While contemporary periodontics has witnessed the continued emergence of sophisticated techniques to resolve esthetic concerns through various periodontal procedures, frequently the early stages of periodontal diseases are best treated with non-surgical periodontal therapy. This short communication presents a case of reactive positioning of pathologically migrated anterior tooth following non-surgical periodontal therapy.

The contextual relationships between orthodontics and periodontology are diverse and complex. While the consequences of orthodontic tooth movements are discussed in terms of possible damage and improvements in the long-term health of periodontal tissues orthodontic treatment of adults is a routine clinical procedure nowadays, even in patients presenting already-damaged periodontal tissues. As developments in both fields have been so rapid, there is a constant need for evidence-based concepts in this interdisciplinary field. The goal of this review was to discuss the latest aspects of interdisciplinary treatment and to reflect on the latest developments in research. A treatment scheme is also presented which aims to facilitate coordination of the orthodontic treatment of patients with periodontal diseases.

BACKGROUND Flaring of maxillary anterior teeth can be caused by primary or secondary occlusal trauma. A differential diagnosis needs to be made with regard to the etiology of the problem to establish a proper treatment plan. TYPES OF STUDIES REVIEWED The authors reviewed relevant articles in the literature addressing migration of maxillary anterior teeth to ascertain the proper diagnosis and methods of therapy pertaining to migrated maxillary anterior teeth. RESULTS The authors identify critical questions that clinicians must answer to ascertain which forces cause flaring of maxillary anterior teeth. They describe treatment methods relevant to flaring of teeth associated with primary and secondary occlusal trauma. The authors provide diagnostic and treatment flowcharts to guide clinicians in making therapeutic decisions. CLINICAL IMPLICATIONS Failure to treat maxillary flared anterior teeth can result in an unappealing esthetic appearance. Furthermore, if these problems are not treated in a timely manner, they can become worse and result in loss of teeth. Initiation of proper therapy may include occlusal equilibration, periodontal therapy, orthodontic retraction--alone or in combination with each other--and, in certain types of cases, splinting of teeth.

Pathologic tooth migration (PTM) is a common complication of moderate to severe periodontitis and is often the motivation for patients to seek periodontal therapy. In this review of the literature, available information concerning prevalence, etiology, treatment, and prevention of pathologic tooth migration is summarized. Prevalence of PTM among periodontal patients has been reported to range from 30.03% to 55.8%. A survey of the literature regarding chief complaints of periodontal patients support these high prevalence findings. The etiology of PTM appears to be multifactorial. Periodontal bone loss appears to be a major factor in the etiology of PTM. Many aspects of occlusion can contribute to abnormal migration of teeth, and more than one of those factors may be present in an individual patient. Soft tissue forces of the tongue, cheeks, and lips are known to cause tooth movement and in some situations can cause PTM. Also considered important in the etiology of PTM is pressure produced from inflammatory tissues within periodontal pockets. Because extrusion is a common form of PTM, clinical observations support the theory that eruption forces sometimes play a role in the etiology of PTM. Many oral habits have been associated with PTM which are often difficult for the therapist to detect. Most cases of severe PTM require a team approach to achieve success. Periodontal, orthodontic, and prosthodontic treatment are often required. Many patient variables enter into the selection of treatment for PTM. In early stages of PTM, spontaneous correction of migrated teeth sometimes occurs after periodontal therapy. Light intrusive forces are used successfully to treat extrusion and flaring forms of PTM. Based on the literature reviewed, it appears that many cases of PTM could be prevented through the early diagnosis and treatment of periodontal disease, occlusal contributing factors, gingival enlargement, and oral habits.

