Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Management of a Periodontal Pocket Using a Removable Orthodontic Appliance and Nonsurgical Periodontal Therapy Thu, 03 Sep 2015 16:59:51 +0000 Purpose. As documented in the literature, bony defects can be managed by an orthodontic approach. Methods. This case report describes the treatment of a bony defect caused by orthodontic malposition through phase I periodontal therapy and a simple removable orthodontic appliance used for the first time in a 20-year-old girl. Results. The periodontal pocket was reduced from 8 mm to 3 mm shortly after treatment. Conclusion. This case report concludes that orthodontic therapy can be used successfully in treatment of bony defects caused by mesially tilted molars. Serhat Köseoğlu, Ahmet Fidancıoğlu, Mehmet Sağlam, and Levent Savran Copyright © 2015 Serhat Köseoğlu et al. All rights reserved. Solitary Peripheral Osteoma of the Angle of the Mandible Tue, 01 Sep 2015 13:28:11 +0000 Solitary peripheral osteoma is a benign, slow-growing osteogenic tumor arising from craniofacial bones such as the sinus, temporal, or jaw bones but rarely originating from the mandible. Osteoma consists of compact or cancellous bone that may be of peripheral, central, or extraskeletal type. Peripheral osteoma arises from the periosteum and is commonly a unilateral, pedunculated mushroom-like mass. Solitary peripheral osteomas are characterized by well-defined, rounded, or oval radiopaque mass in the computed tomography. Although multiple osteomas of the jaws are a hallmark of Gardner’s syndrome (familial adenomatous polyposis), nonsyndromic cases are typically solitary. Herein, we report a rare case of solitary peripheral osteoma of the angle of the mandible in a 27-year-old female with clinical, radiologic, and histopathologic findings. Kapil Kshirsagar, Kalyani Bhate, Vivek Pawar, S. N. SanthoshKumar, Supriya Kheur, and Shrikant Dusane Copyright © 2015 Kapil Kshirsagar et al. All rights reserved. Riga-Fede Disease Associated with Natal Teeth: Two Different Approaches in the Same Case Tue, 01 Sep 2015 11:25:22 +0000 Natal teeth are those present in the oral cavity at the child’s birth. These teeth can cause ulcers on the ventral surface of the tongue, lip, and the mother’s breast characterizing the Riga-Fede Disease. The treatment depends on the tooth’s mobility and the risk of aspiration or swallowing; whether it is supernumerary or regular primary teeth; whether it is causing interference in breastfeeding; breast and oral soft tissue injuries; and the general state of child’s health. A 1-month-old female infant was diagnosed with two natal teeth and an ulcerated lesion on the ventral surface of the tongue, leading to the clinical diagnosis of Riga-Fede Disease. The treatment performed consisted of the maintenance of the natal tooth that showed no increased mobility, adding a small increment of glass ionomer cement to its incisal edge, and orientation for hygiene with saline solution. Due to the increased mobility of the other natal tooth, surgical removal was performed. There was regular monitoring of the patient and complete wound healing was observed after 15 days. The proposed treatment was successful and the patient is still in follow-up without recurrence of the lesion after one year. Luiz Evaristo Ricci Volpato, Cintia Aparecida Damo Simões, Flávio Simões, Priscila Alves Nespolo, and Álvaro Henrique Borges Copyright © 2015 Luiz Evaristo Ricci Volpato et al. All rights reserved. Soft Tissue Reconstruction with Free Gingival Graft Technique following Excision of a Fibroma Tue, 18 Aug 2015 10:57:47 +0000 Background. Oral fibromas are benign, asymptomatic, smooth surfaced, firm structured tumoral lesions that originate from gingival connective tissue or periodontal ligament. Histologically, they are nodular masses characterized by a dense connective tissue, surrounded by stratified squamous epithelium. Case Report. This case report includes the clinical, radiographical, and histological findings and periodontal treatment of a 38-year-old female patient having painless swelling on the gingiva. Intraoral examination revealed a fibrotic, sessile, smooth surfaced gingival overgrowth interdentally between the teeth #13 and #14. Radiographical findings were normal. Initial periodontal treatment (IPT) was applied including oral hygiene instructions, scaling, and