Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Conservative, Surgical, and Prosthetic Treatment of a Patient with a Periapical Lesion Associated with an Atypical Intraoral Sinus Tract Wed, 06 May 2015 10:26:15 +0000 This report describes a clinical case with an atypical intraoral sinus tract formation from diagnosis and treatment to short-term outcome and definitive prosthetic rehabilitation. In detail, the patient underwent conservative nonsurgical root canal treatment followed by guided bone augmentation of the regions involved in periapical inflammation and sinus tract formation. The removal of the inflammatory source of the lesion as well as the affected tissue clearly led to a healing of the surrounding bone tissues. Subsequently, the tooth was reconstructed using a fibreglass post and a metal-ceramic crown; an implant was successfully placed in the previously inflamed bone region. Michael Wolgin, Peter Tschoppe, and Andrej M. Kielbassa Copyright © 2015 Michael Wolgin et al. All rights reserved. Talon Cusp Type I: Restorative Management Wed, 06 May 2015 09:03:44 +0000 The teeth are formed during intrauterine life (i.e., gestation) during the odontogenesis stage. During this period, the teeth move until they enter the oral cavity. This course covers various stages of dental development, namely, initiation, proliferation, histodifferentiation, morphodifferentiation, and apposition. The talon cusp is an anomaly that occurs during morphodifferentiation, and this anomaly may have numerous adverse clinical effects on oral health. The objective of this study was to report a case of “Talon Cusp Type I” and to discuss diagnostic methods, treatment options for this anomaly, and the importance of knowledge of this morphological change among dental professionals so that it is not confused with other morphological changes; such knowledge is required to avoid unnecessary surgical procedures, to perform treatments that prevent caries and malocclusions as well as enhancing aesthetics, and to improve the oral health and quality of life of the patient. Rafael Alberto dos Santos Maia, Wanessa Christine de Souza-Zaroni, Raul Sampaio Mei, and Fernando Lamers Copyright © 2015 Rafael Alberto dos Santos Maia et al. All rights reserved. Decontamination Using a Desiccant with Air Powder Abrasion Followed by Biphasic Calcium Sulfate Grafting: A New Treatment for Peri-Implantitis Mon, 27 Apr 2015 09:56:48 +0000 Peri-implantitis is characterized by inflammation and crestal bone loss in the tissues surrounding implants. Contamination by deleterious bacteria in the peri-implant microenvironment is believed to be a major factor in the etiology of peri-implantitis. Prior to any therapeutic regenerative treatment, adequate decontamination of the peri-implant microenvironment must occur. Herein we present a novel approach to the treatment of peri-implantitis that incorporates the use of a topical desiccant (HYBENX), along with air powder abrasives as a means of decontamination, followed by the application of biphasic calcium sulfate combined with inorganic bovine bone material to augment the intrabony defect. We highlight the case of a 62-year-old man presenting peri-implantitis at two neighboring implants in positions 12 and 13, who underwent access flap surgery, followed by our procedure. After an uneventful 2-year healing period, both implants showed an absence of bleeding on probing, near complete regeneration of the missing bone, probing pocket depth reduction, and clinical attachment gain. While we observed a slight mucosal recession, there was no reduction in keratinized tissue. Based on the results described within, we conclude that the use of HYBENX and air powder abrasives, followed by bone defect grafting, represents a viable option in the treatment of peri-implantitis. Giorgio Lombardo, Giovanni Corrocher, Angela Rovera, Jacopo Pighi, Mauro Marincola, Jeffrey Lehrberg, and Pier Francesco Nocini Copyright © 2015 Giorgio Lombardo et al. All rights reserved. Traumatic Displacement of Maxillary Permanent Canine into the Vestibule of the Mouth Mon, 27 Apr 2015 09:15:58 +0000 Dentoalveolar injuries are common and are caused by many factors. Dental trauma requires special consideration when a missing tooth or tooth fracture accompanies soft tissue laceration. A tooth or its fragment occasionally penetrates into soft tissue and may cause severe complications. This report presents a case of delayed diagnosis and management of a displaced tooth in the vestibule of the mouth following dentoalveolar injury. This report suggests that radiography can lead to an early diagnosis and surgical removal of an embedded tooth in the soft tissue. Masayasu