Treatment of a fused/geminated tooth: a multidisciplinary conservative approach.

OBJECTIVE: To report a multidisciplinary treatment of gemination/fusion of the left maxillary first incisor. CASE REPORT: An 11-year-old boy presented to our clinic with the chief complaint of an unpleasant appearance of his anterior teeth. Clinical and radiographic evaluation revealed gemination/fusion of the left maxillary first incisor combined with an Angle's Class II relationship (skeletal), retruded mandible, deep bite, short lower face height, and proclinaion of the maxillary incisors. The multidisciplinary approached treatment included orthodontic treatment engaged with root canal treatment of the left maxillary first incisor followed by periodontal surgical separation of the mesial root of the left maxillary first incisor and restoration of the crown using resin restoration. CONCLUSION: Tooth shape anomalies in general dental practice may be rare, but the dentist should be aware of the nature of the problems encountered and the specific treatment needs. The treatment may be complex and contain various treatment protocols that may include interdisciplinary endodontic, surgical, and periodontal interventions.

Transitional implants in a patient with Williams-Beuren syndrome: a four-year follow-up.

Williams-Beuren syndrome (WBS) is characterized by several diagnostic features, including oligodontia. Restoration of congenitally missing teeth in patients with WBS is a challenge, both emotionally and clinically. In the atrophied alveolar bone process of a juvenile patient with WBS, the maxillary lateral incisors were replaced with two Immediate Provisional Implants (IPI). Early implant loading was used with temporary acrylic resin crowns that were replaced by semi-permanent restorations; the case has been followed for four years. Restoration of the missing maxillary lateral incisors with IPIs and temporary crowns proved to be a convenient, long-lasting and psychologically acceptable solution to the patient and her family.

Posttraumatic dental implant placement in a patient with maple syrup urine disease.

Maple syrup urine disease (MSUD) is an inborn error of metabolism resulting from a defect in the oxidation of the branched-chain amino acids leucine, isoleucine, and valine. Patients present in early infancy with brain edema; delay in diagnosis and treatment is common and associated with residual neurologic damage, which includes alternating muscular hypotonia and hypertonia, dystonia, and seizures. These signs can result in trauma, especially to the anterior maxilla, which is the most traumatized region. In patients with MSUD, a fixed prosthesis is recommended because a removable one can be dangerous because of the risk of aspiration. Rehabilitation, using dental implants, is especially challenging in these patients because of the strong muscular forces of the tongue and lips. An implant-supported fixed prosthesis might provide an effective functional, esthetic, and predictable solution for patients with late-treated MSUD. The present report describes a 10-year follow-up of the successful, posttraumatic use of a dental implant to replace an anterior maxillary tooth in a patient with MSUD.

Rehabilitation of an irradiated mandible after mandibular resection using implant/tooth-supported fixed prosthesis: a clinical report.

Patients undergoing mandibular resection often have facial asymmetry and cosmetic disfigurement, which include a retruded, deviated mandible, motor and sensory deficiencies, and abnormal intermaxillary relationship and occlusion. An implant-supported fixed prosthesis can be an optimal treatment modality. However, there is a problem in creating a repeatable, stable plane of occlusion and maxillomandibular relationship. This report describes the treatment sequence and considerations to rehabilitate a patient undergoing mandibular resection and radiotherapy with an implant-supported fixed prosthesis.

Cavity preparation by Er-YAG laser on pulpal temperature rise.

PURPOSE: To measure the intrapulpal temperature changes in vitro, during cavity preparation and caries removal, using the Opus 20 Er-YAG laser plotted as a function of the laser energy and pulse rate. MATERIALS AND METHODS: Class I and V cavity preparations were made in 175 fresh extracted caries-free human teeth and caries removal was carried out in 42 carious extracted teeth by the Opus 20 Er-YAG laser. K-type thermocouples were inserted into the pulp chambers filled with heat conducting paste. Lasing was carried out at different irradiation energies and pulse frequencies, using air-water spray. Temperature changes in the pulp chamber were measured during lasing. RESULTS: In all groups tested, the maximum temperature rise was lower than 5.5 degrees C, which is considered as critical value for pulp vitality. The highest temperature values were measured during Cl I preparations (3.13 degrees C +/- 1.54 - 4.11 degrees C +/- 1.29), medium values were in Cl V in enamel (2.38 degrees C +/- 1.37 - 4 degrees C +/- 1.07) and the lowest were in cementum (2.10 degrees C +/- 0.61 - 3.61 degrees C +/- 1.15) and during caries removal (1.21 degrees C +/- 0.46 - 3.51 degrees C +/- 0.68).