Objective: To evaluate the type and the frequency of antibiotic prescribing along with endodontic therapy in Croatia. The aim is, also, to assess the attitudes of Croatian doctors towards endodontic treatment of patients at risk of developing bacterial endocarditis. Material and methods: Data were collected by a survey questionnaire. Results: 8.4% of the examined practitioners stated that they prescribe antibiotics often, and 91.6% of them stated that they prescribed them never/ very rarely/rarely. Most of them (41%) prescribe antibiotics once or twice a month, 32.5% once or twice in several months and 20.5% once or twice a week. The most commonly used antibiotic was penicillin with clavulanic acid. Also, 26.2% of examined practitioners prescribed antibiotics for gangrene pulp, 51.2% of them for localized acute apical periodontitis without swelling, 85% of them for cellulitis, 75% of them for fever and enlarged lymph nodes, 16.9% of them for tooth with fistula and 94.1% of them for prophylaxis of infectious endocarditis. According to the results of study, 54.4% of dental practitioners did not prescribe antibiotics without intervention on susceptible tooth; 76% of participants often/almost always/ always accepted endodontic treatment of patients requiring antibiotic prophylaxis to prevent infectious endocarditis, and 96.7% of participants indicated they were familiar with recent instructions for antibiotic prophylaxis. Conclusion: These findings point to inappropriate use of antibiotics in the practice of 83 dental practitioners questioned regarding the frequency of administration and indications. The most commonly used antibiotic was penicillin with clavulanic acid. A high percentage of surveyed practitioners stated that they were familiar with recent instructions for antibiotic prophylaxis. They also stated that they performed endodontic procedures on patients who were at risk of bacterial endocarditis. There is a noticeable need for targeted continuing education of dental practitioners in the Republic of Croatia.

Prescribing antibiotics is a regular part of daily dental practice. Antibiotics have a significant but a limited role in general dental practice due to the threat of emergence of antimicrobial resistance (AMR). As such, the aim of this study was to assess prescribing trends in dental antibiotics use from 2014–2023 in Croatia. Data on antibiotic prescribing practices for this study were provided by the Croatian Health Insurance Fund. The analysis included the number of prescriptions, packages, cost, and the World Health Organization’s defined daily dose per 1000 inhabitants (DID) per day as an objective utilization for comparison. Over the 10-year period, dentists in Croatia prescribed an annual average of 357,875 antibiotic prescriptions, representing an annual average of 78.7% of all dental prescriptions. The most commonly prescribed antibiotic was the combination of amoxicillin and the beta-lactamase inhibitor clavulanic acid, which made up 58.54% of antibiotics and 46.1% of all dental prescriptions. This was followed by amoxicillin (12.61%), clindamycin (12.58%), and metronidazole (9.96%). The trend showed two discontinuations, the first for the pandemic years, and the second caused by disruption in amoxicillin production. The rise in the use of broad-spectrum antibiotics needs to be addressed and regulated to ensure patients and dentists understand that antibiotics are not a substitute for dental treatment. Dentists should always begin treatment with narrow-spectrum antibiotics regardless of possible exceptional circumstances.

In response to the global trend of decreasing antibiotic usage, this study aimed to evaluate the nature and frequency of antibiotic prescriptions in conjunction with endodontic therapy in Croatia and to assess the attitudes of Croatian dental practitioners towards the endodontic treatment of patients susceptible to bacterial endocarditis. A survey questionnaire was sent to all dental practitioners in Croatia, achieving a response rate of 27%. The most frequently prescribed antibiotic was penicillin with clavulanic acid (63.4%), while standalone penicillin was less prevalent (18.6%). For patients exhibiting penicillin allergies, 90% of respondents indicated clindamycin as their preferred alternative. Antibiotics were mostly prescribed for localized acute apical abscesses without fever, followed by prophylaxis for infectious endocarditis and cellulitis. Only 1.3% of the respondents reported frequent antibiotic prescriptions without accompanying local treatment. While a substantial proportion of surveyed practitioners professed familiarity with the latest guidelines for antibiotic prophylaxis, their choice of antibiotics did not consistently reflect this claim. Most respondents conducted endodontic procedures on patients at risk of bacterial endocarditis. The findings highlight a need for targeted continuing education for dental practitioners in the Republic of Croatia, ensuring their practices align with current guidelines and global trends in antibiotic prescription.

The aim of the study was to assess the biocompatibility of modern composite and amalgam dental fillings. The research was conducted on 150 healthy patients between the ages of 10 and 20 who had amalgam and composite fillings between 6 and 12 months. Under in vivo conditions, a swab of buccal cells near the fillings was taken, and the cytotoxic and genotoxic impact of composite and amalgam fillings on these cells was analyzed using the extended micronucleus test (cytomeassay). The results showed statistically significant differences between the groups of subjects with amalgam and composite fillings and subjects without fillings for the following parameters: number of micronuclei (p=0.006), number of buds (p<0.001), number of binuclear cells (p<0.001), number of nucleoplasmic bridges (p<0.001).The number of micronuclei was statistically significantly higher in the group of subjects with amalgam and composite fillings compared to the group without fillings. The results for nuclear buds, for the number of binuclear cells and the number of nucleoplasmic bridges showed that the group with amalgam fillings had a statistically significantly higher number of these changes compared to other groups.The results of the analysis of the relationship between the parameters of the micronucleus test and the number of amalgam and composite surfaces did not show statistically significant values. Parameters indicating cell cytotoxicity were not statistically significantly elevated in subjects with fillings. The results of the analysis of the influence of the patients' lifestyle on the results of the micronucleus test showed statistically significant results for certain predictors (diagnostic X-ray radiation, coffee consumption, consumption of cooked, dried meat and baked food). Based on the results, it can be concluded that the buccal cells of subjects with amalgam fillings showed the highest degree of genotoxic changes, followed by those with composite fillings and the least buccal cells of patients without fillings.

Calcium silicate–based materials, known for their bioactive properties, are increasingly being used in endodontic therapy. Accidental extrusion of these materials into the periapical tissue is a relatively common phenomenon that can impede periapical healing. The aim of this article is to present three endodontically retreated case reports with moderate to extensive periapical lesions and to review the literature on this topic. The comprehensive search and analysis of the relevant literature included a review of 51 articles, of which nine case reports/series from 2010 to 2023 were considered. Based on the summarized data, over 80% of the retreated cases showed complete healing of the periapical lesions, while the success rate in initially treated teeth was over 90%. Healing of periapical lesions is the most common therapeutic outcome, even in cases where extrusion occurs. Despite this conclusion, extrusion of materials into periapical tissues should be avoided. Further case reports on the extrusion of calcium silicate–based materials other than MTA are recommended. When evaluating the success rate of periapical healing in such cases, it is recommended to extend the follow‐up periods to several years.

AIM: This study aims to assess the state of endodontic continuing education (ECE) among dental practitioners in Croatia and identify factors influencing participation in such education. METHODS: A questionnaire was sent to all dental offices in Croatia, yielding 819 responses. The data were analyzed descriptively and statistically modeled. RESULTS: Most respondents had participated in some form of ECE during their careers. However, in the past 5 years, only about 78% had engaged in such education, with participation decreasing by 2% for each additional year of practice. Male practitioners had significantly less continuing education in the past 5 years, particularly in private clinics, dental clinics with concession contracts, and certain regions. Practitioners who performed more endodontic treatments reported higher levels of continuing education. The endometer was the only modern technique consistently used by about 60% of practitioners with continuing dental education. CONCLUSION: Continuing education in endodontics should be more strongly promoted among practitioners with longer careers, particularly men.