Case Reports in Dentistry最新文献

Chondrosarcomas are a group of malignant neoplasms with cartilaginous matrix production mostly found in flat and peripheral long bones. Mesenchymal chondrosarcoma is one of the most unusual and rare histological variants of chondrosarcoma, with a distinct histopathological appearance and biologically aggressive behavior. The amount of cartilage in mesenchymal chondrosarcoma may be so abundant that it is easily found in random sections or so scarce that numerous sections are required to discover it. In such cases, it is tough to make an accurate diagnosis, which leads to a big dilemma for pathologists and surgeons regarding diagnosis and treatment. Here, we report a mandibular mesenchymal chondrosarcoma in a 38-year-old male with a diagnosis of malignant small round cell tumor in incisional biopsy without any bone or chondroid formation. After ruling out lymphoma, a complete lesion excision was done. Diagnosis of mesenchymal chondrosarcoma was confirmed with small foci of chondroid material and strong positivity of tumoral cells for CD99 and S100. We highlight the fact that incisional biopsy frequently fails to provide sufficient tissue to establish the diagnosis of mesenchymal chondrosarcoma. Adequate tissue with multiple sections, detailed histopathological examination, and adjunctive IHC study are the keys to a definitive diagnosis.

Amyloidosis is a disease in which amyloid protein is deposited in organs and tissues, resulting in functional impairment. Amyloidosis occurs in 12%-30% of patients with multiple myeloma, but in rare cases, amyloidosis may precede the diagnosis of multiple myeloma. Our patient was a 76-year-old Japanese male on dialysis. Multiple nodules accompanied by ulcers were observed on his tongue. He had no subjective symptoms or clinical findings associated with multiple myeloma. The histopathological findings suggested amyloidosis. We suspected both systemic and localized amyloidosis and performed a comprehensive systemic examination. Since the patient had been on dialysis for only a short period of time (~3 months), dialysis-related amyloidosis was ruled out. After blood and urine tests, a diagnosis of multiple myeloma was made. Chemotherapy treatment was started, but the patient's multiple myeloma could not be suppressed and the tongue amyloidosis worsened, leading to his death 2 years and 2 months after the initial diagnosis.

Background: Restoration of the mandibular region after segmental resection surgery is crucial for masticatory function and facial aesthetics. The precision of three-dimensional printers has advanced in recent years, enabling the development of fully customized reconstruction plates. In recent years, three-dimensional printing technology has been applied in the field of dental and oral surgery. Among these, the selective laser melting method has been developed. This case report was aimed at exploring the utility in restoring mandibular morphology. Cases: Patients diagnosed with medication-related osteonecrosis of the jaw (MRONJ) in Oral and Maxillofacial Surgery at Kanazawa Medical University Hospital who underwent mandibular disarticulation and immediate completely customized reconstruction plate (COSMOFIX) were included. Case 1 involved a female in her 70s with MRONJ on the right side of the mandible. Case 2 involved a female who received bisphosphonates for extensive metastatic breast cancer, resulting in MRONJ affecting the bilateral mandible. Case 3 involved a woman who developed MRONJ on the right side of the mandible during alendronate treatment for osteoporosis. Completely customized reconstruction plates were used for reconstruction after segmental resections. Findings: The three patients adapted to the remaining bone. The reconstructed and preoperative mandibular morphologies were similar. Conclusions: In conclusion, the use of completely customized reconstruction plates obviates the need for bending and other adaptations, reduces surgical time, and improves postoperative aesthetics. Of significance, preparing completely customized reconstruction plate requires about 3 weeks; thus, careful case selection and scheduling are indispensable.

