Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Giant Cell Fibroma in a Paediatric Patient: A Rare Case Report Thu, 26 Nov 2015 14:03:03 +0000 Giant cell fibroma is a form of fibrous tumour affecting the oral mucosa. Its occurrence is relatively rare in paediatric patients. Clinically it is presented as a painless, sessile, or pedunculated growth which is usually confused with other fibrous lesions like irritation fibromas. Here we are presenting a case where a seven-year-old male patient reported with a painless nodular growth in relation to lingual surface of 41 and 42. Considering the size and location of the lesion, excisional biopsy was performed and sent for histopathological analysis which confirmed the lesion as giant cell fibroma. Veera Kishore Kumar Reddy, Naveen Kumar, Prashant Battepati, Lalitha Samyuktha, and Swapna Priya Nanga Copyright © 2015 Veera Kishore Kumar Reddy et al. All rights reserved. Oral Lesions: The Clue to Diagnosis of Pemphigus Vulgaris Thu, 19 Nov 2015 12:36:34 +0000 Pemphigus is a group of potentially fatal dermatoses with both cutaneous and oral manifestations. Characterized by the appearance of vesicle or bullae, their manifestations in the oral cavity often precede those on the skin by many months or may remain as the only symptoms of the disease. It is therefore important that the oral manifestations of the disease are recognized on time, to make a proper diagnosis and initiate timely treatment. Here we present a case of Pemphigus Vulgaris (PV) that presented with oral lesions at multiple sites including tongue, to highlight the importance of timely recognition of the oral lesions during routine dental practice for the diagnosis and management of this disease. Diana Kuriachan, Rakesh Suresh, Mahija Janardhanan, and Vindhya Savithri Copyright © 2015 Diana Kuriachan et al. All rights reserved. Atypical Trigeminal Neuralgia Secondary to Meningioma Thu, 19 Nov 2015 11:43:10 +0000 Trigeminal neuralgia is a disorder of the fifth cranial nerve that causes episodes of intense, stabbing, electric shock-like pain that lasts from few seconds to few minutes in the areas of the face where the branches of the nerve are distributed. More than one nerve branch can be affected by the disorder. We report an unusual case of trigeminal neuralgia affecting right side of face presenting atypical features of neuralgia and not responding to the usual course of treatment. The magnetic resonance imaging study of brain revealed a large extra-axial mass involving right cerebellopontine angle region causing moderate pressure effect on trigeminal nerve and brain stem. The aim of this case report is to show a tumor of cerebellopontine angle, presenting clinically as atypical trigeminal neuralgia. Premeshwar Niwant, Mukta Motwani, and Sushil Naik Copyright © 2015 Premeshwar Niwant et al. All rights reserved. Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series Wed, 18 Nov 2015 13:14:38 +0000 Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions. Naina Pattnaik, Anurag Satpathy, Rinkee Mohanty, Rashmita Nayak, and Surjeet Sahoo Copyright © 2015 Naina Pattnaik et al. All rights reserved. Identification and Endodontic Management of Middle Mesial Canal in Mandibular Second Molar Using Cone Beam Computed Tomography Tue, 17 Nov 2015 11:19:31 +0000 Endodontic treatments are routinely done with the help of radiographs. However, radiographs represent only a two-dimensional image of an object. Failure to identify aberrant anatomy can lead to endodontic failure. This case report presents the use of three-dimensional imaging with cone beam computed tomography (CBCT) as an adjunct to digital radiography in identification and management of mandibular second molar with three mesial canals. Bonny Paul and Kavita Dube Copyright © 2015 Bonny Paul and Kavita Dube. All rights reserved. Pycnodysostosis with Special Emphasis on Dentofacial Characteristics Mon, 16 Nov 2015 14:11:31 +0000 Pycnodysostosis is an autosomal recessive disorder that manifests as osteosclerosis of the skeleton due to the defective osteoclasts mediated bone turnover. The diagnosis of this disorder is established on the basis of its characteristic features and must be