MyMedR

Fulltext Camouflage of Severe Skeletal Class II Gummy Smile Patient Treated Nonsurgically with Mini Implants

Qamruddin I, Shahid F, Alam MK, Zehra Jamal W

Case Rep Dent, 2014;2014:382367.

PMID: 25548686 DOI: 10.1155/2014/382367

Skeletal class II has always been a challenge in orthodontics and often needs assistance of surgical orthodontics in nongrowing patients when it presents with severe discrepancy. Difficulty increases more when vertical dysplasia is also associated with sagittal discrepancy. The advent of mini implants in orthodontics has broadened the spectrum of camouflage treatment. This case report presents a 16-year-old nongrowing girl with severe class II because of retrognathic mandible, and anterior dentoalveolar protrusion sagittally and vertically resulted in severe overjet of 13 mm and excessive display of incisors and gums. Both maxillary central incisors were trimmed by dental practitioner few years back to reduce visibility. Treatment involved use of micro implant for retraction and intrusion of anterior maxillary dentoalveolar segment while lower incisors were proclined to obtain normal overjet, and overbite and pleasing soft tissue profile. Smile esthetics was further improved with composite restoration of incisal edges of both central incisors.

Fulltext Maturogenesis of an Immature Dens Evaginatus Nonvital Premolar with an Apically Placed Bioceramic Material (EndoSequence Root Repair Material®): An Unexpected Finding

Sockalingam SNMP, Awang Talip MSAA, Zakaria ASI

Case Rep Dent, 2018;2018:6535480.

PMID: 29977625 DOI: 10.1155/2018/6535480

Dens evaginatus is a dental developmental anomaly that arises due to the folding of the inner dental epithelium that leads to the formation of an additional cusp or tubercle on the occlusal surface of the affected tooth. This accessory tissue projection may carry with it a narrow and constricted pulp horn extension. Occasionally, the tubercle easily fractures, thus leading to microexposure of the pulp horn and eventual pulp necrosis. Often, the pulp necrosis occurs at a time the root development of the affected tooth is incomplete. Apexification with calcium hydroxide and mineral trioxide aggregates has been the mainstay of treatment options before root canal obturation in immature nonvital permanent teeth. Lately, regenerative endodontics (maturogenesis) is becoming one of the preferred treatment modalities to manage such teeth. The current case highlights the possibility of a bioceramic material (EndoSequence Root Repair Material, BC RRM-Fast Set Putty™, Brasseler, USA) which supposed to provide apical root closure (apexification) and could also induce continuation of root growth (maturogenesis).

Fulltext A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay

Ismail N, Hamzah SH, Wan Mokhtar I

Case Rep Dent, 2022;2022:5288515.

PMID: 35070457 DOI: 10.1155/2022/5288515

Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.

Fulltext Management of Edentulous Microstomia Patient: A Case Report and Classification System

Abbasi MS, Ahmed N, Irfan AB, Al-Saleh S, Abduljabbar T, Vohra F

Case Rep Dent, 2022;2022:2686983.

PMID: 35154831 DOI: 10.1155/2022/2686983

Microstomia is an abnormally reduced oral aperture. In the literature, it is not classified by any particular size criteria, rather defined by its effects on function and esthetics. Prosthodontic management of edentulous patients with microstomia is a challenging task. Use of conventional methods for recording an impression and fabricating prosthesis is not effective in such patients. To fabricate well-fitting prosthesis, accuracy of impression recording important anatomic landmarks is essential. Formation of an exacting custom tray and diagnostic cast is critical for final impression accuracy. Provision of a well-fitting prosthesis in microstomia patient will restore esthetics, comfort, and function with oral and systemic patient wellbeing. This paper presents a case report of managing an edentulous microstomia patient with sectional removable prosthesis. Furthermore, it proposes a novel classification system for microstomia patients according to severity of the condition.

Fulltext Endodontic Management of a Severely Dilacerated Mandibular Third Molar: Case Report and Clinical Considerations

Arora S, Gill GS, Setia P, Abdulla AM, Sivadas G, Vedam V

Case Rep Dent, 2018;2018:7594147.

