Case Reports in Dentistry The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Quality of Life Following Early Orthodontic Therapy for Anterior Crossbite: Report of Cases in Twin Boys Thu, 22 Sep 2016 14:27:26 +0000 Anterior crossbite (AC) refers to a condition in which the maxillary anterior teeth are placed lingually in their relationship with the mandibular anterior teeth. This dental condition results in visible incisor differences that are associated with higher levels of dissatisfaction with appearance and have potential to negatively impact on oral health-related quality of life (OHRQoL) of the children. The aim of this paper was to report two cases of interceptive orthodontic treatment of twin children with anterior crossbite and its impact on OHRQoL of these children. Although AC affects negatively psychosocial aspects of OHRQoL of the children, the interceptive orthodontic treatment of children with AC was essential to improve their OHRQoL. Eluza Piassi, Leonardo Santos Antunes, Marcia Rejane Thomas Canabarro Andrade, and Lívia Azeredo Alves Antunes Copyright © 2016 Eluza Piassi et al. All rights reserved. Cementoblastoma Relating to Right Mandibular Second Primary Molar Thu, 22 Sep 2016 12:37:43 +0000 Cementoblastoma is a benign lesion of the odontogenic ectomesenchymal origin. It rarely occurs in primary dentition. This report describes a case of a cementoblastoma relating to the right mandibular second primary molar in a 7-year-old girl. Her panoramic radiograph revealed a well-defined radiopaque lesion with a radiolucent border extending from the distal surface of the mandibular right first primary molar to the distal surface of mandibular second primary molar. The tumor was attached to the mesial root of primary second molar and was excised along with the teeth involved and sent for histopathological evaluation, which showed irregular trabeculae of mineralized tissue interspersed with fibrovascular connective tissue, trabeculae of mineralized tissue with prominent reversal lines, and peripheral rimming of the mineralized tissue with blast cells. On a six-month follow-up, there has been no recurrence of the lesion. Sivakumar Nuvvula, Swapna Manepalli, Abinash Mohapatra, and Sreekanth Kumar Mallineni Copyright © 2016 Sivakumar Nuvvula et al. All rights reserved. Hard and Soft Tissue Management of a Localized Alveolar Ridge Atrophy with Autogenous Sources and Biomaterials: A Challenging Clinical Case Wed, 21 Sep 2016 12:26:55 +0000 Particularly in the premaxillary area, the stability of hard and soft tissues plays a pivotal role in the success of the rehabilitation from both a functional and aesthetic aspect. The present case report describes the clinical management of a localized alveolar ridge atrophy in the area of the upper right canine associated with a thin gingival biotype with a lack of keratinized tissue. An autogenous bone block harvested from the chin associated with heterologous bone particles was used to replace the missing bone, allowing for a prosthetic driven implant placement. Soft tissues deficiency was corrected by means of a combined epithelialized and subepithelial connective tissue graft. The 3-year clinical and radiological follow-up demonstrated symmetric gingival levels of the upper canines, with physiological peri-implant probing depths and bone loss. Thus, the use of autogenous tissues combined with biomaterials might be considered a reliable technique in case of highly aesthetic demanding cases. C. Maiorana, D. Andreoni, and P. P. Poli Copyright © 2016 C. Maiorana et al. All rights reserved. Interdisciplinary Management of Maxillary Canine Buccal Ectopia Associated with Peg Shaped Lateral Incisor Tue, 20 Sep 2016 12:02:52 +0000 Aligning a displaced maxillary canine into the dental arch is one of the most complicated problems in orthodontics. In cases of extremely high displacement, the tooth is frequently removed surgically. Because of the upper canines’ significance to dental esthetics and functional occlusion, such a decision is a very serious one. The purpose of this report is to illustrate an interdisciplinary approach involving both orthodontic management and conservative tooth restoration. The case was treated through an orthodontic nonextraction fixed appliance mechanotherapy for successful alignment of buccally ectopic upper left canine followed by a conservative direct composite tooth buildup of peg lateral incisor associated with the upper left ectopic canine in a 16-year-old adolescent North Indian female. Posttreatment records demonstrated good alignment of the displaced tooth and restoration of normal anatomy of the peg shaped lateral