Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Oral Syphilis: A Reemerging Infection Prompting Clinicians’ Alertness Wed, 18 May 2016 14:30:30 +0000 Syphilis is a rare but increasing disease. Due to changing sexual habits, presentation of oral manifestations may rise. Since syphilis may mimic other oral manifestations, diagnoses can be difficult. Clinicians need to be aware that ambiguous oral manifestations may in fact be caused by oral syphilis. Here, we present a case of extended diagnostic delay highlighting the importance of consulting an expert in infectious diseases in case of obscure oral lesions not responding to standard treatment. Despite seven visits to six different medical doctors, a patient who presented with oral syphilis was continuously misdiagnosed. After 6 months of increasing complaints and deteriorating severity of disease, the patient was referred to an oral and maxillofacial surgeon where the correct diagnosis was determined and proper treatment initiated. Sebastian Dybeck Udd and Bodil Lund Copyright © 2016 Sebastian Dybeck Udd and Bodil Lund. All rights reserved. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings Tue, 17 May 2016 09:42:44 +0000 Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research. L. A. N. Santos, L. J. Lopes, G. D. Roque-Torres, V. F. Oliveira, and D. Q. Freitas Copyright © 2016 L. A. N. Santos et al. All rights reserved. Immediate Nonfunctional Loading of Two Single-Maxillary Postextractive Implants: 6-Year Postloading Results of Two Case Reports Mon, 16 May 2016 08:27:02 +0000 Objectives. The aim of the study was to evaluate and compare crestal bone loss of single-maxillary immediate postextractive implants and immediate nonfunctional loading (INFL) during 72 months of follow-up. Material and Methods. Two single titanium implants (Certain Prevail, Biomet 3I, USA) were placed in two patients using INFL technique. Implant stability and crestal bone level were measured on periapical radiographs at 1, 3, and 6 months after surgery. Results. All osseointegrated implants were clinically successful after 6 years of functional loading. Conclusion. Within the limit of the present case report, the paper supports the concept that INFL of single dental implant can be a successful treatment procedure. Vincenzo Ariano, Manuele Mancini, Andrea Cardi, Roberta Condò, Loredana Cerroni, and Guido Pasquantonio Copyright © 2016 Vincenzo Ariano et al. All rights reserved. Splinting of Longitudinal Fracture: An Innovative Approach Mon, 09 May 2016 09:52:42 +0000 Trauma may result in craze lines on the enamel surface, one or more fractured cusps of posterior teeth, cracked tooth syndrome, splitting of posterior teeth, and vertical fracture of root. Out of these, management of some fractures is of great challenge and such teeth are generally recommended for extraction. Literature search reveals attempts to manage such fractures by full cast crown, orthodontic wires, and so forth, in which consideration was given to extracoronal splinting only. However, due to advancement in materials and technologies, intracoronal splinting can be achieved as well. In this case report, longitudinal fractures in tooth #27, tooth #37, and tooth #46 had occurred. In #27, fracture line was running mesiodistally involving the pulpal floor resulting in a split tooth. In teeth 37 and 46, fractures of the mesiobuccal cusp and mesiolingual cusp were observed, respectively. They were restored with cast gold inlay and full cast crown, respectively. Longitudinal fracture of 27 was treated with an innovative approach using intracanal reinforced composite with Ribbond, external reinforcement with an orthodontic band, and full cast metal crown to splint the split tooth. Rashmi Bansal, Priyanka Chowdhary, Anuraag Gurtu, Nakul Mehrotra, and Abhinav Kishore Copyright © 2016 Rashmi Bansal et al. All rights reserved. Complete Maxillary Crossbite Correction with a Rapid Palatal Expansion in Mixed Dentition Followed by a Corrective Orthodontic Treatment Thu, 28 Apr 2016 12:44:54 +0000 This case report presents the interceptive orthodontic treatment of a boy, aged 8 years 4 months with a Class I malocclusion with severe transverse maxillary deficiency and complete maxillary crossbite and correction using Haas expansion and fixed appliance. The treatment goals were to correct the posterior crossbite and anterior crossbite and restore the normality of the dentition and occlusion. In phase I, the patient was treated with a modified Haas-type palatal expander, which provided a clinically significant palatal expansion and increased the maxillary arch perimeter with favorable conditions for orthodontic treatment with fixed appliances in phase II. The optimization of E-space and the use of intermaxillary Class III elastics helped to maintain the mandibular incisors upright. A removable wraparound type appliance and a bonded lingual canine-to-canine retainer were used as retention. Although the literature has reported a high rate of relapse after palatal expansion, after 2 years 9 months of posttreatment follow-up, the occlusal result was stable and no skeletal reversals could be detected. Orlando Motohiro Tanaka, Isabelle Adad Fornazari, Ariane Ximenes Graciano Parra, Bruno Borges de Castilhos, and Ademir Franco Copyright © 2016 Orlando Motohiro Tanaka et al. All rights reserved. A New Multi-Ingredient Recipe for the Treatment of Localized Advanced Periodontal Disease following the Surgical Removal of Impacted Wisdom Teeth Wed, 27 Apr 2016 08:42:05 +0000 Periodontal disease is a chronic inflammation of the tooth supporting structures. It leads to bone and attachment loss which is irreversible. Extraction of horizontally impacted lower third molar (L3M) teeth