Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Compound Composite Odontoma and Its Management Sun, 21 Dec 2014 12:06:56 +0000 Odontomas are odontogenic benign tumors composed of dental tissue. Majority of these lesions are asymptomatic and are often detected on routine radiographs. They can be thought of as “tooth hamartomas" with the lesion consisting of various tooth components. They are divided histologically into complex odontomas and compound odontomas. This paper describes the case of a compound odontoma in a 13-year-old girl diagnosed due to the retention of the primary right mandibular second molar. A surgical excision was performed without disturbing the unerupted premolar. The results achieved indicate that early diagnosis of odontomas enables adoption of less complex treatment, a better prognosis, and displacement or devitalisation of adjacent tooth. Morawala Abdul, Kapila Pragati, and Chunawala Yusuf Copyright © 2014 Morawala Abdul et al. All rights reserved. Rare Periodontal Ligament Drainage for Periapical Inflammation of an Adjacent Tooth: A Case Report and Review of the Literature Sun, 21 Dec 2014 11:20:19 +0000 Aim. To report a case with an unusual drainage route of periapical inflammation exiting through the gingival sulcus of an adjacent vital tooth and review probable factors determining the diversity of the discharge routes of periapical inflammation. Summary. An 18-year-old male patient presented with periodontal abscess of tooth 46, which was found to be caused by a periapical cyst with an acute abscess of tooth 45. During endodontic surgery, a rarely reported drainage route for periapical inflammation via the gingival sulcus of an adjacent vital tooth was observed for the first time. Complete periodontal healing of the deep pocket of tooth 46 and hiding of the periapical cyst of tooth 45 followed after root canal treatment and periapical surgery with Bio-Oss Collagen implantation on tooth 45. The drainage routes of periapical inflammation are multivariate and the diversity of drainage pathways of periapical inflammation is mainly related to factors such as gravity, barriers against inflammation, and the causative tooth itself. Hongmei Guo, Wei Lu, Qianqian Han, Shubo Li, and Pishan Yang Copyright © 2014 Hongmei Guo et al. All rights reserved. Craniodentofacial Manifestations in a Rare Syndrome: Orofaciodigital Type IV (Mohr-Majewski Syndrome) Sun, 21 Dec 2014 00:10:25 +0000 Background. The orofaciodigital syndromes (OFDS) are a heterogeneous group of syndromes that affect the face, oral cavity, and the digits. OFDS type IV (OMIM %258860) is rare and characterized by broad nasal root and tip, orbital hypertelorism or telecanthus, micrognathia, hypoplastic mandible, and low-set ears. Oral symptoms may include cleft lip, cleft or highly arched palate, bifid uvula, cleft or hypoplastic maxillary and mandibular alveolar ridge, oral frenula, lingual hamartoma, and absent or hypoplastic epiglottis. Dental anomalies are common and generally include disturbances in the number of teeth. Case Report. This report presents a six-year-old girl, referred with the chief complaint of missing teeth. She was diagnosed as having OFDS type IV based on clinical findings. Her parents reported three deceased children and two fetuses that had the same phenotype. She was the seventh child of consanguineous parents who were first cousins. Conclusion. This is a very rare syndrome. Many reported OFDS type IV cases have consanguineous parents, consistent with an autosomal recessive trait. Manifestation of cleft palate in the healthy sibling may be mild expression of the disorder or an unrelated isolated cleft. Meltem Ozdemir-Karatas, Didem Ozdemir-Ozenen, P. Suzanne Hart, and Thomas C. Hart Copyright © 2014 Meltem Ozdemir-Karatas et al. All rights reserved. Fraser Syndrome-Oral Manifestations and a Dental Care Protocol Sun, 21 Dec 2014 00:10:24 +0000 Fraser syndrome is a rare genetic malformation with an autosomal recessive pattern of inheritance and an incidence of consanguinity ranging from 15% to 25%. A 5-year-old male patient who is a carrier of Fraser syndrome initiated treatment in the pediatric dentistry sector. The patient was fed parenterally since birth, experienced recurring bouts of chronic lung disease, and was referred to the pediatric dentistry sector by the medical team. Radiographic examination revealed the presence of all permanent teeth. Supragingival dental calculus, halitosis, and gingival inflammation were also observed. Dental