root planing. Following IPT, the lesion (0.7 × 0.6 × 0.4 cm) was excised and examined histopathologically. Subsequently, flap operation was performed to have an access to alveolar bone. Surgical site was reconstructed with free gingival graft obtained from hard palate. Hematoxylin-eosin stained sections revealed a nodular mass composed by dense collagen fibers in lamina propria covered by a stratified squamous epithelium, which were consistent with fibroma. Gingival healing was uneventful and without any recurrence during the 12-month follow-up. Conclusions. In order to achieve optimal functional and aesthetical outcomes, free gingival graft can be used for the reconstruction of the wound site after the excision of the fibroma. Nurcan Tezci, Suleyman Emre Meseli, Burcu Karaduman, Serap Dogan, and Sabri Hasan Meric Copyright © 2015 Nurcan Tezci et al. All rights reserved. A Rare Case of a Lost Suture Needle during Third Molar Surgery Wed, 12 Aug 2015 08:28:18 +0000 The authors report a case that is started with a simple upper third molar’s surgical extraction and a broken 3.0 suture needle tip incident occurred. Broken fragment’s localization has been detected with 3D cone beam computed tomography (CBCT). Needle tip has been reached with the help of CBCT vision. CBCT’s benefits have been discussed on these types of cases and further migration of the needle tip during surgical procedure is reported. Sertac Aktop, Gokhan Gocmen, M. Elif Özturk, Onur Gonul, and Altan Varol Copyright © 2015 Sertac Aktop et al. All rights reserved. Temporary Mental Nerve Paresthesia Originating from Periapical Infection Thu, 06 Aug 2015 06:28:51 +0000 Many systemic and local factors can cause paresthesia, and it is rarely caused by infections of dental origin. This report presents a case of mental nerve paresthesia caused by endodontic infection of a mandibular left second premolar. Resolution of the paresthesia began two weeks after conventional root canal treatment associated with antibiotic therapy and was completed in eight weeks. One year follow-up radiograph indicated complete healing of the radiolucent periapical lesion. The tooth was asymptomatic and functional. Ozgur Genc Sen and Volkan Kaplan Copyright © 2015 Ozgur Genc Sen and Volkan Kaplan. All rights reserved. When the Midline Diastema Is Not Characteristic of the “Ugly Duckling” Stage Wed, 05 Aug 2015 13:11:43 +0000 This case report presents the interceptive orthodontic treatment of a 9-year, 5-month-old boy with class I malocclusion, a 9.0-mm maxillary midline diastema, and deviation from the midline. The treatment goals were to decrease the magnitude of the diastema and to simulate the characteristics of the “ugly duckling” stage. Braces were placed on the first molars and the maxillary central incisors. The biomechanics of the anchors on the first molars elicited substantial mesial movement of the left central incisor to match the midline. A flat wire segment was bonded onto the palatal surface of the central incisors for retention. Orlando Motohiro Tanaka, Alessandro Yuske Kusano Morino, Oscar Fernando Machuca, and Neblyssa Ágatha Schneider Copyright © 2015 Orlando Motohiro Tanaka et al. All rights reserved. CT Imaging of Craniofacial Fibrous Dysplasia Mon, 03 Aug 2015 11:44:13 +0000 Fibrous dysplasia is a benign fibroosseous bone dysplasia that can involve single (monostotic) or multiple (polyostotic) bones. Monostotic form is more frequent in the jaws. It is termed as craniofacial fibrous dysplasia, when it involves, though rarely, adjacent craniofacial bones. A 16-year-old girl consulted for a painless swelling in the right posterior mandible for two years. Panoramic radiography revealed ground-glass ill-defined lesions in the three different regions of the maxilla and mandible. Axial CT scan (bone window) showed multiple lesions involving skull base and facial bones. Despite lesions in the skull base, the patient had no abnormal neurological findings. The lesion was diagnosed as fibrous dysplasia based on radiological and histopathological examination. In this paper, CT findings and differential diagnosis of CFD are discussed. CT is a useful imaging technique for CFD cases. Zerrin Unal Erzurumlu, Peruze Celenk, Emel Bulut, and Yakup Sancar Barıs Copyright © 2015 Zerrin Unal Erzurumlu et al. All rights reserved. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries Mon, 03 Aug 2015 07:37:34 +0000 The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case. Yeliz Guven, Sevgi Zorlu, Abdulkadir Burak Cankaya, Oya Aktoren, and Koray Gencay Copyright © 2015 Yeliz Guven et al. All rights reserved. Canine Gouging: A Taboo Resurfacing in Migrant Urban Population Tue, 21 Jul 2015 07:44:29 +0000 Cosmopolitan cities have become a pool of migrants from different parts of the world, who carry their cultural beliefs and superstitions with them around the globe. Canine gouging is a kind of infant oral mutilation (IOM) which is widely practiced among rural population of Africa where the primary tooth bud of the deciduous canine is enucleated. The belief is that the life threatening illnesses in children like vomiting, diarrhoea, and fevers are caused by worms which infest on tooth buds. This case report is of a 15-year-old Somalian born boy, who presented at the dental institute with intermittent pain in his lower right permanent canine which was associated with a discharging intra oral buccal sinus. The tooth was endodontically treated and then restored with composite. General dental practitioners need to be vigilant when encountered with tooth presenting unusual morphology, unilateral missing tooth, and shift in the midline due to early loss of deciduous/permanent canines. Identification of any such dental mutilation practice will need further counselling of the individual and family members. It is the duty of every dental professional to educate and safeguard the oral and dental health of general public. Anila Virani Noman, Ferranti Wong, and Ravikiran Ramakrishna Pawar Copyright © 2015 Anila Virani Noman et al. All rights reserved. Oral Manifestations of Crohn’s Disease: A Case Report and Review of the Literature Thu, 09 Jul 2015 13:38:37 +0000 Crohn’s disease (CD) is an inflammatory disorder of the gastrointestinal tract that is likely caused by an inappropriate mucosal inflammatory response to intestinal bacteria in a genetically predisposed host. The lesions of CD can involve any region of the GI tract as well as extraintestinal sites such as the skin, joints, and eyes. The most common presenting symptoms are abdominal pain and prolonged diarrhea associated with fevers, fatigue, and malaise. Delayed growth and failure to thrive may also be observed in pediatric patients. Oral manifestations of CD are known as oral CD and may precede GI involvement, thus serving as early markers of this condition. We describe a 6-year-old male who presented with oral lesions as his initial manifestation of disease and review the current literature pertaining to oral CD. Victoria L. Woo Copyright © 2015 Victoria L. Woo. All rights reserved. Gingival Cyst of the Adult as Early Sequela of Connective Tissue Grafting Mon, 06 Jul 2015 10:28:57 +0000 The subepithelial connective tissue graft (SCTG) is a highly predictable procedure with low complication rate. The reported early complications consist of typical postsurgical sequelae, such as pain and swelling. This case report describes the development and management of a gingival cyst following SCTG to obtain root coverage. Three weeks after SCTG procedure, a slightly raised, indurated, ~5 mm diameter asymptomatic lesion was evident. Excisional biopsy was performed and the histopathological evaluation confirmed the gingival cyst diagnosis. At the 1-year follow-up, the site had complete root coverage and normal tissue appearance and the patient remained asymptomatic. Mariana Gil Escalante and Dimitris N. Tatakis Copyright © 2015 Mariana Gil Escalante and Dimitris N. Tatakis. All rights reserved. Full Mouth Reconstruction of a Bruxer with Severely Worn Dentition: A Clinical Report Wed, 01 Jul 2015 12:05:02 +0000 Tooth wear is attributed to several factors many of which often remain unidentified. Management of tooth wear is challenging in preventive and restorative dentistry. Correct assessment of occlusal vertical dimension, interocclusal rest space, and centric relation records are critical for successful treatment. In order to evaluate different treatment modalities and select the treatment of choice some information can be obtained from study casts and diagnostic wax-up. In order to achieve a predictable and desirable result, a systematic approach may be helpful. This paper describes the full mouth rehabilitation of a 36-year-old bruxer with severely