differentially diagnosed with other bone disorders. Dental surgeons should be aware of the limitations and possible adverse oral complications such as osteomyelitis of bone in these patients. This will guide them in planning realistic treatment goals. This paper reports the clinical and radiographic features of pycnodysostosis with the great emphasis on its dentofacial characteristics. The aim of this case report is to give an insight into the etiology, pathogenesis, and differential diagnosis of this disorder and to prepare the dentists and maxillofacial surgeons to overcome the challenges in treating these patients. Aisha Khoja, Mubassar Fida, and Attiya Shaikh Copyright © 2015 Aisha Khoja et al. All rights reserved. The Immediate Aesthetic and Functional Restoration of Maxillary Incisors Compromised by Periodontitis Using Short Implants with Single Crown Restorations: A Minimally Invasive Approach and Five-Year Follow-Up Sun, 15 Nov 2015 07:31:46 +0000 The functional and aesthetic restoration of teeth compromised due to aggressive periodontitis presents numerous challenges for the clinician. Horizontal bone loss and soft tissue destruction resulting from periodontitis can impede implant placement and the regeneration of an aesthetically pleasing gingival smile line, often requiring bone augmentation and mucogingival surgery, respectively. Conservative approaches to the treatment of aggressive periodontitis (i.e., treatments that use minimally invasive tools and techniques) have been purported to yield positive outcomes. Here, we report on the treatment and five-year follow-up of patient suffering from aggressive periodontitis using a minimally invasive surgical technique and implant system. By using the methods described herein, we were able to achieve the immediate aesthetic and functional restoration of the maxillary incisors in a case that would otherwise require bone augmentation and extensive mucogingival surgery. This technique represents a conservative and efficacious alternative to the aesthetic and functional replacement of teeth compromised due to aggressive periodontitis. Mauro Marincola, Giorgio Lombardo, Jacopo Pighi, Giovanni Corrocher, Anna Mascellaro, Jeffrey Lehrberg, and Pier Francesco Nocini Copyright © 2015 Mauro Marincola et al. All rights reserved. Nasal Sinus Tract of Odontogenic Origin: Report of a Case Sun, 15 Nov 2015 06:10:46 +0000 Extraoral sinus tract often poses a diagnostic challenge to the clinician owing to its rare occurrence and absence of symptoms. The accurate diagnosis and comprehensive management are inevitable as the aetiology of such lesions is often masked and requires holistic approach. The present case report encompasses the management of an extraoral discharging sinus tract at the base of the right nostril in a chronic smoker. The lesion which was earlier diagnosed to be of nonodontogenic origin persisted even after erratic treatment modalities. Our investigations showed the aetiology of sinus tract to be odontogenic. Initially, a five-step program as recommended by the Agency for Health Care Research and Quality was used for smoking cessation followed by root canal therapy (RCT) and surgical management of the sinus tract. The patient has been under stringent follow-up and no reoccurrence has been noted. Sagar Sareen, Anjani Kumar Pathak, Parth Purwar, Jaya Dixit, Divya Singhal, Isha Sajjanhar, Kopal Goel, and Vaibhav Sheel Gupta Copyright © 2015 Sagar Sareen et al. All rights reserved. Maxillary Swelling as the First Evidence of Multiple Myeloma Thu, 12 Nov 2015 07:25:55 +0000 Multiple myeloma is a malignant neoplasm of plasma cells characterized by proliferation of a single clone of abnormal immunoglobulin-secreting plasma cells. Since the amount of hemopoietic bone marrow is decreased in the maxilla, oral manifestations of multiple myeloma are less common in the maxilla than in the mandible. We report the case of 33-year-old Japanese man who presented with a mass in the right maxillary alveolar region. Computed tomography and magnetic resonance images showed a soft tissue mass in the right maxilla eroding the anterior and lateral walls of the maxillary sinus and extending into the buccal