Iwase, Michiko Ito, Hanon Katayama, Hiroaki Nishijima, Hirokazu Shimotori, Airi Fukuoka, and Yoko Tanaka Copyright © 2015 Masayasu Iwase et al. All rights reserved. Oral Squamous Cell Carcinoma Arising in a Patient after Hematopoietic Stem Cell Transplantation with Bisphosphonate-Related Osteonecrosis of the Jaws Mon, 20 Apr 2015 13:37:28 +0000 A 55-year-old man with a history of acute myeloid leukaemia treated with hematopoietic stem cell transplantation and with a 5-year history of bisphosphonate-related osteonecrosis of the jaws, following 12 cycles of intravenous zoledronic acid therapy, presented in December 2009 with a history of increasingly severe unilateral lower jaw pain. Oral examination revealed, as previously, exposed bone in the left mandible, but also a new exophytic mass on the lower-left buccal mucosa. Biopsy confirmed a diagnosis of oral squamous cell carcinoma. To the best of our knowledge, this is the first report of an oral squamous cell carcinoma that appeared adjacent to an area of osteochemonecrosis. Paolo G. Arduino, Crispian Scully, Luigi Chiusa, and Roberto Broccoletti Copyright © 2015 Paolo G. Arduino et al. All rights reserved. Aesthetic Depigmentation of Gingival Smoker’s Melanosis Using Carbon Dioxide Lasers Sun, 12 Apr 2015 07:59:52 +0000 Melanic pigmentation results from melanin produced by the melanocytes present in the basal layer of the oral epithelium. One of the most common causes of oral pigmentation is smoker melanosis, a condition associated with the melanocyte stimulation caused by cigarette smoke. This paper aims to illustrate the use of a carbon dioxide laser in the removal of the gingival melanic pigmentation for aesthetic reasons in a 27-year-old female patient with history of a smoking habit. The carbon dioxide laser vaporisation was performed on the gingival mucosa with effective and quick results and without any complications or significant symptoms after the treatment. We conclude that a carbon dioxide laser could be a useful, effective, and safe instrument to treat the aesthetic complications caused by oral smoker melanosis. Luis Silva Monteiro, José Adriano Costa, Marco Infante da Câmara, Rui Albuquerque, Marco Martins, José Júlio Pacheco, Filomena Salazar, and Fernando Figueira Copyright © 2015 Luis Silva Monteiro et al. All rights reserved. Comment on “Nonsyndromic Mandibular Symphysis Cleft” Thu, 09 Apr 2015 12:57:24 +0000 Keyur Mevada and A. Gopalakrishna Copyright © 2015 Keyur Mevada and A. Gopalakrishna. All rights reserved. Immediate, Early, and Conventional Implant Placement in a Patient with History of Periodontitis Wed, 08 Apr 2015 11:30:25 +0000 The aim of this paper is to describe a case of implant-prosthetic rehabilitation in a patient with periodontitis, focusing on the different timing of implant placement. After initial periodontal treatment, teeth with advanced mobility degree and severe bone resorption were extracted. At different healing time oral implants were placed in a prosthetic-guided position. After osseointegration period the implants were loaded and the results at one year of follow-up are presented. Alessandro Lanza, Fabio Scognamiglio, Felice Femiano, and Michele Lanza Copyright © 2015 Alessandro Lanza et al. All rights reserved. A Rare Case of Intraosseous Fibrolipoma of the Mandible: Diagnosis and Treatment Sun, 05 Apr 2015 11:46:28 +0000 Lipomas are common soft tissue tumors. Intraosseous lipoma is a rare lesion that constitutes not more than 0.1% of bone tumors. It can occur anywhere in the body and there have only been a few cases found in the mandible. Intraosseous fibrolipoma of the jaw is an uncommon histological variant of the classic lipoma and to the best of our knowledge only one case has previously been reported in the literature. The cause of this lesion is uncertain. Clinically the lesion is generally asymptomatic and its radiographic feature is a well-defined radiolucency. Surgery is the treatment of choice. We present a case of an intraosseous fibrolipoma in the right mandibular ramus in a 25-year-old female. Andrea Castellani, Gabriele Bocchialini, and Luca Ferrari Copyright © 2015 Andrea Castellani et al. All rights reserved. Myofibroma of the Gingiva: A Rare Case Report and Literature Review Mon, 30 Mar 2015 11:51:47 +0000 Myofibromas are benign uncommon fibroblastic tumors of the soft tissue, bone, or internal organs affecting all ages. These lesions histopathologically may mimic many other soft tissue tumors of the oral cavity such as spindle cell tumors of neurogenic and smooth muscle cell origin, thus leading to misdiagnosis and mistreatment. This case report describes a rare benign tumor, which presented as a