worn dentition and other dental problems such as unfavorable restorations. A diagnostic work-up was performed and provisional restorations were made; then, they were clinically evaluated and adjusted based on the criteria dictating esthetics, phonetics, and vertical dimension. After endodontic therapy, clinical crown lengthening was performed. Two short implants were inserted in the posterior mandible. Custom-cast dowel cores and metal-ceramic restorations were fabricated and a full occlusal splint was used to protect the restorations. We ensured stable contacts on all teeth with equal intensity in centric relation and anterior guidance in accord with functional jaw movements. Somayeh Zeighami, Hakimeh Siadat, and Sakineh Nikzad Copyright © 2015 Somayeh Zeighami et al. All rights reserved. Facial Swelling as a Primary Manifestation of Multiple Myeloma Wed, 01 Jul 2015 09:00:53 +0000 Facial swellings are commonly encountered in the dental office, the cause of which could range from a congenital etiology to an acquired one or it may even be a manifestation of an underlying systemic disease. The clinician must have a thorough knowledge of the various clinical and imaging manifestations and the sites of occurrence of the various conditions to arrive at the appropriate diagnosis. Facial swellings can be classified into different groups which include acute swellings with inflammation, nonprogressive swellings, and slowly or rapidly progressive swellings. The various imaging modalities like CT and MRI are useful for assessing the extent of the swelling as well as evaluating the soft tissue and osseous involvement of the swelling. Multiple myeloma represents clonal proliferation of plasma cells and is a condition in which a facial swelling might be present, though not common. This paper reports a case of a patient with a unilateral facial swelling, which on investigation led to a diagnosis of multiple myeloma. Anju E. Thomas, Seema Kurup, Renju Jose, and Cristalle Soman Copyright © 2015 Anju E. Thomas et al. All rights reserved. Neurilemmoma of Retromolar Region in the Oral Cavity Mon, 29 Jun 2015 09:24:25 +0000 Neurilemmoma also known as schwannoma is benign nerve sheath tumor rarely occurring in the oral cavity. Only 1% of all extracranial schwannomas show that intraoral occurrence with tongue is the commonest site and retromolar region is the least common site. It presents as encapsulated, slow growing, solitary, smooth-surfaced, usually asymptomatic tumor. We report a case of 70-year-old male with well-defined mass on left retromolar region which was painless and slow growing. Diagnosis is made by histological examination and immunohistochemistry analysis to confirm the neural tissue origin of the lesion. The treatment is complete surgical excision of the lesion without recurrence. Ajit Singh Rathore, Deepti Srivastava, Nidhi Narwal, and Devi Charan Shetty Copyright © 2015 Ajit Singh Rathore et al. All rights reserved. Surgical Management of Compound Odontoma Associated with Unerupted Tooth Thu, 25 Jun 2015 12:02:15 +0000 Odontomas represent the most common type of odontogenic benign jaws tumors among patients younger than 20 years of age. These tumors are composed of enamel, dentine, cementum, and pulp tissue. According to the World Health Organization classification, two distinct types of odontomas are acknowledged: complex and compound odontoma. In complex odontomas, all dental tissues are formed, but appeared without an organized structure. In compound odontomas, all dental tissues are arranged in numerous tooth-like structures known as denticles. Compound odontomas are often associated with impacted adjacent permanent teeth and their surgical removal represents the best therapeutic option. A case of a 20-year-old male patient with a compound odontoma-associated of impacted maxillary canine is presented. A minimally invasive surgical technique is adopted to remove the least amount of bone tissue as far as possible. Andrea Pacifici, Daniele Carbone, Roberta Marini, and Luciano Pacifici Copyright © 2015 Andrea Pacifici et al. All rights reserved. A Technique for Removing Implant-Retained Denture: Direct Relining Complication Tue, 23 Jun 2015 12:40:39 +0000 The aim of this case report is to present a technique for removing the denture which locked to ball-attachment because of excessive hard relining resin material