Case Reports in Dentistry http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Five Canalled and Three-Rooted Primary Second Mandibular Molar Thu, 24 Jul 2014 11:48:53 +0000 http://www.hindawi.com/journals/crid/2014/216491/ A thorough knowledge of root canal anatomy and its variation is necessary for successful completion of root canal procedures. Morphological variations such as additional root canals in human deciduous dentition are rare. A mandibular second primary molar with more than four canals is an interesting example of anatomic variations, especially when three of these canals are located in the distal root. This case shows a rare anatomic configuration and points out the importance of looking for additional canals. Haridoss Selvakumar, Swaminathan Kavitha, Rajendran Bharathan, and Jacob Sam Varghese Copyright © 2014 Haridoss Selvakumar et al. All rights reserved. Lasers in Esthetic Dentistry: Soft Tissue Photobiomodulation, Hard Tissue Decontamination, and Ceramics Conditioning Wed, 23 Jul 2014 09:35:41 +0000 http://www.hindawi.com/journals/crid/2014/927429/ The increasing concern and the search for conservative dental treatments have resulted in the development of several new technologies. Low and high power lasers can be cited as one of these new technologies. Low power lasers act at cellular level leading to pain reduction, modulation of inflammation, and improvement of tissue healing. High power lasers act by increasing temperature and have the potential to promote microbial reduction and ablation of hard and soft tissues. The clinical application of both low and high power lasers requires specific knowledge concerning laser interaction with biological tissues, so that the correct irradiation protocol can be established. The present case report describes the clinical steps of two metal-ceramic crowns development in a 60-year-old patient. Three different laser wavelengths were applied throughout the treatment with different purposes: Nd:YAG laser (1,064 nm) for dentin decontamination, diode (660 nm) for soft tissue biomodulation, and Er:YAG laser (2,940 nm) for inner ceramic surface conditioning. Lasers were successfully applied in the present case report as coadjutant in the treatment. This coadjutant technology can be a potential tool to assist treatment to reach the final success. Karen Müller Ramalho, Patrícia Moreira de Freitas, Ana Cecília Correa-Aranha, Marina Stella Bello-Silva, Roberta Marques da Graça Lopes, and Carlos de Paula Eduardo Copyright © 2014 Karen Müller Ramalho et al. All rights reserved. Mandibular Atrophy and Genial Spines Enlargement on Cone Beam Computed Tomography Wed, 23 Jul 2014 07:23:55 +0000 http://www.hindawi.com/journals/crid/2014/803572/ Purpose. The aim of this paper is to report a case in which the cone beam computed tomography (CBCT) was important for the confirmation of the presence of mandibular atrophy and genial spines enlargement. Case Description. A 76-year-old female patient was referred for the assessment due to the complaint of chronic trauma in the anterior region of the floor of the mouth, which had been present for 2 months. CBCT images showed severe resorption of alveolar ridge and genial spines enlargement (5.5 mm × 12 mm). Conclusion. Accurate imaging assessment with the aid of 3D reconstructions allows the elimination of image superimposition and, therefore, plays an important role in the depiction of anatomical and pathological conditions, such as genial spines enlargement. Marcelo Lupion Poleti, Christiano Oliveira-Santos, Luciana Maria Paes da Silva Ramos Fernandes, and Izabel Regina Fischer Rubira-Bullen Copyright © 2014 Marcelo Lupion Poleti et al. All rights reserved. Correction of Multiple Canine Impactions by Mixed Straightwire and Cantilever Mechanics: A Case Report Tue, 22 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crid/2014/925019/ Background. This case report describes the orthodontic treatment of a woman, aged 17 years, with a permanent dentition, brachyfacial typology, Angle Class I, with full impaction of two canines (13,33), and a severe ectopy of the maxillary left canine. Her main compliant was the position of the ectopic teeth. Methods. Straightwire fixed appliances, together with cantilever mechanics, were used to correct the impaired occlusion and to obtain an ideal torque control. Results and Conclusion. The treatment objectives were achieved in 26 months of treatment. The impactions