Complex prosthodontic treatment with dental implants for a patient with polymyalgia rheumatica: a clinical report

Prosthodontic and implant treatment for a patient with polymyalgia rheumatica can be complicated not only by its symptoms, but also by the side effects of long-term use of certain medications, particularly systemic glucocorticoids. This clinical report presents a polymyalgia rheumatica patient who required full-mouth rehabilitation with dental implants. The patient had a sensitive gag reflex and refused the use of any removable prostheses. She presented clinically with a skeletal Class II malocclusion with severe overbite and overjet. All her remaining dentition was determined to be unrestorable. Full-mouth extractions and immediate placement of implants followed by early implant loading were performed. The use of systemic glucocorticoids might have exacerbated her type 4 maxillary bone and compromised her healing capacity and consequently made implant surgery challenging. Her treatment with full-arch fixed implant-supported dentures to correct her severe overbite and overjet and manage misaligned dental implants is summarized here. The effects of polymyalgia rheumatica in prosthodontic and dental implant treatments are reviewed and discussed.     

An interdisciplinary approach for improved functional and esthetic results in a periodontally compromised adult patient

In contemporary dental care, an increasing number of adult patients are seeking orthodontic treatment. In such adult patients, a combined orthodontic and other specialized therapy often offers the best option for achieving a predictable outcome to solve complex clinical problems. This case report demonstrates a combined therapy with orthodontic, periodontic, and implant-prosthodontic treatments in a 56-year six-month-old female patient with mild diastemata in the maxillary anterior region and a missing left maxillary second premolar caused by a periodontal disease with medium bone loss. The patient had improved her oral hygiene condition through periodontal treatment before orthodontic treatment. The patient was orthodontically treated with a maxillary lingual arch and a maxillary edgewise orthodontic appliance. Active orthodontic treatment was completed in 18 months, and an implant-supported prosthesis was placed with a single crown in the region of the left maxillary second premolar. The treatment outcomes, including the periodontal condition and the dental implant treatment, were stable at two years after the active orthodontic treatment. We demonstrate that combined orthodontic-periodontic-implant-prosthodontic treatment can achieve an improved masticatory function, esthetics, occlusion, and periodontal condition.     

Treatment of a patient with cleidocranial dysplasia using a single-stage implant protocol

This patient report describes the treatment of a 45-year-old Caucasian woman with cleidocranial dysplasia who had significant dental problems that greatly affected her quality of life. The patient had orthodontic treatment in her earlier years along with surgical removal of supernumerary teeth. Using implants, the maxillary and mandibular arches were restored with fixed screw-retained prostheses. Eight implants and six implants were placed in the maxilla and mandible, respectively. Both arches were immediately loaded following the Teeth in a Day? protocol using an all-acrylic resin provisional prosthesis. Five months later, definitive maxillary and mandibular prostheses were fabricated. The patient has been followed for a period of 5 years, and all postoperative evaluations have been uneventful.     

Interdisciplinary management of a patient with skeletal anteroposterior discrepancy, impacted canine, and missing teeth

For patients with complex dentofacial problems, orthodontic treatment is often not enough to obtain optimal esthetic and functional results. This case report demonstrates the treatment of a patient with skeletal anteroposterior discrepancy through an interdisciplinary approach and emphasizes the importance of collaboration with other dental disciplines to achieve the desired esthetic results.     

The dental management of a patient with a cocaine-induced maxillofacial defect: a case report

There are several dental complications associated with cocaine abuse, Including adverse reactions to dental anesthetics, post-operative bleeding, and cellulltls, which can lead to necrosis of orbital, nasal, and palatal bones. Following Is a report of the Initial treatment rendered to a patient who had destroyed most of her hard palate over a ten-year period of cocaine abuse. There are no classic socio-economic or educational profiles for abusers of cocaine. Drug abuse victims may present as patients In any dental office. Though there are certain classic physiological and psychological symptoms of their condition, they may not display symptoms at all.     

Fixed prosthodontic rehabilitation in a wear patient with Fabry's disease

Fabry's disease is an uncommon X-linked metabolic disorder that leads to abnormal accumulation of glycosphingolipids in the body resulting in a variety of systemic disorders. Few reports have addressed dental findings and management of these patients. This clinical report describes the fixed prosthodontic rehabilitation of an adult male patient with Fabry's disease, who presented with generalized severe wear of the dentition. In addition to numerous systemic morbidities, the patient also presented with intraoral angiokeratomas, telangiactasias, anterior diastemata, bimaxillary prognathism, and other oral findings known to be prominent in these patients. The patient was managed by an interdisciplinary team of dental specialists in close coordination with his nephrologist. The prosthodontic treatment included restorations on all teeth, except mandibular anterior teeth, and the patient was restored with a partial group function scheme of occlusion. At the 3.5-year follow-up appointment, the patient's oral health and integrity of the restorations remained stable. This is the first clinical report describing the prosthodontic management of a patient with Fabry's disease. Unique features related to this patient's fixed prosthodontic treatment include accommodation to complex medical problems, management of maxillary diastemata, and choice of occlusal scheme.     