incisor. Karuna Singh Sawhny and Asheesh Sawhny Copyright © 2016 Karuna Singh Sawhny and Asheesh Sawhny. All rights reserved. Root Canal Stripping: Malpractice or Common Procedural Accident—An Ethical Dilemma in Endodontics Thu, 08 Sep 2016 12:08:49 +0000 Root canal stripping is defined as an oblong, vertical perforation that appears especially in the middle section of curved root canals during endodontic treatments with nickel-titanium (Ni-Ti) instruments. Its occurrence may drastically affect the outcome of the treatment, transforming a common otherwise efficient endodontic procedure into a complication such as tooth extraction. In order to discuss the ethical and legal consequences, two cases of dental strip perforations are herewith presented. Due to the existence of risk factors for dental strip perforation, experience of the clinician and the use of magnification and modern imagistic methods (CBCT) may avoid or reduce the frequency of this type of accidents. Under correct working circumstances, dental stripping should not be regarded as a malpractice but as a procedural accident. However, the patient must always be informed, before and during the endodontic procedure, about the event and the possible complications that may occur. Ionela Elisabeta Ciobanu, Darian Rusu, Stefan-Ioan Stratul, Andreea Cristina Didilescu, and Corina Marilena Cristache Copyright © 2016 Ionela Elisabeta Ciobanu et al. All rights reserved. Medication-Related Osteonecrosis of Jaws: A Low-Level Laser Therapy and Antimicrobial Photodynamic Therapy Case Approach Wed, 07 Sep 2016 16:44:45 +0000 Medication-related osteonecrosis of the jaws (MRONJ) can be considered an inability of the alveolar bone to respond to an injury, which frequently leads to severe local and systemic complications. Once the problem is installed, dentist must use all therapeutic approaches recommended. This manuscript reports a successful management of MRONJ handled with antibiotics, conservative debridement, low-level laser therapy (LLLT), and photodynamic therapy (PDT) up to 12 months. As healing of MRONJ may be very slow, combined therapeutic approaches are required. Besides the recommended conventional treatment protocol, LLLT and PDT are important tools to contribute to healing and improvement of patient’s quality of life. Mariana Comparotto Minamisako, Guilherme Henrique Ribeiro, Mariáh Luz Lisboa, Mabel Mariela Rodríguez Cordeiro, and Liliane Janete Grando Copyright © 2016 Mariana Comparotto Minamisako et al. All rights reserved. Esthetic Rehabilitation through Crown Lengthening Surgery and Conservative CAD/CAM Veneers: A Multidisciplinary Case Report Wed, 07 Sep 2016 14:03:09 +0000 This case report describes a successful multidisciplinary approach used to improve the smile esthetics of a patient presenting with excessive gingival display, asymmetric gingival margins, and small upper anterior teeth and lower anterior teeth. The treatment combined esthetic crown lengthening, dental bleaching, and restorative dentistry using CAD/CAM veneer. The 6-month follow-up examination confirmed the stability of the modification and absence of adverse effects. Leandro Passos, Fernando Peixoto Soares, and Mauricio Gallo Copyright © 2016 Leandro Passos et al. All rights reserved. Two-Step Extraction of the Lower First Molar for Class III Treatment in Adult Patient Tue, 06 Sep 2016 12:34:12 +0000 The aim of this article is to describe a case report of Class III malocclusion treatment with lower first molar extraction. The 27-year-old Caucasian male patient presented a symmetric face with a straight profile, hyperdivergent growth pattern, molar and cuspid Class III relation, and an anterior crossbite as well as a mild crowding on cuspids area, in both upper and lower arches and a tendency to posterior crossbite. The treatment was performed by the use of Haas expansion appliance followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance, extraction of lower teeth aiming the correction of the incisors proclination and end the treatment with a Class I molar relationship. It resulted in a significant change in the patient’s profile, dentoalveolar Class III correction, upper arch expansion, leveling and alignment of the upper and lower arches, and improvement of tipping of the upper and lowers incisors. In cases of a dentoalveolar compensation in well positioned bone bases the treatment with fixed appliances is an alternative and extraction of lower teeth is considered. Kélei Cristina de Mathias Almeida, Ricardo Fabris Paulin, Taísa Barnabé Raveli, Dirceu Barnabé Raveli, and Ary Santos-Pinto Copyright © 2016 Kélei Cristina de Mathias Almeida et al. All rights reserved. Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case Sun, 28 Aug 2016 14:08:15 +0000 Bisphosphonates have been used for years in the treatment of patients with distant bony metastasis and in the prevention of osteoporosis. One of main side effects of these medications is the development of bisphosphonate related osteonecrosis of the jaw (BRONJ) in a small subset of patients. A new class of medications with a shorter half-life, known as receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors, was introduced with the hopes of avoiding this side effect. However, reports of osteonecrosis of the jaw after the use of RANKL inhibitors have also been documented. We report on a patient who developed a life threatening osteonecrosis of the jaw with sepsis shortly after switching from a bisphosphonate to a RANKL inhibitor for osteoporosis treatment. This patient developed several soft tissue defects including spontaneous necrosis of the soft palate. To our knowledge this is the first time this presentation has been described. Mohammed Qaisi, Jamie Hargett, Matthew Loeb, Jeffrey Brown, and Ronald Caloss Copyright © 2016 Mohammed Qaisi et al. All rights reserved. Clinical Management of Two Root Resorption Cases in Endodontic Practice Sun, 28 Aug 2016 09:58:14 +0000 Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment. Jozef Mincik, Daniel Urban, and Silvia Timkova Copyright © 2016 Jozef Mincik et al. All rights reserved. Infection Related Inferior Alveolar Nerve Paresthesia in the Lower Premolar Teeth Thu, 11 Aug 2016 12:07:50 +0000 Introduction. The aim of this paper was to describe two cases of IAN infection-induced paresthesia and to discuss the most appropriate treatment solutions. Methods. For two patients, periapical lesions that induced IAN paresthesia were revealed. In the first case, the tooth was previously endodontically treated, whereas in the second case the lesion was due to pulp necrosis. Results. For the first patient, a progressive healing was observed only after the tooth extraction. In the second patient, the paresthesia had resolved after endodontic treatment. Conclusions. The endodontic-related paresthesia is a rare complication that can be the result of a combination of etiopathogenic mechanisms such as mechanical pressure on the nerve fibers due to the expanding infectious process and the production of microbial toxins. Paresthesia resulting from periapical lesions usually subsides through elimination of infection by root canal treatment. However, if there are no signs of enhancement, the immediate extraction of the tooth is the treatment of choice in order to prevent irreversible paresthesia because it was demonstrated that there is a correlation between the duration of mechanical or chemical irritation and the risk of permanent paresthesia. Rachele Censi, Virna Vavassori, Andrea Enrico Borgonovo, and Dino Re Copyright © 2016 Rachele Censi et al. All rights reserved. Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient Wed, 10 Aug 2016 07:53:18 +0000 A case report is presented which demonstrates the effectiveness of comprehensive orthodontic treatment combined with orthognathic surgery in the correction of malocclusion and reduction in the sequelae of Obstructive Sleep Apnea (OSA). The patient’s severe OSA was improved to very mild as evaluated by full overnight polysomnogram. The orthodontic treatment included the expansion of both dental arches and mandibular advancement surgery. There was significant improvement in the patient’s sleep continuity and architecture with the elimination of obstructive apneas. Gregory W. Jackson Copyright © 2016 Gregory W. Jackson. All rights reserved. A Novel Approach to Treat Traumatized Alveolar Ridges: Two Case Reports Tue, 09 Aug 2016 12:45:07 +0000 Functional forces are transmitted to the basal seat mucosa through a hard denture base during mastication. Such hard base dentures are not comfortably tolerated in patients with fragile oral mucosa and will cause sore spots, masticatory pain, and further resorption of alveolar bone. Soft liners materials can be advocated successfully to manage such clinical situations. The soft liner material absorbs masticatory forces by means of the cushioning effect and distributes occlusal forces uniformly to prevent trauma to compromised residual ridges. Mahesh Verma, Sneha Menghani, Jyoti Devi, Rekha Gupta, and Shubhra Gill Copyright © 2016 Mahesh Verma et al. All rights reserved. Replacement of Anterior Composite Resin Restorations Using Conservative Ceramics for Occlusal and Periodontal Rehabilitation: An 18-Month Clinical Follow-Up Sun, 31 Jul 2016 13:46:56 +0000 This case report describes a