calculus was removed by manual scraping, and chemotherapeutic agents were used, chlorhexidine 0,12%, chlorhexidine gel 2%, and PVP-I, to control the bacterial flora. The patient is still being monitored after an 8-year follow-up period, the complications associated with periodontal disease decreased, and since the initiation of treatment, the patient has not needed to be hospitalized because of chronic lung disease. This study reports the case of a patient diagnosed with Fraser syndrome and describes the clinical manifestations (general and oral). Talita Lopes de Oliveira and Giselle Rodrigues de Sant’Anna Copyright © 2014 Talita Lopes de Oliveira and Giselle Rodrigues de Sant’Anna. All rights reserved. Cartilaginous Choristoma of the Gingiva: A Rare Clinical Entity Thu, 18 Dec 2014 13:06:08 +0000 Choristomas are rare entities which are aggregates of microscopically normal cells or tissues in aberrant locations. They are a “heterotopic” rest of cells, as they appear as a tumor-like mass. Herein we report a case of cartilaginous choristoma in a 54-year-old male who presented with a swelling on right lower gingiva. The histopathological examination revealed features of a well circumscribed mass of mature cartilage in a dense fibrous connective tissue stroma. Ramalingam Suganya, Narasimhan Malathi, Subramani Vijaya Nirmala, Chinnaswami Ravindran, and Harikrishnan Thamizhchelvan Copyright © 2014 Ramalingam Suganya et al. All rights reserved. Unilateral Fusion of Maxillary Lateral Incisor: Diagnosis Using Cone Beam Computed Tomography Thu, 18 Dec 2014 09:01:49 +0000 Objective. The objective of this paper is to report a dental fusion case focusing on clinical and radiographic features for the diagnosis. Method. To report a case of right maxillary lateral incisor fusion and a supernumerary tooth, the anatomy of the root canal and dental united portion were assessed by cone beam computed tomography (CBCT). Results. The clinical examination showed dental juxtaposition with the absence of interdental papilla and esthetic impairment in the right maxillary lateral incisor region. The periapical radiography did not provide enough information for the differential diagnosis due to the inherent limitations of this technique. CBCT confirmed the presence of tooth fusion. Conclusion. CBCT examination supports the diagnosis and provides both the identification of changes in tooth development and the visualization of their extent and limits. Iury Oliveira Castro, Carlos Estrela, Vinícius Rezende Souza, Lawrence Gonzaga Lopes, and João Batista de Souza Copyright © 2014 Iury Oliveira Castro et al. All rights reserved. Numb Chin Syndrome as First Symptom of Diffuse Large B-Cell Lymphoma Tue, 16 Dec 2014 00:10:22 +0000 Numb chin syndrome is a rare sensory neuropathy of the mental nerve characterized by numbness, hypoesthesia, paraesthesia, and very rarely pain. Dental causes, especially iatrogenic ones, maxillofacial trauma, or malignant neoplasm are etiologic factors for this rare syndrome. Many malignant and metastatic neoplasms are causing this syndrome, like primary osteosarcoma, squamous cell carcinoma, and mandibular metastasis of primary carcinoma of breast, lung, thyroid, kidney, prostate, and nasopharynx. Haematological malignancies like acute lymphocytic leukaemia, Hodgkin and non-Hodgkin lymphoma, and myeloma can cause this neuropathy. The authors report a case of a 71-year-old woman in which the numb chin syndrome was the first symptom of the diffuse large B-cell lymphoma, which caused infiltration and reabsorption of the alveolar ridge and lower mandibular cortex. A biopsy of the mass was performed on fragments of tissue collected from the mandibular periosteum, medullary and cortical mandibular bone, and inferior alveolar nerve. Mario Carbone, Francesco Della Ferrera, Lucio Carbone, Gaia Gatti, and Marco Carrozzo Copyright © 2014 Mario Carbone et al. All rights reserved. Mini-Implants: New Possibilities in Interdisciplinary Treatment Approaches Sun, 14 Dec 2014 09:55:51 +0000 The introduction of mini-implants has broadened the range of tooth movements possible by fixed appliance therapy alone. The limits of fixed orthodontic treatment have become more a matter of facial appearance than anchorage. Many complex cases which would previously have required surgery or functional appliances can now be treated with fixed appliance therapy using mini-implants. A mutilated dentition case where mini-implants were used to provide anchorage for intrusion of molars