Search results for: dentition

Authors: Preethy Mary Donald, Renjith George Pallivathukal

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Dens evaginatus (DE) is a rare developmental anomaly characterized by a slender enamel-covered tubercle which projects from the occlusal surface of an otherwise normal premolar. DE can often interfere normal occlusion and can lead to complications like sensitivity, pulpal exposure and temporo mandibular joint problems. The orthopantomographs (OPGs) and dental records of patients under the age of 20 who attended the faculty of dentistry, Melaka-Manipal Medical College were examined for DE. Results: The prevalence of DE was 23% among the study group. Males presented with a higher prevalence of 67% and females with 33%. The prevalence of Dens evaginatus was distributed as 28% in maxillary central incisor, 52% in maxillary lateral incisors, 12% in mandibular second premolars. Prevalence in permanent dentitions appeared to be higher than deciduous dentition. The bilateral occurrence of Dens evaginatus is an interesting phenomenon. 57% of the cases of the DE were bilateral.

Keywords: deciduous dentition, dens evaginatus, permanent dentition, prevalence

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Authors: Margarita A. Belousova, Sergey N. Ermoliev, Nina K. Loginova

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The method of intraoral ultrasound densitometry developed to diagnose mineral density of alveolar bone jaws during retention period of orthodontic treatment (Patent of Russian Federation № 2541038). It was revealed significant decrease of the ultrasonic wave speed and bone mineral density in patients with relapses dentition anomalies during retention period of orthodontic treatment.

Keywords: intraoral ultrasonic densitometry, speed of sound, alveolar jaw bone, relapses of dentition anomalies, retention period of orthodontic treatment

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Authors: T. Almutairi, K. Naudi, N. Nairn, X. Ju, B. Eng, J. Whitters, A. Ayoub

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Purpose: At present Cone Beam Computed Tomography (CBCT) imaging does not record dental morphology accurately due to the scattering produced by metallic restorations and the reported magnification. The aim of this pilot study is the development and validation of a new method for the replacement of the distorted dentition of CBCT scans with the dental image captured by the digital intraoral camera. Materials and Method: Six dried skulls with orthodontics brackets on the teeth were used in this study. Three intra-oral markers made of dental stone were constructed which were attached to orthodontics brackets. The skulls were CBCT scanned, and occlusal surface was captured using TRIOS® 3D intraoral scanner. Marker based and surface based registrations were performed to fuse the digital intra-oral scan(IOS) into the CBCT models. This produced a new composite digital model of the skull and dentition. The skulls were scanned again using the commercially accurate Laser Faro® arm to produce the 'gold standard' model for the assessment of the accuracy of the developed method. The accuracy of the method was assessed by measuring the distance between the occlusal surfaces of the new composite model and the 'gold standard' 3D model of the skull and teeth. The procedure was repeated a week apart to measure the reproducibility of the method. Results: The results showed no statistically significant difference between the measurements on the first and second occasions. The absolute mean distance between the new composite model and the laser model ranged between 0.11 mm to 0.20 mm. Conclusion: The dentition of the CBCT can be accurately replaced with the dental image captured by the intra-oral scanner to create a composite model. This method will improve the accuracy of orthognathic surgical prediction planning, with the final goal of the fabrication of a physical occlusal wafer without to guide orthognathic surgery and eliminate the need for dental impression.

Keywords: orthognathic surgery, superimposition, models, cone beam computed tomography

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Authors: Amin Akbari, Dongcai Wang, Huiru Li, Xiaoping Du, Jie Chen