patient with discolored and fractured composite resin restorations on the anterior teeth in whom substitution was indicated. After wax-up and mock-up, the composite was removed and replaced with minimally invasive ceramic laminates. An established and predictable protocol was performed using resin cement. Minimally invasive ceramic restorations are increasingly being used to replace composite restorations. This treatment improves the occlusal and periodontal aspects during the planning and restorative phases, such as anterior guides, and laterality can be restored easily with ceramic laminates. In addition, the surface smoothness and contour of ceramic restorations do not affect the health of the surrounding periodontal tissues. Here we present the outcome after 18 months of clinical follow-up in a patient in whom composite resin restorations in the anterior teeth were replaced with minimally invasive ceramic laminates. Leonardo Fernandes da Cunha, Rayane Alexandra Prochnow, Adriana Osten Costacurta, Carla Castiglia Gonzaga, and Gisele Maria Correr Copyright © 2016 Leonardo Fernandes da Cunha et al. All rights reserved. The Use of an Alternative Extraoral Periapical Technique for Patients with Severe Gag Reflex Sun, 31 Jul 2016 07:59:33 +0000 Gag reflex is a physiologic mechanism that promotes contraction of the muscles of the tongue and pharyngeal walls. Different factors, including intraoral radiographic films and sensors, may trigger this reflex. Patients with severe gag reflex may not be able to tolerate the presence of intraoral radiographic films or sensors during root canal therapy (RCT). This factor may prevent an appropriate intraoral radiograph, which is important in RCT. Different approaches have been used to facilitate dental procedures in patients suffering from severe gag reflex. The use of an extraoral radiographic technique is an alternative method to obtain working length confirmation in patients with severe gag reflex. In this report of 2 cases, the use of an extraoral radiographic technique as an alternative approach during RCT in patients with severe gag reflex associated with phobic behavior and trismus was successfully demonstrated. Mauro Henrique Chagas e Silva, Marcelo Santos Coelho, Mariane Floriano Lopes Santos, Carolina Oliveira de Lima, and Celso Neiva Campos Copyright © 2016 Mauro Henrique Chagas e Silva et al. All rights reserved. Low Level Laser Therapy to Reduce Recurrent Oral Ulcers in Behçet’s Disease Sun, 31 Jul 2016 05:54:21 +0000 Behçet’s disease (BD) is a chronic, relapsing multisystemic vascular condition. Behçet’s disease was described by Hulusi Behçet in 1937. This rare multisystem relapsing-remitting inflammatory disease is poorly understood but is thought to be an autoimmune inflammatory vasculitic process in a genetically predisposed population. Diagnosis of Behçet’s disease is based on International Criteria of Behçet’s Disease (ICBD). The present paper describes a case report of Behçet’s syndrome where aphthous stomatitis was treated with low level laser therapy. D. B. Gandhi Babu, Sunanda Chavva, Shefali Waghray, Neeharika Satya Jyothi Allam, and Marella Kondaiah Copyright © 2016 D. B. Gandhi Babu et al. All rights reserved. Ectopic Premolar Tooth in the Sigmoid Notch Thu, 28 Jul 2016 16:36:45 +0000 Impaction of a mandibular premolar is relatively uncommon. Ectopic placement is more unusual and there has been no discussion in the literature of an ectopic mandibular premolar in the coronoid process. In this case report, we present an impacted ectopic mandibular permanent premolar in the sigmoid notch (incisura mandibulae) region. Etiology of the tooth and treatment options are discussed and illustrated by Cone Beam Computed Tomography (CBCT) images. K. Törenek, H. M. Akgül, and I. S. Bayrakdar Copyright © 2016 K. Törenek et al. All rights reserved. Two-Stage Mucogingival Surgery with Free Gingival Autograft and Biomend Membrane and Coronally Advanced Flap in Treatment of Class III Millers Recession Mon, 25 Jul 2016 14:11:00 +0000 Introduction. Gingival recession is an apical shift of the gingival margin with exposure of the root surface. This migration of the marginal tissue leads to esthetic concerns, dentin hypersensitivity, root caries, and cervical wear. It is, paradoxically, a common finding in patients with a high standard of oral hygiene, as well as in periodontally untreated populations with poor oral hygiene. Changing the topography of the marginal soft tissue in order to facilitate plaque control is a common indication for root coverage procedures and forms a major aspect of periodontal plastic surgeries. The regeneration of a new connective