Mandibular molars often exhibit high variation in canal anatomy. Failing to identify these variations can negatively impact treatment outcomes. This report describes two cases of mandibular first molars with middle distal canals. In Case 1, the patient was a United Arab Emirates (UAE) national who presented with symptomatic irreversible pulpitis; whereas in Case 2, the patient had a previously treated tooth and chronic apical abscess. Both cases were treated with nonsurgical root canal therapy, and the extra canals were identified using magnification and troughing with ultrasonic tips. In Case 2, healing was observed at the 6 months and 1 year follow-up. This report highlights the lack of data on the incidence of middle distal canals in Emirati population and underscores the importance of meticulous canal exploration and the use of enhanced diagnostic aids to detect atypical canal anatomy.
Background:Impaction of mandibular second molars is uncommon, particularly when associated with severe root dilaceration and intimate proximity to the inferior alveolar canal. Such cases present considerable diagnostic and therapeutic challenges because surgical extraction may result in neurosensory injury. This case report describes the successful interdisciplinary management of a deeply impacted mandibular second molar using controlled orthodontic traction supported by skeletal anchorage. Case Presentation:An 18-year-old female presented seeking orthodontic treatment because of dissatisfaction with her smile esthetics. Clinical examination demonstrated a skeletal Class I relationship with increased vertical facial proportions, mild mandibular deviation, posterior crossbite, and reduced overjet and overbite. Panoramic radiography and cone-beam computed tomography (CBCT) revealed a deeply impacted mandibular left second molar with severe root dilaceration, intimate proximity to the inferior alveolar canal, and a pericoronal radiolucency suggestive of a dentigerous cyst.Following interdisciplinary consultation with oral and maxillofacial surgeons, orthodontic traction was selected as a conservative alternative to surgical extraction. Initial treatment included maxillary expansion, alignment, and space creation, followed by surgical exposure, marsupialization of the pericoronal lesion, and attachment of a gold chain. Controlled orthodontic traction was subsequently performed using fixed orthodontic appliances, temporary anchorage devices (TADs), and a customized auxiliary levering arm. Results:After 30 months of active treatment, the impacted mandibular second molar erupted successfully into functional occlusion while maintaining pulp vitality and without clinical evidence of inferior alveolar nerve injury. A stable occlusion was maintained throughout the 6-month follow-up period. Conclusion:This case demonstrates that carefully planned interdisciplinary management combined with controlled skeletal anchorage-supported orthodontic traction can provide a safe and effective alternative to surgical extraction in selected patients with deeply impacted mandibular second molars presenting with severe root dilaceration and close proximity to the inferior alveolar canal.
Management of multiple impacted teeth in nonsyndromic adolescents can be challenging, particularly when impactions involve several quadrants. This case report describes two adolescent patients with extensive impactions affecting both permanent and supernumerary teeth, with an emphasis on the clinical reasoning that guided treatment decisions. A quadrant-by-quadrant approach was used to determine when teeth were extracted, surgically exposed, or retained based on eruption potential, root development, and surgical access. Although the anatomical complexity of the cases was similar, treatment strategies differed according to individualized risk-benefit considerations. These cases highlight the value of structured clinical judgment in managing complex impactions without relying on rigid treatment algorithms.
Bar-retained maxillary overdentures supported by four implants have shown favorable survival and consistently positive patient-reported outcomes, particularly when careful prosthetic planning and high primary stability are achieved. The case presented here illustrates the clinical application of this treatment approach as part of a full mouth rehabilitation. A 64-year-old male presented with poor esthetics and function due to multiple missing teeth in both arches and nonrestorable maxillary teeth and mandibular molars. Although the mandibular arch could be restored with a combination of fixed crowns and a removable partial denture, the remaining maxillary teeth were all deemed to have a poor prognosis. In shared decision making, the patient opted for removal of these maxillary teeth and replacement with an implant-supported bar overdenture. Following minimally traumatic extraction and partial grafting of sockets using a xenogeneic bone substitute, four bone-level implants were placed immediately in the canine-premolar positions (13, 15, 23, and 25) according to a prosthetically driven three-dimensional plan, achieving insertion torques of 40-45 Ncm. After a 5-month uneventful osseointegration period and minimally invasive uncovering surgery, straight multiunit abutments and an Ackermann-type bar (a prosthetic bar design unrelated to the Eckermann implant system) were used to support a bar-retained maxillary overdenture with bilateral balanced occlusion. At the 4- and 7-month follow-up visits, peri-implant tissues were healthy, the implants and bar remained stable, and no biological complications were detected. The patient reported improved comfort, chewing ability, and esthetics. These findings illustrate the short-term clinical feasibility of this treatment approach in this individual patient.
