Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Infection Related Inferior Alveolar Nerve Paresthesia in the Lower Premolar Teeth Thu, 11 Aug 2016 12:07:50 +0000 Introduction. The aim of this paper was to describe two cases of IAN infection-induced paresthesia and to discuss the most appropriate treatment solutions. Methods. For two patients, periapical lesions that induced IAN paresthesia were revealed. In the first case, the tooth was previously endodontically treated, whereas in the second case the lesion was due to pulp necrosis. Results. For the first patient, a progressive healing was observed only after the tooth extraction. In the second patient, the paresthesia had resolved after endodontic treatment. Conclusions. The endodontic-related paresthesia is a rare complication that can be the result of a combination of etiopathogenic mechanisms such as mechanical pressure on the nerve fibers due to the expanding infectious process and the production of microbial toxins. Paresthesia resulting from periapical lesions usually subsides through elimination of infection by root canal treatment. However, if there are no signs of enhancement, the immediate extraction of the tooth is the treatment of choice in order to prevent irreversible paresthesia because it was demonstrated that there is a correlation between the duration of mechanical or chemical irritation and the risk of permanent paresthesia. Rachele Censi, Virna Vavassori, Andrea Enrico Borgonovo, and Dino Re Copyright © 2016 Rachele Censi et al. All rights reserved. Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient Wed, 10 Aug 2016 07:53:18 +0000 A case report is presented which demonstrates the effectiveness of comprehensive orthodontic treatment combined with orthognathic surgery in the correction of malocclusion and reduction in the sequelae of Obstructive Sleep Apnea (OSA). The patient’s severe OSA was improved to very mild as evaluated by full overnight polysomnogram. The orthodontic treatment included the expansion of both dental arches and mandibular advancement surgery. There was significant improvement in the patient’s sleep continuity and architecture with the elimination of obstructive apneas. Gregory W. Jackson Copyright © 2016 Gregory W. Jackson. All rights reserved. A Novel Approach to Treat Traumatized Alveolar Ridges: Two Case Reports Tue, 09 Aug 2016 12:45:07 +0000 Functional forces are transmitted to the basal seat mucosa through a hard denture base during mastication. Such hard base dentures are not comfortably tolerated in patients with fragile oral mucosa and will cause sore spots, masticatory pain, and further resorption of alveolar bone. Soft liners materials can be advocated successfully to manage such clinical situations. The soft liner material absorbs masticatory forces by means of the cushioning effect and distributes occlusal forces uniformly to prevent trauma to compromised residual ridges. Mahesh Verma, Sneha Menghani, Jyoti Devi, Rekha Gupta, and Shubhra Gill Copyright © 2016 Mahesh Verma et al. All rights reserved. Replacement of Anterior Composite Resin Restorations Using Conservative Ceramics for Occlusal and Periodontal Rehabilitation: An 18-Month Clinical Follow-Up Sun, 31 Jul 2016 13:46:56 +0000 This case report describes a patient with discolored and fractured composite resin restorations on the anterior teeth in whom substitution was indicated. After wax-up and mock-up, the composite was removed and replaced with minimally invasive ceramic laminates. An established and predictable protocol was performed using resin cement. Minimally invasive ceramic restorations are increasingly being used to replace composite restorations. This treatment improves the occlusal and periodontal aspects during the planning and restorative phases, such as anterior guides, and laterality can be restored easily with ceramic laminates. In addition, the surface smoothness and contour of ceramic restorations do not affect the health of the surrounding periodontal tissues. Here we present the outcome after 18 months of clinical follow-up in a patient in whom composite resin restorations in the anterior teeth were replaced with minimally invasive ceramic laminates. Leonardo Fernandes da Cunha, Rayane Alexandra Prochnow, Adriana Osten Costacurta, Carla Castiglia Gonzaga, and Gisele Maria Correr Copyright © 2016 Leonardo Fernandes da Cunha et al. All