International Poster Journal of Dentistry and Oral Medicine, 01/2024

Objective: This case report and systematic review aimed to answer whether patients with osteogenesis imperfecta (OI) can be prosthetically treated with implants. Osteogenesis imperfecta is a rare genetic disease characterized by a type I collagen defect leading to bone fragility and connective tissue disorders. Case Report: A 64-year-old female patient with OI type 1 presented for the first time to a specialty consultation for rare diseases with oral involvement in May 2019. The patient had received alendronic acid (p.o.) for many years to treat OI. At the consultation time, she was fitted with maxillary and mandibular complete dentures, and the complete mandibular denture had inadequate support. Implants were planned to stabilize the prosthesis. Under local anaesthesia, two tissue-level implants (Straumann Standard Plus®, Basel, Switzerland, SLActive 3.3 mm × 10 mm) were placed in regions 32 and 44. After a healing period of three months, uncovery took place, and the prosthetic restoration with locators could be performed two weeks later. Since implant placement, the patient has attended regular check-ups for one year and has shown no signs of drug-associated osteonecrosis or peri-implant infection. Methods: Because of the paucity of studies on implants in individuals with OI, a systematic review was performed. The search queries were based on the Population Intervention Comparison Outcome (PICO) procedure with the question, "Can people with osteogenesis imperfecta (P) be successfully treated and prosthetically restored (O) with dental implants (I)?" Results: The primary outcome was implant survival. Supporting data were analysed descriptively. Twelve studies were finally included. Twenty-three patients were treated with a total of 116 implants, with 5.0 (±3.8) implants placed per patient. Bone augmentation was performed before or during implant placement in 30 implants (25.8%). A sinus lift was performed before the placement of 19 implants (28.8%). In 18 patients, implants were placed in a two-stage procedure. In four patients, 14 implants (12.1%) were immediately loaded. Implant survival was 94.0%, with a mean follow-up of 59.1 months (±36.1). A total of seven implants were lost in four different patients. Three implants (2.6%) were lost before loading, and two implant fractures (1.7%) were described. Conclusion: The available data show the loss of only seven implants, with two of these implants lost due to implant fractures not attributable to the patient. With the limitations of this review and based on the available data, implants have a high survival rate (94.0%) in patients with osteogenesis imperfecta. Therefore, implants may be a viable treatment option for replacing missing teeth in patients with OI and should be considered in treatment planning after a detailed individual risk assessment. Keywords: Osteogenesis imperfecta, implants, rare disease, case report, systematic review

Simpson-Golabi-Behmel syndrome is an x-linked recessive overgrowth disorder characterized by macrosomia, mental deficits, a large head, prominent cranial sutures, midface deficits, hypertelorism, a broad nose, a wide mouth, macroglossia, dental malocclusions, a strongly arched palate, and musculoskeletal and limb abnormalities. The male sex is more commonly affected, with only about 200 cases being described. The presented case of a 2-year-old patient showed a flat facial profile, macroglossia, a deep tongue position with forced mouth closure, a large upper and lower jaw, and enamel formation disturbances at the primary molars. Preventive, interdisciplinary care of the patient regarding his oral health as well as dentition and speech development are recommended. Keywords: Simpson-Golabi-Behmel syndrome, rare diseases associated with oral symptoms

In order to achieve a functional and, from an aesthetic point of view, optimal treatment result, various things have to be taken into account in cleft patients: comprehensive interdisciplinary cooperation, favourable tooth positions and intermaxillary relationships, and appropriate peri-implant soft tissue management. Nevertheless, difficult conditions, e.g., narrow interdental gaps, often persist despite extensive pretreatment over many years from a preimplantological point of view. The present case report shows a patient with a left-sided cleft. At the age of 21, the patient could be treated implantologically with a single-tooth implant in region 22. The success prognosis of implants in the cleft jaw region is comparable to implants placed after trauma. Sufficient bone supply is absolutely essential for this. Keywords: cleft, implant