flows around the ball-attachment. An alternative method was used in the present case. A cylindrical resin was removed with a diamond bur at the level of matrix and by this way the matrix was removed safely. The advantage of the presented method is that it may be extended to other clinical situations when facing a similar complication for implant supported dentures and also that the technique is simple and does not require special equipment. İbrahim Duran, Betül Yilmaz, and Çağrı Ural Copyright © 2015 İbrahim Duran et al. All rights reserved. The Enigma behind Pituitary and Sella Turcica Tue, 23 Jun 2015 11:10:49 +0000 The pituitary gland’s role as a functional matrix for sella turcica has not been suggested in orthodontic literature. This paper is an attempt to correlate the role of pituitary gland in the development of sella turcica. A case report of dwarfism associated with hypopituitarism is presented to highlight the above hypothesis. Umarevathi Gopalakrishnan, Lodd Mahendra, Sumanth Rangarajan, Ramasamy Madasamy, and Mohammad Ibrahim Copyright © 2015 Umarevathi Gopalakrishnan et al. All rights reserved. Apexification of an Immature Permanent Incisor with the Use of Calcium Hydroxide: 16-Year Follow-Up of a Case Thu, 11 Jun 2015 06:12:59 +0000 Apexification is a process of forming a mineralized apical barrier and had been performed by using calcium hydroxide paste, due to its biological and healing performances in cases of existent trauma. This clinical report aims to report the results of a 16-year follow-up study of an apexification treatment applied to nonvital tooth 22 of a healthy 8-year-old male after a trauma. Clinical inspection of the tooth showed fractures of the incisal edge and mesial angle, absence of coronal mobility, and negative pulp vitality under cold testing. Radiographic analysis of the root revealed incomplete apex formation. The possibility of fracture into the root or luxation injury was rejected, and the diagnosis of pulp necrosis was verified. Apexification by calcium hydroxide and subsequent endodontic treatment were planned. Initial formation of the mineralized apical barrier was observed after 3 months, and the barrier was considered to be completed after 8 months. Clinical, radiographic, and CBCT examinations after 16 years verified the success of the treatment, although the choice of calcium hydroxide for apexification treatment is discussed. Camila Maggi Maia Silveira, Cátia Cilene Nass Sebrão, Larissa Soares Reis Vilanova, and Alfonso Sánchez-Ayala Copyright © 2015 Camila Maggi Maia Silveira et al. All rights reserved. Extensive Epidermoid Cyst and Breathing Difficulty Tue, 09 Jun 2015 07:58:07 +0000 Epidermoid cysts are common cystic lesions in the skin, ovaries, and testicles, but their occurrence in the oral cavity is uncommon. They consist of cysts delimited by a fibrous capsule without cutaneous annexes and are lined by stratified squamous epithelium. The differential diagnosis includes ranula, dermoid cysts, and lingual thyroid. Despite their benign presentation, these cysts can cause functional limitations, requiring special clinical attention for extensive lesions located in regions that preserve vital structures. This paper aims to report a case of epidermoid cyst in patient with swallowing and breathing difficulty, highlighting the clinical and surgical planning. Ciro Dantas Soares, Alberto Costa Gurgel, Francisco de Assis de Souza Júnior, Samila Neres de Oliveira, Maria Goretti Freire de Carvalho, and Hanieri Gustavo Oliveira Copyright © 2015 Ciro Dantas Soares et al. All rights reserved. Multidisciplinary Management of Complicated Crown-Root Fracture of an Anterior Tooth Undergoing Apexification Thu, 04 Jun 2015 08:18:18 +0000 The purpose of this case report was to present the multidisciplinary management of a subgingival crown-root fracture of a patient undergoing apexification treatment. A 12-year-old male patient was referred to the pediatric dentistry clinic with an extensive tooth fracture of the right permanent maxillary lateral incisor. Clinical and radiographic examinations revealed the presence of a complicated crown-root fracture, which had elongated to the buccal subgingival area. The dental history disclosed that the apexification procedure had been started to be performed after his first trauma experience and he had neglected his appointment. The coronal