PMID: 30402298 DOI: 10.1155/2018/7594147

This article aims at providing an insight to the clinical modifications required for the endodontic management of severely dilacerated mandibular third molar. A 35-year-old patient was referred for the root canal treatment of the mandibular left third molar. An intraoral periapical radiograph revealed a severe curvature in both the canals. A wide trapezoidal access was prepared following the use of intermediate-sized files for apical preparation. Owing to increased flexibility, Hero Shaper NITI files were used for the biomechanical preparation and single cone obturation was carried out. Third molars owing to their most posterior location-limited access coupled with a severe curvature pose utmost clinical challenges require meticulous skill, advanced technology, and patience to achieve success.

Fulltext Occurrence of Recurrent Aphthous Stomatitis (RAS) as a Rare Oral Manifestation in a Patient with Gilbert's Syndrome

Heboyan A, Avetisyan A, Skallevold HE, Rokaya D, Marla V, Vardanyan A

Case Rep Dent, 2021;2021:6648729.

PMID: 33953989 DOI: 10.1155/2021/6648729

Recurrent aphthous stomatitis is an ulcerative disease of the oral cavity and can occur in isolation or as a manifestation of many systemic diseases. It is a quite common entity and may hence often be overlooked as an isolated lesion. Gilbert's syndrome is a genetic disorder where a deficiency of an enzyme associated with the conjugation of bilirubin results in unconjugated hyperbilirubinemia. The disease is generally asymptomatic and is aggravated by certain trigger factors. No associated oral manifestations are known. In this case report, we discuss the concomitant presence of recurrent aphthous stomatitis in a patient of Gilbert's syndrome. The presence of such recurrent stomatitis may represent as an oral manifestation of Gilbert's syndrome. Early identification of these entities may improve the overall quality of life of the patient.

Fulltext Orthodontically Induced External Apical Root Resorption in Class II Malocclusion

Karnati PKR, Seth P, Zamzuri ATB, Tharwani P

Case Rep Dent, 2021;2021:8290429.

PMID: 34976417 DOI: 10.1155/2021/8290429

Orthodontic-induced external apical root resorption is one of the idiopathic phenomena as an effect, with force generated through mechanotherapy as the cause and the biological tissues with their diversified variations as witness. It is also classified as iatrogenic as a result of indeterminate application of orthodontic forces with subconscious appreciation of the existing underlying conditions. Numerous factors were identified to relate to this irreversible pathologic condition, but none were proven scientifically. Genetics and salivary markers have proved the reliability with time, but the application became insignificant limiting mostly to the research field. Different assessment methods were also identified to clinically diagnose it both subjectively and objectively. Mostly, it is identified through routine radiographic stage records like orthopantomogram or certain prediction radiographs for root resorption probability assessment like in this case. This case report discusses one such encounter which was experienced after stage 1 and 2 mechanics involving quite a few teeth. Considering the biotype of the individual and tooth morphology, the ongoing treatment was terminated and recovery measures were briefed to uplift the self-esteem of the individual. Furthermore, the prognosis is compromised to be very poor with unpredictability to any other treatment modalities.

Fulltext Cracked tooth: a report of two cases and role of cone beam computed tomography in diagnosis

Kalyan Chakravarthy PV, Telang LA, Nerali J, Telang A

Case Rep Dent, 2012;2012:525364.

PMID: 23198164 DOI: 10.1155/2012/525364

Cracked tooth is a distinct type of longitudinal tooth fracture which occurs very commonly and its diagnosis can be challenging. This type of fracture tends to grow and change over time. Clinical diagnosis is difficult because the signs and symptoms are variable or nonspecific and may even resemble post-treatment disease following root canal treatment or periodontal disease. This variety and unpredictability make the cracked tooth a challenging diagnostic entity. The use of cone beam computed tomography (CBCT) in diagnosis of complex endodontic cases has been well documented in the literature. In this paper we present two cases of cracked tooth and emphasise on the timely use of cone beam computed tomography as an aid in diagnosis and as a prognostic determinant.