BACKGROUND The reactive correction of a single tooth anterior crossbite following periodontal therapy is described. This case report provides new information regarding correction of a crossbite relationship and con- firms existing reports of tooth movement following periodontal therapy. METHODS A 39-year-old woman in good general health presented with a history of recurrent periodontal abscesses of a maxillary incisor. Probing depths of the abscessed tooth ranged from 5 to 12 mm, and class 1 mobility was noted. Radiographs revealed that the tooth had previously been treated endodontically. The patient's periodontal diagnosis was generalized chronic moderate to severe periodontitis. Treatment considerations were complicated by a single-tooth crossbite relationship of the involved incisor and clinical evidence that the periodontal abscess communicated with an apical infection. Treatment of the abscess consisted of cause-related therapy, bone grafting, and occlusal adjustment. RESULTS Five months after surgical treatment, an edge-to-edge incisal relationship was observed, the first indicator of tooth movement. Further correction to a normal incisal relationship resulted 1 year after modification of the proximal contact. At this time, there was normal probing depth with only slight recession and mobility. Bone fill was radiographically noted. CONCLUSION It appears that some cases of maxillary incisor crossbite that are complicated by periodontal disease may be corrected, without orthodontic appliances, following periodontal treatment.

Results of overexpression or downregulation of a microRNA (miRNA) on its target mRNA expression are often validated by reverse-transcription and quantitative PCR analysis using an appropriate housekeeping gene as an internal control. The possible direct or indirect effects of a miRNA on the expression of housekeeping genes are often overlooked. Among many housekeeping genes, expressions of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and β-actin have been used extensively for normalization of gene expression data. Here, we show that GAPDH and β-actin are direct targets of miR-644a. Our data demonstrate the unsuitability of GAPDH and β-actin as internal controls in miR-644a functional studies and emphasize the need to carefully consider the choice of a reference gene in miRNA experiments.

We are reporting a very unusual case of unilateral lower limb gangrene in 12 days neonate, who was brought to us with bluish discoloration of left foot with gangrene of toes. A negative sepsis screen, normal Doppler study, normal magnetic resonance angiography and absence of evidence of hypercoagulable state prompted us to make the diagnosis of idiopathic unilateral lower limb gangrene in this newborn. Because of the rarity we are reporting this case with vide review of literature.

Joubert syndrome is a very rare disorder characterised by respiratory irregularities, saccadic eye movements, hypotonia, ataxia, developmental retardation with abnormalities of cerebellum and brainstem. Epilepsy is rarely associated with this syndrome. Herein such a case with associated epilepsy is presented. Here in this case, a male child of 4 years was presented with delayed milestones and generalised tonic-clonic seizure. Pregnancy and prenatal period was uneventful. There was history of one of his siblings having the disorders of respiratory irregularities, saccadic eye movements, ataxia, hypotonia, etc (same as the child) and died at 3 1/2 years of age. MRI brain showed features of Joubert syndrome.

Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. The correction of such fistula is associated with a failure rate of 10 to 40%. The step in successful repair of a fistula is separation of the suture lines in the urethra and skin using well vascularized elastic tissue. We report our experience of using the tunica vaginalis flap as a layer between the neourethra and skin suture line in repair of recurrent urethrocutaneous fistula. Patients and Methods: We have used the tunica vaginalis flap for the repair of recurrent urethrocutaneous fistula in 14 children with a mean age of 6.5 years (range 3-14 years). All patients had undergone previous hypospadias repair and at least one previous attempt to close the fistula had failed. Surgery was initiated by injecting a povidone solution via urethral meatus to identify all fistulae. The fistulae were closed primarily and urethral suture line was covered with a flap of tunica vaginalis which was harvested either through a small scrotal incision and mobilized via a subcutaneous tunnel into the penile shaft (8/14) or by the same incision as for fistula closure (6/14). The testis was fixed to the scrotum. A urethral catheter was kept for urinary diversion for 10 days. Results: The repair was successful in all but one patient in whom there was leak from the fistula site. One patient in whom tunica vaginalis fascia was tunnelled into neourethra developed scrotal haematoma which needed drainage. Penile cosmesis was acceptable without any significant postoperative testicular complication in 13/14 patients. Conclusion: Repair of recurrent urethrocutaneous fistula with a tunica vaginalis flap is highly effective regardless of fistula location. This flap is easy to mobilize and provide effective coverage of urethral suture line. Putting a glove drain should be considered into scrotal wound if perfect haemostasis is doubtful.