fragment was gently extracted; endodontic treatment was performed; flap surgery was performed to make the fracture line visible. The coronal fragment was reattached to the root fragment with a dual-cure luting composite. A fiber post was stabilized and the access cavity of the tooth was restored with composite resin. At the end of the 24th month, the tooth was asymptomatic, functionally, esthetically acceptable and had no periapical pathology. It is important for the patients undergoing apexification treatment to keep their appointments because of the fracture risk. Restoration of the fractured tooth by preparing retention grooves and a bonding fiber-reinforced post are effective and necessary approaches for successful management. Merve Mese, Merve Akcay, Bilal Yasa, and Huseyin Akcay Copyright © 2015 Merve Mese et al. All rights reserved. Telescopic Overdenture and Implant Supported Fixed Partial Denture: A Pragmatic Treatment Approach Wed, 27 May 2015 10:42:07 +0000 This case report presents a patient who had been rehabilitated with a telescopic overdenture and implant supported fixed partial denture (ISFPD). The treatment process was as follows: (1) fabricating telescopic crowns and overdenture prosthesis for the lower jaw and a temporary complete denture for the upper jaw, (2) using the temporary denture as diagnostic and surgical guide to optimize dental implant placement, and (3) fabricating ISFPD for the upper jaw. Using the patient’s existing or temporary denture not only serves as an alternative surgical guide to calibrate the dental implant locations but also helps to finish the restoration at desired dimension, size, and anatomic form. Doğu Ömür Dede, M. Cenk Durmuşlar, Onur Şahın, Ayşegül Köroğlu, and Özer İşısağ Copyright © 2015 Doğu Ömür Dede et al. All rights reserved. Unusual Bilateral Paramolars Associated with Clinical Complications Thu, 21 May 2015 16:01:22 +0000 Paramolars are rare supernumerary structures of maxillofacial complex that occur buccally or lingually near the molar row. Predominantly these occur singly; bilateral presentation is very rare. This paper reports two unusual bilateral presentations of paramolars with clinical complication and its management. One of the cases in the present paper also documents the cooccurrence of bilateral paramolars and microdontia of single tooth and one of its paramolars presented with multilobed crown with an anomalous buccal tubercle. A. N. Sulabha and C. Sameer Copyright © 2015 A. N. Sulabha and C. Sameer. All rights reserved. Multiple Geminated Supernumerary Premolars: A Rare Case Report Wed, 20 May 2015 09:58:52 +0000 Supernumerary teeth may be defined as any teeth or tooth substance in excess of the usual configuration of 20 deciduous and 32 permanent teeth. Gemination is defined as an attempt by a single tooth bud to divide, with a resultant formation of either a large tooth with a bifid crown or two completely divided teeth throughout the crown and root. Geminated supernumerary premolar is a rarity and the possibility of multiple occurrences is even rarer. An exhaustive review of English literature and a PubMed search conducted using the terms “gemination’’ and “multiple geminated supernumerary” revealed no case of multiple geminated supernumerary premolars. We report a case of multiple geminated supernumerary premolars in a 23-year-old male. Atul Soin, Gaurav Sharma, Gayatri Soin, Anudeep Raina, Puneet Mutneja, and Archna Nagpal Copyright © 2015 Atul Soin et al. All rights reserved. Coronal Pulpotomy Technique Analysis as an Alternative to Pulpectomy for Preserving the Tooth Vitality, in the Context of Tissue Regeneration: A Correlated Clinical Study across 4 Adult Permanent Molars Sun, 17 May 2015 13:15:02 +0000 Aim. (1) The aim of the clinical study revolves around the accurate diagnosis, proper case selection, and the management of acute irreversible pulpitis in permanent molars with closed apices using conservative and economical treatment modalities like vital pulpotomies with regenerative approaches over conventional root canal procedures. (2) To evaluate the use of autologous substances such as platelet concentrates and calcium silicate based materials in promoting the healing and regeneration of the inflamed pulp. Summary. Vital pulpotomy was performed on 5 carious involved, permanent molars diagnosed with acute irreversible pulpitis in 