Indonesian Journal of Case Reports

Dynamic Navigation vs Freehand Dental Implant Placement: A Systematic Review of Surgical Efficiency and Clinical Outcomes

2026-04-08T08:16:57+07:00

Precise implant positioning is critical for functional, biological, and prosthetic success in dental implant therapy. Dynamic navigation systems provide real-time intraoperative guidance and may enhance placement accuracy compared with conventional freehand techniques. However, their impact on clinical outcomes remains incompletely clarified. To evaluate clinical outcomes, surgical efficiency, and complication rates of dynamic navigation–assisted dental implant placement compared with freehand techniques in adult patients. A systematic search of PubMed, Cochrane Library, and ScienceDirect identified comparative clinical studies evaluating dynamic navigation versus freehand implant placement. Primary outcomes included postoperative pain, operative time, surgical complications, and early implant success. Nine studies were included in the qualitative synthesis. Dynamic navigation consistently demonstrated significantly reduced coronal, apical, and angular deviations compared with freehand placement. Selected studies reported shorter operative times and lower early postoperative pain in navigation groups. Major complications were rare in both techniques, although minor transient neurosensory disturbances were reported more frequently with freehand placement. Early implant survival rates were high and comparable across groups. While dynamic navigation reliably enhances surgical precision and may improve procedural efficiency, its influence on early implant survival appears limited. Improved accuracy may offer greater safety in anatomically complex regions; however, long-term clinical superiority remains uncertain. Dynamic navigation improves implant placement accuracy and may enhance surgical efficiency without increasing complications, but further long-term evidence is needed to establish definitive clinical advantages.

A 16-Year-Old Female with Diabetic Ketoacidosis, Diabetes Mellitus, Sepsis, and Constipation: A Case Report

2026-03-17T23:10:43+07:00

Diabetic ketoacidosis (DKA) is a serious and potentially fatal complication of hyperglycemia, with a reported mortality rate of 2–5% depending on age. It commonly occurs in patients with uncontrolled insulin-treated diabetes mellitus (DM), especially when accompanied by severe underlying illness. Infection and insulin withdrawal are the two main triggers of DKA, with bacterial infections accounting for approximately 50% of cases, including urinary tract infections, pneumonia, and gastrointestinal conditions such as constipation. Constipation is more prevalent in diabetic patients with colonic neuropathy and may further complicate clinical outcomes. This case report presents a 16-year-old female with suspected new-onset type 1 DM who was admitted with DKA complicated by severe constipation and sepsis. The case highlights the complex interaction between poor glycemic control, infection, and systemic inflammatory responses in DKA. Diabetes mellitus can alter immune responses, infection patterns, and sepsis outcomes, contributing to increased morbidity and mortality. Diagnosing infection in patients with DKA remains challenging because both conditions share overlapping clinical and laboratory features, including fever, leukocytosis, and systemic inflammation. Early identification of bacterial infection is essential to ensure prompt and appropriate treatment while avoiding unnecessary antibiotic use that may contribute to antimicrobial resistance. This case report emphasizes the importance of early diagnosis of concurrent infection in patients with DKA to enable prompt management and improve clinical outcomes.

Delayed Bilateral Congenital Cataract with Asymmetric Morphology (Membranous and Nuclear) Managed with Different Surgical Techniques in a 19-Year-Old Female: A Case Report