This clinical report describes how a decubital ulcer arose from the direct contact of the vestibular movable mucous membrane against mini-implant balled-type heads after the mini-implant insertion in the edentulous atrophic mandible of a 78-year-old patient who was not wearing a conventional mandibular complete denture for more than 10 years. Due to severe alveolar ridge atrophy, mini-implant insertion (2.0 mm wide) was an option without extensive surgical procedures. The patient signed the informed consent. A few days after the implant insertion, injury, inflammation, and induration of the vestibular movable mucous membrane were observed on the movable vestibular mucosa on the right side, opposing the mini-implants. The cause of inflammation was attributed to increased perioral muscle tonus which pushed the movable mucosa onto the mini-implant heads and caused mechanical trauma. During the period of edentulism, the perioral muscle tonus increased, directing the mucous membrane of the lips and cheeks against residual ridge to enable food comminution. To treat the persistent decubitus, a bulk of dental composite resin was placed around mini-implant heads and light-cured to protect the mucosa from further mechanical trauma, as the patient did not possess an old mandibular denture to cover the mini-implant heads. Vestibuloplastic surgery (disinsertion of movable attachments and deepening of the vestibulum) was also done. After the surgery, a silicone splint, resembling an occlusal rim, was made to protect the mucous membrane, keep medicaments for faster epitalization in place, to decrease perioral muscle tonus before the new dentures' delivery, and to prevent movable tissue relapse. The custom impression, jaw relationship determination, and try-in of the artificial teeth setup were made with sutures still in place. After the denture delivery and implant loading, the patient was instructed to sleep with the dentures to protect the movable mucous membrane. One year later, almost no peri-implant marginal bone loss was observed, attached and peri-implant mucosa were healthy, and the patient was delighted.

Background: Systemic sclerosis (SS) is a debilitating disease that affects oral and any other tissues including skin, bone, blood vessels, and the connective tissues by excessive collagen accumulation. It is a difficult case for oral rehabilitation, let alone dental implantation. In this regard, only few studies have been conducted. This article reports a case of full-mouth implant-supported prostheses in a SS patient. Case: After diagnosing most remaining teeth as hopeless through clinical and radiographic examinations, implant-based fixed prosthesis for both jaws was planned, considering the progressive microstomia. Hopeless teeth were extracted. In the maxilla, the areas of central incisors, canines, first premolars, and first molars were implanted. In the mandible, the areas of the lateral incisors and the right second premolar were implanted. Also, according to the surgeon's opinion, the anterior mandible needed bone grafting. After 3 months, the prosthetic treatment was started. Because in scleroderma, the limitation of mouth opening is progressive (and also in order to allow the restoration of the prosthesis in the future), screw-retained abutments were used for the posterior segment. Nevertheless, the anterior abutments were cement-retained. Result: The patient was followed up until the present time (for 3 years). In these follow-ups, no bone resorption was observed, and the treatment was deemed successful. Conclusion: This report suggests that dental implants might be successful and safe for at least some cases of systemic scleredema.

Root canal perforations are frequent but critical complications in endodontic treatments, which can pose a risk of irreversible damage to the affected tooth. These perforations typically occur during root canal preparation or endodontic post placement, presenting significant therapeutic challenges. The main objective in the management of such complications is to seal the perforation, thus preventing bacterial invasion and tooth loss. This report details the case of a 70-year-old patient with a perforation in the palatal wall of the middle root section of tooth #11. The treatment approach involved magnification techniques and the application of a bioactive material known as Biodentine. This case underscores the critical role of accurate radiographic evaluation and the use of biocompatible materials in the management of root perforations. Despite inherent challenges, proper diagnosis and planning, combined with appropriate techniques and materials, can lead to satisfactory results, effectively preserving the structure of the tooth.