17- to 22-year-old patients. Taking into consideration the patient’s age and the condition of the underlying pulp tissue, PRF pulpotomy was planned in view of preserving the vitality of the intact radicular pulps. Regenerative procedures with second generation blood matrices were chosen to encourage the recovery of the inflamed pulps. The systematic follow-up examinations performed at 3, 6, 9, 12, 18, 22, and 24 months revealed a successful clinical and radiological outcome. Within the limits of the present clinical study and correlating the success across the treated clinical cases, we safely conclude the potential scope of regenerative pulpotomy approaches in acute irreversible pulpitis in adult permanent teeth. Raji Viola Solomon, Umrana Faizuddin, Parupalli Karunakar, Grandhala Deepthi Sarvani, and Sevvana Sree Soumya Copyright © 2015 Raji Viola Solomon et al. All rights reserved. Massive Lingual and Sublingual Haematoma following Postextractive Flapless Implant Placement in the Anterior Mandible Sun, 17 May 2015 09:55:05 +0000 Dental implants placement in the anterior mandible with flap or flapless technique is a routine procedure and is considered to be safe. However, serious life-threatening complications may occur. We report the first case of massive lingual and sublingual haematoma following postextractive implant placement in the anterior mandible with flapless technique. A 45-year-old female patient underwent placement of four immediately postextractive implants in the anterior mandible using flapless technique. During the procedure, the patient referred intense acute pain and worsening sign of airway obstruction, dysphagia, dyspnea, and speech difficulties. Bimanual compression of the mouth floor, lingual surface of the mandible, and submental skin was maintained for approximately 25 minutes in order to stop the bleeding. Computerized tomography highlighted the massive lingual and sublingual haematoma. The symptoms and signs had almost completely resolved in the next 48 hours. The prevention of these complications is mandatory with clinical and CT analyses, in order to highlight mandibular atrophy and to select carefully the correct length and angulation of bone drilling and to keep more attention to the flapless technique considering the elevation of a lingual mucoperiosteal flap to access the mandibular contour intraoperatively and to protect the sublingual soft tissues and vasculature in high risk cases. Luisa Limongelli, Angela Tempesta, Vito Crincoli, and Gianfranco Favia Copyright © 2015 Luisa Limongelli et al. All rights reserved. Foreign Bodies Simulating a Congenital Palatal Fistula and Vascular Anomaly Thu, 14 May 2015 16:27:04 +0000 Foreign bodies embedded in the palate are uncommon findings and may occasionally mimic oral lesions. In the majority of the cases, foreign body embedment in the palate happens in infants and children who are unable to give history. Physical examination in the oral cavity of this group of patients in order to arrive at a definitive diagnosis is limited. We present two female infants with foreign bodies adherent to the hard palate. The first was ten months old and the second was 11 months old. In both cases the materials removed from the palate were plastic in nature (black or red in color and circular in shape). The first simulated a palatal fistula and the second a vascular anomaly. Mekonen Eshete, Fikre Abate, Taye Hailu, Mulualem Gessesse, and Azeez Butali Copyright © 2015 Mekonen Eshete et al. All rights reserved. Surgical Treatment of Peri-Implantitis: A 17-Year Follow-Up Clinical Case Report Tue, 12 May 2015 06:14:55 +0000 The purpose of the present case report was to describe the surgical treatment of a peri-implantitis lesion associated with a regenerative approach. A 48-year-old patient came to authors’ attention 36 months after the placement of a dental implant (ITI-Bonefit Straumann, Waldenburg, Switzerland) in position 46. A swelling of the peri-implant soft tissues was observed, associated with bleeding on probing and probing depth > 10 mm. A significant peri-implant bone loss was clearly visible on the periapical radiograph. A nonsurgical periodontal supportive therapy was firstly conducted to reduce the inflammation, followed by the surgical treatment of the defect. After mechanical and chemical decontamination with tetracycline solution, a regenerative