and retraction of anterior teeth is reported here to illustrate this point. Biju Sebastian Copyright © 2014 Biju Sebastian. All rights reserved. Treatment of Odontogenic Myxoma: A Multidisciplinary Approach—6-Year Follow-Up Case Sun, 14 Dec 2014 07:28:51 +0000 The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants. João Gustavo Oliveira de Souza, Jonathas Daniel Paggi Claus, Felipe Damerau Ouriques, Luiz Fernando Gil, José Nazareno Gil, Antonio Carlos Cardoso, and Marco Aurélio Bianchini Copyright © 2014 João Gustavo Oliveira de Souza et al. All rights reserved. Dental Management of a 14-Year-Old with Cockayne Syndrome under General Anesthesia Wed, 10 Dec 2014 00:10:54 +0000 Cockayne’s syndrome is a rare, autosomal recessive disorder characterized clinically by cachectic dwarfism, cutaneous photosensitivity, loss of adipose tissue, mental retardation, skeletal and neurological abnormalities, and pigmentary degeneration of the retina. Dental caries is a common finding. Dental rehabilitation of a 14-year-old male with Cockayne’s syndrome is presented. Divya Gaddam, Mukesh Singh Thakur, Niranjani Krothapalli, and Saujanya Kaniti Copyright © 2014 Divya Gaddam et al. All rights reserved. Familial Case of Cherubism from South India: Differential Diagnosis and Report of 2 Cases Mon, 08 Dec 2014 00:10:25 +0000 Cherubism is a rare familial multilocular cystic lesion of the jaws. The condition clinically appears as a bilateral symmetric swelling of the cheeks in children and is the primary reason for referral. It is a rare lesion of the jaws that has a dominant pattern of inheritance. We report two cases of cherubism, that of a boy and his mother suggestive of a strong familial incidence. A variety of lesions of the jaw mimic this condition and hence the differential diagnosis has been emphasised. Varun Muthuraman and Soundarya Srinivasan Copyright © 2014 Varun Muthuraman and Soundarya Srinivasan. All rights reserved. Treatment Algorithm for Ameloblastoma Sun, 07 Dec 2014 13:03:13 +0000 Ameloblastoma is the second most common benign odontogenic tumour (Shafer et al. 2006) which constitutes 1–3% of all cysts and tumours of jaw, with locally aggressive behaviour, high recurrence rate, and a malignant potential (Chaine et al. 2009). Various treatment algorithms for ameloblastoma have been reported; however, a universally accepted approach remains unsettled and controversial (Chaine et al. 2009). The treatment algorithm to be chosen depends on size (Escande et al. 2009 and Sampson and Pogrel 1999), anatomical location (Feinberg and Steinberg 1996), histologic variant (Philipsen and Reichart 1998), and anatomical involvement (Jackson et al. 1996). In this paper various such treatment modalities which include enucleation and peripheral osteotomy, partial maxillectomy, segmental resection and reconstruction done with fibula graft, and radical resection and reconstruction done with rib graft and their recurrence rate are reviewed with study of five cases. Madhumati Singh, Anjan Shah, Auric Bhattacharya, Ragesh Raman, Narahari Ranganatha, and Piyush Prakash Copyright © 2014 Madhumati Singh et al. All rights reserved. Camouflage of Severe Skeletal Class II Gummy Smile Patient Treated Nonsurgically with Mini Implants Sun, 07 Dec 2014 12:32:59 +0000 Skeletal class II has always been a challenge in orthodontics and often needs assistance of surgical orthodontics in nongrowing patients when it presents with severe discrepancy. Difficulty increases more when vertical dysplasia is also associated with sagittal discrepancy. The advent of mini implants in orthodontics has broadened the spectrum of camouflage treatment. This case report presents a 16-year-old nongrowing girl with severe class II because of retrognathic mandible, and anterior dentoalveolar protrusion sagittally and vertically resulted in severe overjet of 13 mm and excessive display of incisors and gums. Both maxillary central incisors were trimmed by general practitioner few years back to reduce visibility. Treatment involved use of micro implant for retraction and intrusion of anterior maxillary dentoalveolar segment while lower incisors were proclined to obtain normal overjet, and overbite and pleasing soft tissue profile. Smile esthetics was further improved with composite restoration of incisal edges of both central incisors. Irfan Qamruddin, Fazal Shahid, Mohammad Khursheed Alam, and Wafa Zehra Jamal Copyright © 2014 Irfan Qamruddin et al. All rights reserved. Comprehensive Orthodontic Treatment