Fulltext Fabricating CAD/CAM Implant-Retained Mandibular Bar Overdentures: A Clinical and Technical Overview

Goo CL, Tan KB

Case Rep Dent, 2017;2017:9373818.

PMID: 28396807 DOI: 10.1155/2017/9373818

This report describes the clinical and technical aspects in the oral rehabilitation of an edentulous patient with knife-edge ridge at the mandibular anterior edentulous region, using implant-retained overdentures. The application of computer-aided design and computer-aided manufacturing (CAD/CAM) in the fabrication of the overdenture framework simplifies the laboratory process of the implant prostheses. The Nobel Procera CAD/CAM System was utilised to produce a lightweight titanium overdenture bar with locator attachments. It is proposed that the digital workflow of CAD/CAM milled implant overdenture bar allows us to avoid numerous technical steps and possibility of casting errors involved in the conventional casting of such bars.

Fulltext An unusual case of tooth in the floor of the orbit: the libyan experience

Shetty YN, Majid IA, Patel RU, Shammam M

Case Rep Dent, 2012;2012:954789.

PMID: 23056963 DOI: 10.1155/2012/954789

Maxillary dentigerous cysts although uncommon need to be considered in the differential diagnosis in children with painless facial swelling. We present a case of dentigerous cyst associated with maxillary deciduous canine and maxillary premolars manifesting as a unilateral swelling in canine region of the face. A ten-year-old boy came to oral and maxillofacial surgery unit with a painless left facial swelling. The local dentist had prescribed antibiotics for treatment for the facial swelling, but the swelling did not subside, and the parents brought the child to our unit in Zliten Dental College. After clinical examination and imaging, the diagnosis of dentigerous cyst was made. Caldwell-Luc approach was done, the cyst was enucleated, and primary closure was done. The patient was followed up for a period of two years and there was no evidence of any recurrence.

Fulltext Dislodged Bonded Molar Tube into Wound during Orthognathic Surgery

Shaeran TAT, Samsudin AR

Case Rep Dent, 2018;2018:6540945.

PMID: 29971169 DOI: 10.1155/2018/6540945

Introduction: Dislodgement of orthodontic appliance into operation wounds may occur while performing orthognathic surgery. Its occurrence is commonly associated with bonded upper molar tube.

Case Report: A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure.

Conclusion: Dislodged metal orthodontic appliance in oral wound acts as a foreign body that may exert allergic reactions, infection, or inflammation. Pre- and postoperative intraoral examination of fixed orthodontic appliances including its count should be recorded in orthognathic surgery protocol.

Fulltext Stevens-Johnson Syndrome following Failure of Genetic Screening prior to Carbamazepine Prescription

Nasir SA, Tan HL, Tan HJ, Hussaini HM, Ramli R

Case Rep Dent, 2017;2017:4201357.

PMID: 28473929 DOI: 10.1155/2017/4201357

Failure to screen susceptible individuals for human leucocyte allele B∗1502 leads to the onset of Stevens-Johnson syndrome (SJS). We report a case of a 27-year-old Malay female who was treated with carbamazepine following the diagnosis of trigeminal neuralgia without a genetic screening. She was prescribed 150 mg of carbamazepine initially and the dose was increased to 300 mg following the initial dose. A sudden development of skin and mucous membrane ulcers was observed and this warranted immediate hospitalization. A diagnosis of SJS was made and she was treated immediately with intravenous corticosteroids. Genetic screening prior to carbamazepine prescription is essential especially in susceptible populations.

Fulltext Long-Term Follow-Up following Condylotomy in a Case of Traumatic Unilateral Anterosuperior Mandibular Condyle Dislocation

Nabil S, Kuppusamy E, Nordin R, Nazimi AJ, Ramli R

Case Rep Dent, 2019;2019:6810461.