rights reserved. The Use of an Alternative Extraoral Periapical Technique for Patients with Severe Gag Reflex Sun, 31 Jul 2016 07:59:33 +0000 Gag reflex is a physiologic mechanism that promotes contraction of the muscles of the tongue and pharyngeal walls. Different factors, including intraoral radiographic films and sensors, may trigger this reflex. Patients with severe gag reflex may not be able to tolerate the presence of intraoral radiographic films or sensors during root canal therapy (RCT). This factor may prevent an appropriate intraoral radiograph, which is important in RCT. Different approaches have been used to facilitate dental procedures in patients suffering from severe gag reflex. The use of an extraoral radiographic technique is an alternative method to obtain working length confirmation in patients with severe gag reflex. In this report of 2 cases, the use of an extraoral radiographic technique as an alternative approach during RCT in patients with severe gag reflex associated with phobic behavior and trismus was successfully demonstrated. Mauro Henrique Chagas e Silva, Marcelo Santos Coelho, Mariane Floriano Lopes Santos, Carolina Oliveira de Lima, and Celso Neiva Campos Copyright © 2016 Mauro Henrique Chagas e Silva et al. All rights reserved. Low Level Laser Therapy to Reduce Recurrent Oral Ulcers in Behçet’s Disease Sun, 31 Jul 2016 05:54:21 +0000 Behçet’s disease (BD) is a chronic, relapsing multisystemic vascular condition. Behçet’s disease was described by Hulusi Behçet in 1937. This rare multisystem relapsing-remitting inflammatory disease is poorly understood but is thought to be an autoimmune inflammatory vasculitic process in a genetically predisposed population. Diagnosis of Behçet’s disease is based on International Criteria of Behçet’s Disease (ICBD). The present paper describes a case report of Behçet’s syndrome where aphthous stomatitis was treated with low level laser therapy. D. B. Gandhi Babu, Sunanda Chavva, Shefali Waghray, Neeharika Satya Jyothi Allam, and Marella Kondaiah Copyright © 2016 D. B. Gandhi Babu et al. All rights reserved. Ectopic Premolar Tooth in the Sigmoid Notch Thu, 28 Jul 2016 16:36:45 +0000 Impaction of a mandibular premolar is relatively uncommon. Ectopic placement is more unusual and there has been no discussion in the literature of an ectopic mandibular premolar in the coronoid process. In this case report, we present an impacted ectopic mandibular permanent premolar in the sigmoid notch (incisura mandibulae) region. Etiology of the tooth and treatment options are discussed and illustrated by Cone Beam Computed Tomography (CBCT) images. K. Törenek, H. M. Akgül, and I. S. Bayrakdar Copyright © 2016 K. Törenek et al. All rights reserved. Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession Mon, 25 Jul 2016 14:11:00 +0000 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. Avita Rath, Smrithi Varma, and Renny Paul Copyright © 2016 Avita Rath et al. All rights reserved. Diagnosis and Management of a Patient with Congenitally Missing Maxillary First Permanent Molars: A Rare Case Report Mon, 25 Jul 2016 06:32:05 +0000 Congenitally missing teeth are the most commonly seen dental anomalies. Agenesis of the permanent first molar has the least frequency of all the tooth types, and it usually occurs in association with oligodontia or anodontia. Thus, agenesis of the bilateral maxillary first permanent molar is an extremely rare occurrence, and no such case has been reported in ethnic Saudi Arabian population. We hereby report a case of nonsyndromic bilateral congenitally missing maxillary first permanent molar in an eight-year-old Saudi female patient. Comprehensive oral rehabilitation was done for the patient. The implications of the tooth agenesis are also discussed. The prognosis of this case is presented. Megha Gupta, Suman Panda, Fahad Ahmed Mutawwam, and Fahad Musawi Mohammed Kariri Copyright © 2016 Megha Gupta et al. All rights reserved. Solitary Encapsulated Neurofibroma Not Associated with Neurofibromatosis-1 Affecting Tongue in a 73-Year-Old Female Wed, 20 Jul 2016 14:18:41 +0000 Neurofibromas are benign tumors of nerve cell origin arising due to proliferation of Schwann cells and fibroblasts. They are usually asymptomatic and hence remain undiagnosed. They are commonly found on the skin and intraorally tongue is the most common site for their occurrence. Here, we