space. The biopsy results, imaging, and laboratory investigations led to the diagnosis of multiple myeloma. This case report suggests that oral surgeons and dentists should properly address oral manifestations as first indications of multiple myeloma. Atsushi Kasamatsu, Yasushi Kimura, Hideki Tsujimura, Harusachi Kanazawa, Nao Koide, Isao Miyamoto, Yosuke Endo-Sakamoto, Masashi Shiiba, Hideki Tanzawa, and Katsuhiro Uzawa Copyright © 2015 Atsushi Kasamatsu et al. All rights reserved. A Single Versatile Appliance for Habit Interception and Crossbite Correction Thu, 12 Nov 2015 06:24:14 +0000 Digit sucking is a common childhood behavior, which has an adaptive value for children up to the fourth year of life. It is usually associated with oral pleasure and self-comforting behavior. But chronic practice may produce deleterious effect in the form of dental and skeletal deformities. Adjunctive therapy using bluegrass appliance as a permanent reminder and quadhelix appliance as a reminder as well as a slow palatal expander has proven successful in intercepting digit-sucking habit and expanding the arch for crossbite correction. In the present case, a versatile modified quadhelix appliance incorporating a roller was designed to clinically correct the habit and its resulting dentofacial deformities. Mohammed Zameer, Syed Nahid Basheer, Arun Reddy, and Suresh Kumar Kovvuru Copyright © 2015 Mohammed Zameer et al. All rights reserved. Cystic Odontoma in a Patient with Hodgkin’s Lymphoma Thu, 05 Nov 2015 15:24:54 +0000 Cystic odontoma is a rare entity, which is characterized by the association of a cyst with complex/compound odontoma. The aim of this study was to report the case of a 5-year-old male patient diagnosed previously with Hodgkin’s lymphoma and treated successfully with chemotherapy and radiotherapy, who developed a mandibular odontogenic lesion. Physical examination revealed a swelling on the right side of the mandible. Radiographically, a well-defined radiolucent area surrounded by radiopaque material was observed. An incisional biopsy was performed and microscopic analysis showed a cystic lesion consisting of an atrophic epithelium comprising 2-3 cell layers and the absence of inflammation in the cystic capsule. The cyst was decompressed and the lesion was removed after 3 months of follow-up. Microscopic analysis of the surgical specimen showed a cystic hyperplastic epithelium surrounded by an intense chronic inflammatory cell infiltrate, which was in close contact with mineralized tissue resembling dentin and cementum. The final diagnosis was cystic odontoma. Since chemotherapy can affect the growth and development of infant teeth, a relationship between chemotherapy-associated adverse events and cystic odontoma is suggested in the present case. Victor Costa, Adriana Rocha Caris, Jorge Esquiche León, Carolina Judica Ramos, Vaneska Jardini, and Estela Kaminagakura Copyright © 2015 Victor Costa et al. All rights reserved. Orocutaneous Fistula or Traumatic Infectious Skin Lesion: A Diagnostic Dilemma Wed, 04 Nov 2015 12:23:08 +0000 Orocutaneous fistula (OCF) (of dental origin) is an uncommon but well-described condition in the literature. These are often misdiagnosed by physicians and dentists. Careful selection of investigating modality is important in case of diagnostically challenging cases. A 19-year-old female came with a complaint of a lesion on the chin reported with h/o trauma with the impact on chin presented as diagnostic dilemma because of unusual case history and clinical examination. Commonly used radiographic investigations like IOPA and orthopantomograph did not resolve the dilemma whereas advanced imaging modality like CT scan, 3D volume imaging, and contrast enhanced CT played an important role in the diagnosis of OCF and selecting the treatment plan. Mayank Vermani, Vimal Kalia, Sumita Singh, Sunny Garg, Shweta Aggarwal, Richa Khurana, and Geeta Kalra Copyright © 2015 Mayank Vermani et al. All rights reserved. Aesthetic Surgical Crown Lengthening Procedure Mon, 02 Nov 2015 12:00:40 +0000 The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. Pablo Santos de Oliveira, Fabio Chiarelli, José A. Rodrigues, Jamil A. Shibli, Vincenzo