6^th Annual Congress on Dentistry and Dental Medicine November 22-23, 2018 Bucharest, Romania

Dr. Bader Hassosah obtained his degree in Dentistry from the University of King Abdulaziz University, and postgraduate in Orthodontics at KAU (Board Certified). He is Head of orthodontic division and full time practice as Consultant in Orthodontics in KFAFH hospital, Jeddah, Saudi Arabia.rnrn

This case report describes a successful orthognathic treatment of a skeletal Class III malocclusion due to deficient maxilla and prognathic mandible in an adult individual. The patient with skeletal Class III malocclusion was treated with orthodontics and double jaws surgery. The surgical-orthodontic combination therapy has resulted in near-normal skeletal, dental and soft tissue relationship, with marked improvement in the facial esthetics in turn. The interdisciplinary approach is the treatment of choice in most of the skeletal malocclusions in an adult.rnrnINTRODUCTIONrnThe Skeletal Class III malocclusion is characterized by mandibular prognathism, maxillary deficiency or both. The effect of environmental factors and oral function on the etiological factors of a Class III malocclusion is not completely understood. However, there is a definite familial and racial tendency to mandibular prognathism. For moderate to severe class III malocclusions in adult, surgical treatment can be the best alternative. Depending on the amount of skeletal discrepancy, surgical correction may consist of mandibular setback, maxillary advancement or a combination of mandibular and maxillary procedures.rnrnTREATMENT OBJECTIVESrnThe treatment objectives were to correct the skeletal class III relationship via orthognathic surgery to achieve class I buccal segment with normal overjet and overbite.rnrnTREATMENT PLAN AND ALTERNATIVESrnThe plan was combined surgical and orthodontic treatment that will correct the anteroposterior discrepancy, the anterior and bilateral posterior crossbite and will achieve a balanced face.rnThe alternative plan was surgically assisted rapid palatal expansion aimed for correction of the bilateral crossbite and extraction of one lower incisor that will increase the compensation and correct the anteroposterior discrepancy. The drawbacks of this plan it will not target the chief complaint of the patient that is the large lower jaw. In addition, this treatment modality usually done in mild to moderate cases as the mandibular incisors were not suitable for much distal movement because of the thin symphysis bone that could damage the periodontal tissues and diagnostic wax up should be checked for tooth size discrepancy after lower incisor extraction. For these reasons discussed above this plan was ignored.rnrnrnrnTREATMENT RESULTrnA well-aligned dentition and a good facial balance were obtained. Class I relationships were achieved with normal overjet and overbite and correction of the relative crossbite.rnrnCONCLUSIONrnThis case report describes the surgical orthodontic treatment of an adult with severe skeletal and dental class III relationships. The orthognathic treatment was the best option for achieving an acceptable occlusion with good esthetic result. An experienced multidisciplinary team approach ensures a satisfactory outcome.rn

Yazeed Alharbi graduated from King Saud Collage of dentistry in 2008. He is a broad certified in Endodontic from Saudi Health commission since 2016. Now, he is a head of Endodontic department at Specialty Dental Center In Jeddah.

Disinfecting and three-­‐dimensionally sealing immature permanent teeth has been a classical challenge for endodontists. Treatment strategies have focused on inducing an arti:icial apical barrier either consequent to long-­‐ term intra-­‐canal calcium hydroxide application or immediately utilizing mineral trioxide aggregate (MTA). Surgical intervention has been opted in case of failure of the non-­‐surgical modality. Recently, revascularization of such cases has been practiced as it facilitates root thickening and maturation.rnThis report presents a case done at North Jeddah Specialty Dental center, in which revascularization of an immature necrotic mandibular second molar of a 14-­‐years-­‐old boy was attempted. After gaining access under rubber dam isolation and profound anesthesia, disinfection was attempted with light mechanical instrumentation and copious irrigation with 5.25% sodium hypochlorite.rnrnAfter one week calcium hydroxide medication, bleeding was induced by over-­‐instrumentation and allowed to clot inside the four canals. The clots were covered with 3-­‐mm white MTA. Next day, the tooth was restored with composite.rnrnAt 6-­‐, 12-­‐ and 18-­‐month recalls, the tooth was asymptomatic with no sensitivity to percussion or palpation while not responding to sensibility tests. Periapical radiographs demonstrated resolution of periapical radiolucency, continued gain in canals length and width with continuing apical closurern

Dr Ali A Alharbi has completed his PhD in restorative dentistry at the University of Dundee School of Dentistry. He is the Director of Prosthodontics Division at Alkharj Armed Forces Hospital Dental Department

Proteolytic activity of matrix metalloproteinases (MMPs) has been linked to degradation of the dentine-resin bond. These MMPs can be released from the dentine and activated by the acid in resin cements. Several methods such as SDS-PAGE and Western Blotting, ELISA and zymography are used to identify this proteolytic activity. In situ zymography is a variation of zymography where the enzymatic activity can be directly visualised on the dentine sample utilising fluorescence microscopy.\r\nIn this study, proteins conjugated to quenched fluorescein were applied to the dentine samples after bonding the samples to a self-adhesive resin cement. The proteolysis of these proteins by the enzymes in the sample released the fluorescence, which can be visualised by using fluorescence microscopy.\r\nDentine slices were obtained from human permanent molars then covered with RelyXTM Unicem AplicapTM self-adhesive resin cement (3M Company, Minnesota, USA) from one side. Other dentine slices obtained from the same teeth were left unbonded to the resin cement, to be used as negative control specimens.\r\nAs well as fluorogenic gelatine substrate solution, a negative-control (non-fluorescent) gelatine solution was also prepared. The solutions were applied to the dentine specimens then the specimens were inculpated in a light-protected humidified chamber at 37°C for 24 hours to permit for the enzymatic activity to take place.\r\nThe specimens were viewed at 40X under a compound microscope with fluorescence attachment. Digital images of the specimens were obtained using an attached digital microscope camera.\r\nThe obtained images have shown gelatinolytic activity in all of the dentine specimens bonded to RelyXTM cement.\r\nThis method is a very unique method that enables accurate localisation of matrix-degrading MMPs activity in dentine sections.\r\n