Case Reports in Dentistry最新文献

This report presents a rare case of direct invasion from a metastatic submandibular lymph node (SMLN) to submandibular gland (SMG) in a resected specimen of neck dissection (ND) of buccal mucosal squamous cell carcinoma (SCC). The patient was an 82-year-old woman with a clinical diagnosis of the left buccal mucosal SCC (cT4bN2bM0, Stage IVB). The tracheostomy, modified radical neck dissection, buccal mucosal cancer resection including maxillary partial resection, mandibular segmentectomy, and reconstructive surgery with a plate and a free rectus abdominis flap were performed. Pathologically, the infiltrating SCC was observed in the SMG continuous with SMLN metastasis (pT4bN3bM0). No adjuvant therapy was performed for old age and oral intake dysfunction. Contrast CT detected the multiple lung and left scapula metastases at postoperative 5 months, which made the policy of best supportive care. Finally, she died 9 months after the surgery from distant metastases. SMG involvement from direct invasion from a metastatic SMLN is relatively rare. In our case, although the patient died from distant metastases, locoregional control was achieved through curative resection of the primary tumor and ND performed as one block with reconstructive surgery.

Background: The most common odontogenic tumor is the solid ameloblastoma. This is concerning due to the progressive bone destruction in its intraosseous variant; this type of pathology often gets a delayed diagnosis due to the asymptomatic characteristic it has. Objective: The aim of the article is to propose a conservative treatment for multicystic ameloblastoma, reviewing the latest concepts, controversies, and treatment options described in the literature. Case Report: A patient arrives to our department with a diagnosis of unicystic ameloblastoma, so decompression and subsequent enucleation were decided as treatment. However, the new histopathological result was a multicystic ameloblastoma; with this result, we decided to continue with the initial treatment, which in fact had an adequate response. A 5-month radiographic follow-up was performed in which a decrease in size was evident and enucleation was decided. The postoperative results were favorable after a 2.5-year follow-up. Conclusion: The solid ameloblastoma may have a cystic component, in which there is the possibility of diagnostic errors when studying an incisional biopsy; for this reason, the definitive diagnosis should be established until complete enucleation of the lesion is performed. This characteristic in a solid ameloblastoma makes possible a positive response to decompression, making it easier to perform the enucleation subsequently, avoiding other aggressive treatments that can dramatically affect the patient's quality of life and also avoiding costly reconstruction bills.

The aim of this study is to present a method that optimizes clinical and laboratory workflow in the fabrication of implant-supported removable dentures by combining conventional and digital protocols. A 73-year-old patient came to our clinic for treatment of a completely edentulous lower jaw. Two Neodent Helix GM implants were placed in the canine regions and a removable denture with Locator GM Novaloc retention elements was fabricated. The DENTCA system was used for impressions, border molding, and to determine both occlusovertical dimension (OVD) and reproducible, physiological position of lower jaw (RPPLJ) in a single clinical visit. In result, we have fabricated a removable denture with implant retention in just two appointments. We can conclude that DENTCA system is a reliable method that allows fabrication of implant-retained removable denture in two clinical visits. The registration of the prosthetic field boundaries, OVD and RPPLJ, combined with CAD technologies, represents a contemporary and accurate method. It takes less time, and expenses are reduced both for the dentist and the patient.

Soft tissue management for immediate implant placement in the esthetic zone is crucial for successful treatment outcomes. Several surgical and restorative techniques have been proposed to treat unesthetic implant soft tissue defects or dehiscence. However, there is a scarcity of clinical evidence on addressing complications associated with through-and-through soft tissue defect (TTSD). In this case, a 61-year-old female patient, who underwent immediate implant placement at the right central incisor 3 months prior, presented with chronic peri-implant mucosal infection and soft tissue recession of TTSD in 2015. The palatal pedicle connective tissue flap (PPCTF) was utilized to provide horizontal and vertical soft tissue augmentation and to cover the defect in combination with the labial contour collapse. At the 8-year follow-up, favorable white and pink esthetic outcomes were observed, and the pink esthetic score (PES) for soft tissue around the implant achieved 9 points, indicating satisfactory esthetic and functional results. The findings from this case study suggest that soft tissue augmentation techniques, such as PPCTF grafts, can provide a reliable and innovative method for both soft tissue augmentation and reconstruction of TTSD, resulting in long-lasting functional and esthetic outcomes and stable ideal PES scores.

Periodontal maintenance is crucial for long-term periodontal stability, but some patients do not undertake maintenance following their initial treatment. To date, the motivations, backgrounds, and concerns of patients who underwent maintenance have not been researched. Therefore, we analyzed the subject's intentions and the behavior of the patient affected by periodontal maintenance using Step for Coding and Theorization (SCAT). The subject was a 50-year-old woman diagnosed with periodontitis. Periodontal therapy included oral hygiene instruction, scaling, root planing, and periodontal surgery. She has been continuing maintenance for 21 years. An interview was conducted on a one-to-one basis, between the patient and the surgeon, using a semistructured interview. The contents of the interview included her reasons for visiting the university hospital and her reasons for continuing maintenance. For the qualitative analysis using SCAT, the vocabulary obtained from the interview was filled out in a SCAT form. We determined that the relationship between the dental personnel and the patient was good, and we could convey the importance of maintenance to the patient. Appropriate periodontal treatment and the maintenance of a good relationship with the dental health oral care provider are key factors in improving the rate of maintenance visits and ensuring long-term periodontal stability.

