskoj. Materijal i metode rada U studiji je učestvovao 81 ispitanik uzrasta od 11 do 13 godina. Studija je obavljena u osnovnim školama na teritoriji opštine Foča. Ispitanicima je urađen klinički pregled, uzeti su otisci zuba u alginatu, napravljeni i analizirani studijski modeli. U određivanju ortodontskih nepravilnosti (teskoba, rastresitost, ukršten zagrižaj, dubok zagrižaj, otvoren zagrižaj i okluzija po Englu) korišćen je indeks ICON (engl. index of complexity, outcome and need). Rezultati Rastresitost zuba je ustanovljena kod 17,3% ispitanika, teskoba zuba kod 80,2% dece, ukršten zagrižaj kod 23,4%, dubok zagrižaj kod 29,6%, dok je otvoren zagrižaj zabeležen kod 2,4% ispitanika. Okluzija klase II/1 po Englu utvrđena je kod 38,3% ispitanika, klase II/2 kod 12,3%, klase I kod 40,7%, a klase III kod 2,4% dece. Zaključak Uočena je visoka prevalencija ortodontskih nepravilnosti kod pregledane dece. Ovakav nalaz ukazuje na neophodnost primene preventivnih programa, ranu terapiju karijesa, sprečavanje prevremenog gubitka zuba i mere interceptivne ortodoncije, kako bi se smanjila učestalost ortodontskih nepravilnosti.

Introduction. Urea is the final product of protein degradation secreted in saliva. It has low molecular weight and neutral molecule that can freely diffuse through bacterial wall, mature plaque and extracellular polysaccharides exerting a buffering effect. In the presence of urease, urea is broken down into one molecule of ammonia and two molecules of weak carbonic acid, causing alkalization of the substrate and pH increase. Hydrolysis of urea begins at pH 4-6. In mature plaque with low pH, urea hydrolysis is a compensatory mechanism that opposes pH decrease trying to keep an optimal acidbase balance. This mechanism explains the role of urea in controlling plaque, caries and gingivitis. The aim of this study was to investigate the effect of urea on the quality and speed of epithelialisation of thermally wounded gingiva in rats. Material and Methods. The study included 36 Wistar albino rats, 3-4 months old, divided in three groups (12 in each group). According to the protocol thermal wounding of gingiva was performed in all animals. Wounded gingival epithelial tissue was treated with: 10% urea solution (experimental group), 3% hydrogen peroxide and saline (control groups). The extent and quality of epithelialisation was verified histologically after 3, 5, 8, 11 and 14 days. Results. There was a strong cellular infiltration and stromal edema with no significant morphological differences between groups in the samples analyzed after 3 days. The acceleration of epithelialisation in the experimental group observed in samples obtained after 5 days was evidenced by rapid mitotic division of epithelium and initial covering of defects in both directions. In samples obtained after 8 days, in the experimental group, epithelial defect was covered and in some areas cells were differentiated in vertical direction. After 11 days horizontal coverage of defects as well as accelerated cell differentiation in the vertical direction were noted. Restitutio ad integrum in the experimental group and significant delay in wound healing in the control groups was demonstrated in 14-day samples. Conclusion. Complete epithelialisation of gingiva occurred significantly faster in the group treated with 10% urea solution, than in the control groups treated with 3% hydrogen peroxide solution and saline.

Introduction. Oral health is an important part of general health. Knowledge, beliefs and attitudes that students acquire during dental school can influence their behavior towards not just their own health, but also towards health in their immediate environment. The aim of the study was to assess the level of oral health among dental students of the second and fifth year at the University of East Sarajevo. Material and Methods. Sixty-six students from the Dental Department of the Faculty of Medicine, the University of East Sarajevo were assessed. The study was conducted in 2012. The parameters used to assess oral health were: DMFT (decayed, missing, filled teeth) index and its components, index for the assessment of periodontal tissues (CPITN), and Green’s Vermillion oral hygiene debris index (DI). According to the methodology and criteria of the World Health Organization (WHO) all patients were examined using standard dental diagnostic tools under artificial light on dental chair. Results. Average number of decayed teeth of the second year students was 9.93 while it was 11.44 in the fifth year students. The mean dental caries index was 38.23% and person caries index was 100%. The average value of the debris index was 0.42. Healthy periodontium had 18.2% of students, while in 34.8% of students shallow periodontal pockets were observed. Conclusion. Oral hygiene and periodontal health was satisfactory in dental students. However, high average values of decayed teeth indicated that for better results caries preventive services should be activated earlier, even in school or preschool period.

INTRODUCTION The paper presents important facts in the application of recombinant human factor VIIa (rFVIIa) and in the treatment of renal cell carcer. CASE REPORT A 69-year old male with infiltrative renal cell carcer underwent radical nephrectomy using Hasagawa's approach. The extirpated tumor was 35 cm in diameter. During surgery, the patient suffered cardiac arrest with 3500 ml blood loss. Twenty-four hours after operation, he lost additional 2100 ml of blood. Despite adequate blood substitution with intensive surgical attempts to treat haemostasis, bleeding did not stop until the application of rFVIIa (300 IU). The patient survived and fully recovered. CONCLUSION To control massive non-surgical bleeding additionally complicated by paraneoplastic syndrome, extensive surgical intervention, haemodilution and massive blood substitution, the application of rFVIIa has proved to be most successful.