Modified apically repositioned flap in the treatment of unerupted maxillary central incisors.

The successful management of labially unerupted maxillary central incisors requires a coordinated surgical, orthodontic and general practitioner approach. The key to achieving maximal eruption of these teeth is their surgical exposure, central to which is the philosophy that the surgeon must provide a functional width of attached gingiva on the labial surface. This case describes the incorporation of palatal mucosa into an apically repositioned flap, resulting in the successful establishment of an attached gingival margin, where routine flap design would have seriously compromised the eventual outcome.

A nasopalatine cyst in an 8-year-old child.

The nasopalatine cyst (NPC) was first described in 1914 and it is considered the most common non-odontogenic cyst. Most studies show a higher incidence of NPC among males than females, with a male/female ratio of 1.7:1. The majority of the cases described in people in their fifth decade involve Afro-Caribbeans, while those in their sixth decade are mainly caucasians. These cysts are normally asymptomatic, unless they are infected. The most commonly reported clinical symptom is swelling in the anterior part of the palate. The treatment of choice is enucleation. Even though it has been stated that NPCs may occur at any age no reports have been made on children less than 9 years old. Some reports support a predisposition in young Afro-Caribbeans, where NPCs appear to be more aggressive, larger and symptomatic. We present a case of a NPC in an 8-year-old caucasian female.

The provision of dental implants and a fixed prosthesis in the treatment of a patient with scleroderma: a clinical report.

This clinical report highlights some of the problems in providing a suitable prosthesis for a patient who suffers from systemic sclerosis. A conventional removable partial denture may not have been suitable because of the lack of denture bearing area, changing peripheral seal, and insufficient teeth to support and retain the denture. An implant-retained FPD overcame these difficulties. One would hope that, with regular maintenance and monitoring, quoted prosthesis success of 15 years can be achieved.

Multiple supernumeraries: a case report.

Supernumerary teeth, which usually appear in small numbers and are easily dealt with, may affect the permanent dentition if not removed. In this paper the case of multiple supernumerary teeth in the presence of a complete dentition is reported.

Ehlers Danlos syndrome type I with novel dental features.

The clinical, radiographic and histologic findings are described in two cases of Ehlers Danlos Syndrome Type I with novel dental features. Defective dentinogenesis principally affecting the mandibular incisors result in aplasia or hypoplasia of root development predisposing to localized periodontal disease. A striking radiographic appearance with a bulbous enlargement of the roots together with pulp stones is seen in other teeth. 'Giant channels' and vascular inclusions resembling 'intermediate cementum' are prominent within this area. No evidence of Type III procollagen or collagen was detected with indirect immunofluorescence. It is suggested that an inherited collagen abnormality in a component common to dentin, skin, ligament and tendon probably explains both EDS I and the dentin dysplasia.

Neoplasia masquerading as periapical infection.

Seven examples of neoplasia which presented as periapical radiolucencies are described. These were all initially treated for presumed periapical infection. The atypical features that should alert dentists to the possibility of a tumour presenting in this manner are: a vital tooth with minimal caries, root resorption and an irregular radiolucent outline, tooth mobility in the absence of generalised periodontal disease, regional nerve anaesthesia, and failure to respond to good endodontic therapy. All material removed at the time of apical surgery must be examined histologically to prevent neoplasia being overlooked.

Zygomycosis in aplastic anaemia: response to a combined regimen of amphotericin B and antilymphocyte globulin.

A 22-yr-old man with aplastic anaemia was treated with high dose methylprednisolone. A month later he developed severe epistaxis which was not controlled by regular platelet transfusions. A balloon catheter inserted into the left nostril caused necrosis of the left ala nasi accompanied by gross facial oedema. He received treatment with horse ALG for aplastic anaemia but developed gross facial oedema and anaesthesia of incisor and canine teeth on the right side. Radiographs initially showed thickening of the maxillary antral mucosa and later erosion of the maxilla over the anaesthetic region. A biopsy specimen of this region contained hyphae of zygomycetes. He was treated with amphotericin B and a second course of antilymphocyte globulin followed by oxymetholone. He has made a satisfactory clinical and haematological recovery.