scholarly journals Combination Syndrome

Author(s):  
Sridharan Rajendran ◽  
FNU Baburajan

ABSTRACT Combination syndrome (CS) is a dental condition that is commonly seen in patients with a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth. This syndrome consists of severe anterior maxillary resorption combined with hypertrophic and atrophic changes in different quadrants of maxilla and mandible. This makes it a challenging condition in dentistry that requires significant experience along with advanced restorative and surgical skills. The causes of maxillary bone resorption and ways to correct it are discussed in this article. Conventional treatment with full upper and partial lower dentures for the CS patients is not always adequate or satisfying for patients and it often requires multiple remakes due to continuing bone resorption. Dental implant rehabilitation challenges conventional treatment with bone-anchoring techniques to provide improved retention and stability for implant-retained and supported prostheses. This article presents a successful implant treatment of the partially edentulous maxilla in CS patient. The necessity of a multidisciplinary approach for early prevention and treatment of this complex condition is emphasized. This article illustrates a review of the changes and difficulties faced when treated with conventional approach which can be overcome with the aid of implant-supported prosthesis. How to cite this article Rajendran S, Baburajan. Combination Syndrome. Int J Prosthodont Restor Dent 2012;2(4):156-160.

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Qiannan Sun ◽  
Wenhsuan Lu ◽  
Yunfan Zhang ◽  
Liying Peng ◽  
Si Chen ◽  
...  

Abstract Backgroud To analyze the morphological changes of the anterior alveolar bone after the retraction of incisors in premolar extraction cases and the relationship between incisor retraction and remodeling of the alveolar base represented by points A and B displacements. Methods Pre- (T0) and post-treatment (T1) lateral cephalograms of 308 subjects in the maxilla and 154 subjects in the mandible who underwent the orthodontic treatment with extraction of 2 premolars in upper or lower arches were included. Alveolar bone width and height in both the maxillary and mandible incisor area were measured at T0 and T1 respectively. By superimposing the T0 and T1 cephalometric tracings, changes of points A and B, and the movement of the incisors were also measured. Then the correlation between incisor movement and the displacements of points A and B was analyzed. Results The alveolar bone width (ABW) showed a significant decrease in both maxilla and mandible (P < 0.001) except the labial side of the mandible (P > 0.05). The alveolar bone height (ABH) showed a significant increase in the labial side of maxilla and a significant decrease in the lingual side of maxilla and mandible. A strong positive correlation was verified between incisor movement and position changes of points A and B in both horizontal and vertical directions. Conclusions Anterior alveolar bone width and height generally decreased after orthodontic treatment. Incisor retraction led to significant position changes of points A and B. The decrease of anterior alveolar bone due to significant incisor retraction should be taken into account in treatment planning.


2013 ◽  
Vol 2 (2) ◽  
pp. 50-54
Author(s):  
Ashok Sethi ◽  
Thomas Kaus ◽  
Naresh Sharma ◽  
Peter Sochor

Safe clinical practice in implant dentistry requires an accurate investigation of the availability of bone for implant placement and the avoidance of critical anatomical structures. Modern imaging techniques using computed tomography (CT) and cone beam computed tomography (CBCT) provide the clinician with the required information. The imaging thus obtained provides accurate representation of the height, width and length of the available bone.1 In addition, whenever adequate radiation dose is used, accurate information about the bone density in Hounsfield units can be obtained. Important spatial information regarding the orientation of the ridges and the relationship to the proposed prosthetic reconstruction can be obtained with the aid of radiopaque templates during the acquisition of CT scan data. Modern software also provides the facility to decide interactively upon the positioning of the implants and is able to relate this to a stereolithographic model constructed from the imaging data. A surgical guide for the accurate positioning of the implants can be constructed. The construction of screw retained prostheses is fraught with difficulties regarding the accuracy of the construction. Accurate fit of the prosthesis is difficult to obtain due to the inherent errors in impression taking, component discrepancies, investing and casting inaccuracies.2,3 CAD/CAM technology eliminates the inaccuracies involved with the investing and casting of superstructures. Clinical Case This case describes the management of an 84 year old female patient, who had recently lost her remaining mandibular anterior teeth. This resulted in the patient's inability to wear conventional dentures in the mandible.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A218-A218
Author(s):  
Melissa Kaori S Litao ◽  
Deepa Badrinath Murthy ◽  
Jason Klein