A mini dental implant-supported obturator application in a patient with partial maxillectomy due to tumor: case report

Following a partial maxillectomy in a patient, the oral and nasal cavities remain open, providing a passageway for transmission of air and fluids between the 2 cavities. In such cases the primary aim should be the construction of an implant-supported obturator prosthesis with adequate retention, stability, and peripheral seal. In this case report, a 34-year-old female patient who underwent a class II (according to Okay et al.) partial maxillectomy 14 years before was fitted with an obturator that was supported by 5 mini dental implants. The reason for the preference of mini dental implants is the lack of adequate bone tissue for conventional implant placement in the resected area and the placement of mini dental implants with a simple surgical procedure. The treatment achieved restoration of the lost functions, which satisfied the patient, restoring her self-confidence and enhancing her quality of life. Thus, applying obturators supported by mini dental implants was successful and may be considered as an alternative to more complicated surgical techniques. Although the presented case is promising, further clinical research is needed to draw more definite conclusions.     

Lawsuit against a dentist related to serious ocular infection possibly linked to water from a dental handpiece

This case report highlights the risks that may be associated with amoebae in the water of a dental unit. A woman with contact lenses visited her dentist for replacement of a bridge. During the treatment, a stream of water was directed from the handpiece into her right eye. Because of subsequent pain in the eye, the patient consulted several ophthalmologists, who discovered abrasive lesions of the cornea and inflammation. Despite antibacterial and anti-inflammatory treatments, the patient"s visual acuity declined gradually over a period of several days. A microbiological examination nearly 2 months later revealed amoebae in corneal samples. A lawsuit against the dentist was initiated. Although a causal relation with the dental treatment was rejected by the judge in this case, high numbers of amoebae in the water of dental units can present a risk if a patient with pre-existing corneal lesions is splashed. According to the precautionary principle, complete evidence of risk does not have to exist to institute measures to protect individuals and society from that risk. This case reinforces the importance of having patients wear safety glasses during dental treatments and of dental personnel draining the waterlines of dental units, as recommended by the Canadian Dental Association.     

Oral rehabilitation of a bulimic patient: a case report.

Bulimia nervosa is among the most common health problems in contemporary society. It is a self-induced weight loss syndrome associated with distinct dental manifestations involving physical and psychologic symptoms. It is characterized by recurrent binge-purge episodes that occur at least once a day. This article describes the complete-mouth rehabilitation of a bulimic patient with a generalized enamel erosion of her dentition and a poor esthetic appearance. Porcelain-fused-to-metal restorations were used as the definitive treatment. Good esthetics and high self-esteem were the final results. Comprehensive restorative therapy was applied in this clinical case report to achieve both function and esthetics in a demanding situation.     

The use of dental implants to retain thumb prostheses: a short-term evaluation of 2 cases

This article presents the use of dental implants for the retention of thumb prostheses. Two patients with traumatic amputation of the thumb were rehabilitated with implant-supported digital prostheses. A dental implant was placed in the residual bone of the thumb. After a 3-month osseointegration period, retentive attachment and silicone prostheses were fabricated. Osseointegration of the implant, peri-implant skin health, and prosthesis function were assessed every 6 months. The follow-up period was 18 months for patient 1 and 21 months for patient 2. Osseointegration was achieved, and there were no skin problems. Some degree of tactile sensation was observed, and the patients were satisfied with the esthetic result.     

Dental management of the pregnant patient

The pregnant patient presents several considerations for providing dental treatment. Among these are that there are two persons involved in the dental treatment of a pregnant woman, the woman and the baby. Each presents a different set of problems. The mother basically presents no difficult problems for dental treatment. She needs to have routine dental treatment provided. All procedures can be done. Because of the fetus, certain precautions in the use of drugs and radiographs must be taken. If it is determined in taking the history that a person may be pregnant and she is not seeing an obstetrician, the dentist should urge her to see one at her earliest convenience. It is well documented that early and good prenatal care decreases the risk to the mother and to the fetus. Diabetes, hypertension, and anemias are frequently associated with pregnancy and produce a threat to the developing fetus. These diseases, along with any other systemic diseases and infections that pose threats to either the mother or the fetus, are normally detected with good prenatal care.     

Combined therapy in a patient with Papillon-Lefèvre syndrome: a 13-year follow-up

BACKGROUND: Papillon-Lefèvre syndrome (PLS) is an autosomal recessive disease characterized by hyperkeratosis of the palms and soles combined with premature loss of the primary and permanent dentition. Several treatment regimens have been recommended in the literature; however, a definitive treatment protocol has not been established. This case report evaluates the success of combined therapy in managing a patient with PLS. METHODS: A 6-year-old girl diagnosed with PLS presented with aggressive periodontal destruction of her primary and permanent dentitions. After extraction of periodontally affected teeth, the edentate region was rehabilitated with different temporary dentures until her skeletal growth was complete. At the same time, her orthodontic treatment was performed. The early loss of her incisors resulted in inadequate alveolar bone height and width for esthetic-advanced prosthetic rehabilitation. Alveolar bone augmentation was performed, and 6 months later, two intraosseous dental implants were placed into the central incisor zone. RESULTS: After 13 years of treatment and follow-up, the patient had periodontally healthy permanent dentition. She had practiced meticulous oral hygiene, and the orthodontic treatment was successful and without incident. Alveolar ridge augmentation and placement of an intraosseous implant with guided bone regeneration were performed successfully. CONCLUSIONS: This case report demonstrates that individually developed treatment protocols can provide long-term dental/periodontal success in patients with PLS. A multidisciplinary approach with advanced periodontal surgery, orthodontic and prosthetic treatment, and implant therapy may be an appropriate treatment modality for dental rehabilitation in patients with PLS.     