Luca Zizzari, Adriano Piattelli, Giovanna Iezzi, and Vittoria Perrotti Copyright © 2015 Pablo Santos de Oliveira et al. All rights reserved. A Case of Simultaneous Unilateral Anterior and Posterior Stafne Bone Defects Thu, 29 Oct 2015 13:34:20 +0000 Stafne bone defects (SBDs) are asymptomatic mandibular lingual bone depressions mainly caused by soft tissue inclusions. The most common form of SBDs is posterior; the anterior variant of SBD is relatively uncommon. Although posterior SBD is easily diagnosed by the unique location on radiography, anterior SBD is sometimes misdiagnosed and confused with other pathological entities owing to the location. We report herein a case of simultaneous unilateral anterior and posterior SBDs. In the present case, definitive diagnosis for the anterior mandibular cavity was unclear, as in reported cases. Surgical exploration was thus performed for the lesion in the anterior mandibular cavity. Pathologic examination of the removed tissue showed salivary gland with chronic inflammation. Postoperatively, no functional disturbance has been observed. Management of the posterior SBD was conservative, with radiographic follow-up. To the best of our knowledge, this represents the first report of simultaneous unilateral anterior and posterior SBDs. Hisashi Ozaki, Shigeo Ishikawa, Kenichirou Kitabatake, Kazuyuki Yusa, Hirohiko Tachibana, and Mitsuyoshi Iino Copyright © 2015 Hisashi Ozaki et al. All rights reserved. Combined Periodontal, Orthodontic, and Prosthetic Treatment in an Adult Patient Mon, 26 Oct 2015 13:12:25 +0000 A 41-year-old man had a significant loss of bone and supporting tissues with pathologic migration of several teeth and several missing teeth. He was treated with an interdisciplinary therapeutic protocol that included nonsurgical periodontal therapy based on strict control of supragingival plaque, subgingival periodontal therapy, orthodontic and endodontic treatment, and replacement of restorations. The orthodontic therapy was performed in a severely reduced bone support and the presence of pathological tooth migration after periodontal disease control. The interdisciplinary treatment protocol was the key to achieve a significant improvement in his facial and dental esthetics, masticatory function, and quality of life. Claudio Vinicius Sabatoski, Regis Claret Bueno, Ariel Adriano Reyes Pacheco, Matheus Melo Pithon, and Orlando Motohiro Tanaka Copyright © 2015 Claudio Vinicius Sabatoski et al. All rights reserved. Evaluation of Low-Level Laser Therapy in TMD Patients Mon, 26 Oct 2015 11:52:23 +0000 Light amplification by stimulated emission of radiation (laser) is one of the most recent treatment modalities in dentistry. Low-level laser therapy (LLLT) is suggested to have biostimulating and analgesic effects through direct irradiation without causing thermal response. There are few studies that have investigated the efficacy of laser therapy in temporomandibular disorders (TMD), especially in reduced mouth opening. The case report here evaluates performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in two cases of TMD patients. First patient had a history of limited mouth opening and pain in temporomandibular joint (TMJ) region since nine months. Second patient’s main complaint was his restricted mouth opening, which was progressed in one year. LLLT was performed with a 685 nm red probed diode laser that has an energy density of 6.2 J/cm2, three times a week for one month, and application time was 30 seconds (685 nm, 25 mW, 30 s, 0.02 Hz, and 6.2 J/cm2) (BTL-2000, Portative Laser Therapy Device). The treatment protocol was decided according to the literature. One year later patients were evaluated and there were no changes. This application suggested that LLLT is an appropriate treatment for TMD related pain and limited mouth opening and should be considered as an alternative to other methods. Simel Ayyildiz, Faruk Emir, and Cem Sahin Copyright © 2015 Simel Ayyildiz et al. All rights reserved. Reestablishment of Occlusal Vertical Dimension in Complete Denture Wearing in Two Stages Mon, 26 Oct 2015 11:30:25 +0000 The assessment and reestablishment of the occlusal vertical dimension (OVD) are