soft tissue swelling on posterior gingiva. Surgical excision of the lesion was carried out under local anaesthesia. Histopathologic and immunohistochemical examination confirmed the diagnosis of myofibroma. Myofibroma should be included in the clinical differential diagnosis of masses of the oral soft tissues; however immunohistochemical examination is essential to establish an accurate diagnosis. Vaishali Narayen, Syed Afroz Ahmed, Charu Suri, and Shahela Tanveer Copyright © 2015 Vaishali Narayen et al. All rights reserved. Oral Adverse Reactions Caused by Over-the-Counter Oral Agents Thu, 26 Mar 2015 12:39:35 +0000 Over-the-counter products rarely cause unwanted reactions in the oral cavity. Oral reactions to these agents are not specific and might present with various clinical oral findings. Detailed medical history is a key to the proper diagnosis of these lesions and fortunately other diagnostic procedures are rarely needed. Lesions are usually managed with elimination of the offending agent and with topical steroids. In more severe cases systemic steroids should be applied. Vanja Vucicevic Boras, Vlaho Brailo, Ana Andabak Rogulj, Danica Vidovic Juras, Dragana Gabric, and Danko Velimir Vrdoljak Copyright © 2015 Vanja Vucicevic Boras et al. All rights reserved. Inadvertent Apical Extrusion of Sodium Hypochlorite with Evaluation by Dental Volumetric Tomography Wed, 25 Mar 2015 11:30:43 +0000 This case report describes the tissue injury caused by inadvertently extruded NaOCl through the apical constriction. A 56-year-old female patient with complaints of pain, swelling, and ecchymosis on the left side of her face was referred to our clinic. The symptoms had emerged following root canal treatment of the maxillary left first premolar, and a soft tissue complication due to apical extrusion of NaOCl was diagnosed. Antibiotics and analgesics were prescribed. DVT images revealed that the buccal root apex had perforated the maxillary bone. The patient was followed up every other day and became asymptomatic on the 10th day. Endodontic therapy was completed with routine procedures. Determining working length precisely and following irrigation protocols meticulously are indispensable to prevent this type of complication. 3D visualization of the affected area may reveal the cause of the incident. Elif Delve Başer Can, Meriç Karapınar Kazandağ, and Rabia Figen Kaptan Copyright © 2015 Elif Delve Başer Can et al. All rights reserved. Elastic Band Causing Exfoliation of the Upper Permanent Central Incisors Sun, 22 Mar 2015 14:08:36 +0000 Objective. This study reports a case in which elastic band use culminated in the loss of the incisors. Case Report. An 11-year-old white girl was seen complaining of pain, with purulent discharge and severe tooth mobility. The bone destruction detected radiographically in the region, despite its single location and absence in posterior quadrants of the maxilla and/or mandible, was similar to that observed in Langerhans cell disease. To our surprise, an elastic band involving the midportion of the roots of the two upper central incisors was found during biopsy. The debris was removed and a metal wire was placed in permanent maxillary right and left incisors. The patient was followed up, but no improvement in tooth mobility was observed. Bone loss increased, and internal resorption and root exposure occurred, which culminated in the extraction of permanent maxillary right and left incisors. Conclusion. The present case highlights the fact that professionals sometimes are confronted by anamnestic reports never seen before. Monica Ghislaine Oliveira Alves, Dárcio Kitakawa, Joao Batista Macedo Becker, Adriana Aigotti Haberbeck Brandão, Luiz Antonio Guimarães Cabral, and Janete Dias Almeida Copyright © 2015 Monica Ghislaine Oliveira Alves et al. All rights reserved. Lipoid Proteinosis: A Rare Encounter in Dental Office Thu, 19 Mar 2015 12:18:21 +0000 Lipoid proteinosis is a sporadic congenital metabolic disorder which is characterized by deposition of hyaline material in dermis, submucosal connective tissue, and various internal organs. It has an extremely low prevalence rate with less than 300 cases reported so far. This progressive disease has a vast spectrum of manifestations ranging from asymptomatic lesions to fatal seizures and respiratory obstruction making timely diagnosis of this rare disorder an imperative task for oral health care practitioners. We report a case of characteristic oral manifestations of lipoid proteinosis in a 28-year-old male patient along with a review of relevant prevailing literature. Prasannasrinivas Deshpande, Mahima Veeranna Guledgud, Karthikeya Patil, Usha Hegde, Ankita