were fully corrected with an optimal torque. The cantilever mechanics succeeded in obtaining tooth repositioning in a short lapse of time. After treatment, the dental alignment was stable. Sergio Paduano, Iacopo Cioffi, Giorgio Iodice, Vincenzo d’Antò, Francesco Riccitiello, Gioacchino Pellegrino, and Rosa Valletta Copyright © 2014 Sergio Paduano et al. All rights reserved. S-Shaped Canals: A Series of Cases Performed by Four Specialists around the World Wed, 16 Jul 2014 09:18:01 +0000 http://www.hindawi.com/journals/crid/2014/359438/ Recognition of anatomical variations is a real challenge for clinicians undertaking therapy regardless of the teeth that are to be treated. The extent of the curvature is one of the most important variables that could lead to instrument fracture. In clinical conditions, two curves can be present in the same root canal trajectory. This type of geometry is denoted as the “S” shape, and it is a challenging condition. This report describes a different clinical and educational scenario where four specialists around the world present different approaches for the treatment of root canals with double curvatures or S-shaped canals. Endodontic therapy is a very nuanced and challenging science and art. The clinical and teaching experience of the authors show different approaches that can be successfully employed to treat challenging teeth having roots with multiple curves. The necessity of precise knowledge of the root canal morphology and its variation is also underlined. Ricardo Machado, Antonis Chaniottis, Jorge Vera, Carlos Saucedo, Luiz Pascoal Vansan, and Emmanuel João Nogueira Leal Silva Copyright © 2014 Ricardo Machado et al. All rights reserved. Ectopic 3rd Molar Tooth in the Maxillary Antrum Tue, 15 Jul 2014 11:06:24 +0000 http://www.hindawi.com/journals/crid/2014/620741/ Location of ectopic tooth in a nondentate area like the maxillary antrum is rare. A 17-year-old boy, with one year history of recurrent right facial swelling and radiographic finding of a maxillary third molar tooth located at the posterior wall of the maxillary antrum, is presented. Under endotracheal intubation, the tooth was extracted through a Caldwell-Luc antrostomy approach and patient had an uneventful recovery and has been symptom free for eight months. Ectopic tooth in the maxillary antrum is rare and is commonest with maxillary third molar. It may be symptomless but is more commonly associated with inflammatory symptoms. The treatment of choice is surgical excision which is mostly carried out with Caldwell-Luc approach, even though endoscopic approach is being reported. Seidu A. Bello, Ifeoluwa O. Oketade, and Otasowie D. Osunde Copyright © 2014 Seidu A. Bello et al. All rights reserved. Nonsurgical Treatment of Two Periapical Lesions with Calcium Hydroxide Using Two Different Vehicles Tue, 15 Jul 2014 08:47:47 +0000 http://www.hindawi.com/journals/crid/2014/901497/ Calcium hydroxide is used extensively as an intracanal medicament in endodontics for many years. It is used in various clinical situations such as to promote apexification, to repair perforation, to enhance healing of periapical lesions, to control root resorption, and to control exudation in teeth with persistent periapical inflammation. This paper presents a case report in which Ca(OH)2 was used as an intracanal medicament for treatment of periradicular lesions using two different vehicles in two different teeth of same patient. Seema Dixit, Ashutosh Dixit, and Pravin Kumar Copyright © 2014 Seema Dixit et al. All rights reserved. Schwannoma of the Tongue in a Paediatric Patient: A Case Report and 20-Year Review Mon, 14 Jul 2014 12:01:05 +0000 http://www.hindawi.com/journals/crid/2014/780762/ Schwannomas (Neurilemmomas) are benign, encapsulated, slow-growing, and usually solitary tumours originating from Schwann cells of the peripheral nerve sheath with uncertain etiology. Approximately 25–48% of cases are seen in the head and neck region, of which 1% appears in the oral cavity. Lingual schwannoma can affect all age groups with peak incidence between the third and sixth decade. We report a rare case of lingual schwannoma in a 14-year-old girl complaining of asymptomatic swelling over lateral border of tongue since two years. Clinical examination revealed a nodule  cm in size, rubbery, nontender, smooth at right lateral border of tongue covered by normal mucosa, with no cervical lymphadenopathy. Excisional