of Adult Patient with Cleft Lip and Palate Wed, 03 Dec 2014 07:49:11 +0000 The aim of the paper is to present full orthodontic treatment of an operated cleft lip adult patient. Case Report. An 18-year-old patient consulted for severe crowded teeth. He comes from a poor family. At that time he already had four operations (velum, palate, lip, and myringotomy). Treatment included maxillary expansion, tooth extraction, and fixed orthodontic, as well as kinesiology and speech therapy treatment. A multidisciplinary approach allowed us to achieve successfully an excellent result for this patient and gave him a harmonic smile and an optimal function without orthognathic surgery. Two years after treatment, occlusion remains stable. Noemí Leiva Villagra, Miguel Muñoz Domon, and Sebastian Véliz Méndez Copyright © 2014 Noemí Leiva Villagra et al. All rights reserved. Cone Beam Computed Topographic Evaluation and Endodontic Management of a Rare Mandibular First Molar with Four Distal Canals Mon, 01 Dec 2014 09:28:16 +0000 Root canal system is complex to understand because of its unpredictable nature. It differs for different teeth and for the same teeth in different individuals. Successful endodontic therapy thus depends on the clinician’s ability to anticipate and look for these variations. A mandibular first molar with six root canals represents a rare anatomical variant, particularly when four canals are found in distal root. This case report discusses successful nonsurgical endodontic management of two-root mandibular first molar with four distal canals and two mesial canals reported for the first time in Indian population. Cone beam computed tomography was used as a diagnostic method to confirm the position and presence of 4 root canals in the distal root. Nidhi Sinha, Bijay Singh, Akshay Langaliya, Nitin Mirdha, Irfanul Huda, and Ashwin Jain Copyright © 2014 Nidhi Sinha et al. All rights reserved. A Rare Interstitial Duplication of 8q22.1–8q24.3 Associated with Syndromic Bilateral Cleft Lip/Palate Tue, 25 Nov 2014 00:00:00 +0000 We present a rare case of 8q interstitial duplication derived from maternal balanced translocations in a patient with bilateral cleft lip and palate in syndromic form associated with other congenital malformations. G-banding cytogenetic analysis revealed a chromosomal abnormality in the form of the karyotype 46,XX der(22)t(8;22)(q22.1;p11.1)mat. Chromosome microarray analysis evidenced a 49 Mb duplicated segment of chromosome 8q with no pathogenic imbalances on chromosome 22. Two siblings also carry the balanced translocation. We have compared this case with other “pure” trisomies of 8q patients reported in the literature and with genome wide association studies recently published. This work highlights the involvement of chromosome 8q in orofacial clefts. Regina Ferreira Rezek, Ana Angélica Rodrigues Abbas, Juliana Forte Mazzeu, Siliana Maria Duarte Miranda, and Cibele Velloso-Rodrigues Copyright © 2014 Regina Ferreira Rezek et al. All rights reserved. Diagnosis and Treatment of Pseudo-Class III Malocclusion Mon, 24 Nov 2014 08:43:49 +0000 Pseudo-Class III malocclusion is characterized by the presence of an anterior crossbite due to a forward functional displacement of the mandible; in most cases, the maxillary incisors present some degree of retroclination, and the mandibular incisors are proclined. Various types of appliances have been described in the literature for the early treatment of pseudo-Class III malocclusion. The objectives of this paper are to demonstrate the importance of making the differential diagnosis between a skeletal and a pseudo-Class III malocclusion and to describe the correction of an anterior crossbite. The association of maxillary expansion and a 2 × 4 appliance can successfully be used to correct anterior crossbites. Ariel Reyes, Luis Serret, Marcos Peguero, and Orlando Tanaka Copyright © 2014 Ariel Reyes et al. All rights reserved. Interdisciplinary Management of an Isolated Intrabony Defect Sun, 23 Nov 2014 12:00:02 +0000 The treatment of intrabony defects is a real challenge in molar teeth as it is chronic, slowly progressing disease which needs timely intervention. Periodontal inflammation associated with intrabony defect is not a separate entity as it secondarily affects the pulp causing retrograde pulpitis. However, treatment of these lesions will be complicated due to extensive bone loss. The tooth was endodontically treated followed by periodontal surgery to eliminate the deep periodontal