Dental avulsion is a traumatic dental injury with complete displacement of the tooth outside the bony socket. Both primary and permanent teeth are predisposed to such traumatic incidents. The most effective treatment in such cases is tooth replantation. Additionally, a short-term flexible splint is needed to stabilize the avulsed/replanted tooth. This case report describes orthodontic braces as a standardized flexible splint option for the treatment of tooth avulsion. Herein, the case of a 9-year-old female patient who presented to a private dental clinic with an avulsed upper left central incisor, 1 h after the accident has occurred. Once the tooth was replanted with all the necessary precautions, orthodontic braces and wire were utilized to stabilize the tooth. Most dental splints are custom-made, requiring thorough professional knowledge and expertise for their fabrication and placement. The protocol described in this report is aimed at easing tooth stabilization using materials within the scope of a basic dental setup consultation room.

Early diagnosis of oncologic pathologies has a crucial role to determine patient's prognosis and therapeutic path. Nonetheless, clinical errors and omissions that can occur during diagnostic, as well as detection of preneoplastic or neoplastic condition, may result in devasting consequences both for patients in terms of health and for professionals in terms of medico-legal responsibility. This study is aimed at examining in depth, through the presentation of a specific clinical case, the medico-legal aspects inherent to the diagnosis of oral cancer, analyzing the preventive, interceptive, and diagnostic strategies, the legal implications of clinical evaluation errors and diagnostic omission, and the type of medical damage produced and professional liability. The medico-legal landscape surrounding oral squamous cell carcinoma is multifaceted and characterized by diagnostic challenges, treatment complexities, and legal considerations. Health-care providers must remain vigilant in navigating these complexities to ensure optimal patient care while mitigating legal risks. By prioritizing high-quality medical records, fostering transparent communication with patients, and implementing preventive strategies, health-care institutions can strive to minimize the incidence of litigation and uphold standards of ethical practice in oral carcinoma cases. Additionally, continued research and education in forensic and legal medicine are essential in informing evidence-based practices and promoting patient safety in this evolving field.

Smiling expresses emotions and affects interpersonal relationships, influencing self-esteem and social life. Nowadays, concerns about aesthetics and access to the Internet have made people more informed and demanding about treatments for gingival smile. Excessive gingival display (EGD) is caused by a variety of factors that can act alone or in combination. These factors may include altered passive eruption (APE), vertical maxillary excess, a short upper lip, and hyperactive upper lip, among other factors that cause gingival hyperplasia. In this case report, the EGD was caused by vertical maxillary excess, hypermobility of the upper lip, and APE. The proposed treatment included two procedures: the Modified Lip Repositioning Surgery (Modified LipStat) Technique, with internal sutures to attempt to restrict the traction of the upper lip elevator muscles, and Esthetic Crown Lengthening (ECL) from the right first premolar to the left first premolar for the treatment of APE. The result provided an aesthetic improvement of the smile, with harmonization in relation to the size of the teeth. The mobility of the upper lip in spontaneous smiles remained reduced up to 6 months of follow-up; however, there was a partial relapse in the position of the upper lip during spontaneous smiling at the end of 6 years of follow-up.

Endo-perio lesions are lesions involving pulp tissue with periodontal tissue. The bacterial infection of the pulp can spread to the furcation area through the accessory canal, causing damage to the furcation area. Regeneration therapy has good success when performed with flap surgery and is performed in cases of Grades I and II furcation involvement. Demineralized freeze-dried bone allograft (DFDBA) is a regenerating material that has osteoinductive and osteoconductive abilities. It has the advantage of successful treatment of bone defects. Biodentine is an agent used for direct pulp capping, root perforation and furcation repair, and apexification. It can bind and enter the dentinal tubules and create interlocking crystals with dentin. This case report presents the treatment of furcation involvement Grade II originating from endo-perio lesions by using DFDBA and Biodentine as regeneration materials with 6 months of follow-up.

Soft and hard tissue deficiencies around dental implants which can potentially compromise implant survival are commonly encountered. Complicated interventions are often required to address and resolve combinations of soft and hard tissue defects. This case report describes the management of peri-implant soft tissue fenestration accompanied by bony dehiscence associated with intrabony defect through soft tissue modification. A 51-year-old female was referred to the Periodontics and Oral Medicine Clinic with labial soft tissue fenestration at the maxillary left canine implant-supported crown. The patient complained of discomfort and malodor at the implant site. The implant showed mucosal fenestration and 6 mm probing depth (PD) with profuse bleeding at the distolabial site without mobility. A cone beam computed tomography (CBCT) demonstrated labial bony dehiscence associated with a 5.56-mm intrabony defect at mesial and distal surfaces. The implant was diagnosed as peri-implantitis with soft tissue deficiency. The treatment comprised oral hygiene instruction, debridement of the implant and all natural teeth, and mucogingival surgery with free connective tissue graft by the envelope technique. Two weeks after debridement, the mucosal margin of the implant disappeared, presenting soft tissue dehiscence of 4 × 4 mm. Mucogingival surgery was performed 3 weeks later. A 2-year follow-up revealed a stable mucosal margin with PD ranged 2-4 mm. In conclusion, modification of the soft tissue thickness around the implant together with excellent plaque control by the patient successfully maintained peri-implant health.