biopsy of the lesion was done under local anaesthesia. The histological sections spindle cells with thin wavy nuclei arranged as typical Antoni A (with Verocay bodies) and Antoni B areas. Nuclear palisading distribution (typical of a schwannoma) was readily identifiable. The patient was recurrence-free after one year. Nitin Bhola, Anendd Jadhav, Rajiv Borle, Gaurav Khemka, Umesh Bhutekar, and Sanatan Kumar Copyright © 2014 Nitin Bhola et al. All rights reserved. CTCFL (BORIS) mRNA Expression in a Peripheral Giant Cell Granuloma of the Oral Cavity Thu, 10 Jul 2014 09:55:05 +0000 http://www.hindawi.com/journals/crid/2014/792615/ Peripheral giant cell granuloma (PGCG) is a relatively common benign reactive lesion of the oral cavity which can occur at any age. CTCFL/BORIS (CTCF like/Brother of the Regulator of Imprinted Sites) and CTCF (CCCTC-binding factor) are paralogous genes with an important role in the regulation of gene expression, genomic imprinting, and nuclear chromatin insulators regulation. BORIS expression promotes cell immortalization and growth while CTCF has tumor suppressor activity; the expression pattern may reflect the reverse transcription silencing of BORIS. The aim of this work was to describe a histopathological and molecular approach of an 8-year-old pediatric male patient with PGCG diagnosis. It was observed that the PGCG under study expressed CTCF as well as BORIS mRNAs alongside with the housekeeping gene GAPDH, which may be related to possible genetic and epigenetic changes in normal cells of oral cavity. Graciela Zambrano-Galván, Miguel Reyes-Romero, Ronell Bologna-Molina, Oscar Eduardo Almeda-Ojeda, and Obed Lemus-Rojero Copyright © 2014 Graciela Zambrano-Galván et al. All rights reserved. Odontogenic Keratocyst Mimicking Paradental Cyst Tue, 08 Jul 2014 12:03:30 +0000 http://www.hindawi.com/journals/crid/2014/974241/ Objective. The aim of this paper is to present an uncommon clinical and radiographic aspect of odontogenic keratocyst (OKC) mimicking paradental cyst. Methods. A 32-year-old female patient showed a well-delimited radiolucent lesion connected with the root of the left third molar with close anatomical relationship with the mandibular canal. The clinical, radiographic, and anamnestic features lead us to diagnose a paradental cyst that was treated by enucleation after extraction of the partially impacted tooth. Results. Histological analysis showed typical histological features of PKC such as the presence of a lining of stratified squamous epithelium with a well-defined basal layer of palisading columnar of cuboidal cells. Conclusion. Initial X-ray analysis and the position of the lesion related to the third mandibular tooth caused us to mistakenly diagnose a paradental cyst. We were only able to identify the cyst as an PKC rather than a paradental cyst after histological analysis. Andrea Enrico Borgonovo, Luigi Bernardini, Paola Francinetti, Federica Rizza, and Dino Re Copyright © 2014 Andrea Enrico Borgonovo et al. All rights reserved. Surgical Management of Mandibular Central Incisors with Dumbbell Shaped Periapical Lesion: A Case Report Tue, 08 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crid/2014/769381/ Dental traumatic injuries may affect the teeth and alveolar bone directly or indirectly. Pulpal necrosis and chronic and apical periodontitis with cystic changes are the most common sequelae of the dental traumatic injuries, if the teeth are not treated immediately. This case report focuses on the conventional and surgical management of mandibular central incisors. A twenty-four-year-old male patient presented with pain in the mandibular central incisors. Radiographic examination revealed mandibular central incisors with dumbbell shaped periapical lesion. After root canal treatment, parendodontic surgery was performed for mandibular central incisors. After one-year recall examination, the teeth were asymptomatic and periapical lesion had healed. Roopadevi Garlapati, Bhuvan Shome Venigalla, Jayaprakash D. Patil, Thumu Jayaprakash, C. H. Krishna Chaitanya, and Rama S. Kalluru Copyright © 2014 Roopadevi Garlapati et al. All rights reserved. Cephalometric Approach to the Occlusal Vertical Dimension Reestablishment Thu, 03 Jul 2014 11:57:46 +0000 http://www.hindawi.com/journals/crid/2014/920840/ The occlusal vertical dimension (OVD) refers to the length of the face as determined by the amount of separation of the jaws. Its determination