Case Reports in Dentistry最新文献

This case report describes a modified deep margin elevation (DME) technique to address a deep subgingival carious lesion in Tooth 9 of a 62-year-old female patient with a history of bisphosphonate therapy and hypothyroidism. Conventional restorative techniques were inadequate because of the lesion's subgingival depth. A customized injectable matrix technique was utilized, incorporating injectable wax, flowable composite, and soft tissue management with aluminum chloride-soaked retraction cord. The wax replicated the internal structure of the cavity, upon which a flowable composite was light-cured to form a patient-specific matrix. Glycerin gel was used to eliminate the oxygen-inhibited layer and facilitate matrix clearance. Composite resin was administered to raise the margin supragingivally, enhancing both periodontal and restorative results. This technique provides superior accuracy, clarity, and flexibility compared to conventional DME, particularly in anatomically complex cases.

This report describes an innovative dynamic computer-guided piezocision technique that integrates preoperative digital planning with real-time intraoperative navigation to accelerate orthodontic treatment while minimizing complications. A 24-year-old female patient who requested short-term orthodontic treatment underwent a minimally invasive, flapless corticotomy using a dynamic system. Preoperative optical scanning and cone-beam computed tomography were performed for comprehensive three-dimensional surgical planning. Intraoperatively, reference trackers were fixed and calibration was performed, enabling precise guidance. A conventional scalpel, adapted with a drill-tag, was employed to execute fully guided soft tissue incisions, and a piezoelectric cutting insert was calibrated for corticotomy cuts. The dynamic navigation system provided continuous real-time feedback on instrument position during the surgical procedure, guiding the surgeon regarding location, depth, and angulation, while ensuring optimal irrigation to reduce thermal risks. The fully guided dynamic piezocision technique enabled the execution of corticotomies following the planned cuts without surgical complications such as damage to dental roots or periodontal tissues. The dynamic approach allowed intraoperative adjustments and improved irrigation, reducing the risk of thermal injury. Fully guided dynamic piezocision may enhance surgical accuracy and safety compared to traditional methods by combining preoperative digital planning with real-time dynamic navigation.

Lichen planus (LP) is a chronic inflammatory disorder affecting mucosa and skin. This report presents a 61-year-old female with refractory LP involving buccal, gingival, and vulvovaginal mucosa, unresponsive to prior therapies including corticosteroids and hydroxychloroquine. The patient was treated with apremilast, a phosphodiesterase-4 inhibitor, combined with total glucosides of paeony. Within 4 weeks with apremilast and total glucosides of paeony, the patient experienced significant clinical improvement, with reduced Investigator Global Assessment and reticulation-erythema-ulceration scores. Periodontal scaling and root planing were performed at 8 weeks, further enhancing oral health. At 14 and 20 months after treatment initiation, the patient's condition remained stable, with no significant adverse effects. This case suggests that sequential therapy with apremilast and total glucosides of paeony may be a promising option for managing refractory LP involving multiple mucosal sites. Strategically timed periodontal intervention, initiated after systemic control, improved tolerability and underscored the value of a sequential, multidisciplinary approach.

Multiple myeloma is characterized by a monoclonal neoplastic proliferation of plasma cells. This pathology can manifest as skeletal-related events (SREs), such as bone pain. However, such events are extremely rare in the mandibular condyle. We describe the case of an 82-year-old woman who presented to her dentist with occlusal pain in the right temporomandibular joint. Temporomandibular disorder (TMD) was diagnosed and treated using lifestyle modification. However, the pain did not subside, and she was referred to our department. On auscultation, crepitations were heard in the temporomandibular joint. Computed tomography showed an osteolytic lesion in the right mandibular condyle and cancellous bone loss in various locations. Abnormal ¹⁸F-fluorodeoxyglucose uptake was observed in the right mandibular condyle, among other locations. Blood testing revealed normocytic normochromic anemia, decreased renal function, delayed 1-h erythrocyte sedimentation rate, and decreased albumen and albumen-to-globulin ratio. Signal hyperintensity was evident in the right mandibular condyle on apparent diffusion coefficient mapping, while whole-body diffusion-weighted imaging with background body signal suppression revealed symmetrical diffusion-restricted areas in the right mandibular condyle, among other locations. These findings were diagnostic of multiple myeloma. The patient underwent chemotherapy, treatment for SREs, and oral care interventions to prevent medication-related osteonecrosis of the jaw (MRONJ). At present, the multiple myeloma remains stable, and TMD-like symptoms have disappeared. She can perform normal jaw movements, and no MRONJ has developed. Dentists must be aware that multiple myeloma can first present as orofacial manifestations. Care must be taken to avoid MRONJ when treating SREs of multiple myeloma.

