Hopeless tooth? Prognosis and comprehensive treatment. A case report.

A hopeless tooth from a periodontal point of view, with severe bone resorption, mobility and abnormal tooth migration, is often extracted. In advanced cases, function and esthetics are impaired, and an interdisciplinary treatment is requested. Retaining or not these teeth is based on clinician judgment. A growing body of evidence claims that prognosis has great potential to be improved in a motivated patient with good oral hygiene and regular maintenance. This case report aims to present a periodontal regenerative technique combining enamel matrix protein derivatives and a particulated xenograft to treat intraosseous defects caused by periodontitis. The patient healed uneventfully, and no complications were recorded after the surgical procedure. To correct abnormal tooth migration and improve function and esthetics, orthodontic treatment was instituted. Tooth prognosis improved from hopeless to questionable. This approach extended the life span of a compromised tooth, improving periodontal support and decreasing tooth mobility. This could be an alternative to extraction and implant.

Eruptive vellus hair cysts: report of a new case with immunohistochemical study and literature review.

Eruptive vellus hair cysts (EVHC) are rather uncommon lesions, of which 222 cases have been published in the literature. Their etiopathogenesis is poorly known. We report herein a new typical case of EVHC that was studied immunohistochemically. A 15-year-old male presented with a 4-year history of progressively developing small brown-gray papules on the trunk and extremities. Microscopically the lesions consisted of small epidermoid cysts containing vellus hairs. Immunohistochemically, the lesions expressed keratin 1/10, calretinin and p63 but no epithelial membrane antigen, filaggrin or androgen receptors. A review of the relevant literature shows that EVHC may be inherited or acquired and may be associated to other genodermatoses, namely sebocystomatosis. They could be due to hamartomatous follicular growth, to a trouble in infundibular keratinization leading to vellus hair follicle occlusion, or represent an example of acquired hamartoma. Although benign, this condition is difficult to treat.

Rapidly growing orf in a renal transplant recipient: favourable outcome with reduction of immunosuppression and imiquimod.

Orf is a viral skin infection due to a poxvirus. It manifests as a nodule of the hands that heals spontaneously within 3-4 weeks, but may be persisting and difficult to treat in immunocompromised patients. Very few cases have been reported in transplant patients; therefore, management is not established. We report a renal transplant recipient with a rapidly growing orf which regressed after application of imiquimod and a reduction in immunosuppression without damage on his renal function. This case suggests that a rapidly growing orf in transplant patients behaves as an opportunistic infection and therefore minimization should be considered along with a topical treatment.