Background:Type 3 von Willebrand disease (VWD) is the most severe and rare form of this inherited bleeding disorder, characterized by near-complete absence of von Willebrand factor (VWF) and markedly reduced Factor VIII activity. These patients are at high risk of excessive bleeding during invasive procedures, including dental treatment. Case Presentation:A 4-year-old boy with a confirmed diagnosis of Type 3 VWD presented with intermittent pain in the maxillary left lateral incisor, without clinical or radiographic signs of an abscess. Comprehensive dental rehabilitation was performed under general anesthesia. Treatment consisted of pulpotomy and placement of stainless-steel crowns for primary molars, as well as pulpectomy and resin composite restorations for primary incisors. Hemostatic management included preoperative and postoperative pdVWF/F VIII concentrate administration in consultation with a hematologist. Conclusion:With meticulous multidisciplinary planning, appropriate perioperative factor replacement, and careful intra- and postoperative management, safe and effective dental rehabilitation can be achieved in pediatric patients with Type 3 VWD.
Anterior open bite is a prevalent malocclusion that can cause occlusal dysfunction and markedly reduce masticatory efficiency. This case report describes the successful management of a 37-year-old female with an anterior open bite secondary to excessive vertical development in the molar region and clockwise mandibular rotation. The treatment combined clear aligners with implant anchorage for molar intrusion, alongside S-shaped double-arm root control attachments to facilitate the uprighting of severely tilted teeth. Following the placement of four implants in the maxillary posterior region, the therapy was systematically carried out in four distinct phases: molar intrusion, premolar intrusion, correction of mandibular anterior tooth axial inclination, and final occlusal refinement. After 30 months, both the occlusal relationship and facial profile were significantly improved, with complete resolution of the anterior open bite and establishment of normal overbite and overjet. Cephalometric analysis confirmed favorable outcomes, including counterclockwise rotation of the mandible. This case highlights the efficacy of an implant-assisted clear aligner protocol augmented by specialized attachments for managing complex anterior open bite, thereby expanding the scope of clear aligner therapy.
Unlike conventional water-soluble luting cements, which gradually dissolve in oral fluids and partially self-correct over time, polymerized resin cement is insoluble and will not be displaced from the restoration margin without active mechanical intervention. This case report describes the qualitative analysis of the cementation line of three metal-ceramic crowns 1 year after placement using scanning electron microscopy (SEM) and the replica technique, and the subsequent clinical management. A 45-year-old female patient presented with crowns on Teeth 11, 21, and 22 cemented with a self-adhesive dual-cure resin cement (RelyX U200, 3 M ESPE). Despite presenting with clinical signs of localized gingivitis, the patient reported no pain or discomfort and was entirely unaware of the presence of residual cement. SEM analysis revealed cement excess of 200-500+ μm, 10-23 times the manufacturer-specified film thickness of 22 μm, in cervical, interproximal, and subgingival regions. Following mechanical cement removal, resolution of bleeding on probing and reduction in probing depths were observed at all affected sites, providing direct clinical evidence of a causal relationship between residual resin cement and local gingival inflammation. These findings highlight the limitations of symptom-based monitoring and underscore that postcementation polishing is a definitive clinical requirement, not a discretionary step.