considered important factors in the treatment of complete denture wearers. The long-time use of a complete denture can result in jaw displacement due to abrasion of the artificial teeth and residual ridge resorption, causing esthetic complications. Most patients with old dentures and incorrect OVD accept reestablishment of the OVD with new complete dentures, even if they were used to their old dentures. The present clinical report describes a method of gradual reestablishment of OVD using a diagnostic acrylic splint on artificial teeth in old complete dentures before the manufacture of new complete dentures. Clinical Significance. The use of a reversible treatment for reestablishment of the OVD in old complete dentures with a diagnostic occlusal acrylic splint allows for the reestablishment of the intermaxillary relationship, providing physiological conditions of masticatory performance associated with the recovery of facial esthetics in edentulous patients. Danny Omar Mendoza Marin, Andressa Rosa Perin Leite, Norberto Martins de Oliveira Junior, Marco Antonio Compagnoni, Ana Carolina Pero, and João Neudenir Arioli Filho Copyright © 2015 Danny Omar Mendoza Marin et al. All rights reserved. Cystic Adenomatoid Odontogenic Tumor Thu, 22 Oct 2015 11:14:44 +0000 Adenomatoid Odontogenic Tumor (AOT) is a well-established benign epithelial lesion of odontogenic origin. Rightfully called “the master of disguise,” this lesion has been known for its varied clinical and histoarchitectural patterns. Not only does AOT predominantly present radiologically as a unilocular cystic lesion enclosing the unerupted tooth (which is commonly mistaken as a dentigerous cyst) but the lesion also presents rarely with a cystic component histopathologically. We present one such unusual case of cystic AOT associated with an impacted canine, mimicking a dentigerous cyst. The present case aims to highlight the difference between cystic AOT and dentigerous cyst radiographically. The exact histogenesis of AOT and its variants still remains obscure. An attempt has been made to hypothesize the new school of thought regarding the origin of AOT. Sonal Grover, Ahmed Mujib Bangalore Rahim, Nithin Kavassery Parakkat, Shekhar Kapoor, Kumud Mittal, Bhushan Sharma, and Anil Bangalore Shivappa Copyright © 2015 Sonal Grover et al. All rights reserved. Management of Inflammatory Internal Root Resorption with Biodentine and Thermoplasticised Gutta-Percha Thu, 22 Oct 2015 08:06:10 +0000 Internal root resorption is a chronic inflammatory process initiated within the pulp space with the loss of dentin. This condition demands a comprehensive understanding of the pathologic process, so as to identify the cause and arrest the resorptive phenomena. It is a rare occurrence, asymptomatic, with slow progression, detected through routine radiographic examination, where it appears as a radiolucent lesion. This paper reports a clinical case of inflammatory internal root resorption in the premolar tooth. Because it is asymptomatic, internal root resorption needs an early diagnosis in order to institute the endodontic treatment before the process compromises the remaining mineralized structures of the tooth. Biodentine was used to reinforce the weaker structures in the root. Thermoplasticised gutta-percha was used to completely obturate the defect. Ten-month follow-up showed arrest of internal root resorption. Girish Umashetty, Upendra Hoshing, Suvarna Patil, and Nishant Ajgaonkar Copyright © 2015 Girish Umashetty et al. All rights reserved. Vital Life-Threatening Hematoma after Implant Insertion in the Anterior Mandible: A Case Report and Review of the Literature Sun, 18 Oct 2015 16:41:38 +0000 Dental implant insertion is considered a safe and reliable surgical procedure and severe complications are seldom reported. However, we present a case of a 52-year-old patient who attended our Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University Medical Center, Mainz, with spreading hematoma in the floor of the mouth and acute airway obstruction after insertion of a dental implant in the anterior mandible. The hematoma was removed and submentally drained by a silicon drainage. However, the progressive