is important for the manufacture of restorations. However, defining the correct occlusal vertical dimension for edentulous patients is one of the most important steps for function and esthetics rehabilitation. Cephalometry is a standardized method of assessing dental and facial proportions and their interrelation. Additionally, cephalometric analysis of the facial vertical dimension can establish an individual pattern for each patient. This analysis should become a permanent part of each patient’s record. Hence, this study presented a case report with the use of cephalometry as an auxiliary tool in the rehabilitation of OVD. Clinical relevance showed that cephalometric analysis can be an accurate and convenient instrument to treatment planning and prognostic of oral rehabilitation. The reader should understand the clinical implications of using cephalometry as a tool in the rehabilitation of OVD. João César Zielak, David Gulin Neto, Leonardo Fernandes da Cunha, Tatiana Miranda Deliberador, and Allan Fernando Giovanini Copyright © 2014 João César Zielak et al. All rights reserved. Root Canal Treatment of Mandibular Second Premolar with Three Separate Roots and Canals Using Spiral Computed Tomographic Thu, 03 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crid/2014/816576/ Anatomic and internal morphology of a root canal system is more complex and differs for each individual tooth of which mandibular premolars have earned the reputation for having aberrant anatomy. The occurrence of three canals with three separate foramina in mandibular second premolars is very rare. A wider knowledge on both clinical and radiological anatomy especially spiral computed tomographic is absolutely essential for the success of endodontic treatment. These teeth may require skillful and special root canal special shaping and obturating techniques. This paper reports an unusual case of a mandibular second premolar with atypical canal pattern that was successfully treated endodontically. V. P. Hariharavel, A. Ashok Kumar, C. Ganesh, Sankar Annamalai, Kavitha Ramar, and R. Aravindhan Copyright © 2014 V. P. Hariharavel et al. All rights reserved. Noninvasive and Multidisciplinary Approach to the Functional and Esthetic Rehabilitation of Amelogenesis Imperfecta: A Pediatric Case Report Wed, 02 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/crid/2014/127175/ Case Report. An 8-year-old girl with amelogenesis imperfecta (AI) reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed. Juliana Feltrin de Souza, Camila Maria Bullio Fragelli, Marco Aurélio Benini Paschoal, Edson Alves Campos, Leonardo Fernandes Cunha, Estela Maris Losso, and Rita de Cássia Loiola Cordeiro Copyright © 2014 Juliana Feltrin de Souza et al. All rights reserved. A Peripheral Ameloblastic Fibro-Odontoma in a 3-Year-Old Girl: Case Report, Immunohistochemical Analysis, and Literature Review Mon, 30 Jun 2014 12:01:18 +0000 http://www.hindawi.com/journals/crid/2014/321671/ Ameloblastic fibro-odontoma (AFO) predominantly occurs in the jaw bones of children and young adults. Extraosseous AFO is extremely rare. We describe a peripheral ameloblastic fibro-odontoma in the maxillary gingiva of a 3-year-old girl. The clinical appearance resembled fiery red reactive gingival lesions. The histopathological examination of the excised lesion showed small islands and cords of odontogenic epithelium with cellular myxoid stroma in the subepithelial tissue. The mass contained calcified material and an enamel-like deposit. Many small blood vessels appeared in the connective tissue surrounding the odontogenic epithelium. The immunohistochemical assays showed strong reactivity for amelogenin, β-catenin, CD44, and CD31 in the tissue sections. There was no recurrence after the 1-year follow-up. Because this lesion clinically resembles other nonneoplastic lesions and is very rare in gingiva, establishing a correct diagnosis is achieved only based on specific histological characteristics. Conservative excision of the tumor is the treatment of choice. Yi-Chun Lin, Hsiu-Ming Hsu, Chiang-Shin Liu, and Kuo Yuan Copyright © 2014 Yi-Chun Lin et al. All rights reserved. Impression Material Mass Retained in the Mucobuccal Fold Sun, 29 Jun 2014 11:28:19 +0000 http://www.hindawi.com/journals/crid/2014/416965/ Trapped foreign bodies and tissue reactions to foreign materials are commonly encountered in the oral cavity. Traumatically introduced dental