2026-06-03T20:20:27+07:00

Congenital cataract is a major cause of preventable childhood blindness, and delayed treatment may lead to irreversible amblyopia and complex lens degeneration. We report a 19-year-old female with long-standing bilateral congenital cataract and marked intra-individual asymmetry. The left eye (OS) had absolute sensory deprivation since infancy, while the right eye (OD) retained partial vision until late adolescence. Examination showed alternating exotropia of 45 prism diopters and intraocular pressures of 18 mmHg OD and 27 mmHg OS. The elevated OS pressure, attributed to secondary lens-induced angle crowding, was controlled to 19 mmHg with topical timolol 0.5%. B-scan ultrasonography confirmed flat, intact retinas and normal optic disc excavation bilaterally. Using SRK/T biometry, staged bilateral cataract surgery was performed under general anesthesia one month apart. OS showed a fully resorbed membranous cataract and required manual irrigation–aspiration with a Simcoe cannula, micro-scissor membranectomy, automated anterior vitrectomy, and sulcus-fixated IOL implantation (20.0 D). OD showed a mature nuclear cataract and was managed with phacoemulsification-assisted irrigation–aspiration and in-the-bag single-piece IOL implantation (22.50 D). Postoperatively, both eyes achieved a clear visual axis and stable IOL position without early complications. At 6 months, IOP remained stable (14 mmHg OD, 15 mmHg OS), with healthy pink optic discs. Corrected visual acuity reached 6/6 OD but remained 2/60 OS due to irreversible deprivation amblyopia. Delayed congenital cataract surgery in adulthood requires morphology-based planning. Nuclear cataracts may be safely treated with phacoemulsification, whereas membranous cataracts require meticulous manual extraction and anterior vitrectomy. Early red-reflex screening remains essential.

En Coup de Sabre: A Classical Case of Linear Morphea in a Young Woman

2026-04-27T15:21:46+07:00

Morphea, or localized scleroderma, is a rare inflammatory disorder characterized by cutaneous sclerosis without systemic involvement. The craniofacial variant, en coup de sabre, is clinically significant due to its potential for deep-tissue extension and neurologic associations. A 22-year-old woman presented with a 10-year history of a progressively widening linear depressed lesion on the forehead. Clinical evaluation showed a well-demarcated atrophic plaque, while laboratory tests, including ANA, were normal. Histopathology revealed thickened collagen bundles with perivascular lymphocytic infiltration, consistent with sclerotic-phase linear morphea. The patient was diagnosed with linear morphea en coup de sabre and treated with methotrexate and corticosteroids, resulting in clinical improvement after 4 weeks. This case highlights the delayed presentation and slow progression of adult-onset craniofacial linear morphea. Despite minimal inflammatory activity, the lesion location carries a risk of deeper involvement, warranting early systemic immunomodulatory therapy. Adult-onset linear morphea en coup de sabre should be recognized in patients with slowly progressive linear atrophic forehead lesions. Early diagnosis and timely systemic treatment are essential to prevent progression and long-term deformity.

From Leukocoria to Orbital Retinoblastoma: Consequences of Delayed Treatment in a 3-Year-Old Child

2026-06-03T20:20:45+07:00

Retinoblastoma is the most common primary intraocular malignancy of childhood, and delayed treatment can shift management from globe preservation to survival-oriented intervention. We report a 3-year-and-4-month-old girl with bilateral advanced retinoblastoma who re-presented after an 18-month default from recommended treatment. She had progressive left-eye proptosis and severe cancer-related cachexia, weighing 9.2 kg, below the 3rd percentile for age. She had initially been evaluated at 1 year of age for bilateral leukocoria, when urgent enucleation was advised but declined by caregivers. On re-presentation, contrast-enhanced CT of the brain and orbits showed a 24 × 18 mm retrobulbar soft-tissue mass surrounding a collapsed left globe. At the same time, the right eye contained an advanced calcified intraocular tumor filling the vitreous cavity, consistent with ICRB Group E disease. Systemic staging confirmed locoregionally confined disease. The patient received four cycles of neoadjuvant pediatric VEC chemotherapy. Subsequent assessment showed no light perception in either eye, tumor- and chemotherapy-induced phthisis bulbi in the left eye, and an unsalvageable Group E tumor in the right eye. Because severe malnutrition and systemic frailty made simultaneous bilateral surgery high risk, sequential bilateral enucleations were performed under general anesthesia with a four-week interval to optimize physiological recovery. Histopathology confirmed poorly differentiated bilateral retinoblastoma, with transmural scleral invasion in the left eye and massive choroidal invasion in the right eye; both elongated optic nerve margins were tumor-free. Dermis-fat graft reconstruction was not feasible due to the absence of subcutaneous adipose tissue. At 6 months, the sockets were stable with no clinical or radiological recurrence. This case highlights the consequences of treatment delay and supports individualized staged enucleation in fragile pediatric patients.