Background: Especially in the anterior region, late implantation can lead to unsatisfactory aesthetic soft tissue results. This case report is intended to demonstrate a possibility to achieve aesthetic soft tissue contours and emergence profiles even in late implantations. Case report: In February 2022, a then 27-year-old courier cyclist presented to the Interdisciplinary Ambulance Centre of the Department of Oral and Maxillofacial Surgery Münster after a fall. Teeth 11 and 21 were avulsed (non-recoverable); tooth 22 had a complicated crown-root fracture and was also not worth preserving. For insurance reasons, the implantation could not take place until 5 months after the accident. In the meantime, the patient was treated with a deep-drawn splint designed for maximum papilla preservation. Three Straumann implants BL 3.3 mm (10/12/12 mm) were placed in region 11, 21, and 22. After another three months, the implants were uncovered and the emergence profiles were designed with PMMA crowns. Over a period of three months, the PMMA crowns were successively adjusted in the subgingival area to ensure the most aesthetic soft tissue contouring possible. For the definitive restoration, individualised zirconium abutments on a titanium adhesive base were fabricated and restored with fully veneered zirconium crowns. Due to the long shaping phase with PMMA crowns, highly aesthetic results could be achieved even though implant placement took place only 5 months after the accident. Discussion: Several studies have already addressed the shaping of implant crowns (including temporaries) and the transfer of the emergence profile to the definitive model in order to achieve aesthetic results. The case presented takes up several of these approaches to achieve aesthetic results here with delayed implant placement and restoration. Keywords: dental implants, missing teeth, soft tissue, prosthodontics, ceramic crowns

Objectives: The objectives of this in-vitro study were to evaluate dentin tubule occlusion caused by Predicta^TM Bioactive Desensitizer, a methacrylate-free, nanohydroxyapatite-based desensitizer, and the effects of phytic acid pretreatment. Materials and Methods: Occlusal surfaces were prepared from 55 caries-free human premolars extracted as part of orthodontic treatment with informed consent. The teeth were stored in 0.5% thymol solution at 4°C and then randomly allocated to 6 groups, each consisting of 10 samples except the control group. Using a low speed diamond saw, 2mm thick dentin discs were cut. The central area (5mm) was defined as the experimental area and polished with 600 and 1000 grit silicon carbide. These polished samples were immersed in 17% EDTA for 40 minutes to open up the dentin tubules. Groups A, B, C, D, and E (n=10 each) were treated with Predicta^TM Bioactive Desensitizer. Samples of Group D and E were pretreated with 1% phytic acid with and without wash, respectively; Group F (n=5) was left immersed in artificial saliva as a control. Micromorphological analysis using a scanning electron microscope was performed to assess tubular occlusion. A blinded reviewer independently scored the level of tubule occlusion. Means were compared using one-way analysis of variance (ANOVA). Results: The mean occlusion scores computed from micromorphological analysis using scanning electron microscope showed that: Group E > Group D > Group C = Group B > Group A > Group F. Conclusion: The tubule occlusion efficacy of Predicta Bioactive Desensitizer seems to be more effective with 1% phytic acid pretreatment than without. Keywords: dentin, phytic acid, dentin sensitivity, smear layer, desensitizers, SEM, bioactive

Objective: The objective of this preclinical study was to evaluate a predictable technique that combines layering and injection moulding for easy, efficient and consistent polychromatic anterior restorations. Materials and Methods: This preclinical study was conducted on a Nissin Jaw Model with push-type typodont. Thirty maxillary anterior typodonts were prepared using diamond abrasives to simulate multiple diastemata and divided into equal groups. Group A was restored using the traditional injection moulding technique and Group B was restored using the experimental technique, which combines the histological layering technique with the traditional injection moulding technique. Unprepared typodonts were used as a laboratory wax up for consistency and reproducibility. Stents were prepared using a clear, vinyl polysiloxane impression material. Samples of Group A were restored with G-ænial Universal Flo after adhesive protocol. For Group B, after adhesive protocol, packable composite (Shades A3, A2, A1, CT) was used to create internal anatomical features such as mamelons, incisal halo, and cervical high value areas, following which G-ænial Universal Flo was injected to mimic the enamel layer. Standardised finishing and polishing protocols were followed for both groups. An aesthetic evaluation was performed by blinded evaluators using the FDI World Dental Federation clinical criteria for direct restorations. The parameters considered were surface luster, translucency, and aesthetic anatomical form. Results: The surface luster of both groups was comparable; Group B received better scores for translucency and aesthetic anatomical form. Conclusion: This preclinical study demonstrated that layering followed by injection moulding resulted in predictable, aesthetic, polychromatic, life-like restorations. Keywords: adhesives, composite resins, dental bonding, aesthetics, injection moulding, layering