present a unique case of solitary encapsulated neurofibroma in the oral cavity without any clinical manifestations or family history of Neurofibromatosis type 1 in a 73-year-old female patient who presented with a painless swelling on the tongue. The histopathologic findings closely mimicked benign fibrous histiocytoma. In our case, definitive diagnosis of neurofibroma was made based on clinical findings, family history, and histopathological and immunohistochemical evaluation. Through this case report we want to emphasize the role of biopsy and immunohistochemistry in arriving at a confirmatory diagnosis. The patient was treated by surgical excision and showed no signs of recurrence over a follow-up period of 12 months. Sk. Abdul Mahmud, Neha Shah, Moumita Chattaraj, and Swagata Gayen Copyright © 2016 Sk. Abdul Mahmud et al. All rights reserved. Maxillofacial Changes in Melnick-Needles Syndrome Tue, 12 Jul 2016 13:08:33 +0000 Background. Melnick-Needles Syndrome is rare congenital hereditary skeletal dysplasia caused by mutations in the FLNA gene, which codifies the protein filamin A. This condition leads to serious skeletal abnormalities, including the stomatognathic region. Case Presentation. This paper describes the case of a 13-year-old girl diagnosed with Melnick-Needles Syndrome presenting with different forms of skeletal dysplasia, such as cranial hyperostosis, short upper limbs, bowed long bones, metaphyseal thickening, genu valgum (knock-knee), shortened distal phalanges, narrow pelvis and shoulders, rib tapering and irregularities, elongation of the vertebrae, kyphoscoliosis, micrognathia, hypoplastic coronoid processes of the mandible, left stylohyoid ligament suggesting ossification, and dental development anomalies. Conclusion. Knowledge of this rare syndrome on the part of dentists is important due to the fact that this condition involves severe abnormalities of the stomatognathic system that cause an impact on the development of the entire face as well as functional and esthetic impairments. Leilane Larissa Albuquerque do Nascimento, Monica da Consolação Canuto Salgueiro, Mariana Quintela, Victor Perez Teixeira, Ana Carolina Costa Mota, Camila Haddad Leal de Godoy, and Sandra Kalil Bussadori Copyright © 2016 Leilane Larissa Albuquerque do Nascimento et al. All rights reserved. Bilateral Postoperative Cyst after Maxillary Sinus Surgery: Report of a Case and Systematic Review of the Literature Mon, 11 Jul 2016 06:52:13 +0000 Purpose. We present a case of a bilateral postoperative maxillary cyst (PMC) and discuss this with a systemic review. Case Report and Literature Review. A 68-year-old female with pain and swelling on the right side of the face. MRI and CT showed a cystic tumors of the right and left maxillary sinus. Radical maxillary surgery via a Caldwell-Luc procedure had been performed 55 years ago and bilateral PMC was diagnosed. The PubMed database was searched for PMC within the last 30 years. Results. Together with the current case, we found 23 reports including 284 patients describing PMC. It was diagnosed at a mean time of 22 years after causal surgery at a mean age of 47 years. Initial symptoms were mostly pain with or without swelling. The main radiological sign was a unilocular radiolucency with a slight preference for the left side. Discussion. PMC is a long-term complication that can occur after maxillary sinus surgery and a second surgical approach is required in order to stop cystic expansion. Therefore, patients’ informed consent on this complication as well as a prolonged follow-up is recommended. Simple paranasal ultrasound or paranasal sinus plain radiography may lead to an earlier detection reducing interventional morbidity. Boris-Mark Niederquell, Peter A. Brennan, Michael Dau, Maximilian Moergel, Bernhard Frerich, and Peer Wolfgang Kämmerer Copyright © 2016 Boris-Mark Niederquell et al. All rights reserved. Lateralization Technique and Inferior Alveolar Nerve Transposition Tue, 28 Jun 2016 06:24:58 +0000 Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. Angélica Castro Pimentel, Marco Antonio Sanches, Gabriel Cardoso Ramalho, Caio Vinicius Roman-Torres, Marcello Roberto Manzi, and Wilson Roberto Sendyk Copyright © 2016 Angélica Castro Pimentel et al. All rights reserved. The Use of Invisalign® System in the Management of the Orthodontic Treatment before and after Class III Surgical