Gingival tissue proliferation into the tooth following iatrogenic miniscrew insertion: A newer underreported complication.

Miniscrew implant (MSI) has been reported to be an excellent, supportive orthodontic anchorage tool. The placement of MSI is not free from complication and foremost of which is penetration of MSI into the vital tooth structures. This case report is probably the first to report a newer underreported complication. Interestingly, a small bit of gingival tissue was found deep inside the dentin of the tooth, surviving and proliferating in the MSI-damaged zone. This case report is probably the first to give direct histological evidence in humans that a MSI can cause implantation phenomenon which has the potential to give rise to numerous pathologies including pulpal, periodontal, and cystic transformation. Through this report, it is emphasized that clinicians should have a structured, formal MSI placement training to avoid such instances and also underlines the need to develop protocols to be followed in the instance of an inadvertent MSI penetration.

Treatment of a unilateral complete lingual crossbite in an adult with skeletal anchorage assisted orthodontics.

An asymmetry caused by a complete lingual crossbite can compromise aesthetics and impair occlusal function. The following case report describes the correction of a complete lingual crossbite using orthodontic mini implants and mini-plates to achieve absolute anchorage. A comprehensive correction of the crossbite and re-establishment of the buccal occlusion was achieved.

Miniscrew implant fracture and effects of such retained tip on dentin-pulp complex: a histological report.

Miniscrew implants provide an excellent orthodontic anchorage. Besides the clinical benefits, miniscrew implants cause minor discomforts and in certain instances poses problematic complications. Damage to the adjacent tooth structure is the most feared complication of miniscrew implant placement, while fracture of miniscrew implants is the rarest. Miniscrew fracture could occur either during its placement or during its removal. An unusual case report is presented of a miniscrew implant tip fracture following root contact while attempting to remove it. This report highlights the effect of such miniscrew implant fracture on the dentin-pulp complex. The present case is probably the first to give direct histological evidence in humans that a miniscrew fracture or a retained miniscrew implant tip along the dentin/cementum without obvious miniscrew implant penetration could elicit pulp changes. Therefore this case report emphasizes the fact that prior to placing miniscrew implant, clinicians should have acquired proper training and adequate skills in terms of MSI placement and management of fractured MSI.

Rotational panoramic radiographs-unusual triple images.

Currently clinicians advice rotational panoramic radiography (RPR) for preliminary investigation. Despite few inherent limitations, rotational panoramic radiography still remains the diagnostic tool of choice. Abnormal structures such as a supernumerary tooth or a device falling within the certain central regions in conventional RPR images may mislead the clinicians towards an inaccurate diagnosis by producing multiple ghost images. Such cases must be treated with circumspect, and apart from RPR, additional imaging modalities need be employed to provide a judicious interpretation of the clinical situation. Thus this manuscript, we present a case where a paramedian supernumerary tooth which exhibited double ghost images on a conventional RPR. This prompted us to elicit the use of a CBCT and 3 dimensional images to determine the true nature of the problem. We outline the working of the diamond principle behind a conventional RPR which cause the appearance of multiple ghost images. The discerning clinician must be cognizant of the possible positional and analytical errors which may be prevalent in a conventional RPR when viewing structures lying in the palatal region, specifically in the midline while making diagnosis. Key words:CBCT, double image, midline supernumerary, OPG.

Orthodontic and orthognathic management of a complex mandibular asymmetry.

The application of a combined surgical-orthodontic procedure for the treatment of major facial deformities (eg, asymmetries) and associated malocclusions has become an increasingly prevalent treatment modality over the past few decades. Development of sound conjoint treatment principles made possible the correction of skeletal and dental dysplasias that were unyielding to either surgical or orthodontic treatment alone. The presence and severity of dentofacial asymmetries has been the subject of many commentaries and investigations. Treatment of facial asymmetry has always been a challenge with respect to the cause and the rationale behind the corrective procedures adopted. This case report describes a 23-year-old male patient whose chief complaint was attributed solely to the clinically discernible facial asymmetry. A combined orthodontic and surgical approach was done to correct both the dental and skeletal asymmetry. The reasons for selecting this treatment protocol and the 5-year postretention stability of the final results obtained are highlighted in this report.

Root damage and repair in patients with temporary skeletal anchorage devices.

INTRODUCTION: The aim of this study was to evaluate the reparative potential of cementum histologically after intentional root contact with a temporary skeletal anchorage device. METHODS: Seventeen patients (8 male, 9 female; mean age, 16.2 years; range, 13.5-21.6 years) who were scheduled for extraction of 4 first premolars as part of their orthodontic treatment participated in this study. The roots of the premolars were intentionally injured with a temporary skeletal anchorage device. The teeth were extracted at 4, 8, or 12 weeks after the injury. Root contact with the temporary skeletal anchorage device was confirmed by using a stereomicroscope. Histologic samples were prepared. Demineralized serial sections were stained with eosin and hematoxylin, and cementum repair was assessed histomorphometrically. RESULTS: Despite varying depths of the injuries, including involvement of dentin, reparative cementum formation was observed in all sections. Healing cementum was almost exclusively of the cellular type; 70% of all the teeth exhibited good repair by the end of week 12. CONCLUSIONS: This study established that healing of cementum takes place after an injury with a temporary skeletal anchorage device, and it is a time-dependent phenomenon.

Comparison of two imaging programs in predicting the soft tissue changes with mandibular advancement surgery.

Establishing common objectives and expectations concerning the outcome of proposed surgical orthodontic therapy is a crucial part of the treatment planning process, which has been greatly simplified by imaging software. The purpose of this study was to investigate the reliability of two surgical imaging programs--Dolphin Imaging 10 and Vistadent OC--in simulating the actual outcome of mandibular advancement surgery by using a visual analog scale (VAS) judged by a panel of orthodontists, oral surgeons, and laypersons. The predictions were also analyzed with soft tissue cephalometric evaluation. The results of the study showed that in predicting the surgical outcome evaluated by the VAS, both programs received a mean rating of fair. One was marginally superior for the overall assessment among all three panelist groups. Region-wise, rating indicated the lower lip region to be the least accurate, and the submental region received the highest scores. The soft tissue cephalometric parameters showed minimal differences except for the lower lip parameters. Thus, Dolphin Imaging 10 and Vistadent OC are reliable in predicting mandibular advancement surgical outcomes with inaccuracies chiefly in the lower lip region.