PMID: 31218085 DOI: 10.1155/2019/6810461

Anterosuperior temporomandibular joint dislocation is rare. Manual reduction of such dislocation is difficult especially when treatment is delayed. Therefore, it has an increased likelihood of needing surgical intervention to achieve reduction. The authors report a case of an anterosuperior temporomandibular dislocation in a 19-year-old male following a motor vehicle accident. Difficulties were encountered in reducing the dislocation necessitating surgically assisted reduction. The long-term outcome following management by condylotomy is reported. This present report also reviews the literature regarding the classification and management of this uncommon dislocation.

Fulltext The Integration of a Dual-Wavelength Super Pulsed Diode Laser for Consistent Tissue Ablation in the Esthetic Zone: A Case Series

Kamar Affendi NH, Ahmad R, Vahidi F, Hassan MZ, Rahimi SN

Case Rep Dent, 2020;2020:8883156.

PMID: 33343944 DOI: 10.1155/2020/8883156

Introduction: A diode laser is one of the universally compact accepted laser systems used fundamentally for soft tissue applications. Most diode laser devices have a single wavelength of either 810 nm for superior coagulation or 980 nm for tissue ablation. In these case series, the use of dual wavelengths (810 nm and 980 nm) in combination with super pulsing has provided a cleaner cut (no charring) with faster healing that eases the placement of the final restoration in the esthetic zone. Case Description. The present case series describe four cases in the esthetic zone that achieved hemostasis ablation without collateral damage to enhance gingival balance of definitive restoration. The gingivoplasty and gingivectomy modes are used to achieve efficient tissue ablation. Although there is no specific mode indicated in the FDA laser requirement for gingival depigmentation, the procedure could be safely performed with the dual-wavelength diode laser.

Result: All four patients revealed a good esthetic outcome and reported no pain postoperatively. Healing was uneventful, and definitive restoration was delivered within two to four weeks postoperatively.

Conclusion: Within the limitation of these case series, the dual-wavelength super pulsed diode laser has the capacity to deliver peak powers resulting in efficient cutting and less tissue charring and also as an alternative tool for removal of gingival pigmentation. Prospective clinical research with larger sample size is needed for conclusive results.

Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession

Rath A, Varma S, Paul R

Case Rep Dent, 2016;2016:9289634.

PMID: 27525131 DOI: 10.1155/2016/9289634

Introduction. Gingival recession is an apical shift of the gingival margin with exposure of the root surface. This migration of the marginal tissue leads to esthetic concerns, dentin hypersensitivity, root caries, and cervical wear. It is, paradoxically, a common finding in patients with a high standard of oral hygiene, as well as in periodontally untreated populations with poor oral hygiene. Changing the topography of the marginal soft tissue in order to facilitate plaque control is a common indication for root coverage procedures and forms a major aspect of periodontal plastic surgeries. The regeneration of a new connective tissue attachment to denuded root surface is by allowing the selective coronal regrowth of periodontal ligament cells while excluding the gingival tissues from the root during wound healing by means of a barrier membrane. Case Presentation. This case reports a two-stage surgical technique for treatment of Miller's class III defect using free gingival autograft and type I absorbable collagen membrane (BioMend®, Zimmer Dental, USA)(§). Conclusions. The 6-month follow-up of the case showed a significant increase in attached gingiva suggesting it as a predictable alternative in the treatment of Millers class III defects.

Fulltext Simple Orthodontic Correction of Rotated Malpositioned Teeth Using Sectional Wire and 2 × 4 Orthodontic Appliances in Mixed-Dentition: A Report of Two Cases

Sockalingam SNMP, Zakaria ASI, Khan KAM, Azmi FM, Noor NM

Case Rep Dent, 2020;2020:6972196.

PMID: 32695527 DOI: 10.1155/2020/6972196

The correction of rotated malpositioned tooth/teeth into the dental arch alignment in the mixed-dentition is often a challenging task for paediatric dentists. Failure in addressing this issue can bring about detrimental effect to the developing dentition and increases the probability of a complex orthodontic treatment in later years. Factors such as severity of the malpositioned teeth, patient's treatment compliance, limitation in specific functions of the selected appliance, availability of bone and space may dictate the success of the treatment. The combined use of a simple sectional orthodontic wire appliance and a 2 × 4 orthodontic appliance has been shown to produce a positive effect. The appliances resulted in derotation of the rotated malpositioned teeth and bringing them into arch alignment in two cases. This treatment option had eliminated the detrimental effects to the developing dentition and helped patients to enhance their smile and dental aesthetics.