The geropsychiatric patient

To achieve successful treatment in the geropsychiatric patient, the dentist should understand the difference between depression and dementia and be able to adapt his or her approach to the patient, depending on the diagnosis. The practitioner should also take time to review the geropsychiatric patient's clinical record and appreciate the patient's behavioral potentialities. Before starting dental treatment, the practitioner should plan appropriate psychotropic medications as a form of psychopharmacologic crisis intervention. This method reflects the team approach in geriatric medicine and dentistry.     

Glycogen storage disease and von Willebrand's disease implications for dental treatment: Dental management of a pediatric patient

Glycogen storage diseases (GSD) are metabolic disorders which impair the body's ability to store glucose and utilize it later, requiring patients to take multiple daily dietary supplementation with a high carbohydrate content. Patients undergoing this treatment modality are placed at increased risk for gross dental caries and other oral abnormalities. Additionally, GSD may prolong the patient's bleeding time, which may necessitate consultation with the treating physician. In the following case, our patient required a multi-disciplinary approach to address not only her dental needs, but also to coordinate the management of both her GSD and an additional complication, von Willebrand's disease. This was best achieved in a hospital setting     

Changes in neurophysiologic parameters in a patient with dental anxiety by hypnosis during surgical treatment

It was hypothesized that dental anxiety, which leads to neurophysiologic alterations in heart rate, respiratory rate and blood pressure prior, during and subsequent to dental treatment, can be influenced by medical hypnosis. We report the positive impact from non-invasive hypno-sedation during dental implant surgery on a 54-year-old female patient who experienced neurophysiologic reactions as a result of the psychosomatic process of dental anxiety (dental anxiety scale value = 13). The neurophysiologic changes during dental surgery performed with and without hypnosis were compared after the patient underwent the same surgical treatment protocol. This case report was part of a study designed to evaluate hypnosis as a non-invasive therapy for dental-anxious patients over six sessions using subjective experience and objective parameters, which included electroencephalogram, electrocardiogram, heart rate, blood pressure, oxygen saturation of the blood, respiration rate, salivary cortisol concentration and body temperature.     

Prosthodontic rehabilitation of an anhidrotic ectodermal dysplasia patient: a clinical report

This clinical report describes the characteristics and prosthodontic restoration of a young male patient with anhidrotic ectodermal dysplasia. With proper care and prosthodontic treatment, the patient can enjoy a relatively normal life. It is important that the patient and his parents fully understand the dental problems related to his physiologic and psychologic conditions. The need for continued dental treatment is necessary.     

Periodontal considerations in the overdenture patient

The overdenture is a complex treatment that involves several dental disciplines. This discussion of periodontal considerations in the overdenture patient emphasized diagnosis, treatment, and maintenance.     

Treatment of aggressive periodontitis by osseointegrated dental implants. A case report

BACKGROUND: Generalized aggressive periodontitis is described as a clinical entity affecting both deciduous and permanent dentition with extensive alveolar bone loss, mobility, and exfoliation of all or many teeth. Controversy exists on dental implant use to restore missing dentition in younger patients. METHODS: This case report presents a patient diagnosed with aggressive periodontitis who has lost all but 4 of her teeth. Her personal and functional desires led us to include implant therapy in her treatment plan. The hematological data are presented with an analysis of the immunological profile. RESULTS: Dental implants were placed, and following 3 months of osseointegration, an implant-supported prosthesis was completed. The patient was followed up for 36 months. CONCLUSIONS: This case report presents an alternative treatment for rehabilitating dentition in a young patient treated for aggressive periodontitis. Similar case studies may help eliminate some of the controversy that exists regarding the use of dental implants in aggressive periodontitis patients.     

Integrating dental and medical care for the chronic bulimia nervosa patient: a case report

Excessive tooth erosion and resulting sensitivity and esthetic concerns are well-documented problems in patients with eating disorders. Several techniques for restoring lost tooth structure have been reported in the literature. However, the potential significant role of dental care in the comprehensive treatment of the chronically bulimic patient has received little attention. Integration and coordination of dental treatment with medicopsycho-social therapy of the bulimic patient may enhance the patient's success in combating this complex disorder. The key to proper dental management is a definitive approach to data collection and close coordination among all health care personnel providing primary health care therapy. A specific dental approach model is recommended in this report of a patient with a 15-year history of bulimia.