Background:Rehabilitation of the posterior maxilla is challenging due to sinus pneumatization, limited vertical bone height, and thin peri-implant soft tissues. Minimally invasive, biologically guided approaches aim to reduce morbidity while ensuring predictable outcomes. This report presents a staged protocol integrating hard- and soft-tissue augmentation to optimize implant site development. Case Presentation:A 48-year-old female presented with a missing maxillary left first molar (#26) and impaired mastication. The left premolars (#24 and #25) were buccopalatally malaligned and exhibited a poor periodontal prognosis. Radiographic examination revealed poor-prognosis premolars, advanced ridge atrophy, and sinus pneumatization, with a residual bone height < 6 mm. Initial alveolar ridge preservation was performed, but vertical bone gain remained insufficient after 6 months. Intervention:Following extraction of the premolars, socket preservation with bone grafting and a barrier membrane was performed. Implant placement was performed using a minimally invasive crestal sinus floor elevation with simultaneous grafting, achieving vertical bone augmentation and primary stability. Standard OSSTEM implants (4.5/11 and 4.5/10 mm) were used. After osseointegration, staged peri-implant soft-tissue augmentation increased keratinized mucosa width and mucosal thickness to improve tissue stability. The implants were restored with delayed-loading, screw-retained metal-ceramic single crowns following complete soft-tissue maturation. Results:The staged protocol achieved stable vertical bone gain, healthy peri-implant soft tissues, and successful functional and esthetic rehabilitation. These outcomes were maintained at the 2-year follow-up after crown delivery, with no biological or prosthetic complications, stable marginal bone levels, a favorable emergence profile, and high patient satisfaction. Conclusion:Sequential alveolar ridge preservation, minimally invasive crestal sinus elevation, and delayed soft-tissue augmentation provide a safe, predictable approach for atrophic posterior maxillary sites. This strategy minimizes surgical morbidity while enhancing implant stability, peri-implant tissue health, and long-term clinical outcomes.
Erosive tooth wear (ETW) is increasingly prevalent, particularly among younger populations, and is often associated with dietary habits, including frequent soft-drink consumption. Patients with advanced tooth wear may report hypersensitivity, impaired mastication, and dissatisfaction with their smile, all of which can negatively affect daily function and quality of life. This case report describes the full-mouth rehabilitation of a young patient with severe ETW using a minimally invasive approach. Treatment combined digital planning, diagnostic digital wax-ups, and 3D-printed preparation guides to support precision and tissue preservation. Lithium disilicate was selected because of its favorable mechanical and optical properties. Its reduced thickness allowed conservative tooth preparation, and the restorations were adhesively cemented according to a carefully planned protocol. Re-establishing an appropriate vertical dimension of occlusion (VDO) addressed the patient's functional and esthetic concerns while preserving healthy tooth structure. At the 1-year follow-up, the restorations remained stable, supporting the effectiveness of a minimally invasive protocol based on contemporary adhesive techniques and durable ceramic materials.
Objective:We are aimed at describing the clinical and psychosocial benefits of resin infiltration as a minimally invasive treatment option for hypomature amelogenesis imperfecta in a child. Hypomature amelogenesis imperfecta is a rare hereditary enamel defect that significantly compromises dental esthetics, function, and psychosocial well-being. Conventional management often involves invasive restorative approaches such as composites, veneers, or crowns, which may require removal of sound tooth tissue and pose challenges in pediatric patients. Clinical Considerations:An 11-year-old girl presenting with hypomature amelogenesis imperfecta and severe esthetic concerns associated with impaired oral health-related quality of life was treated using an erosion infiltration technique with resin (Icon, DMG). Following enamel surface conditioning, a low-viscosity resin infiltrant was applied to penetrate and mask hypomature enamel opacities. The procedure led to immediate and significant esthetic improvement, with enhanced enamel translucency and high patient satisfaction. Esthetic outcomes remained stable over a 3-year follow-up period, including during orthodontic treatment, and were associated with a marked improvement in oral health-related quality of life. Conclusions:This case highlights the potential of resin infiltration to offer a conservative alternative to conventional restorative methods in hypomature amelogenesis imperfecta, with meaningful improvement in dental esthetics and oral health-related quality of life. Nevertheless, further clinical studies and long-term follow-up are required to validate its durability and to establish standardized treatment protocols.