tissue attachment to denuded root surface is by allowing the selective coronal regrowth of periodontal ligament cells while excluding the gingival tissues from the root during wound healing by means of a barrier membrane. Case Presentation. This case reports a two-stage surgical technique for treatment of Miller’s class III defect using free gingival autograft and type I absorbable collagen membrane (BioMend®, Zimmer Dental, USA)§. Conclusions. The 6-month follow-up of the case showed a significant increase in attached gingiva suggesting it as a predictable alternative in the treatment of Millers class III defects. Avita Rath, Smrithi Varma, and Renny Paul Copyright © 2016 Avita Rath et al. All rights reserved. Diagnosis and Management of a Patient with Congenitally Missing Maxillary First Permanent Molars: A Rare Case Report Mon, 25 Jul 2016 06:32:05 +0000 Congenitally missing teeth are the most commonly seen dental anomalies. Agenesis of the permanent first molar has the least frequency of all the tooth types, and it usually occurs in association with oligodontia or anodontia. Thus, agenesis of the bilateral maxillary first permanent molar is an extremely rare occurrence, and no such case has been reported in ethnic Saudi Arabian population. We hereby report a case of nonsyndromic bilateral congenitally missing maxillary first permanent molar in an eight-year-old Saudi female patient. Comprehensive oral rehabilitation was done for the patient. The implications of the tooth agenesis are also discussed. The prognosis of this case is presented. Megha Gupta, Suman Panda, Fahad Ahmed Mutawwam, and Fahad Musawi Mohammed Kariri Copyright © 2016 Megha Gupta et al. All rights reserved. Solitary Encapsulated Neurofibroma Not Associated with Neurofibromatosis-1 Affecting Tongue in a 73-Year-Old Female Wed, 20 Jul 2016 14:18:41 +0000 Neurofibromas are benign tumors of nerve cell origin arising due to proliferation of Schwann cells and fibroblasts. They are usually asymptomatic and hence remain undiagnosed. They are commonly found on the skin and intraorally tongue is the most common site for their occurrence. Here, we present a unique case of solitary encapsulated neurofibroma in the oral cavity without any clinical manifestations or family history of Neurofibromatosis type 1 in a 73-year-old female patient who presented with a painless swelling on the tongue. The histopathologic findings closely mimicked benign fibrous histiocytoma. In our case, definitive diagnosis of neurofibroma was made based on clinical findings, family history, and histopathological and immunohistochemical evaluation. Through this case report we want to emphasize the role of biopsy and immunohistochemistry in arriving at a confirmatory diagnosis. The patient was treated by surgical excision and showed no signs of recurrence over a follow-up period of 12 months. Sk. Abdul Mahmud, Neha Shah, Moumita Chattaraj, and Swagata Gayen Copyright © 2016 Sk. Abdul Mahmud et al. All rights reserved. Maxillofacial Changes in Melnick-Needles Syndrome Tue, 12 Jul 2016 13:08:33 +0000 Background. Melnick-Needles Syndrome is rare congenital hereditary skeletal dysplasia caused by mutations in the FLNA gene, which codifies the protein filamin A. This condition leads to serious skeletal abnormalities, including the stomatognathic region. Case Presentation. This paper describes the case of a 13-year-old girl diagnosed with Melnick-Needles Syndrome presenting with different forms of skeletal dysplasia, such as cranial hyperostosis, short upper limbs, bowed long bones, metaphyseal thickening, genu valgum (knock-knee), shortened distal phalanges, narrow pelvis and shoulders, rib tapering and irregularities, elongation of the vertebrae, kyphoscoliosis, micrognathia, hypoplastic coronoid processes of the mandible, left stylohyoid ligament suggesting ossification, and dental development anomalies. Conclusion. Knowledge of this rare syndrome on the part of dentists is important due to the fact that this condition involves severe abnormalities of the stomatognathic system that cause an impact on the development of the entire face as well as functional and esthetic impairments. Leilane Larissa Albuquerque do Nascimento, Monica da Consolação Canuto Salgueiro, Mariana Quintela, Victor Perez Teixeira, Ana Carolina Costa Mota, Camila Haddad Leal de Godoy, and Sandra Kalil Bussadori Copyright © 2016 Leilane Larissa Albuquerque do Nascimento et al. All rights reserved. Bilateral Postoperative Cyst after Maxillary Sinus Surgery: Report of a Case and Systematic Review of the Literature Mon, 11 Jul 2016 06:52:13 +0000 Purpose. We present a case of a bilateral postoperative