Objective: This clinical case series reports a non-invasive treatment of complex transposition using injection moulding to obtain a predictable aesthetic outcome. Material and Methods: A 25-year-old female and a 29-year-old female reported with a request to improve the aesthetic appearance. Clinical examination revealed transposition of maxillary canines in place of a central and lateral incisor, respectively. The proposed treatment in both cases was injection moulding due to its non-invasive nature. A wax-up was made to replicate ideal tooth morphology. A silicone key of the wax-up was obtained using a clear polyvinyl siloxane impression material. A fine needle diamond was used to drill the holes in the key to facilitate injection of composite resin. After prophylaxis, the procedure was started sequentially for both cases. The teeth were isolated with teflon tape and adhesive protocol was followed. Next, the silicone key was positioned onto the teeth and composite was injected. G-ænial Universal Injectable, shade A1 was selected for the procedure. Next, it was light cured through the transparent silicone. Finishing and polishing were performedincluding surface textures to obtain a natural and life-like appearance. Results: The injection moulding technique provided an easy, non-invasive and predictable approach to plan restorations in challenging scenarios with complex morphology. Conclusions: This treatment approach provided excellent function and aesthetics with advantages including minimal tooth structure loss and cost effectiveness. Keywords: composite resins, adhesive, aesthetics, injection moulding, transposition, layering

Introduction: Excessive gingival display (EGD) is commonly referred to as gummy smile, which is an aesthetic concern for an individual. Lip repositioning is a simple procedure to treat this problem. The procedure restricts the muscle pull of elevator lip muscles, thereby reducing gingival display while smiling. This is a safe and predictable procedure with minimal risk and side effects. Objectives: Reduction of EGD using surgical lip repositioning Methodology: A 20-year-old female patient reported to the Department of Periodontology, PGIDS Rohtak with a chief complaint of gummy smile. Clinical examination revealed 5-6mm of maxillary gingival display. The maxillary anterior teeth had smaller crown height with adequate attached gingiva, and vestibular depth was present. Crown lengthening and lip repositioning surgery was performed. Result: Gingival display at baseline was 5-6mm, which was reduced and stable at 1st month, 3rd month, and 6th month postoperatively. Conclusion: Lip repositioning procedure is an effective way of reducing excessive gingival display and appears to be a promising alternative treatment option for gummy smile. Keywords: dental aesthetics, gingiva, crown lengthening

The limitations associated with reconstruction of critical-sized bony defects arising from maxillofacial trauma has averted researchers towards bone tissue engineering employing scaffolds prepared from biomaterials having osteogenic potential. In this study we have developed a novel 3-D scaffold with BMP-2 for reconstruction in critical-sized bone defects and compared its regenerative properties with β-TCP and PCL/HA scaffolds in vivo (rabbit model). Material and methods: Novel Chitosan-gelatin nanohydroxyapatite (nHaP) scaffold reinforced with PCL-nHaP nanofibres was developed. Physical characteristics were evaluated through SEM analysis. Sterilized scaffolds- Novel Graft + BMP2 (G), Polycaprolactone /HA (P) and βTCP (B) were placed in surgically created critical-sized defects in rabbit bone and analysed at an interval of 2, 4, and 6 weeks post implantation. Bone formation was evaluated through Micro CT and histomorphometry. Results: SEM analysis revealed smooth and bead-free continuous PCL-nHaP fibers with specific peaks of HaP on X-Ray diffraction. The scaffold was highly porous, exhibiting long, smooth partially interconnected polygonal pores. Micro CT images revealed a substantial amount of bone formation in Group G followed by Group P and Group B. The HE stained sections revealed appreciable bone formation at the vicinity of the novel graft. Conclusion: The novel Chitosan-gelatin nHaP graft reinforced with PCL-nHaP nanofibres is a tested bone substitute for critical-sized bone defects. Its superior physical properties as compared to other commercial bone substitutes, adequate cell attachment and growth, and better neo-osteogenesis and bone healing may contribute topersonalised rehabilitation of maxillofacial trauma patients in the near future. Keywords: biomaterial, bone tissue engineering, critical size defects, PCL nanofibres, chitosan, nano-hydroxyapatite, scaffold

Traumatic neuroma is an exuberant, but non-neoplastic, proliferation of peripheral nerves that occurs after any trauma or surgery. The lesion develops most commonly in the jaws or in the soft tissues of the mental foramen area, lower lip and tongue. This case report discusses a case of traumatic neuroma present extra- orally in the cheek that occurred following an injury. It also gives a brief overview on the relevant demographic, clinical, radiographic, histologic, immunohistochemical, and treatment aspects of traumatic neuromas. Keywords: amputation neuroma, traumatic neuroma, mandible