swelling of the tongue and the floor of the mouth necessitated a temporary tracheotomy for three days. The review of the literature summarizes guidelines for prevention and management of this life-threatening complication. Eik Schiegnitz, Maximilian Moergel, and Wilfried Wagner Copyright © 2015 Eik Schiegnitz et al. All rights reserved. Esthetic Rehabilitation of the Smile with No-Prep Porcelain Laminates and Partial Veneers Sun, 18 Oct 2015 14:38:53 +0000 Rehabilitation of patients with anterior conoid teeth may present a challenge for the clinician, especially when trying to mimic the nature with composite resins. This clinical report exemplifies how a patient with conoid upper lateral incisors was rehabilitated with minimally invasive adhesive restorations. Following diagnostic wax-up and cosmetic mock-up, no-prep veneers and ceramic fragments (partial veneers) were constructed with feldspathic porcelain. This restorative material presents excellent reproduction of the optical properties of the dental structure, especially at minimal thicknesses. In this paper, the details about the treatment are described. A very pleasing outcome was achieved, confirming that minimally invasive adhesive restorations are an excellent option for situations in which the dental elements are healthy, and can be modified exclusively by adding material and the patient does not want to suffer any wear on the teeth. Arcelino Farias-Neto, Edna Maria da Cunha Ferreira Gomes, Alfonso Sánchez-Ayala, Alejandro Sánchez-Ayala, and Larissa Soares Reis Vilanova Copyright © 2015 Arcelino Farias-Neto et al. All rights reserved. Full Mouth Oral Rehabilitation by Maxillary Implant Supported Hybrid Denture Employing a Fiber Reinforced Material Instead of Conventional PMMA Sun, 18 Oct 2015 08:13:27 +0000 Many people have life-long problems with their dentures, such as difficulties with speaking and eating, loose denture, and sore mouth syndrome. The evolution of dental implant supported prosthesis gives these patients normal healthy life for their functional and esthetic advantages. This case report presents the fabrication of maxillary implant supported hybrid prosthesis by using Nanofilled Composite (NFC) material in teeth construction to rehabilitate a complete denture wearer patient. Ala Hassan A. Qamheya, Sinem Yeniyol, and Volkan Arısan Copyright © 2015 Ala Hassan A. Qamheya et al. All rights reserved. Endocrown with Leucite-Reinforced Ceramic: Case of Restoration of Endodontically Treated Teeth Sun, 18 Oct 2015 07:55:35 +0000 A common problem encountered by dentists is the restorative treatment of nonvital teeth. When the pulp chamber presents appropriate conditions for retention, the endocrown is indicated. This monolithic, ceramic adhesive restoration is singularly used yet warrants wider recognition and use. The endocrown allows preservation of the tooth structure and is minimally invasive. Currently, this treatment option, of a core buildup and full coverage restoration, reduces tooth structure excessively. This treatment presents not only functional limitations but also aesthetic concerns. Recently, the VITA-PM9 system, a leucite-reinforced glass ceramic, has been increasingly used in a variety of clinical situations due to its satisfactory physical-mechanical and aesthetic properties. Therefore, the present study describes a case of surgical restoration of a nonvital tooth using the endocrown technique and the VITA-PM9. Leonardo Fernandes da Cunha, José Mondelli, Caroline Moreira Auersvald, Carla Castiglia Gonzaga, Rafael Francisco Lia Mondelli, Gisele Maria Correr, and Adilson Yoshio Furuse Copyright © 2015 Leonardo Fernandes da Cunha et al. All rights reserved. Atypical Case of Three Dental Implants Displaced into the Maxillary Sinus Thu, 08 Oct 2015 13:27:19 +0000 Oral rehabilitation with dental implants has become a routine treatment in contemporary dentistry. The displacement of dental implants into the sinus membrane, a complication related to the maxillary sinus, is one of the most common accidents reported in the literature. The treatment for this complication is the surgical removal of the implant. A 60-year-old woman with three dental implants displaced