Approach Mon, 27 Jun 2016 15:54:36 +0000 The approach to skeletal dysmorphisms in the maxillofacial area usually requires an orthodontic treatment by means of fixed appliances, both before and after the surgical phase. Since its introduction, Invisalign system has become a popular treatment choice for the clinicians because of the aesthetics and comfort of the removable clear aligners compared with the traditional appliances. Therefore, the aim of the present report was to illustrate the management of a malocclusion by means of Invisalign system associated with the traditional surgical technique. The present paper shows a case of a 23-year-old male patient characterized by a Class III malocclusion with lateral deviation of the mandible to the left side and cross-bite on teeth 2.2, 2.3, and 2.4. Invisalign system was used during the pre- and postsurgical phases rather than fixed appliances. The posttreatment cephalometric analysis emphasized the stability of the dental and skeletal symmetry corrections, occlusion and functional balance, over a 6-year follow-up. The results achieved at the end of the treatment showed how Invisalign can be effective in the management of the orthodontic phases in orthognathic surgery. The follow-up after 6 years emphasizes the stability of the treatment over time. Renato Pagani, Fabrizio Signorino, Pier Paolo Poli, Pietro Manzini, and Irene Panisi Copyright © 2016 Renato Pagani et al. All rights reserved. Removal of Deeply Impacted Mandibular Molars by Sagittal Split Osteotomy Mon, 27 Jun 2016 10:45:19 +0000 Mandibular third molars are the most common impacted teeth. Mandibular first and second molars do not share the same frequency of occurrence. In rare cases the occlusal surfaces of impacted molars are united by the same follicular space and the roots pointing in opposite direction; these are called kissing molars. In some cases, a supernumerary fourth molar can be seen as unerupted and, in this case, such a supernumerary, deeply impacted fourth molar is seen neighboring kissing molars. The extraction of deeply impacted wisdom molars from the mandible may necessitate excessive bone removal and it causes complications such as damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. This case report describes the use of the sagittal split osteotomy technique to avoid extensive bone removal and protect the inferior alveolar nerve during surgical extruction of multiple impacted teeth. Erol Cansiz, Sabri Cemil Isler, and B. Alper Gultekin Copyright © 2016 Erol Cansiz et al. All rights reserved. Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis Thu, 23 Jun 2016 10:31:36 +0000 Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases. Mina D. Fahmy, Paul G. Luepke, Mohamed S. Ibrahim, and Arndt Guentsch Copyright © 2016 Mina D. Fahmy et al. All rights reserved. Extremely Rare Form of Impaction Bilateral Kissing Molars: Report of a Case and Review of the Literature Wed, 15 Jun 2016 07:00:32 +0000 Kissing molars (KM) or rosette formation is a term that is used to describe impacted teeth contacting occlusal surfaces in a single follicular space and their roots pointing in opposite directions. In some cases kissing molars can be seen but occurrence of bilateral kissing molars is extremely rare phenomenon in the dental literature and the aetiology of this phenomenon is still unknown. In this paper we describe a case and review of the literature and discuss the management of this pathology. In our case, extremely rare form of impacted bilateral kissing molars was extracted surgically. The decision of extraction of asymptomatic kissing molars represents surgical dilemma. There may be many surgical complications; on the other hand in some cases surgical intervention is unavoidable. Few treatment options were described in the literature. This phenomenon can be sign of various medical conditions that may require further investigation. In this paper, our treatment option is in agreement with the literature suggesting the surgical removal of both teeth at either side of the mandible. Tamer Zerener, Gurkan Rasit Bayar, Hasan Ayberk Altug, and Serkan Kiran Copyright © 2016 Tamer Zerener et al. All rights reserved. A Review and Report of Peripheral Giant Cell Granuloma in a 4-Year-Old Child Wed, 15 Jun 2016 05:58:31 +0000 Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. It is often difficult to make a clinical diagnosis; thereby definitive diagnosis depends on histopathologic features. We report a case of a 4-year-old Caucasian boy presenting with a five-month history a 20 × 15 × 12 mm pedunculated, lobular soft tissue mass of the left anterior maxilla gingiva which was misdiagnosed and maltreated before his referral. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed distinctive features of peripheral giant cell granuloma. Early detection and excision of this hyperplastic nodule especially in children are important to minimize potential dentoalveolar complications. Afsaneh Nekouei, Alireza Eshghi, Parisa Jafarnejadi, and Zahra Enshaei Copyright © 2016 Afsaneh Nekouei et al. All rights reserved. Early Loaded Single Implant Reinforced Mandibular Overdenture Tue, 14 Jun 2016 11:55:44 +0000 Rehabilitating atrophied mandible with two-implant supported denture is a common treatment modality for implant retained removable overdenture in mandible. This paper aims to design a treatment modality where single implant reinforced overdenture is fabricated for a severely atrophied mandibular ridge with early loading protocol. Results of studies have shown that a single implant mandibular overdenture significantly increases the satisfaction and quality of life of patients with edentulism. Midline fracture of the prosthesis is the most common complication related to single implant and two-implant retained mandibular overdentures. To manage such complication, a thin metal mesh is used to reinforce the overdenture and also to make the prostheses lighter and cost effective as compared to conventional cast metal framework. K. Nischal and R. Chowdhary Copyright © 2016 K. Nischal and R. Chowdhary. All rights reserved. The Histopathological Spectrum of Pyogenic Granuloma: A Case Series Sun, 12 Jun 2016 08:15:44 +0000 Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i) cellular phase, (ii) capillary phase/vascular phase, and (iii) involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH) and non-lobular capillary hemangioma (non-LCH). Case Presentation. In this series, four cases (varied age groups and both genders) of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification. Vinay Marla, Ashish Shrestha, Khushboo Goel, and Sajeev Shrestha Copyright © 2016 Vinay Marla et al. All rights reserved. Cervical Necrotizing Fasciitis Caused by Dental Extraction Wed, 08 Jun 2016 08:48:14 +0000 Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections. José Alcides Arruda, Eugênia Figueiredo, Pâmella Álvares, Luciano Silva, Leorik Silva, Antônio Caubi, Marcia Silveira, and Ana Paula Sobral Copyright © 2016 José Alcides Arruda et al. All rights reserved. New Parameter for In-Office Dental Bleaching Tue, 07 Jun 2016 12:37:14 +0000 Dental bleaching is considered a conservative and biologically safe treatment for discolored teeth. Despite this, one of the major undesirable effects of bleaching is dentin sensitivity which may occur during and after treatment. To address these sensitivity issues, new dental bleaching preparations with lower concentrations of hydrogen peroxide (H2O2) have recently been introduced to the market. This paper presents a clinical case report of a 20-year-old female patient admitted to the Araraquara Dental School, UNESP, Brazil. The patient underwent dental bleaching using one of the new products with reduced hydrogen peroxide concentration, Lase Peroxide Lite 6%, a 6% H2O2 gel containing titanium oxide nanoparticles doped with nitrogen (6% H2O2/N-doped TiO2). Cristina Dupim Presoto, Janaina Freitas Bortolatto, Priscila Petrucelli Freire de Carvalho, Tamara Carolina Trevisan, Michael Christopher Floros, and Osmir Batista de Oliveira Junior Copyright © 2016 Cristina Dupim Presoto et al. All rights reserved. Blade of Grass as an Unusual Cause of Recurrent Facial Cutaneous Sinus Tract: A Clinical Case Wed, 01 Jun 2016 12:58:34 +0000 The presence of an embedded foreign body in the oral and maxillofacial region is not unusual, but the impaction of a foreign body with vegetative nature is rare. Prompt diagnosis and surgical removal of these foreign bodies will minimize their associated complications. This case report presents a patient with recurrent submandibular abscess and persistent facial cutaneous sinus tract caused by a retained blade of grass inside the facial soft tissue. The fact that the plain radiograph misdiagnosed the