maxillary cyst (PMC) and discuss this with a systemic review. Case Report and Literature Review. A 68-year-old female with pain and swelling on the right side of the face. MRI and CT showed a cystic tumors of the right and left maxillary sinus. Radical maxillary surgery via a Caldwell-Luc procedure had been performed 55 years ago and bilateral PMC was diagnosed. The PubMed database was searched for PMC within the last 30 years. Results. Together with the current case, we found 23 reports including 284 patients describing PMC. It was diagnosed at a mean time of 22 years after causal surgery at a mean age of 47 years. Initial symptoms were mostly pain with or without swelling. The main radiological sign was a unilocular radiolucency with a slight preference for the left side. Discussion. PMC is a long-term complication that can occur after maxillary sinus surgery and a second surgical approach is required in order to stop cystic expansion. Therefore, patients’ informed consent on this complication as well as a prolonged follow-up is recommended. Simple paranasal ultrasound or paranasal sinus plain radiography may lead to an earlier detection reducing interventional morbidity. Boris-Mark Niederquell, Peter A. Brennan, Michael Dau, Maximilian Moergel, Bernhard Frerich, and Peer Wolfgang Kämmerer Copyright © 2016 Boris-Mark Niederquell et al. All rights reserved. Lateralization Technique and Inferior Alveolar Nerve Transposition Tue, 28 Jun 2016 06:24:58 +0000 Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. Angélica Castro Pimentel, Marco Antonio Sanches, Gabriel Cardoso Ramalho, Caio Vinicius Roman-Torres, Marcello Roberto Manzi, and Wilson Roberto Sendyk Copyright © 2016 Angélica Castro Pimentel et al. All rights reserved. The Use of Invisalign® System in the Management of the Orthodontic Treatment before and after Class III Surgical Approach Mon, 27 Jun 2016 15:54:36 +0000 The approach to skeletal dysmorphisms in the maxillofacial area usually requires an orthodontic treatment by means of fixed appliances, both before and after the surgical phase. Since its introduction, Invisalign system has become a popular treatment choice for the clinicians because of the aesthetics and comfort of the removable clear aligners compared with the traditional appliances. Therefore, the aim of the present report was to illustrate the management of a malocclusion by means of Invisalign system associated with the traditional surgical technique. The present paper shows a case of a 23-year-old male patient characterized by a Class III malocclusion with lateral deviation of the mandible to the left side and cross-bite on teeth 2.2, 2.3, and 2.4. Invisalign system was used during the pre- and postsurgical phases rather than fixed appliances. The posttreatment cephalometric analysis emphasized the stability of the dental and skeletal symmetry corrections, occlusion and functional balance, over a 6-year follow-up. The results achieved at the end of the treatment showed how Invisalign can be effective in the management of the orthodontic phases in orthognathic surgery. The follow-up after 6 years emphasizes the stability of the treatment over time. Renato Pagani, Fabrizio Signorino, Pier Paolo Poli, Pietro Manzini, and Irene Panisi Copyright © 2016 Renato Pagani et al. All rights reserved. Removal of Deeply Impacted Mandibular Molars by Sagittal Split Osteotomy Mon, 27 Jun 2016 10:45:19 +0000 Mandibular third molars are the most common impacted teeth. Mandibular first and second molars do not share the same frequency of occurrence. In rare cases the occlusal surfaces of impacted molars are united by the same follicular space and the roots pointing in opposite direction; these are called kissing molars. In some cases, a supernumerary fourth molar can be seen as unerupted and, in this case, such a supernumerary, deeply impacted fourth molar is seen neighboring kissing molars. The extraction of deeply impacted wisdom molars from the mandible may necessitate excessive bone removal and it causes complications such as damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. This case report describes the use of the sagittal split osteotomy technique to avoid extensive bone removal and protect the inferior alveolar nerve during surgical extruction of multiple impacted teeth. Erol Cansiz, Sabri Cemil Isler, and B. Alper Gultekin Copyright © 2016 Erol Cansiz et al. All rights reserved. Treatment of a Periodontic-Endodontic Lesion in a Patient with Aggressive Periodontitis Thu, 23 Jun 2016 10:31:36 +0000 Case Description. This case report describes the successful management of a left mandibular first molar with a combined