Abstract Background: Cherubism, caused by autosomal dominant mutations in the SH3BP2 gene, is characterized by increased bone resorption with development of bilateral fibro-osseous lesions limited to the maxilla and mandible. The SH3BP2 gene is thought to be involved in osteoclastogenesis. Affected children, while usually asymptomatic at birth, typically present at 2–5 years of age with cheek and jaw swelling with upward tilting of eyes due to expansion of fibrous tissues. Bone resorption and proliferation of lesions continues until puberty after which spontaneous regression occurs. RANKL is a cytokine expressed on the surface of osteoclast precursors and is responsible for inducing osteoclast differentiation. Denosumab is an anti-RANKL monoclonal antibody which prevents osteoclast maturation. However, it has a short half-life, and effects on bone turnover have been found to be rapidly reversible after drug discontinuation. The rebound increased bone turnover can lead to severe hypercalcemia. Clinical Case: A 4 year old boy with cherubism (c.1253C&gt;G pathogenic variant in SH3BP2), after failing a 10-month trial of tacrolimus, was placed on monthly denosumab (2 mg/kg) for a total of 10 doses. During denosumab therapy, he received calcium and vitamin D to prevent hypocalcemia; these were stopped once denosumab was discontinued. He presented to the hospital 4 months after the final denosumab dose with polyuria, polydipsia, fatigue, nausea and abdominal pain. Work-up revealed serum Ca 15.3 mg/dL (N: 8.4–10.2), PTH &lt;3 pg/mL (N: 24–86), 25-OH vitamin D 32 ng/mL (N: &gt;19 ng/mL), 1,25-dihydroxyvitamin D 6.7 pg/mL (N: 19.9–79.3), and urine Ca/Cr 0.48. Renal ultrasound showed normal kidneys with a small amount of layering debris in the bladder. During hospitalization, he received IV fluids, 1 dose of furosemide, 3 doses of calcitonin, 24 hours of hydrocortisone, and a single 0.5 mg/kg dose of pamidronate. He was discharged 48 hours after the bisphosphonate with serum Ca 9.5 mg/dL. He returned with serum Ca 13.5 mg/dL 9 days after the pamidronate and was readmitted. He again received 4 doses of calcitonin and 1 dose of pamidronate (0.5 mg/kg). Calcium levels improved to 9.5 mg/dL at discharge but rose to 11.6 mg/dL a week later. He received a 0.05 mg/kg dose of zoledronate outpatient, with improvement in serum Ca to 10.1 mg/dL. A week later, he twisted his ankle, resulting in transverse impacted buckle fractures of his left distal tibia and fibula; no lytic or sclerotic lesions were noted on x-ray. His leg was immobilized by Orthopedics. Calcium levels remained within range (9.9 mg/dL) 7 months after the zoledronate. Conclusion: Rebound hypercalcemia can occur months after denosumab withdrawal, indicating the need for close monitoring of calcium levels in patients who receive this drug. The hypercalcemia appears to respond best to bisphosphonates, with a more sustained response to zoledrenate compared to pamidronate.


Author(s):  
Rizwan Nazeer ◽  
Shizrah Jamal ◽  
Farhan Raza Khan

Abstract This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. Continuous...  


2019 ◽  
Vol 44 (1) ◽  
pp. E45-E57
Author(s):  
NI Pavesi Pini ◽  
LM De Marchi ◽  
AL Ramos ◽  
RC Pascotto

SUMMARY Tooth wear is a multifactorial condition of growing concern. In clinical practice, it is often a challenge for prevention and treatment since many etiological factors may be involved. This case report describes an esthetic rehabilitation of a young patient presenting tooth wear due to erosion. The etiological factor of this case was the patient sucking on lemons, an acidic fruit. The main complaint of the patient was the appearance of short maxillary incisors. The treatment involved orthodontic and restorative dentistry techniques. First of all, an orthodontic device was used to increase the vertical dimension of occlusion and create an adequate space for the direct restorations. The posterior teeth were restored with two direct composite resin techniques; the anterior teeth were then restored using a balanced occlusion. The seven-year follow-up of the case is presented. Replicas of the restorations were made and visualized under scanning electron microscopy up to the 12-month evaluation. In the clinical follow-up at seven years, maintenance of the results and restorations can be clearly seen.


Author(s):  
T. Christy Bobby ◽  
Shwetha V. ◽  
Vijaya Madhavi

The stability of a dental implant is one of the most important aspects that decide the success rate of implant treatment. The stability is considerably affected by the strength of trabecular bone present in maxilla and mandible. Thus, finding of trabecular bone strength is a key component for the success of dental implants. The trabecular bone strength is usually assessed by quantity of bone in terms of bone mineral density (BMD). Recently, it has been revealed that along with quantity of bone, strength of the bone also depends on quality features commonly referred as trabecular bone microarchitecture. Since the quality of the trabecular bone is varying across the maxilla and mandible, preoperative assessment of trabecular bone microarchitecture at sub-region of maxilla and mandible are essential for stable implant treatment. Thus, in this chapter, the authors inscribe the quantitative analysis of trabecular bone quality in maxilla and mandible using CBCT images by employing contourlet transform.


2010 ◽  
Vol 54 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Henrique Pierotti Arantes ◽  
André Gonçalves da Silva ◽  
Marise Lazaretti-Castro

Osteoporosis is a disease characterized by low bone mass associated with the deterioration of microarchitecture, due to an imbalance either in high bone resorption or low bone formation or in both, leading to a high risk of fractures. Bisphosphonates are medications which reduce the ability of osteoclasts to induce bone resorption and consequently improve the balance between resorption and formation. There are bisphosphonates approved for the prevention and treatment of osteoporosis. Administration can be oral (daily, weekly or monthly) or intravenous (quarterly or yearly). These medications are well tolerated and with the correct instructions of administration have a good safety profile. Serious side effects, such as, osteonecrosis of jaw is very rare. Bisphosphonates are the most prescribed medication for the treatment of osteoporosis.


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