presence of a foreign body meant that the pathology persisted for about three months, and the patient underwent hospitalization, surgical procedures, and antibiotic regimens; however all of these failed until the foreign body was detected and removed. Conclusion. To avoid misdiagnosis of foreign body presence in the orofacial region, notably suspected foreign bodies with low radiopacity, the clinician must perform careful clinical examination and use the ultrasonography. Also, in the uncertain cases where the pathology persists, despite having undertaken surgical procedures and antibiotic regimens, the clinician should pay more attention to the patient’s history which may suggest the presence of the foreign body. Resmije Ademi-Abdyli, Feriall Perjuci, Teuta Bicaj, and Yll Abdyli Copyright © 2016 Resmije Ademi-Abdyli et al. All rights reserved. Facial Atrophy in Oral Submucous Fibrosis: An Association or a Coincidence Tue, 31 May 2016 11:27:40 +0000 The anecdotal clinical presentation of OSMF that includes vesicle formation, burning sensation, intolerance to hot and spicy food, and trismus due to circumoral fibrous bands has been ringing in our ears for decades but the current paper flags novelty by portraying a rare presentation of an advanced stage of OSMF. Sameep S. Shetty, Premalatha Shetty, and Amruta Ramgonda Chougule Copyright © 2016 Sameep S. Shetty et al. All rights reserved. Hypophosphatemic Rickets in Siblings: A Rare Case Report Tue, 31 May 2016 11:26:07 +0000 Hypophosphatemic rickets (HR) is a type of hereditary rickets characterized by persistent hypophosphatemia and hyperphosphaturia. The most predominant type is inherited in an X-linked fashion and caused by mutation in the gene encoding the phosphate-regulating endopeptidase homolog, X-linked (PHEX), identified in 1995. The X-linked hypophosphatemic (XLH) rickets is a rare hereditary metabolic disorder with a prevalence of 1 in 20,000 and causes deficient calcification of mineralized structures such as bones and teeth resulting in dental problems in terms of delayed eruption, spontaneous periapical infections, and exfoliation. We report one such unique case of hypophosphatemic vitamin D-resistant rickets in siblings exhibiting classical features of rickets with emphasis on its treatment and dental considerations. Gummadapu Sarat, Nuthalapati Priyanka, Meka Purna Venkata Prabhat, Chintamaneni Raja Lakshmi, Sujana Mulk Bhavana, and Dharmavaram Ayesha Thabusum Copyright © 2016 Gummadapu Sarat et al. All rights reserved. Recurrent Monostotic Fibrous Dysplasia in the Mandible Tue, 31 May 2016 10:24:33 +0000 Fibrous dysplasia (FD) is a condition in which normal bone marrow is replaced by an abnormal proliferation of new fibrous connective tissue. Female patient, white, 20 years old, attended the dental clinic reporting a slow increase in volume in the right mandible region over the last 5 years. She was examined by imaging: the panoramic X-ray revealed a lesion with the appearance of ground glass while the cone-beam computed tomography showed an extensive lesion in the region of the right hemimandible. The histopathological examination was compatible with fibrous dysplasia. Bone gammagraphy was indicated, plus an endocrinological study to eliminate polyostotic forms, which produced a negative result. Monostotic fibrous dysplasia in the right hemimandible was diagnosed. Conservative surgery was carried out and after 1 year recurrence of the tumour was observed. We may conclude that conservative surgery might not be the best choice for treatment for monostotic fibrous dysplasia in the mandible and that other options must be considered, such as radical surgery or the use of bisphosphonates. In our study, we may also conclude that it is very important to explain to the patient the possibility of recurrence of the lesion and the need for monitoring with periodic imaging studies. Nilton Alves, Reinaldo José de Oliveira, Denise Takehana, and Naira Figueiredo Deana Copyright © 2016 Nilton Alves et al. All rights reserved. Disseminated Intravascular Coagulation after Surgery for Facial Injury Mon, 30 May 2016 14:01:39 +0000 A case of disseminated intravascular coagulation (DIC) presenting after surgery for facial trauma associated with multiple facial bone fractures is described. With regard to the oral and maxillofacial region, DIC has been described in the literature following