Pulp canal obliteration (PCO), commonly following dental trauma, is characterized by progressive canal calcification and may be associated with pulp necrosis and apical periodontitis (AP). Conventional root canal treatment (RCT) may be technically unfeasible or associated with a high risk of iatrogenic complications. In the case reports, we explored endodontic microsurgery (EMS) as a primary treatment strategy for managing PCO with AP. Three patients (aged 30-46 years) presented with a history of dental trauma, severe canal calcification, and radiographic evidence of apical radiolucency, with or without associated bone loss. All cases were diagnosed using cone beam computed tomography (CBCT) and managed with EMS as the primary treatment approach, combined with iRoot BP Plus for apical sealing. Clinical symptoms, including gingival abscesses, resolved following treatment, and radiographic follow-up (up to 3 years) demonstrated resolution of periapical radiolucency and evidence of bone healing in all cases. Within the limitations of these case reports, primary EMS may represent a feasible alternative for selected cases of PCO with AP, allowing effective management of periapical pathology while avoiding the risks associated with attempting RCT in severely calcified canals.
Sialolithiasis of the minor salivary glands is a rare clinical entity that is seldom detected through preoperative imaging. Due to its nonspecific clinical presentation, it is frequently misdiagnosed as mucocele, fibroma, or minor salivary gland tumor; consequently, most cases are identified only through postoperative histopathological examination. We report a rare case of sialolithiasis in a minor salivary gland of the upper lip in a 73-year-old male patient. Despite the lesion's small size, a history of suppuration prompted radiographic investigation. A standard dental radiograph identified a 0.5-mm radio-opaque entity, enabling an accurate preoperative diagnosis. This case underscores that dental radiography remains a simple, cost-effective, and highly efficient screening tool for differentiating sialolithiasis from other soft-tissue lesions in the lip.
Molar incisor hypomineralization (MIH) is a qualitative enamel defect characterized by reduced mineralization, increased porosity, and compromised mechanical properties, making affected teeth highly susceptible to posteruptive breakdown, hypersensitivity, and restorative failure. Conventional direct restorations often exhibit limited longevity in severely affected molars due to weak enamel bonding and structural fragility. Consequently, indirect restorations with cuspal coverage have been increasingly recommended as a more durable and protective treatment option. This clinical case reports the restorative management of MIH-affected maxillary first molars in a 24-year-old patient using lithium disilicate ceramic overlays. Following the removal of defective amalgam restorations, a minimally invasive tooth preparation with a butt-joint design was performed, combined with immediate dentin sealing to enhance adhesion. Impressions were taken using polyvinylsiloxane materials, and overlays were fabricated via CAD/CAM technology. Adhesive cementation was carried out under strict isolation, including surface treatment of both the restoration and dental tissues. The use of lithium disilicate overlays provided a conservative yet effective approach, ensuring reinforcement of weakened tooth structure while preserving remaining sound tissues. The literature supports the high survival rates of such restorations in MIH cases, with reduced hypersensitivity and satisfactory functional and aesthetic outcomes. In conclusion, lithium disilicate overlays represent a reliable and minimally invasive solution for the rehabilitation of compromised MIH molars. Careful case selection, proper adhesive protocols, and regular follow-up are essential to ensure long-term success, particularly given the inherent fragility of MIH-affected enamel.