Coronectomy is a conservative surgical technique used to manage deeply impacted mandibular third molars at high risk of inferior alveolar nerve injury. Precise execution is essential to avoid complications, particularly in cases with limited surgical access. Dynamic navigation (DN) systems may enhance accuracy and safety in such procedures. This report describes the 5-year follow-up of a DN-assisted coronectomy in a 42-year-old patient presenting with recurrent pericoronitis and a pericoronal lesion associated with a deeply impacted lower third molar. Preoperative planning was performed using cone beam computed tomography (CBCT), and DN was employed intraoperatively to guide surgical instrumentation in real time. The procedure was carried out according to a standardized protocol, including crown sectioning, root reduction, and primary closure. No intraoperative or early postoperative complications were observed. At 5-year follow-up, the patient was asymptomatic. Clinical examination showed complete mucosal healing and normal probing depths. Radiographic evaluation revealed retained roots without signs of pathology and bone formation distal to the second molar. This case may highlight the potential role of DN in improving surgical control during coronectomy in anatomically complex situations, contributing to a favorable long-term clinical and radiographic outcome.

When maxillary canine emerges in an abnormal position, the so-called ectopic eruption, it can lead to issues that require a combination of surgical, orthodontic, pediatric, and restorative treatments. If the ectopic eruption causes damage to other teeth, they may need to be removed, and the remaining teeth repositioned and reshaped to achieve a functional and esthetic result. This process requires a team effort from pediatric dentists, orthodontists, radiologists, and surgeons and a knowledge of tooth anatomy, root positioning, and restorative techniques. This case report details the replacement of an impacted maxillary canine with a central incisor with a severely resorbed root.

A 60-year-old female patient was referred to the Department of Functional Exploration, Pain, and Orofacial Dysfunction complaining of a pain in the preauricular regions and a recent apparition of an open bite impeding the masticatory function. In the general examination, the patient had a medical history of polyarthralgia with 7 years of evolution. She had no history of trauma in the maxillofacial region. Clinical examination revealed a restricted mouth opening and pain in the right and left temporomandibular joint (TMJ) areas. The palpation of this region revealed the presence of crepitations. A computed tomography (CT) scan of TMJ revealed a flattening of the condylar heads of the mandible. It also confirmed that the resorption of the two mandibular condyles is the origin of the open bite. After biological analysis, the diagnosis of TMJ disorder related to rheumatoid arthritis (RA) was made.

This clinical report describes treatment with a removable partial denture produced using an anatomical impression made with an intraoral scanner and a mucocompressive impression made using the altered-cast technique. First, digital scanning was performed with an intraoral scanner to obtain an anatomical impression of the remaining teeth and the residual ridges. Computer-aided design software was then used to design the framework, which was fabricated by selective laser melting. A mucocompressive impression was subsequently made using the altered-cast technique, and gypsum was poured to modify the cast accordingly. The denture was then fabricated. The patient was satisfied with the stability, retention, and overall function of the prosthesis.

Endodontic treatment success is contingent upon the comprehensive identification and management of all root canals within a tooth's complex anatomy. This is particularly challenging in maxillary molars, which exhibit significant variability in canal morphology. While the presence of two canals in the mesiobuccal (MB) root is well documented, the occurrence of a third canal (MB3) is less common yet clinically relevant. Additionally, the distobuccal (DB) root, typically containing a single canal, may occasionally harbor a second canal (DB2). This case series presents clinical cases that highlight the prevalence and significance of MB3 and DB2 canals in maxillary molars. The findings underscore the necessity for meticulous canal detection using advanced imaging techniques such as cone beam computed tomography (CBCT), as traditional diagnostic methods may overlook these anatomical variations. By sharing these cases, we aim to enhance awareness and encourage further research into the implications of these additional canals on endodontic treatment outcomes.

Maxillectomy defects after oncologic surgery can create a communication between the nasal and oral cavities, leading to significant challenges in mastication, swallowing, speech, and facial aesthetics. Prosthodontists play a critical role in rehabilitating such defects through obturator prostheses. This case report presents a digital workflow for fabricating a two-piece hollow bulb maxillary obturator for a patient with a large acquired maxillary defect and severe trismus. The prosthesis comprises a hollow bulb component and a denture segment, which interlock using neodymium magnets. The two-piece obturator was digitally planned and 3D-printed, resulting in a lightweight, aesthetically pleasing, and easily insertable prosthesis. This approach effectively improved the patient's quality of life, demonstrating the advantages of digital design in complex prosthodontic rehabilitation.