materials, instruments, or needles are the most common materials referred to in the dental literature. This paper describes an iatrogenic foreign body encapsulation in the oral mucosa, clinically appearing as  mm tumor-like swelling with an intact overlying epithelium and diagnosed as a polymeric impression material. Detailed case history and, clinical and radiographic examinations including CBCT and spectrometric analysis of the retrieved sample were necessary to determine accurately the nature, size, and location of the foreign body. It is suggested that the origin of the material relates to an impression made 2 years ago, leaving a mass trapped in a traumatized mucosal tissue. N. Karam Genno and A. Assaf Copyright © 2014 N. Karam Genno and A. Assaf. All rights reserved. Treatment of Ectopic Mandibular Second Permanent Molar with Elastic Separators Sun, 22 Jun 2014 12:45:32 +0000 http://www.hindawi.com/journals/crid/2014/621568/ Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. Ectopic eruption of the second molar is relatively rare. This paper presents the case of thirteen-year-old male with an ectopic mandibular second permanent molar. The condition was corrected with surgical exposure and placement of elastic separators. This case report lays emphasis on the practice of basic methods to obtain acceptable results rather than extensive surgical or orthodontic corrections. It is advised that ectopic teeth should not be neglected especially when it concerns developing caries and malocclusion. R. Rajesh, V. Naveen, S. Amit, Kusai Baroudi, C. Sampath Reddy, and Srinivas Namineni Copyright © 2014 R. Rajesh et al. All rights reserved. Submasseteric Tuberculous Lesion of Mandible: Report of a Case and Review of the Literature Sun, 22 Jun 2014 12:44:35 +0000 http://www.hindawi.com/journals/crid/2014/791630/ Tuberculosis is still a major health hazard in the developing world, while its incidence has recently started to escalate after decreasing for many years. It is a chronic granulomatous disease that can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, are seen in both the primary and secondary stages of the disease. This paper presents a case of tuberculosis of the submasseteric space, manifesting as a persistent swelling at ramus and angle of mandible. The diagnosis was confirmed based on histopathology after an open incisional biopsy. Patient underwent antituberculosis therapy and his extraoral swelling completely resolved after 4 months of the therapy. The purpose of this paper is to emphasize the importance of early and definitive diagnosis of orofacial tuberculosis, to recognize it based on signs and symptoms, and to refer the patients suspected of active tuberculous infection for appropriate medical treatment. Donepudi Nanda Kishore, N. T. Geetha, K. V. Umashankara, and Kirthi Kumar Rai Copyright © 2014 Donepudi Nanda Kishore et al. All rights reserved. Van der Woude Syndrome with Short Review of the Literature Sun, 22 Jun 2014 07:08:56 +0000 http://www.hindawi.com/journals/crid/2014/871460/ Van der Woude syndrome (VWS) is a rare autosomal dominant condition with high penetrance and variable expression. Clinical manifestation of this autosomal dominant clefting syndrome includes bilateral midline lower lip pits, cleft lip, and cleft palate along with hypodontia. These congenital lip pits appear as a malformation in the vermilion border of the lip, with or without excretion. Discomfort caused by spontaneous or induced drainage of saliva/mucus when pressure is applied or during a meal as well as poor aesthetic match is one of the main complaints of patients with congenital lip fistula. The pits are treated by surgical resection. Dentists should be aware of the congenital lip pits as in Van der Woude syndrome because they have been reported to be associated with a variety of malformations or other congenital disorders. Here, the authors report a rare case of Van der Woude syndrome with short review of the literature. Pallavi K. Deshmukh, Kiran Deshmukh, Anand Mangalgi, Subhash Patil, Deepa Hugar, and Saraswathi Fakirappa Kodangal Copyright © 2014 Pallavi K. Deshmukh et al. All rights reserved. Amelogenesis Imperfecta and Screening of Mutation in Amelogenin Gene Thu, 19 Jun 2014 12:19:25 +0000 http://www.hindawi.com/journals/crid/2014/319680/ The aim of this study was to report the clinical findings and the screening of mutations of amelogenin gene of a 7-year-old boy with amelogenesis