approach consisting in the application of deproteinized bovine bone mineral (Bio-Oss, Geistlich Pharma AG, Wolhusen, Switzerland) and a collagen membrane (Bio-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) was performed. An antibiotic therapy was associated with the treatment. The 17-year follow-up showed a physiological probing depth with no clinical signs of peri-implant inflammation and bleeding on probing. No further radiographic bone loss was observed. The treatment described in the present case report seemed to show improved clinical results up to a relevant follow-up period. Fabrizio Bassi, Pier Paolo Poli, Davide Rancitelli, Fabrizio Signorino, and Carlo Maiorana Copyright © 2015 Fabrizio Bassi et al. All rights reserved. Unusual Occurrence of Tongue Sensorial Disorder after Conservative Surgical Treatment of Lymphoepithelial Cyst Mon, 11 May 2015 12:20:36 +0000 Lymphoepithelial cyst is a rare lesion of the oral cavity, with the mouth floor being the most common site of occurrence. The therapeutic approach of choice is the surgical treatment, which has rare cases of postoperative complications. The aim of this study is to report the case of a 53-year-old patient who came to Dental Service in the Federal University of Ceará complaining of a small nodular lesion (0.5 cm) located in the ventral tongue. Excisional biopsy was performed and the surgical specimen was submitted for anatomopathological analysis, which found that there was an oral lymphoepithelial cyst. The patient returned after seven days for suture removal and reported loss of sensitivity around the ventral tongue. We prescribed Citoneurin for ten days; however, there was not any significant improvement of the sensitivity. Low frequency laser therapy sessions were applied. The only postoperative symptom was dysesthesia, where there is only a sensitivity decrease. Currently, the patient has a postoperative period of 1 year without recurrence of the lesion. Although previous reports have no described tongue sensorineural disorders associated with this lesion, the occurrence of this event may be related to an unexpected anatomical variation of the lingual nerve. Luane Macêdo de Sousa, Assis Felipe Medeiros Albuquerque, Paulo Goberlânio Barros Silva, Thâmara Manoela Marinho Bezerra, Ealber Carvalho Macedo Luna, Filipe Nobre Chaves, Francisco Samuel Rodrigues Carvalho, Karuza Maria Alves Pereira, Ana Paula Negreiros Nunes Alves, Thyciana Rodrigues Ribeiro, and Fábio Wildson Gurgel Costa Copyright © 2015 Luane Macêdo de Sousa et al. All rights reserved. Custom-Made Computer-Aided-Design/Computer-Aided-Manufacturing Biphasic Calcium-Phosphate Scaffold for Augmentation of an Atrophic Mandibular Anterior Ridge Sun, 10 May 2015 11:38:04 +0000 This report documents the clinical, radiographic, and histologic outcome of a custom-made computer-aided-design/computer-aided-manufactured (CAD/CAM) scaffold used for the alveolar ridge augmentation of a severely atrophic anterior mandible. Computed tomographic (CT) images of an atrophic anterior mandible were acquired and modified into a 3-dimensional (3D) reconstruction model; this was transferred to a CAD program, where a custom-made scaffold was designed. CAM software generated a set of tool-paths for the manufacture of the scaffold on a computer-numerical-control milling machine into the exact shape of the 3D design. A custom-made scaffold was milled from a synthetic micromacroporous biphasic calcium phosphate (BCP) block. The scaffold closely matched the shape of the defect: this helped to reduce the time for the surgery and contributed to good healing. One year later, newly formed and well-integrated bone was clinically available, and two implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were placed. The histologic samples retrieved from the implant sites revealed compact mature bone undergoing remodelling, marrow spaces, and newly formed trabecular bone surrounded by residual BCP particles. This study demonstrates that custom-made scaffolds can be fabricated by combining CT scans and CAD/CAM techniques. Further studies on a larger sample of patients are needed to confirm these results. Francesco Guido Mangano, Piero Antonio Zecca, Ric van Noort, Samvel Apresyan, Giovanna Iezzi, Adriano Piattelli, Aldo Macchi, and Carlo Mangano Copyright © 2015 Francesco Guido Mangano et al. All rights reserved.