Angina bullosa hemorrhagica (ABH) is an abruptly developing oral blood blister that most often affects the soft palate. Ventral-tongue presentations are uncommon and can mimic traumatic, vascular, hematologic, or immune-mediated disease. A 78-year-old Saudi man with hypertension and Type 2 diabetes presented with a 3-day history of tongue discomfort and a solitary hemorrhagic bulla measuring 1.5 × 1.0 cm on the right ventral tongue. No other oral lesions, cutaneous involvement, or airway symptoms were present, and he reported a previous similar palatal lesion. Based on the characteristic clinical appearance, oral-only distribution, and prior recurrence, a clinical diagnosis of ABH was made. The lesion was managed conservatively. Four days later, it had ruptured. At 2-month follow-up, the lesion had completely healed without scarring. This case highlights an uncommon ventral-tongue presentation of ABH and emphasizes that ABH should be considered in the differential diagnosis of solitary hemorrhagic bullae and postbullous erosions of the tongue. Recognition of its characteristic clinical course may prevent misdiagnosis and unnecessary intervention while ensuring appropriate hematologic evaluation and, when indicated, investigation for immune-mediated disease.
Oral hobnail hemangioma is an exceptionally rare benign vascular lesion of the oral cavity. A 57-year-old edentulous woman presented for evaluation of discomfort associated with her existing prosthesis, and intraoral examination revealed a bluish-purple, smooth-surfaced, asymptomatic nodular lesion located in the anterior maxillary labial mucosa. Clinically, vascular malformation and hemangioma were considered in the differential diagnosis. Histopathological examination revealed dilated superficial vascular channels within the lamina propria, some of which contained erythrocytes, together with characteristic hobnail endothelial cell morphology in the superficial aspect of the lesion. Immunohistochemical analysis demonstrated CD34 positivity and HHV-8 negativity. Based on the clinical, histopathological, and immunohistochemical findings, a diagnosis of oral hobnail hemangioma was established. Accurate recognition of this rare entity is important because of its clinical and histopathological overlap with other benign, intermediate-grade, and malignant vascular proliferations, particularly Kaposi sarcoma and hemangioendothelioma variants.
Introduction:Oral malignant melanoma in situ is a rare lesion that may precede the development of invasive oral malignant melanoma. We report an unusual presentation of a rare oral malignant melanoma in situ as multiple gingival macules around a dental implant-supported prosthesis, posing a significant diagnostic challenge. Method:A 68-year-old Caucasian male presented with two black macules on the buccal gingiva of a dental implant and pontic of the implant-based prosthesis; they were asymmetric, with discrete borders, smooth surface, and homogenous color. Two small areas of gray discoloration were also seen on the palatal gingiva. The provisional diagnosis was postinflammatory pigmentation. Results:Following excision of all lesions, an oral mucosal melanoma in situ was diagnosed. A watch-and-wait approach with a 3-month follow-up was decided. Twelve months later, the lesion recurred in the subpontic area, and wide excision on clinically normal margins of the gingival mucosa to the level of periosteum was performed. Conclusions:This case emphasizes that peri-implant pigmentation should not automatically be attributed to inflammatory or implant-related causes. Early biopsy remains essential because oral mucosal melanoma in situ may present deceptively and can recur despite initial complete excision.
Objectives:External cervical resorption (ECR) is a progressive condition that may compromise both periodontal and pulpal tissues. This report describes the outcome of a single-session combined endodontic-periodontal approach for the management of ECR in a previously treated maxillary central incisor. Case Presentation:A 41-year-old male presented with ECR affecting the maxillary left central incisor, associated with previous trauma, a sinus tract, and defective root canal treatment. Cone-beam computed tomography (CBCT) was used for diagnosis, classification, and treatment planning. A single-session approach combining endodontic retreatment and periodontal surgery was performed. Results:At 28 months, the tooth remained asymptomatic and functional, with clinical periodontal stability and radiographic periapical healing. However, no new bone formation was observed in the cervical buccal bone plate, and a residual probing depth of 5 mm persisted without bleeding or mobility. Conclusions:A single-session combined approach may be a reasonable option for moderate ECR when adequate access and defect sealing are achievable. In this case, the outcome reflected disease control and structural stability rather than complete tissue regeneration.