Sahni, and Sreeshlya Huchanahalli Sheshanna Copyright © 2015 Prasannasrinivas Deshpande et al. All rights reserved. Peripheral Giant Cell Granuloma Associated with a Dental Implant: A Case Report and Review of the Literature Mon, 16 Mar 2015 08:23:35 +0000 The peripheral giant cell granuloma (PGCG) is a nonneoplastic lesion commonly caused by local irritation. This report describes a 46-year-old Caucasian male who presented with a PGCG associated with a dental implant. The dental implant was originally placed in August 2012. Ten months later, the patient presented with a well-circumscribed lesion associated with and covering the implant, at which time the lesion was excised. Four months later, due to recurrence of the lesion, a deeper and wider excisional biopsy with curettage of the adjacent bone was performed. No evidence of recurrence has been reported after 12 months of follow-up. Immunohistochemistry, using the antibody CD68, was performed to investigate the origin of the multinucleated giant cells, with their immunophenotype being similar to those of other giant cell lesions, including central giant cell granuloma, foreign-body reactions, and granulomatous reactions to infectious agents. Amy Louise Brown, Paulo Camargo de Moraes, Marcelo Sperandio, Andresa Borges Soares, Vera Cavalcanti Araújo, and Fabrício Passador-Santos Copyright © 2015 Amy Louise Brown et al. All rights reserved. Effective and Efficient Herbst Appliance Therapy for Skeletal Class II Malocclusion Patient with a Low Degree of Collaboration with the Orthodontic Treatment Tue, 10 Mar 2015 12:01:01 +0000 The current concept for effective and efficient treatment of skeletal Class II malocclusion prescribes that interceptive approach should be delivered during the pubertal growth stage. However, psychosocial issues and a greater risk of dental trauma are also factors that should be addressed when considering early Class II therapy. This paper reports a case of a patient that sought orthodontic treatment due to aesthetic discomfort with the incisors’ protrusion. Two previous treatments failed because patient’s collaboration with removable appliances was inadequate. Given his history of no collaboration and because the patient was in the prepubertal stage, it was decided to try a different approach in the third attempt of treatment. Traumatic injury protective devices were used during the prepubertal stage and followed by Herbst appliance and fixed multibrackets therapy during the pubertal stage, resulting in an adequate outcome and long-term stability. Bernardo Quiroga Souki, Barbra Duque Costa Bastos, Luana Fialho Ferro Araujo, Wagner Fernando Moyses-Braga, Mariele Garcia Pantuzo, and Paula Loureiro Cheib Copyright © 2015 Bernardo Quiroga Souki et al. All rights reserved. Severe Gingival Enlargement with Coexisting Erosive Lichen Planus in Severe Chronic Periodontitis Patient Mon, 09 Mar 2015 12:04:38 +0000 Plaque induced gingival enlargement is most commonly seen and when encountered simultaneously with erosive lichen planus poses a challenge to the treating dentist. Prognosis of one condition may influence the prognosis of another condition. The presented case highlights the significance of proper diagnosis and the management of simultaneously occurring gingival lesions. A 49-year-old hypertensive female presented with painful enlarged bleeding and suppurating gums with burning sensation on eating food along with long-term usage of antihypertensive drug amlodipine known for its gingival enlargement effect. All these multiple factors led to diagnostic dilemma. Effective management of the gingival enlargement was done by using electrocautery to rehabilitate the functions and esthetics of the patient. Gingival condition was also complicated by the presence of coexisting lichen planus which was predominantly erosive for which topical corticosteroid, antifungal, and antimicrobial agents were prescribed. Eight-month follow-up did not show recurrence of gingival enlargement. Electrocautery is an effective tool for the gingivectomy in severe inflammatory type of gingival enlargement because of rapid postoperative hemostasis. For the management of erosive lichen planus, long-term use of topical corticosteroids is an effective approach. Maintenance of oral hygiene and regular follow-ups are essential for these conditions. Ambika Sharma, Chakshu Aggarwal, Vijay P. Mathur, and Divesh Sardana Copyright © 2015 Ambika Sharma et al. All rights reserved. Conservative Treatment of a Large Facial Midroot Perforation Mon, 09 Mar 2015 09:36:48 +0000 Aim. To report on the endodontic and periodontal management of a root and alveolar process perforation in a maxillary