OBJECTIVE To evaluate the safety and efficacy of three benzodiazepine drugs: Lorazepam, Midazolam and Diazepam, when given parenterally in the control of acute seizure. METHODS One hundred and twenty children of either sex in the age group 6 month to 14 years brought convulsing to the pediatric emergency services, were enrolled in the study. These were randomised to three equal groups of 40 patients each; Group A-received diazepam, Group B-received midazolam, Group C-received lorazepam. End of seizure episode (clinically) was defined as cessation of visible epileptic phenomenon or return of purposeful response to external stimuli within 15 min of drug administration. A stopwatch was used to measure various time intervals accurately. The patient's vitals were monitored and recorded in a predesigned performa. The primary outcome was the time to seizure cessation and secondary outcome was the side effects of the drugs. Data obtained was analysed statistically using student's t-test and chi-square test. RESULTS Mean duration to clinical seizure cessation was comparable among the three groups. For diazepam group it was 84.94 ± 38.56 s, for midazolam group it was 92.69 ± 25.97 s, for lorazepam group it was 91.12 ± 23.58 s. Number of patients with any abnormality in seizure cessation were significantly higher in diazepam group [11/40 (27.5%)] when compared to the midazolam [4/40 (10%)] and lorazepam group [2/40 (5%)]. Number of patients requiring 2nd dose to control seizures was significantly higher [4/40 (10%)] in diazepam group when compared to lorazepam group [0/40 (0%)] but diazepam and midazolam and midazolam and lorazepam were comparable in this aspect.All the three drugs were comparable in terms of side effects except excessive somnolence which was significantly higher in diazepam group. CONCLUSIONS All the three groups were comparable in terms of time to clinical seizure cessation, seizure recurrence and uncontrolled seizures after drug administration. However, number of patients requiring second dose to control seizures were significantly higher in diazepam group when compared to lorazepam group. Excessive somnolence and sedation occurred more frequently with diazepam.

The clinical problem of how best to manage an anterior space resulting from a missing central incisor will only be encountered rarely. The goal should be to deliver treatment results that are indistinguishable from normal appearance. This article describes one treatment approach - orthodontic space closure with substitution of the maxillary central incisor by the lateral incisor. Treatment indications, orthodontic and restorative considerations, advantages and disadvantages, as well as the evidence base relating to this treatment modality will be presented and supported by two clinical case examples.

This case report describes the treatment of a 16-year-old girl with ankylosed maxillary central incisors that were noticeably infraoccluded and labially displaced. We performed a segmental osteotomy with an autogenous bone graft in a single-stage surgery to align and level the ankylosed teeth. The dento-osseous segment was successfully repositioned with satisfactory periodontal results.

The burgeoning popularity of dental implant usage in the maxillary anterior region is well recognized. On the other hand, challenges involved in achieving optimal esthetics through implants have also been discussed extensively. Presence of labial/buccal bone in the maxillary anterior region is necessary for esthetic success of treatment, with or without the use of dental implants. This case report describes the multidisciplinary management of a rare case with severe loss of buccal bone confined to the maxillary central incisor region. A patient with a recent history of orthodontic treatment presented with a large buccal dehiscence of soft tissue that exposed nearly the entire buccal root surface of both maxillary central incisors. The treatment plan included extraction of both central incisors, hard and soft tissue ridge augmentation, and an all-ceramic fixed partial denture. After 2 years in function, the condition of soft tissues and integrity of the restorations remained stable. A discussion of traditional versus contemporary treatment planning using dental implants in such situations is presented. CLINICAL SIGNIFICANCE: Although implant therapy has proven to be a highly successful option, traditional treatment without implants may be advantageous in certain clinical situations. Compared to implant therapy, it can provide similar or better esthetic results with reduced treatment procedures, expenses, and time.