pocket and promote bone fill in osseous defect. PepGen P-15 composited with platelet rich plasma was utilized for enhancing bone formation. The combination of these graft materials provides synergistic effect on bone regeneration. Sheetal Ghivari, Anand C. Patil, Shavina Patil, Sunita Shivanand, and Anukriti Tyagi Copyright © 2014 Sheetal Ghivari et al. All rights reserved. Central Odontogenic Fibroma of Simple Type Sun, 23 Nov 2014 09:20:46 +0000 Central odontogenic fibroma (COF) is an extremely rare benign tumor that accounts for 0.1% of all odontogenic tumors. It is a lesion associated with the crown of an unerupted tooth resembling dentigerous cyst. In this report, a 10-year-old male patient is presented, who was diagnosed with central odontogenic fibroma of simple type from clinical, radiological, and histopathological findings. Prasanth Thankappan, Naga Sirisha V. Chundru, Rajesh Amudala, Prashanthi Yanadi, S. A. K. Uroof Rahamthullah, and Meeramma Botu Copyright © 2014 Prasanth Thankappan et al. All rights reserved. Extensive Presentation of Central Ossifying Fibroma Treated with Conservative Surgical Excision Sun, 23 Nov 2014 08:05:51 +0000 Central ossifying fibroma is a benign slow-growing tumor of mesenchymal origin and it tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar and molar areas. Clinically, it is a large asymptomatic tumor of aggressive appearance, with possible tooth displacement. Occasionally treated by curettage enucleation, this conservative surgical excision is showing a recurrence rate extremely low. The objective of this study was to report a case of a 44-year-old woman, presenting a very large ossifying fibroma in the mandible, which was successfully treated with curettage, and to conduct a brief literature review of this lesion, focusing on the histology, clinical behavior, and management of these uncommon lesions. Matheus Henrique Lopes Dominguete, Alexandre Augusto Sarto Dominguette, Bruno Henrique Matos, Paulo Roberto Dominguete, Jorge Esquiche León, and Lucinei Roberto Oliveira Copyright © 2014 Matheus Henrique Lopes Dominguete et al. All rights reserved. A Case of Odontogenic Infection by Streptococcus constellatus Leading to Systemic Infection in a Cogan’s Syndrome Patient Thu, 20 Nov 2014 00:00:00 +0000 Odontogenic infection in immunocompromised patients tends to extend systemically beyond the oral cavity. Our case report presents a patient with sepsis due to a Streptococcus constellatus (S. constellatus) odontogenic infection in a 64-year-old-immunocompromised woman with Cogan’s syndrome. She had been suffering from chronic mandibular osteomyelitis which was thought to have been caused by dental caries and/or chronic periodontitis with furcation involvement of the left mandibular first molar. We suspect that the acute symptoms of the chronic osteomyelitis due to S. constellatus led to the systemic infection. This infection could be accelerated by the use of a corticosteroid and an alendronate. This is the first report which represents the potential association between odontogenic infection and Cogan’s syndrome. Masanobu Abe, Yoshiyuki Mori, Ryoko Inaki, Yae Ohata, Takahiro Abe, Hideto Saijo, Kazumi Ohkubo, Kazuto Hoshi, and Tsuyoshi Takato Copyright © 2014 Masanobu Abe et al. All rights reserved. Endodontic Management of a Maxillary Molar with Three Mesiobuccal Canals Wed, 19 Nov 2014 06:44:42 +0000 It is imperative that the clinician should have comprehensive knowledge about the normal anatomy and its variations of the teeth as the deviations from the usual are very common. An increased awareness of unusual anatomy and a better understanding of the root canal system guide the clinician in accurate diagnosis and treatment of such variations in order to achieve a successful endodontic outcome. The maxillary first molar has been shown to have a wide variation in respect to the number of canals specifically noted in the mesiobuccal root. The current case report shows the successful management of a maxillary molar in which the mesiobuccal root had three canals. Sirisha Gundam, Radhika Maddu, and Sindhura Reddy Gurram Copyright © 2014 Sirisha Gundam et al. All rights reserved. Multidisciplinary Approach for the Treatment of Horizontal Root-Fractured Maxillary Anterior Teeth Mon, 17 Nov 2014 07:02:11 +0000 Dental trauma can lead to a wide range of injuries of which crown and root fractures are examples. Crown-root fractures often need complex treatment planning. This case report describes the use of MTA