This case presents a novel microsurgical approach for managing a severe palatogingival groove (PGG) while preserving pulp vitality. A 29-year-old male exhibited a 10-mm palatal pocket, buccal sinus tract, and an extensive through-and-through cortical plate defect on the maxillary right lateral incisor. Despite the PGG extending 6 mm apically, pulp sensibility remained normal. A conservative microsurgery featuring "selective curettage" was performed to preserve the apical neurovascular bundle. The defect was sealed using a two-segment restoration: iRoot BP Plus radicularly and composite resin coronally. At the 2-year follow-up, the patient was asymptomatic with normal probing depths (< 3 mm), complete sinus tract resolution, substantial alveolar bone healing, and maintained pulp vitality. Combining selective curettage with a two-segment restoration offers a predictable, biologically driven strategy for simultaneous periodontal regeneration and vital pulp preservation.
Oral rehabilitation of patients with severe tooth wear (STW) and loss of vertical dimension of occlusion (VDO) remains a clinical challenge. While ceramics are the traditional choice, 3D-printed resin composites (3D-PRCs) have emerged as a minimally invasive and cost-effective alternative. A young adult patient with severe erosive and attrition wear associated with bruxism presented with an 8-mm discrepancy between vertical dimension at rest (VDR) and VDO. A fully digital workflow was utilized to plan a 5-mm VDO increase, maintaining a 3-mm freeway space. Following clinical validation via a functional mock-up, the patient was restored using a highly filled 3D-printed nanohybrid composite (Voxelprint Ceramic; FGM Dental Products, Joinville, SC, Brazil). The additive manufacturing approach allowed for ultraconservative preparations of 24 teeth, guided by a digital wax-up, prioritizing enamel preservation through minimal surface regularization with chamfer (crowns, onlays, and overlays) and minichamfer (veneers) finish lines. Restorations were cemented using a standardized adhesive protocol: light-cured resin cement for anterior veneers and dual-cure resin cement for posterior restorations, including silanization of the 3D-printed surfaces. According to FDI criteria, the restorations exhibited excellent functional, esthetic, and biological properties, effectively restoring the patient's vertical dimension and occlusal balance. After that, the patient was referred for the fabrication of a 3D-milled Michigan occlusal splint. The integration of 3D-PRCs into a digital workflow provided a predictable and accessible solution for complex functional rehabilitation. This material's mechanical properties, such as high microhardness or flexural resistance, make it particularly suitable for patients with parafunctional habits. Although short-term outcomes are promising, longitudinal studies are essential to validate the long-term performance of ceramic-reinforced resins as a definitive restorative treatment.
Introduction:Condyle fracture may result in functional and cosmetic issues. Malocclusion becomes one of the adverse effects of the fracture that impairs the quality of life. It is crucial for maintaining the mandibular condyle because it is an essential component of jaw movement. The critical decision for the treatment choice in early adolescence has an impact on accurate reduction and rigid fixation. Improper methods of therapy might have major consequences for facial growth and development, with ankylosis as a frequent occurrence. Importance:To report a case of bilateral condylar fracture in pediatrics and its management and long-term follow-up. Case Presentation:A 16-year-old male was referred to the Oral and Maxillofacial Surgery Department after a road traffic accident with complains of pain in the area of TMJ bilaterally. The clinical examination showed an anterior open bite and restricted mandibular movement. CT scan reported a bilateral fracture at the neck condyle, as well as on the right side of the coronoid process, the right side of the symphysis, and the left side angle of the mandible. Case Management:Open reduction internal fixation (ORIF) and the puppet technique are performed under general anesthesia. Temporary immobilization methods involve arch bars and heavy elastics. Intraoral, submandibular, and miniretromandibular incisions were given concerning the fracture site. A 3-year follow-up revealed an occlusion, facial growth, and bone union, which followed the removal of the surgical miniplate. Conclusion:The patient achieved bone union, occlusal stability, facial development, and recovery of jaw movement on both sides. The treatment also successfully maintains vertical dimensions, which are key to treating such cases.