Implant-Retained Obturator for an Edentulous Patient with a Hemimaxillectomy Defect Complicated with Microstomia

Patil PG, Nimbalkar-Patil S

Case Rep Dent, 2016;2016:4618510.

PMID: 27843652

Patient. A 68-year-old man was operated on for squamous cell carcinoma (T3N3M0) of the maxilla creating the hemimaxillary surgical defect on right side. The remaining arch was completely edentulous. There was remarkable limitation in the oral opening with reduced perimeter of the oral cavity due to radiation and surgical scar contracture. This article describes prosthetic rehabilitation by modifying the design of the obturator and achieving the retention with dental implant. Discussion. Severe limitation in the oral opening may occur in clinical situations following the postsurgical management of oral and maxillofacial defects. The prosthetic rehabilitation of the surgical defect in such patients becomes a challenging task due to limited access to the oral cavity. This challenge becomes even more difficult if the patient is edentulous and there are no teeth to gain the retention, stability, and support. Conclusion. In severe microstomia prosthesis insertion and removal can be achieved with modification of the maximum width of the prosthesis. Dental implant retention is useful treatment option in edentulous patients with maxillary surgical defect provided that sufficient bone volume and accessibility are there for implant placement.

Fulltext Cosmetic "Gold Thread Therapy": A Nuisance That Decreases the Diagnostic Quality of a Dental Panoramic Image

Ching ME, Joan LZY, Nambiar P

Case Rep Dent, 2021;2021:4077930.

PMID: 34777877 DOI: 10.1155/2021/4077930

During routine imaging of the craniofacial region, it is recognised that some "cosmetic" procedures with metallic insertions can be revealed radiographically. These objects however make it difficult to obtain a good interpretation of anatomical structures for management of diseases. A 58-year-old female patient visited a private dental facility in Kuala Lumpur for prosthodontic replacement of missing teeth. The dental panoramic image revealed generalized bone loss and numerous unusual multiple thread-like radioopacities. These gold threads made radiographic evaluation difficult and complicated the process of treatment planning for dental implant placement advocated for this patient.

Fulltext Facial Emphysema following Closure of Oroantral Fistulae

Nizar MAM, Nabil S

Case Rep Dent, 2021;2021:5001266.

PMID: 34394997 DOI: 10.1155/2021/5001266

Subcutaneous emphysema (SE) is a swelling which develops due to air entrapped underneath the subcutaneous tissue and facial planes causing distention of the overlying skin. SE can develop due to trauma, surgery, or infection. The diagnosis of SE is mostly based on clinical findings of crepitation upon palpation of the swelling. Once diagnosed, SE is usually managed by close observation and in some cases may require surgical decompression and antibiotic prophylaxis. We report a rare case of SE of the left malar which developed following closure of oroantral communication using the buccal fat pad.

Fulltext Treatment of Extensively Comminuted Mandibular Fracture with the Aid of a Condylar Positioning Device

Nazimi AJ, Ezulia T, Rajaran JR, Mohd Yunus SS, Nabil S

Case Rep Dent, 2017;2017:2732907.

PMID: 29391956 DOI: 10.1155/2017/2732907

We describe a case of extensively comminuted mandibular fracture that extends bilaterally to the angle of mandible successfully treated with the use of condylar positioning device (CPD). This simple, yet effective, technique that almost exclusively described in orthognathic surgery is useful when advance surgical techniques such as pre- or intraoperative landmark identification may not be readily available. CPD technique optimizes the manual manipulations of the comminuted distal segments during fracture reduction and internal fixation. At the same time, it allows greater control of the proximal segments to avoid further surgical complication.

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