Objective: This study is aimed at detailing a technique for digitally fabricated fixed restoration for both immediate replacement after extraction and splinting of the adjacent mobile teeth. Clinical Considerations: Demand for a fixed restoration of the missing teeth in the mandibular anterior region is very common but sometimes problematic for dentists. It often happens that there is significant loosening of the remaining teeth adjacent to the missing tooth, which should be splinted. This case report describes a digitally fabricated fixed restoration for both replacing lost teeth and splinting periodontally compromised mobile teeth. With the CAD-CAM technique, patients can receive the restoration immediately after the extraction. The digital design and fabrication of the restoration were elaborated using the restorative process of a patient with a mandibular anterior tooth to be extracted and multiple loose lower anterior teeth. The immediate restoration process and the pontic modification when the extraction socket had healed were also described. Conclusions: The digital process avoids the nudging of the loose tooth by the traditional impression technique, improves the accuracy of the restoration, and avoids undue stress on the loose tooth when the restoration is in place. In addition, this method allows the patient to obtain a fixed restoration immediately after extraction, and if damage occurs after the restoration has been cemented, such as fracture or debonding, a new restoration can be prepared before the patient's return visit. Clinical Significance: This minimally invasive restorative method achieved the fixation of loose teeth while restoring the missing teeth, but the success of the treatment needed long-time observation.

Congenital dental agenesis, particularly in younger adults, can have a profound impact on aesthetics and overall quality of life. The scientific literature offers various management strategies for this condition, with orthodontic movement and implant-supported rehabilitation being central to treatment. However, achieving predictable and successful outcomes necessitates a comprehensive multidisciplinary approach. Such an approach integrates diverse professional perspectives to ensure accurate diagnosis, prognosis, and treatment planning, ultimately aiming to restore dental function and address aesthetic concerns effectively. In this case report, we present the successful rehabilitation of a young patient with congenital agenesis of the mandibular central incisors. The treatment strategy combined oral surgery (extraction of deciduous teeth and autogenous bone graft), orthodontic movement (opening spaces to allow implant installation), periodontics (connective tissue graft), implantology, and prosthetic planning. We detail the specific surgical approaches employed and discuss how their integration contributed to the overall success of the case. This multidisciplinary treatment approach not only restored dental function but also met the patient's aesthetic expectations and enhanced the patient's quality of life, highlighting the importance of a coordinated approach in managing complex dental conditions.

Background: Hereditary gingival fibromatosis (HGF) is a rare hereditary condition characterized by abnormal enlargement of the gingival tissue with a variable clinical manifestation. Typically, the hyperplastic gingiva is normal in color and consistency, and the tendency of bleeding is minimal. The swelling may be limited to a particular location or generalized over the whole gingiva. Usually, the symptoms appear during and after the eruption of permanent dentition. Gingival proliferation in HGF causes a variety of esthetic and practical issues. Depending on the size and intensity of the overgrowth, speech and chewing may be impaired. Moreover, diastema and prolonged primary dentition retention may occur. Case Reports: This article describes the identification, management, and treatment approaches of four cases affecting a Syrian family who lived in Arbat refugee camp in Sulaymaniyah, Kurdistan, Iraq. Conclusion: Proliferative fibrous outgrowth of the gingival tissue, with different degrees of involvement, is a hallmark of HGF. Surgery is frequently necessary to restore function and appearance, though varying degrees of recurrence is anticipated. Nonetheless, the psychological advantages of cosmetic improvement exceed the dangers of recurrence by a wide margin, especially in teenagers.

Background: The prevalence of supernumerary teeth is increasing in modern dental practice. However, the presence of multiple supernumerary teeth should be further investigated. Proper diagnosis of an underlying syndrome might save the patient from future health hazards through early diagnosis and optimal follow-up screening. Case Presentation: A 13-year-old female patient presented with multiple retained deciduous teeth and delayed eruption of permanent teeth. Although the medical and family history of the patient did not raise any concerns, the clinical and radiographic examinations yielded intriguing findings. The patient presented with a total of 11 supernumerary teeth, which impeded the normal eruption of permanent dentition in addition to the presence of retained deciduous teeth. Additional clinical and laboratory investigations were conducted in response to the case's complexity, resulting in the diagnosis of Trichorhinophalangeal Syndrome (TRPS) Type I. The patient underwent a precise treatment plan and then was followed up for 6 months postoperatively to monitor the eruptive movement of the permanent teeth. Conclusion: When a syndrome is the underlying cause, monitoring unusual cases, such as those with multiple supernumerary teeth, can be lifesaving or aid in the early diagnosis of more serious complications.