imperfecta (AI). The genomic DNA was extracted from saliva of patient and his family, followed by PCR and direct DNA sequencing. The c.261C>T mutation was found in samples of mother, father, and brother, but the mutation was not found in the sequence of the patient. This mutation is a silent mutation and a single-nucleotide polymorphism (rs2106416). Thus, it is suggested that the mutation found was not related to the clinical presence of AI. Further research is necessary to examine larger number of patients and genes related to AI. Fernanda Veronese Oliveira, Carla Vecchione Gurgel, Tatiana Yuriko Kobayashi, Thiago José Dionísio, Lucimara Teixeira Neves, Carlos Ferreira Santos, Maria Aparecida Andrade Moreira Machado, and Thais Marchini Oliveira Copyright © 2014 Fernanda Veronese Oliveira et al. All rights reserved. Cleidocranial Dysplasia Case Report: Remodeling of Teeth as Aesthetic Restorative Treatment Wed, 18 Jun 2014 09:29:32 +0000 http://www.hindawi.com/journals/crid/2014/901071/ Cleidocranial dysplasia (CCD), is an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals. It is generally characterized by orofacial manifestations, including enamel hypoplasia, retained primary teeth, and impacted permanent and supernumerary teeth. The successful treatment involving a timing intervention (orthodontic-maxillofacial surgeons-restorative) is already described. However, the restorative treatment might improve the aesthetic final result in dentistry management for patients with cleidocranial dysplasia. Objective. Therefore, this clinical report presents a conservative restorative management (enamel microabrasion, dental bleaching, and direct composite resin) for aesthetic solution for a patient with CCD. Clinical Considerations. The cosmetic remodeling is a conservative, secure, and low cost therapy that can be associated with other procedures such as enamel microabrasion and dental bleaching to achieve optimal outcome. Additionally, the Golden Proportion can be used to guide dental remodeling to improve the harmony of the smile and the facial composition. Conclusions. Thus, dentists must know and be able to treat dental aesthetic problems in cleidocranial dysplasia patients. The intention of this paper is to describe a restorative approach with the cosmetic remodeling teeth (by grinding or addicting material) associated with enamel microabrasion and dental bleaching to reestablish the form, shape, and color of smile for patients with cleidocranial dysplasia. Leonardo Fernandes da Cunha, Isabela Maria Caetano, Fernando Dalitz, Carla Castiglia Gonzaga, and José Mondelli Copyright © 2014 Leonardo Fernandes da Cunha et al. All rights reserved. Orthostatic Dysregulation during Postural Change on the Dental Chair and Intraoperative Monitoring by Heart Rate Variability Analysis Tue, 17 Jun 2014 06:26:34 +0000 http://www.hindawi.com/journals/crid/2014/656045/ This is the first case report of orthostatic dysregulation (OD) manifested during postural change on the dental chair and intraoperatively monitored by heart rate variability (HRV) analysis. OD-associated autonomic dysfunction is induced by postural changes and easily leads to disturbance in circulatory dynamics; however, most dental practices have not yet realized the importance of managing OD. We measured autonomic activity in a patient with OD during dental therapy and assessed the clinical significance of HRV analysis for OD. The patient was a 17-year-old Japanese female. She was diagnosed with impacted wisdom teeth and had no previous history of a distinct systemic disease. A surgical procedure to extract the teeth was safely performed under both local anesthesia and sedation with nitrous oxide and midazolam. After the surgery, her postural change to sitting induced orthostatic hypotension. HRV variables showed parasympathetic dominance due to the upright position. Subsequently, her posture was returned to supine, and atropine sulfate administration for the immediate treatment of OD returned her blood pressure to normal levels. HRV variables showed relative sympathetic dominance due to an atropine-derived parasympathetic blockade. HRV analysis revealed OD-associated autonomic dysfunction and should become a standard tool for safe and secure dental management of OD. Yukihiro Momota, Shigemasa Tomioka, Mayuko Furukita, Kenji Fujisawa, Hideyuki Takano, and Masayuki Azuma Copyright © 2014 Yukihiro Momota et al. All rights