into the maxillary sinus (one implant displaced into the left maxillary sinus and two implants displaced into the right maxillary sinus) underwent surgery for removal of the implants. The surgery to remove the implants was performed under local anesthesia through the Caldwell-Luc technique. The patient was subsequently administered antibiotic, anti-inflammatory, and analgesic drugs. The patient returned 7 days after the surgery for suture removal and is being regularly monitored to determine whether future rehabilitation of the edentulous area is necessary. In conclusion, surgical removal of the dental implant displaced into the maxillary sinus is the treatment of choice. This technique is appropriate because it allows the use of local anesthesia and provides direct visualization for the removal of the implants. João Felipe Bonatto Bruniera, Yara Teresinha Corrêa Silva-Sousa, and Paulo Esteves Pinto Faria Copyright © 2015 João Felipe Bonatto Bruniera et al. All rights reserved. Dental Management of a Patient with Nager Acrofacial Dysostosis Wed, 07 Oct 2015 13:17:44 +0000 Nager syndrome is a rare syndrome resulting from developmental abnormalities of the first and second branchial arches. Nager syndrome is rare and mostly sporadic. The main clinical features consist of craniofacial, limb, and musculoskeletal morphogenesis. These findings included malar hypoplasia, maxillomandibular hypoplasia, micrognathia, downslanting palpebral fissures, cleft palate, ear anomalies, hypoplastic thumb, short forearm, proximal radioulnar synostosis, atrial septal defect, lower limb deformities, and flat nasal bridge. The prevalence is unknown; about 100 cases of Nager syndrome have been published up to now. Patients with Nager syndrome are found worldwide among all racial and ethnic groups. Trismus and glossoptosis resulting in oropharyngeal airway narrowing cause life-threatening respiratory distress for patients with Nager syndrome. In this case report, dental rehabilitation of a 10-year-old child with Nager syndrome is presented. R. Bozatlıoğlu and A. P. Münevveroğlu Copyright © 2015 R. Bozatlıoğlu and A. P. Münevveroğlu. All rights reserved. Papillion-Lefèvre Syndrome: Periodontists’ Perspective Wed, 07 Oct 2015 11:08:59 +0000 Papillion-Lefèvre Syndrome is a very rare disorder of autosomal recessive inheritance distinguished by palmar plantar hyperkeratosis and early onset of periodontitis affecting the dentition. Genetic studies have identified a mutation in the major gene locus of chromosome 11q14 with loss of function. Cathepsin C gene is to be responsible for Papillion-Lefèvre Syndrome. The present case report describes a 13-year-old female, who visited the Department of Periodontology with the chief compliant of bleeding gums and loose teeth. She presented with the signs and symptoms of Papillion-Lefèvre Syndrome. The patient had premature shedding of her deciduous dentition. On clinical examination, extraorally, the patient presented with persistent thickening, flaking, and scaling of the skin of palms and soles. Her intraoral examination revealed gingival inflammation, abscess formation, and periodontal pockets. Her intraoral radiographs showed bone loss involving the central incisors and molars. The patient underwent periodontal therapy and is under maintenance. Sunil Kumar Biraggari, K. Krishna Mohana Reddy, J. Sudhakar, Shiva Shankar Bugude, Rajesh Nichenametla, Mazher Ahmed Hakeem, and Swati Reddy Tiyyagura Copyright © 2015 Sunil Kumar Biraggari et al. All rights reserved. Fabrication of Zirconia-Reinforced Lithium Silicate Ceramic Restorations Using a Complete Digital Workflow Mon, 05 Oct 2015 07:54:51 +0000 This case report describes the fabrication of monolithic all-ceramic restorations using zirconia-reinforced lithium silicate (ZLS) ceramics. The use of powder-free intraoral scanner, generative fabrication technology of the working model, and CAD/CAM of the restorations in the dental laboratory allows a completely digitized workflow. The newly introduced ZLS ceramics offer a unique combination of fracture strength (>420 MPa), excellent optical properties, and optimum polishing characteristics, thus making them an interesting material