head trauma, infection, and metastatic disease. Until now, only 5 reports have described DIC after surgery for facial injury. DIC secondary to facial injury is thus rare. The patient in this case was young and had no medical history. Preoperative hemorrhage or postoperative septicemia may thus induce DIC. Hisashi Ozaki, Hirohiko Tachibana, Shigeo Ishikawa, Kazuyuki Yusa, Kenichirou Kitabatake, and Mitsuyoshi Iino Copyright © 2016 Hisashi Ozaki et al. All rights reserved. Spontaneous Eruption of Premolar Associated with a Dentigerous Cyst Mon, 30 May 2016 11:27:18 +0000 Dentigerous cyst (DC) is the second most common odontogenic cyst with greater incidence in young patients. It presents as a unilocular, asymptomatic radiolucency involving the crown of an impacted tooth, commonly noticed in X-rays to investigate absence, wrong tooth position, or delay in the chronology of eruption. Decompression/marsupialization (D/M) is the most implemented treatment, especially when preserving the tooth involved is advised. The aim of this study is to discuss the DC characteristics that contribute to spontaneous eruption of premolars, by reporting the case of a conservative treatment of DC. This eruption depends on factors such as age, angulation of inclusion, rate of root formation, depth of inclusion, and eruption space. This paper reports the case of a 10-year-old patient with a radiolucent lesion diagnosed as DC involving element 35, which erupted as a result of treatment. The patient was observed during 1 year and 6 months. Irla Karlinne Ferreira de Carvalho and Anibal Henrique Barbosa Luna Copyright © 2016 Irla Karlinne Ferreira de Carvalho and Anibal Henrique Barbosa Luna. All rights reserved. Radiographic Follow-Up during Orthodontic Treatment for Early Diagnosis of Sequential Supernumerary Teeth Tue, 24 May 2016 13:15:41 +0000 Most supernumerary teeth are impacted and asymptomatic. Objective. The aim of this paper is to describe two cases of sequential development of supernumerary teeth in the mandibular premolar region, identified during orthodontic treatment. Reports. The first case describes the radiographic follow-up of a female patient that presented a supernumerary tooth at the age of 9 years and 10 months in the right mandibular premolar region, followed by a further supernumerary tooth in the left mandibular premolar region identified at the age of 11 years and 3 months. In the second case, the radiographic follow-up of a male patient demonstrated 3 supernumerary teeth in the premolar region at the age of 16 years. During orthognathic surgery planning at the age of 20 years and 5 months, a supplemental supernumerary tooth was found in the left mandibular region. Conclusion. Considering the late developing of supernumerary premolars, appropriate follow-up with panoramic radiographs of patients with previous experience of supernumerary teeth is essential for early diagnosis of supplemental premolars to prevent possible complications. Selma Sano Suga, Paula de Castro Kruly, Talissa Mayer Garrido, Marise Sano Suga Matumoto, Uhana Seifert Guimarães Suga, and Raquel Sano Suga Terada Copyright © 2016 Selma Sano Suga et al. All rights reserved. Altered Apical Morphology (Reverse Architecture): Use of Indirect Ultrasonic Technique for Orthograde MTA Placement in Maxillary Premolars Tue, 24 May 2016 06:58:29 +0000 Aim. To report the management and orthograde technique of MTA placement in case of reverse architecture maxillary premolars. Summary. Two cases of 17-year-old and 21-year-old female patients were referred to endodontic speciality for management of maxillary premolar having reverse architecture with wide immature open apex like a bell mouth. In both the cases, after control of intraradicular infection, it was decided to use MTA for apexification and obturation of canals. Orthograde placement of MTA is a challenging procedure in terms of length control and condensation especially in divergent irregular reverse architecture wide open apex. A novel technique with the help of finger plugger, sterilized paper point, and ultrasonic agitation for 3D compaction of MTA at apical reverse architecture was used. Thickening of the canal wall and complete apical closure were confirmed one year after the treatment. Kapoor Sonali, Agrawal Vineet Suresh, Patel Abhishek, and Patel Jenish Copyright © 2016 Kapoor Sonali et al. All rights reserved.