reserved. Orthodontic Treatment of a Mandibular Incisor Extraction Case with Invisalign Thu, 12 Jun 2014 07:22:55 +0000 http://www.hindawi.com/journals/crid/2014/657657/ Mandibular incisor extraction for orthodontic treatment is considered an unusual treatment option because of the limited number of patients that meet the criteria for such treatment. Accurate diagnosis and treatment planning is essential to achieve the desired results. Adult orthodontic patients are increasingly motivated by esthetic considerations and reject the idea of conventional fixed appliances. In recent years, Invisalign appliances have gained tremendous attention for orthodontic treatment of adult patients to meet their esthetic demands. In this case report, a case of Class I malocclusion was treated with mandibular incisor extraction using the Invisalign appliance system. Successful tooth alignment of both arches was achieved. The use of Invisalign appliance is an effective treatment option in adult patients with Class I malocclusion that requires incisor extraction due to moderate to severe mandibular anterior crowding. Khalid H. Zawawi Copyright © 2014 Khalid H. Zawawi. All rights reserved. Gingival Vitiligo: Report of a Case and Review of the Literature Wed, 11 Jun 2014 12:30:17 +0000 http://www.hindawi.com/journals/crid/2014/874025/ Rarely cases have been reported regarding depigmented lesions of the oral cavity. On reviewing the literature, only few cases of gingival vitiligo or similar lesions have been reported till date. These lesions pose a cosmetic challenge. We present here a case of vitiligo affecting gingiva. Vitiligo has been defined as an acquired, slowly progressive loss of cutaneous pigment which occurs as irregular, sharply defined patches which may or may not be surrounded by macroscopic hyperpigmentation. Differential diagnosis, detailed clinical history, histopathology, immunohistochemistry, and pathogenesis of this condition are discussed. Nipun Ashok, Anila Karunakaran, Prabath Singh, Jean Rodrigues, Navya Ashok, Bassel Tarakji, Azzeghaiby Saleh, and Alzoghaibi Ibrahim Copyright © 2014 Nipun Ashok et al. All rights reserved. Esthetic Rehabilitation of Anterior Teeth with Laminates Composite Veneers Wed, 11 Jun 2014 11:46:08 +0000 http://www.hindawi.com/journals/crid/2014/849273/ No- or minimal-preparation veneers associated with enamel preservation offer predictable results in esthetic dentistry; indirect additive anterior composite restorations represent a quick, minimally invasive, inexpensive, and repairable option for a smile enhancement treatment plan. Current laboratory techniques associated with a strict clinical protocol satisfy patients’ restorative and esthetic needs. The case report presented describes minimal invasive treatment of four upper incisors with laminate nanohybrid resin composite veneers. A step-by-step protocol is proposed for diagnostic evaluation, mock-up fabrication and trial, teeth preparation and impression, and adhesive cementation. The resolution of initial esthetic issues, patient satisfaction, and nice integration of indirect restorations confirmed the success of this anterior dentition rehabilitation. Dino Re, Gabriele Augusti, Massimo Amato, Giancarlo Riva, and Davide Augusti Copyright © 2014 Dino Re et al. All rights reserved. Oral Manifestation of Autosomal Recessive Congenital Ichthyosis in a 2-Year-Old Patient Thu, 05 Jun 2014 12:39:34 +0000 http://www.hindawi.com/journals/crid/2014/483293/ Ichthyosis is a heterogeneous family of hereditary keratinisation disorders mostly characterized by variable erythema of the whole body and different scaling patterns. Although these disorders affect tissues of epidermal origin, there is little evidence regarding the oral and dental manifestations of Lamellar Ichthyosis. A case report of early childhood caries in lamellar ichthyosis is presented and the dental consideration and management is discussed in this paper. Kavitha Ramar, Sankar Annamalai, V. P. Hariharavel, R. Aravindhan, C. Ganesh, and K. Ieshwaryah Copyright © 2014 Kavitha Ramar et al. All rights reserved. Intramuscular Haemangioma with Diagnostic Challenge: A Cause for Strange Pain in the Masseter Muscle Thu, 05 Jun 2014 09:50:38 +0000 http://www.hindawi.com/journals/crid/2014/285834/ Intramuscular hemangiomas are unique vascular tumors which are benign in nature, most commonly occurring in the trunk and extremities. When present in head and neck, they