in the multidisciplinary management of a patient with a horizontally fractured central incisor and luxation in a different central incisor. A 42-year-old female patient presented within 1 h of receiving direct trauma to her maxillary area. Clinical examination revealed that the right and left maxillary central incisors presented mobility and sensitivity to percussion and palpation but no sensitivity to thermal stimulations. Occlusal displacement with extrusion in the left maxillary central incisor and luxation in the right maxillary central incisor was observed. Radiographic examination revealed horizontal root fracture at the apical third of the left maxillary central incisor. Root fracture in the right maxillary incisor was not observed. Endodontic and aesthetic restorative treatments were completed. MTA showed a good long-term outcome when used in root-fractured and luxated teeth. In addition, composite resin restoration provided satisfactory aesthetic results even after 15 months. Berkan Celikten, Ceren Feriha Uzuntas, Reza Safaralizadeh, Gulbike Demirel, and Semra Sevimay Copyright © 2014 Berkan Celikten et al. All rights reserved. Primary Malignant Melanoma of Maxilla: Report of a Case with Discussion Mon, 17 Nov 2014 00:00:00 +0000 Primary oral malignant melanoma, very rare neoplasm of melanocytic origin, usually presents as a bluish black to tan-brown colored lesion Which is accounting for 0.2 to 8% of all melanomas, 1.6% of all head and neck malignancies, and 0.5% of all oral neoplasia. In general, the prognosis of oral melanoma is poor and worse than that of cutaneous melanoma. Here a case of oral malignant melanoma is presented, which was undetected during the first visit to a dental clinic. When a simple oral surgical treatment was carried out in that region, it resulted in the appearance of a massive pigmented lesion which was histopathologically diagnosed as malignant melanoma. This paper is presented to reemphasize the fact that any pigmented lesion in the oral cavity should be viewed with suspicion and proper investigation (biopsy) should be carried out to rule out any untoward experiences later. G. Shirisha Rani, T. Vinay Kumar, Balaram Kolasani, Md Rezwana Begum, and Anu Priya Srinivasan Copyright © 2014 G. Shirisha Rani et al. All rights reserved. Treatment of Two Canals in All Mandibular Incisor Teeth in the Same Patient Sun, 16 Nov 2014 07:03:11 +0000 The main reason for unfavourable outcome in endodontic treatment of mandibular incisor is the inability to detect the presence of second canal. Pain even after extirpation of complete pulp tissue from root canal of vital teeth is the main indication of hidden canals. The present case report is also on pain because of another neglected canal in all mandibular incisors in the same patient. Vandana B. Kokane, Swapnil N. Patil, Mohit K. Gunwal, Rajesh Kubde, and Swaraj Atre Copyright © 2014 Vandana B. Kokane et al. All rights reserved. Management of Sjogren’s Syndrome Patient: A Case Report of Prosthetic Rehabilitation with 6-Year Follow-Up Thu, 13 Nov 2014 00:00:00 +0000 Completely and partially edentulous patients with Sjogren’s syndrome (SS) experience severe hyposalivation, xerostomia, and considerable difficulty in using tissue-supported prosthesis. This clinical paper describes the management, treatment, and 6-year follow-up of a patient diagnosed with SS type II, who uses corticosteroids and antihyperglycemic drugs. The patient received restorative, periodontal, and surgical treatments followed by implant-supported fixed prosthesis. Radiographic evaluation and probing depth showed gingival health and no bone loss after 6 years. Treatment with implant-retained dental prosthesis greatly increased comfort and function, offering an alternative to patients with SS. Marcos de Mendonça Invernici, Amanda Finger Stadler, Gastão Vale Nicolau, Maria Ângela Naval Machado, Antônio Adilson Soares de Lima, and Marilia Compagnoni Martins Copyright © 2014 Marcos de Mendonça Invernici et al. All rights reserved. Iatrogenic Displacement of a Foreign Body into the Periapical Tissues Tue, 11 Nov 2014 11:53:59 +0000 The presence of a foreign body in the periapical tissues can cause endodontic failure by triggering an inflammatory response and a subsequent foreign body reaction. This inflammatory response, which can occur to varying degrees, appears radiographically as a radiolucency that can remain asymptomatic for many years. A foreign object can reach the apical region by accident or iatrogenic