may result in localized periodontal pockets at the distal aspect of the adjacent lower second molars (L2M). We present a case of a 21-year-old male who suffered from a swelling and pain around his lower right second molar following surgical removal of a mesioangular impacted lower right third molar. We showed that oral hygiene measures, surgical access, mixture of autogenous and synthetic bone graft, and guided tissue regeneration (GTR) were enough to control the problem. Nabil Khzam, Adam Fell, Anthony Fisher, Paul Kim, Usman A. Khan, and Mahmoud M. Bakr Copyright © 2016 Nabil Khzam et al. All rights reserved. A Rare Case of an Artery Passing through the Median Perforating Canal of the Mandible Tue, 26 Apr 2016 13:12:02 +0000 Along with the popularization of dental implant surgery, there has been considerable research on the lingual foramen using cone-beam computed tomography. Anatomical research has also revealed that the arteries entering the lingual foramina are branches of the submental and sublingual arteries. There have been no reports, however, of the submental or sublingual artery entering the mandible from the lingual foramen, perforating it, and then distributing to the inferior labial region. A 69-year-old man who donated his body to our department in 2015 was dissected. The mandible with overlying soft tissue of the mental region was resected and examined with microcomputed tomography, which showed that the canal perforated from the lingual foramen to the midline of the labial cortical plate. The canal was thus named the median perforating canal. To the best of our knowledge, there have been no other reports of a perforating artery of the mandible, so this case is thought to be rare. Hence, the existence of perforating arteries, such as in the present case, should be taken into consideration in preoperative diagnoses such as for dental implant surgery. Thus, the fusion of anatomical and radiological study is useful and necessary to understand surgical anatomy. Joe Iwanaga, Koichi Watanabe, Tsuyoshi Saga, Yoko Tabira, and Koh-ichi Yamaki Copyright © 2016 Joe Iwanaga et al. All rights reserved. Unilateral Maxillary First Molar Extraction in Class II Subdivision: An Unconventional Treatment Alternative Thu, 21 Apr 2016 09:47:45 +0000 The asymmetrical intra-arch relationship in Class II subdivision malocclusion poses challenges in the treatment planning and mechanotherapy of such cases. This case report demonstrates a treatment technique engaging unilateral extraction of a maxillary first molar and Begg fixed appliances. The outcome stability and the enhancing effect on the eruption of the third molar in the extraction segment were confirmed by a 4-year follow-up examination. J. W. Booij and Christos Livas Copyright © 2016 J. W. Booij and Christos Livas. All rights reserved. Immediate Esthetic Rehabilitation of Periodontally Compromised Anterior Tooth Using Natural Tooth as Pontic Tue, 19 Apr 2016 13:38:22 +0000 For patients who require removal of anterior teeth and their replacement various treatment modalities are available. With advancement in technology and availability of glass/polyethylene fibres, use of natural tooth as pontic with fibre reinforced composite restorations offers the promising results. The present case report describes management of periodontally compromised mandibular anterior tooth using natural tooth pontic with fibre reinforcement. A 1-year follow-up showed that the bridge was intact with good esthetics and no problem was reported. K. Pavan Kumar, Surya Kumari Nujella, S. Sujatha Gopal, and K. Karthik Roy Copyright © 2016 K. Pavan Kumar et al. All rights reserved. Seven-Year Follow-Up of Peutz-Jeghers Syndrome Mon, 18 Apr 2016 13:28:08 +0000 One of the clinicopathological criteria for diagnosing Peutz-Jeghers syndrome (PJS) is mucocutaneous pigmentation. We present a 57-year-old Iranian female patient with diffuse pigmentation in buccal and labial mucosa. The first colonoscopy revealed one 0.5 cm rectal polyp. However surveillance colonoscopies over a 7-year polyp showed over 100 colorectal polyps. Hamid Reza Mozaffari, Fetemeh Rezaei, Roohollah Sharifi, and S. Ghasem Mirbahari Copyright © 2016 Hamid Reza Mozaffari et al. All rights reserved. Implant-Prosthetic Rehabilitation in Bilateral Agenesis of Maxillary Lateral Incisors with a Mini Split Crest Wed, 13 Apr 2016 10:21:01 +0000 The reported clinical case describes the surgical procedure of ridge augmentation by using a “split crest” technique with a partial thickness flap and a subsequent implant-prosthetic rehabilitation aimed at treating a bilateral agenesis of the upper lateral incisors. In such cases with vestibule-palatal and mesial-distal scarce bone thicknesses associated with the need of a proper functional and aesthetic rehabilitation, the split crest technique is particularly suitable. In the case we reported, because of the poor bone thicknesses, we performed a minimally invasive split crest which allowed a correct insertion of the fixtures. This technique allowed us to achieve an optimal functional and aesthetic rehabilitation; moreover, we obtained a good emergency profile, ensuring the vitality of the close teeth and ensuring a good primary stability and the following osseointegration of dental implants. M. M. Figliuzzi, A. Giudice, S. Pileggi, D. Pacifico, M. Marrelli, M. Tatullo, and L. Fortunato Copyright © 2016 M. M. Figliuzzi et al. All rights reserved. Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis Mon, 11 Apr 2016 14:07:15 +0000 Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction. Tamer Celakil, Merve Dogan, Bilge Gokcen Rohlig, Gulumser Evlioglu, and Haluk Keskin Copyright © 2016 Tamer Celakil et al. All rights reserved.