periodontic-endodontic lesion in a 35-year-old Caucasian woman with aggressive periodontitis using a concerted approach including endodontic treatment, periodontal therapy, and a periodontal regenerative procedure using an enamel matrix derivate. In spite of anticipated poor prognosis, the tooth lesion healed. This case report also discusses the rationale behind different treatment interventions. Practical Implication. Periodontic-endodontic lesions can be successfully treated if dental professionals follow a concerted treatment protocol that integrates endodontic and periodontic specialties. General dentists can be the gatekeepers in managing these cases. Mina D. Fahmy, Paul G. Luepke, Mohamed S. Ibrahim, and Arndt Guentsch Copyright © 2016 Mina D. Fahmy et al. All rights reserved. Extremely Rare Form of Impaction Bilateral Kissing Molars: Report of a Case and Review of the Literature Wed, 15 Jun 2016 07:00:32 +0000 Kissing molars (KM) or rosette formation is a term that is used to describe impacted teeth contacting occlusal surfaces in a single follicular space and their roots pointing in opposite directions. In some cases kissing molars can be seen but occurrence of bilateral kissing molars is extremely rare phenomenon in the dental literature and the aetiology of this phenomenon is still unknown. In this paper we describe a case and review of the literature and discuss the management of this pathology. In our case, extremely rare form of impacted bilateral kissing molars was extracted surgically. The decision of extraction of asymptomatic kissing molars represents surgical dilemma. There may be many surgical complications; on the other hand in some cases surgical intervention is unavoidable. Few treatment options were described in the literature. This phenomenon can be sign of various medical conditions that may require further investigation. In this paper, our treatment option is in agreement with the literature suggesting the surgical removal of both teeth at either side of the mandible. Tamer Zerener, Gurkan Rasit Bayar, Hasan Ayberk Altug, and Serkan Kiran Copyright © 2016 Tamer Zerener et al. All rights reserved. A Review and Report of Peripheral Giant Cell Granuloma in a 4-Year-Old Child Wed, 15 Jun 2016 05:58:31 +0000 Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. It is often difficult to make a clinical diagnosis; thereby definitive diagnosis depends on histopathologic features. We report a case of a 4-year-old Caucasian boy presenting with a five-month history a 20 × 15 × 12 mm pedunculated, lobular soft tissue mass of the left anterior maxilla gingiva which was misdiagnosed and maltreated before his referral. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed distinctive features of peripheral giant cell granuloma. Early detection and excision of this hyperplastic nodule especially in children are important to minimize potential dentoalveolar complications. Afsaneh Nekouei, Alireza Eshghi, Parisa Jafarnejadi, and Zahra Enshaei Copyright © 2016 Afsaneh Nekouei et al. All rights reserved. Early Loaded Single Implant Reinforced Mandibular Overdenture Tue, 14 Jun 2016 11:55:44 +0000 Rehabilitating atrophied mandible with two-implant supported denture is a common treatment modality for implant retained removable overdenture in mandible. This paper aims to design a treatment modality where single implant reinforced overdenture is fabricated for a severely atrophied mandibular ridge with early loading protocol. Results of studies have shown that a single implant mandibular overdenture significantly increases the satisfaction and quality of life of patients with edentulism. Midline fracture of the prosthesis is the most common complication related to single implant and two-implant retained mandibular overdentures. To manage such complication, a thin metal mesh is used to reinforce the overdenture and also to make the prostheses lighter and cost effective as compared to conventional cast metal framework. K. Nischal and R. Chowdhary Copyright © 2016 K. Nischal and R. Chowdhary. All rights reserved. The Histopathological Spectrum of Pyogenic Granuloma: A Case Series Sun, 12 Jun 2016 08:15:44 +0000 Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i) cellular phase, (ii) capillary phase/vascular phase, and (iii) involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH) and non-lobular capillary hemangioma (non-LCH). Case Presentation. In this series, four cases (varied age groups and both genders) of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification. Vinay Marla, Ashish Shrestha, Khushboo Goel, and Sajeev Shrestha Copyright © 2016 Vinay Marla et al. All rights reserved.