A Conservative Aesthetic Rehabilitation in an Adolescent
Pediatric odontogenic tumors are uncommon however can result in developmental penalties leading to points relating to aesthetics and the performance of a affected person’s dentition.1 A majority of those tumors are benign if identified early. A collaboration between a number of specialties is commonly needed to accumulate an optimum final result.1 Probably the most aggressive benign lesions and malignant tumors require main surgical procedure with speedy or delayed reconstruction.2
As well as, the variation of procedures to accommodate a affected person’s medical and social wants is critical to keep up affected person satisfaction and adherence. Though benign, if not handled appropriately, it will probably change into life-threatening.
The World Well being Group (WHO) divided odontogenic tumors into 3 classifications of odontogenic tumors and cysts primarily based on biologic habits: epithelial, mesenchymal, and combined epithelial and mesenchymal odontogenic tumors. Every class is outlined primarily based on tissue evaluation from the tumors.3
Myxoma, one of many benign odontogenic tumors, arises from embryonic connective tissue related to tooth formation. The time period “myxoma” was first utilized in 1863 to explain stomach and soft-tissue lesions.4,5 A myxoma consists primarily of spindle-shaped cells and scattered collagen fibers distributed via a free, mucoid materials.5
The advisable remedy is often surgical excision. Approaches may be conservative, enucleation and curettage, curettage, or extensive resection with or with out bone grafting, relying on the dimensions of the tumor.6
A 12-year-old male introduced together with his dad and mom with a chief grievance of “changing lacking enamel.” The affected person’s well being historical past included prior resection of a spindle cell myxoid tumor of the left posterior maxilla in infancy, unilateral progress disturbance, and a analysis of autism.
The pinnacle and neck examination was unfavorable for any lymphadenopathy and was inside regular limits. Intraoral examination demonstrated lacking enamel on the maxillary left facet (Figures 1 and a pair of). A big issue was the truth that the affected person had a distinguished gag reflex and can’t tolerate lengthy chair occasions nor anesthesia or drilling.
The panoramic radiograph confirmed the agenesis of the maxillary left facet enamel from the lateral incisor to the third molar (Determine 3). In response to each dad and mom, the affected person was a shy baby, socially anxious, and had problem socializing and smiling in public (Determine 4).
After the analysis, the remedy plan was created as a short lived method and with the understanding of the affected person’s points famous above. Thorough scientific examination was carried out; radiographs and preliminary scans have been taken previous to remedy; and consultations with an oral surgeon, an orthodontist, and a prosthodontist have been obtained. Following affected person approval, orthodontic remedy was began with a view to create the required spacing to re-create the affected person’s midline (Figures 5 to 7).
Following 1.5 years of orthodontic remedy, the affected person’s dentition was restored conservatively utilizing a prepless, scanned, milled composite non permanent bridge. As soon as the affected person has completed rising, orthognathic surgical procedure and implant placement shall be carried out.
In response to the analysis, the objectives of this non permanent remedy plan included house closure, establishing his smile, and changing the lacking enamel for enchancment of phonetics, perform, and aesthetics. The affected person refused any remedy on the mandibular arch apart from holding it in common upkeep.
Strategies and Supplies
Remedy planning was primarily based on understanding the affected person’s limitations round chair time, native anesthesia, drilling, and sporting a detachable equipment as a consequence of a distinguished gag reflex, as beforehand famous. An intensive scientific examination was carried out, and radiographs and preliminary TRIOS (3Shape) scans have been taken previous to remedy.7 One of many advances of this know-how that makes use of intraoral scans and digital fashions, on this specific case, is a promising different to traditional impressions in regard to affected person acceptance and effectivity.8
Consultations with an oral surgeon, an orthodontist, and a prosthodontist have been obtained. Following caregiver approval, orthodontic remedy was began with a view to create the required spacing to re-create the affected person’s midline. One yr later, a brand new TRIOS scan was obtained for a diagnostic wax-up (Figures 8 to 10). After evaluating the scan, affected person smile, and occlusion, the enamel distribution was acceptable to finalize the remedy (Figures 11 and 12). A composite overlay bridge utilizing SR Vivodent CAD (Ivoclar Vivadent) was created.
A 38% phosphoric acid etch (Scotchbond Common Adhesive [3M]) and A2 Tetric EvoFlow Refill (Ivoclar Vivadent) have been used as a cement to stabilize the bridge.9,10 Occlusion was adjusted for even contact in centric relation (Figures 13 to fifteen).
Affected person satisfaction with the digital impression expertise resulted in consolation, lowered dental chair time,11-13 and fewer anxiousness.14,15
Digital dentistry strategies enhance the standard of oral rehabilitations, particularly in anxious sufferers, by having larger acceptance charges in comparison with typical strategies.11-15
Conservative provisional remedy of a considerably impaired affected person may be predictably achieved utilizing lower-cost composite supplies and digital scanning and CAD/CAM restorations (Determine 16). As soon as the affected person matures, orthognathic surgical procedure and implant placement shall be carried out.