While contemporary periodontics has witnessed the continued emergence of sophisticated techniques to resolve esthetic concerns through various periodontal procedures, frequently the early stages of periodontal diseases are best treated with non-surgical periodontal therapy. This short communication presents a case of reactive positioning of pathologically migrated anterior tooth following non-surgical periodontal therapy.

Adenomatoid odontogenic tumor is an uncommon tumor of odontogenic origin. It is usually located in the anterior region of the maxilla associated with impacted canines. The purpose of this paper was to present a case of adenomatoid odontogenic tumor in a 14-year-old girl with unusual clinical manifestations involving an impacted mandibular lateral incisor as well as its treatment follow-up.

Ekman-Westborg and Julin is a trait that shows multiple macrodontia and multituberculism affecting only the teeth with no other anomalies (E-WJ). The aim of this report is to present a case which appears to manifest all the clinical signs of the E-WJ trait including odontoma formation. A 18-year-old girl with gingival inflammation particularly in the maxillary insicor area was referred to the authors' department. Panoramic, periapical and cephalometric radiographs were examined and complex odontoma associated with unerupted maxillary permanent lateral incisors was revealed. Intraoral examination revealed anterior crossbite, Angle Class III type malocclusion with mandibulary prominence and macrodontia of teeth 37, 12, 11 and 21. The patient was accepted as a new sporadic case of E-WJ. More case reports are needed to elucidate the causes and pathogenesis of this condition.

Gingival fibromatosis is characterized by fibrotic enlargement of the gingiva that can occur as inherited or sporadic form. Inherited form can be an isolated trait or as a component of a syndrome. This article reports a 35 year old male patient affected by gingival fibromatosis associated with hemiosseous hyperplasia of mandible, maxilla, and zygoma on the right side, viral papillomatosis of maxillary anterior gingiva, fissured tongue and congenitally missing anterior teeth. The patient was subjected to phase I and phase II periodontal therapy. There was no evidence of recurrence of the enlargement after one year but the papillomatosis recurred. Gingival fibromatosis has been reported to be associated with various other abnormalities but not with those described in our case. This observation raises the possibility that the coexistence of these entities in our case may represent a new syndrome.

Abstract -  The treatment plan represents the final step in every diagnostic procedure and is the result of a series of assessments based on information gathered from a detailed clinical history. This clinical case reports the replacement of two central incisors that were lost because of a trauma. The advantages and disadvantages of the two treatment options (i.e. implantology or prosthetic restoration) were carefully evaluated in relation to the case in hand. Patient compliance and aesthetic requirements had been also considered. In this case, a conventional prosthetic restoration was performed using a metal-ceramic bridge, utilising full crowns between the right and left maxillary lateral incisors associated with minimal canine preparation. By this strategy, the treatment plan allows for a future implant restoration, should this become necessary.

Anterior crossbite is a sagittal malocclusion occurring in approximately 4 to 5% of children with primary dentition. Although self-correction may occur, treating an anterior crossbite as early as possible has been proposed to prevent problems in the transitional and permanent dentitions. The purpose of this paper is to present an optional restorative treatment used in 3 cases where an anterior crossbite was treated by restoring the primary maxillary incisors with esthetic pediatric strip crowns. In all 3 cases, the crossbite was successfully treated by using the proposed technique over 1 to 2 weeks. A 6-month follow-up showed that the occlusion stabilized into a sagittal normal relationship, permitting normal dentofacial growth and development to continue. The technique presented here can be added to the armamentarium of pediatric dentists and general practitioners to correct anterior crossbites diagnosed in the primary dentition.

Peripheral cemento-ossifying fibroma is a reactive gingival overgrowth occurring frequently in anterior maxilla. It is a slow-growing benign tumor which may lead to pathologic migration and other periodontal problems, so it should be excised as soon as possible. The recurrence rate of peripheral cemento-ossifying fibroma is reported to be 8% to 20%, so a close postoperative follow-up is required. Herein, we are reporting a similar case of peripheral cemento-ossifying fibroma in the maxillary anterior region.