procedures during dental procedures. The aim of the present case report is to describe the endodontic surgical treatment of an iatrogenic displacement of a foreign body (a metal fragment) into the periapical tissues and to describe its clinical and radiographic follow-up over a period of 52 months. Hugo Plascencia, Alvaro Cruz, Rodrigo Solís, Mariana Díaz, and Josué Vázquez Copyright © 2014 Hugo Plascencia et al. All rights reserved. Impact of Orthodontic Decompensation on Bone Insertion Mon, 10 Nov 2014 11:18:04 +0000 There has always been concern in determining the relationship between orthodontic tooth movement and the consequent biological costs to the periodontium and tooth root. The possibility of evaluating the tooth and bone morphology by CBCT allows more accurate analysis of qualitative and quantitative aspects of these processes. This paper presents a case report of a 20-year-old male patient with Class III malocclusion and hyperdivergent facial pattern, who was surgically treated. A significant amount of labial movement of mandibular incisors was performed during orthodontic treatment before surgery. CBCT was used for evaluation of buccal and lingual bone plates before and after tooth decompensation. The changes in the bone insertion level of maxillary and mandibular incisors in the present case encourage a reflection on the treatment protocol in individuals with dentoskeletal discrepancies. Fabio Pinto Guedes, Leopoldino Capelozza Filho, Daniela Gamba Garib, Hugo Nary Filho, Evandro José Borgo, and Mauricio de Almeida Cardoso Copyright © 2014 Fabio Pinto Guedes et al. All rights reserved. Paradigm Shift in the Management of the Atrophic Posterior Maxilla Mon, 10 Nov 2014 00:00:00 +0000 When the posterior maxilla is atrophic, the reference standard of care would be to perform sinus augmentation with an autologous bone graft through the lateral approach and delayed implant placement. However, placement of short implants with the osteotome sinus floor elevation technique and without graft can be proposed for an efficient treatment of clinical cases with a maxillary residual bone height of 4 to 8 mm. The use of grafting material is recommended only when the residual bone height is ≤4 mm. Indications of the lateral sinus floor elevation are limited to cases with a residual bone height ≤ 2 mm and fused corticals, uncompleted healing of the edentulous site, and absence of flat cortical bone crest or when the patient wishes to wear a removable prosthesis during the healing period. The presented case report illustrates osteotome sinus floor elevation with and without grafting and simultaneous implant placement in extreme conditions: atrophic maxilla, short implant placement, reduced healing time, and single crown rehabilitation. After 6 years, all placed implants were functional with an endosinus bone gain. Rabah Nedir, Nathalie Nurdin, Paul Khoury, Marc El Hage, Semaan Abi Najm, and Mark Bischof Copyright © 2014 Rabah Nedir et al. All rights reserved. Class III Malocclusion Surgical-Orthodontic Treatment Thu, 06 Nov 2014 07:26:32 +0000 The aim of the present case report is to describe the orthodontic-surgical treatment of a 17-year-and-9-month-old female patient with a Class III malocclusion, poor facial esthetics, and mandibular and chin protrusion. She had significant anteroposterior and transverse discrepancies, a concave profile, and strained lip closure. Intraorally, she had a negative overjet of 5 mm and an overbite of 5 mm. The treatment objectives were to correct the malocclusion, and facial esthetic and also return the correct function. The surgical procedures included a Le Fort I osteotomy for expansion, advancement, impaction, and rotation of the maxilla to correct the occlusal plane inclination. There was 2 mm of impaction of the anterior portion of the maxilla and 5 mm of extrusion in the posterior region. A bilateral sagittal split osteotomy was performed in order to allow counterclockwise rotation of the mandible and anterior projection of the chin, accompanying the maxillary occlusal plane. Rigid internal fixation was used without any intermaxillary fixation. It was concluded that these procedures were very effective in producing a pleasing facial esthetic result, showing stability 7 years posttreatment. Bruna Alves Furquim, Karina Maria Salvatore de Freitas, Guilherme Janson, Luis Fernando Simoneti, Marcos Roberto de Freitas, and Daniel Salvatore de Freitas Copyright © 2014 Bruna Alves Furquim et al. All rights reserved.