most frequently involve the masseter and trapezius muscles, accounting for less than 1% of all hemangiomas. Most of these lesions present with pain and discomfort and some patients may demonstrate progressive enlargement. Due to their infrequency, deep location, and unfamiliar presentation, these lesions are seldom correctly diagnosed clinically. Our report is a clinically misdiagnosed case of a painful soft tissue mass in the right side masseteric region of a 23-year-old female patient, confirmed as intramuscular hemangioma based on imaging studies and histopathologic examination, treated by surgical excision which had no recurrence after a 3-year followup. Krithika Chandrasekar Lakshmi, Sathasivasubramanian Sankarapandiyan, and Venkata Sai Pulivadula Mohanarangam Copyright © 2014 Krithika Chandrasekar Lakshmi et al. All rights reserved. A New Trend in Recording Subgingival Tissue around an Implant While Making a Direct Abutment Impression Sun, 01 Jun 2014 11:17:31 +0000 http://www.hindawi.com/journals/crid/2014/847408/ A successful implant-supported restoration must provide adequate function and esthetics. Osseointegrated implants have given an alternative choice for patients who have lost their teeth. Most commonly encountered problems while doing a transfer from patient to the master cast in restoring implant-supported crowns are an uneven distribution of occlusal loads and undue torquing forces on the various elements of implant. This is caused due to poor fit of frameworks connected to implant, which further leads to marginal bone loss, loosening of screws, fatigue fracture of implant components, and ultimately implant failure. This paper presents a simplified and easy solution to overcome such problems by introducing an innovative gingival retraction system for restoring implant-supported crowns to achieve superior and predictable long-term outcomes. Suryakant C. Deogade, Sneha S. Mantri, Gunjan Dube, Radhika Shrivastava, and Syed Noorani Copyright © 2014 Suryakant C. Deogade et al. All rights reserved. Repair for Congenital Macrostomia: Vermilion Square Flap Method Thu, 29 May 2014 13:41:27 +0000 http://www.hindawi.com/journals/crid/2014/480598/ Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse due to failure of mesodermal migration and merging to obliterate the embryonic grooves between the maxillary and mandibular processes to form the angle of the mouth at its normal anatomic position. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a line from the commissure to the tragus or bilateral. It is usually partial but rarely complete. Transverse facial clefts are more common in males and more common on the left side when unilateral. The goal of macrostomia reconstruction is to achieve functional, symmetrical, and accurate oral commissure with minimal scar. In this paper, we present a six-year-old girl with unilateral macrostomia with preauricular skin tags and malformation of pinna on ipsilateral side treated with vermillion-square flap method. The scar is placed at the upper lip. At two-month followup, the oral commissures are symmetric, the scars are inconspicuous, and the overall balance of facial contour and lip is excellent. We recommend this method for patients with mild to moderate macrostomia. Renuka Dhingra, Asheesh Dhingra, and Dipti Munjal Copyright © 2014 Renuka Dhingra et al. All rights reserved. Success and High Predictability of Intraorally Welded Titanium Bar in the Immediate Loading Implants Thu, 22 May 2014 08:02:44 +0000 http://www.hindawi.com/journals/crid/2014/215378/ The implants failure may be caused by micromotion and stress exerted on implants during the phase of bone healing. This concept is especially true in case of implants placed in atrophic ridges. So the primary stabilization and fixation of implants are an important goal that can also allow immediate loading and oral rehabilitation on the same day of surgery. This goal may be achieved thanks to the technique of welding titanium bars on implant abutments. In fact, the procedure can be performed directly in the mouth eliminating possibility of errors or distortions due to impression. This paper describes a case report and the most recent data about long-term success and high predictability of intraorally welded titanium bar in immediate loading implants. Vaniel Fogli, Michele Camerini, Dorina Lauritano, and Francesco Carinci Copyright © 2014 Vaniel Fogli et al. All rights reserved.