front tooth. Summary. Perforation during access cavity preparation is an infrequent complication during endodontic therapy, leading to potential periodontal tissue breakdown. The case described the two-stage management of a massive facial root perforation requiring a connective tissue graft to correct a mucosal fenestration persisting after orthograde repair of the root defect with MTA. Stephane Kerner and François Bronnec Copyright © 2015 Stephane Kerner and François Bronnec. All rights reserved. Posttraumatic Displacement Management: Lateral Luxation and Alveolar Bone Fracture in Young Permanent Teeth with 5 Years of Follow-Up Sun, 08 Mar 2015 09:12:17 +0000 Dental trauma is an important public health problem due to high prevalence and associated limitations. The external impact accounting for trauma may result in different injury types to teeth and supporting structures. This paper describes a clinical case of tooth trauma in an 8-year-old patient exhibiting the displacement of three permanent teeth with open root apexes. Although the traumatic impact resulted in two injury types to teeth and supporting tissues (lateral luxation and alveolar bone fracture), the therapeutic approach was the same in both situations. The bone and teeth were repositioned by digital pressure, stabilized by semirigid splint, and followed up at every week. After six weeks, the splint was removed. At that moment, the clinical and radiographic findings indicated normal soft/hard tissues and absence of pulp/periodontal pathologies. At the fifth year of follow-up, the treatment success of the case was confirmed, although it has been observed that all lower incisors exhibited pulp obliteration as a consequence of the dental trauma. Heitor Marques Honório, Catarina Ribeiro Barros de Alencar, Edmer Silvestre Pereira Júnior, Daniela Silva Barroso de Oliveira, Gabriela Cristina de Oliveira, and Daniela Rios Copyright © 2015 Heitor Marques Honório et al. All rights reserved. Ectopic Compound Odontoma in the Buccal Mucosa: Report of a Rare Case Wed, 25 Feb 2015 13:20:05 +0000 Eruption of tooth into extraosseous locations is an extremely rare condition. We report a case of a six-year-old girl child with tooth-like structure erupting from the right buccal mucosa. Clinical, radiographic, and histopathologic examination suggested the diagnosis of compound odontoma. Very few cases have been reported so far, where tooth has been located completely in the soft tissue and a variety of names have been used for that condition. A brief review of the literature and the ambiguity in naming the situation is discussed. Aparna Venigalla, Leela Krishna Guttikonda, Hasini Nelakurthi, Suresh Babburi, Soujanya Pinisetti, Ajay Banerji Kotti, and Lavanya Kalapala Copyright © 2015 Aparna Venigalla et al. All rights reserved. Severe Impaction of the Primary Mandibular Second Molar Accompanied by Displacement of the Permanent Second Premolar Wed, 25 Feb 2015 11:38:26 +0000 Tooth impaction is defined as any tooth that fails to erupt into a normal functional position and remains unerupted beyond the time at which it should normally erupt. Reports of impaction and eruption failure in primary teeth are relatively rare compared to permanent teeth. We report 2 rare cases where the second premolar was located on the occlusal side of the impacted mandibular second primary molar. In the first case, the succedaneous permanent tooth erupted after extraction of the primary tooth, fenestration, and traction. In the second case, the succedaneous permanent tooth erupted without fenestration or traction. Although the etiology of the tooth displacement was unknown in both cases, inhibition of the eruptive movement of the primary molar may have been associated with displacement of the succedaneous permanent premolar. Junko Matsuyama, Shoko Kinoshita-Kawano, Sachiko Hayashi-Sakai, Tomoe Mitomi, and Tomiko Sano-Asahito Copyright © 2015 Junko Matsuyama et al. All rights reserved. Severe Bradycardia Possibly due to a Local Anesthetic Oral Mucosal Injection during General Anesthesia Wed, 25 Feb 2015 11:38:26 +0000 Local anesthesia may induce systemic complications leading to parasympathetic activity leading to bradycardia and hypotension. We report a case of a 50-year-old man undergoing dental surgery under general anesthesia who experienced severe bradycardia and hypotension after local anesthesia infiltration. Concerns regarding the utilization of a relatively large lumen injection needle for local anesthesia during general anesthesia are discussed. Kenichi Satoh, Ayako Ohashi, Miho Kumagai, Hideki Hoshi, Kousei Otaka, and Shigeharu Joh Copyright © 2015 Kenichi Satoh et al. All rights reserved.