1. Abrahams JM, McClure SA. Pediatric odontogenic tumors. Oral Maxillofac Surg Clin North Am. 2016;28(1):45-58. doi:10.1016/j.coms.2015.08.003
2. Shamim T. The spindle cell neoplasms of the oral cavity. Iran J Pathol. 2015;10(3):175–84.
3. Soluk-Tekkeşin M, Wright JM. The World Well being Group Classification of Odontogenic Lesions: A abstract of the adjustments of the 2017 (4th) version. Turk Patoloji Derg. 2018;34(1). doi:10.5146/tjpath.2017.01410
4. Alhousami T, Sabharwal A, Gupta S, et al. Fibromyxoma of the jaw: case report and evaluate of the literature. Head Neck Pathol. 2018;12(1):44-51. doi:10.1007/s12105-017-0823-0
5. Hajdu SI, Vadmal M. A notice from historical past: Landmarks in historical past of most cancers, Half 6. Most cancers. 2013;119(23):4058–82. doi:10.1002/cncr.28319
6. Covello P, Buchbinder D. Latest tendencies within the remedy of benign odontogenic tumors. Curr Opin Otolaryngol Head Neck Surg. 2016;24(4):343–51. doi:10.1097/MOO.0000000000000269
7. Nedelcu R, Olsson P, Nyström I, et al. Accuracy and precision of three intraoral scanners and accuracy of typical impressions: a novel in vivo evaluation methodology. J Dent. 2018;69:110–8. doi:10.1016/j.jdent.2017.12.006
8. Burzynski JA, Firestone AR, Beck FM, et al. Comparability of digital intraoral scanners and alginate impressions: time and affected person satisfaction. Am J Orthod Dentofacial Orthop. 2018;153(4):534–41. doi:10.1016/j.ajodo.2017.08.017
9. Ivoclar web site. SR Vivodent CAD. https://www.
10. Vivadent I. Tetric EvoCeram® Bulkfill: simplifies composite restoration placement, will increase effectivity. Compend Contin Educ Dent. 2014;35(6):432.
11. Burhardt L, Livas C, Kerdijk W, et al. Remedy consolation, time notion, and choice for typical and digital impression strategies: A comparative research in younger sufferers. Am J Orthod Dentofacial Orthop. 2016;150(2):261–7. doi:10.1016/j.ajodo.2015.12.027
12. Burzynski JA, Firestone AR, Beck FM, et al. Comparability of digital intraoral scanners and alginate impressions: time and affected person satisfaction. Am J Orthod Dentofacial Orthop. 2018;153(4):534–41. doi:10.1016/j.ajodo.2017.08.017
13. Yuzbasioglu E, Kurt H, Turunc R, et al. Comparability of digital and traditional impression strategies: analysis of sufferers’ notion, remedy consolation, effectiveness and scientific outcomes. BMC Oral Well being. 2014;14:10. doi:10.1186/1472-6831-14-10
14. Grünheid T, McCarthy SD, Larson BE. Medical use of a direct chairside oral scanner: an evaluation of accuracy, time, and affected person acceptance. Am J Orthod Dentofacial Orthop. 2014;146(5):673–82. doi:10.1016/j.ajodo. 2014.07.023
15. Mangano A, Beretta M, Luongo G, et al. Typical vs digital impressions: acceptability, remedy consolation and stress amongst younger orthodontic sufferers. Open Dent J. 2018;12:118–24. doi:10.2174/1874210601812010118
ABOUT THE AUTHORS
Dr. Boyd graduated from the Columbia College Faculty of Dental Drugs in New York Metropolis. He accomplished a residency program typically dentistry and prosthodontics from the US Division of Veterans Affairs in New York Metropolis. He now has a non-public apply in Midtown Manhattan—Drs. Boyd, PC—and holds a school place on the Touro Faculty of Dental Drugs as an affiliate scientific professor. Dr. Boyd may be reached through electronic mail at [email protected]
Dr. Paranhos graduated from the Universidade de Odontologia João Prudente in Brazil. She then continued her schooling in the USA on the New York College Faculty of Dentistry (NYUCD) Ashman Division of Periodontology and Implant Dentistry and acquired a postgraduate diploma and Fellowship in implant dentistry. This was adopted by a global postgraduate program in periodontics.
She additionally accomplished an Superior Training in Normal Dentistry (AEGD) Postdoctoral Program on the College of Rochester Eastman Institute of Oral Well being and acquired an accredited DDS diploma in addition to a grasp’s diploma in dental science. She lately acquired her Diplomate standing in implant dentistry from the Worldwide Congress of Oral Implantologists.
Dr. Paranhos has been educating on the NYUCD Implant Division for 9 years and is at present a scientific assistant professor/assistant group apply director within the Cariology & Complete Care Division at NYUCD. She maintains a non-public apply in Manhattan and may be reached at [email protected]
Dr. Seligman earned his diploma on the College of Connecticut Faculty of Dental Drugs and his specialty certificates on the Vanderbilt College Medical Heart Division of Orthodontics. An orthodontic specialist, he’s in personal apply in Manhattan at Seligman Orthodontics PLLC.
Disclosure: The authors report no disclosures.