option for monolithic restorations in the digital workflow. Sven Rinke, Matthias Rödiger, Dirk Ziebolz, and Anne-Kathrin Schmidt Copyright © 2015 Sven Rinke et al. All rights reserved. Laser Phototherapy (660 nm) Can Be Beneficial for Reducing Gingival Inflammation in Prosthodontics Wed, 30 Sep 2015 09:40:43 +0000 Among the new technologies developed, low power lasers have enabled new approaches to provide conservative treatment. Low power lasers act at cellular level, resulting in reduced pain, modulating inflammation, and improved tissue healing. Clinical application of the low power laser requires specific knowledge concerning laser interaction with biological tissue so that the correct irradiation protocol can be established. The present case report describes the clinical steps involved in an indirect composite resin restoration performed in a 31-year-old patient, in whom low power laser was used for soft tissue biomodulation. Laser therapy was applied with a semiconductor laser 660 nm, spot size of 0.028 cm2, energy density of 35.7 J/cm2, mean power of 100 mW, and energy per point as 1 J, in contact mode, on a total of 2 points (mesial and distal), totaling 2 J of energy. The therapy with low power laser can contribute positively to the success of an indirect restorative treatment. Sávio José Cardoso Bezerra, Glauco Fioranelli Vieira, Carlos de Paula Eduardo, Patrícia Moreira de Freitas, and Ana Cecilia Corrêa Aranha Copyright © 2015 Sávio José Cardoso Bezerra et al. All rights reserved. Fabrication of Closed Hollow Bulb Obturator Using Thermoplastic Resin Material Sun, 27 Sep 2015 14:12:02 +0000 Purpose. Closed hollow bulb obturators are used for the rehabilitation of postmaxillectomy patients. However, the time consuming process, complexity of fabrication, water leakage, and discoloration are notable disadvantages of this technique. This paper describes a clinical report of fabricating closed hollow bulb obturator using a single flask and one time processing method for an acquired maxillary defect. Hard thermoplastic resin sheet has been used for the fabrication of hollow bulb part of the obturator. Method. After fabrication of master cast conventionally, bulb and lid part of the defect were formed separately and joined by autopolymerizing acrylic resin to form one sized smaller hollow body. During packing procedure, the defect area was loaded with heat polymerizing acrylic resin and then previously fabricated smaller hollow body was adapted over it. The whole area was then loaded with heat cure acrylic. Further processes were carried out conventionally. Conclusion. This technique uses single flask which reduces laboratory time and makes the procedure simple. The thickness of hollow bulb can be controlled and light weight closed hollow bulb prosthesis can be fabricated. It also minimizes the disadvantages of closed hollow bulb obturator such as water leakage, bacterial infection, and discoloration. Bidhan Shrestha, E. Richard Hughes, Raj Kumar Singh, Pramita Suwal, Prakash Kumar Parajuli, Pragya Shrestha, Arati Sharma, and Galav Adhikari Copyright © 2015 Bidhan Shrestha et al. All rights reserved. Congenital Insensitivity to Pain without Anhidrosis: Orodental Problems and Management Sun, 20 Sep 2015 14:04:43 +0000 This paper reports the case of a 4-year-old male patient who was brought by parents requesting for replacement of multiple missing anterior teeth. The patient suffered from congenital insensitivity to pain without anhidrosis and presented with full blown sequelae of the condition in the form of oral self-mutilation leading to loss of teeth, tongue tip amputation, finger tips destruction, and lower limb wound infections. Dental and orthopaedic treatment consists of local management of oral wound and prevention from further oral and finger injuries that takes the form of dental splints and finger sleeve splints, constant feet coverage with shoes, and behavioural medical therapy. The age of the patient and parents’ education present challenges in managing this condition to avoid morbidity and premature mortality. N. Abdullah, Kausar Sadia Fakhruddin, and A. R. Samsudin Copyright © 2015 N. Abdullah et al. All rights reserved.