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The effect of vibrational force (VF) on accelerating orthodontic tooth movement depends on the level of delivered stimulation to the tooth in terms of peak load (PL), which requires contacts between the tooth and the VF device. A personalized device ensures the contacts, but the resulting PL distribution on the teeth is unknown. Furthermore, it is unclear whether the PL on particular teeth can be adjusted to the prescribed values. The objective of this study was to investigate the efficacy of apersonalized VF device in controlling the level of stimulation on two teeth, the mandibular canines and 2nd molars. A 3-D finite element (FE) model of human dentition, including teeth, PDL, and alveolar bone, was created from the cone beam computed tomography images of an anonymous subject. The VF was applied to the teeth through a VFdevice consisting of a mouthpiece with engraved tooth profile of the subject and a VF source that applied 0.3 N force with the frequency of 30 Hz. The dentition and mouthpiece were meshed using 10-node tetrahedral elements. Interface elements were created at the interfaces between the teeth and the mouthpiece. The upper and lower teeth bite on the mouthpiece to receive the vibration. The depth of engraved individual tooth profile could be adjusted, which was accomplished by adding a layer of material as an interference or removing a layer of material as a clearance to change the PL on the tooth. The interference increases the PL while the clearance decreases it. Fivemouthpiece design cases were simulated, which included a mouthpiece without interference/clearance; the mouthpieces with bilateral interferences on both mandibular canines and 2nd molars with magnitudes of 0.1, 0.15, and 0.2-mm, respectively; and mouthpiece with bilateral 0.3-mm clearances on the four teeth. Then, the force distributions on the entire dentition were compared corresponding to these adjustments. The PL distribution on the teeth is uneven when there is no interference or clearance. Among all teeth, the anterior segment receives the highest level of PL. Adding 0.1, 0.15, and 0.2-mm interferences to the canines and 2nd molars bilaterally leads to increase of the PL on the canines by 10, 62, and 73 percent and on the 2nd molar by 14, 55, and 87 percent, respectively. Adding clearances to the canines and 2nd molars by removing the contactsbetween these teeth and the mouthpiece results in zero PL on them. Moreover, introducing interference to mandibular canines and 2nd molarsredistributes the PL on the entireteeth. The share of the PL on the anterior teeth are reduced. The use of the personalized mouthpiece ensures contactsof the teeth to the mouthpiece so that all teeth can be stimulated. However, the PL distribution is uneven. Adding interference between a tooth and the mouthpiece increases the PL while introducing clearance decreases the PL. As a result, the PL is redistributed. This study confirms that the level of VF stimulation on the individual tooth can be adjusted to a prescribed value.

Keywords: finite element method, orthodontic treatment, stress analysis, tooth movement, vibrational force

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Authors: Shizrah Jamal, Robia Ghafoor, Farhan Raza

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Porcelain fused to metal crown is the most versatile variety of crown that is commonly placed worldwide. Various complications have been reported in the PFM crowns with use over the period of time. These include chipping of the porcelain, recurrent caries, loss of retention, open contacts, and tooth fracture. The objective of the present study was to determine the frequency of these complications in crowns cemented over a period of five years in a tertiary care hospital and also to report the survival of these crowns. A retrospective study was conducted in Dental clinics, Aga Khan University Hospital in which 150 PFM crowns cemented over a period of five years were evaluated. Patient demographics, oral hygiene habits, para-functional habits, crown insertion and follow-up dates were recorded in a specially designed proforma. All PFM crowns fulfilling the inclusion criteria were assessed both clinically and radiographically for the presence of any complication. SPSS version 22.0 was used for statistical analysis. Frequency distribution and proportion of complications were determined. Chi-square test was used to determine the association of complications of PFM crowns with multiple variables including tooth wear, opposing dentition and betel nut chewing. Kaplan- meier survival analysis was used to determine the survival of PFM crowns over the period of five years. Level of significance was kept at 0.05. A total of 107 patients, with a mean age of 43.51 + 12.4 years, having 150 PFM crowns were evaluated. The most common complication observed was open proximal contacts (8.7%) followed by porcelain chipping (6%), decementation (5.3%), and abutment fracture (1.3%). Chi square test showed that there was no statistically significant association of PFM crown complication with tooth wear, betel nut and opposing dentition (p-value <0.05). The overall success and survival rates of PFM crowns turned out to be 78.7 and 84.7% respectively. Within the limitations of the study, it can be concluded that PFM crowns are an effective treatment modality with high success and survival rates. Since it was a single centered study; the results should be generalized with caution.

Keywords: chipping, complication, crown, survival rate

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Authors: Kariem Elhelow

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The task of optimizing teeth surface relations remains perplexing for many dental practitioners. The well-being of teeth, periodontium, and the musculoskeletal system is closely associated with occlusal stability. Dental occlusion is rather far beyond the simple contact of the occlusal surfaces of the opposite jaws, a fact that turned the word “Occlusion” into one of the most complicated puzzles in dentistry. The literature describing the pathological approaches made the practice of occlusion even more intimidating. Understanding the biomechanics of teeth and jaw movements makes the goals of occlusal rehabilitation very lively and simple to practice. The purpose of this article is to establish a path for understanding and practicing the fundamental occlusal principles in a simple yet in depth way. Relying of the evidence based core would deliver a context for showing that occlusion is not as complicated as literatures might reflect. Conclusion: Maintaining a well-defined picture of what a healthy occlusion should be like is very gratifying to both the operator and the patient, with added worth of predictability, esthetics, and function to the whole treatment.

Keywords: occlusal, temporomandibular joint, prosthetic, dentition

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Authors: Awais Ali, Hesham Ali

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The absence of teeth through either premature loss or developmental absence is a common condition with potentially severe impact on affected individuals. Management of these cases presents a clinical challenge which may be difficult to resolve given the effects of tooth loss or hypodontia over the course of a patient’s lifetime. Treatment of such cases is often best provided by a multi-disciplinary team, where the patient’s expectations and care delivery can be optimally managed. Orthodontic treatment is often used to prepare the dentition in advance of restorative replacement of missing teeth. Conversely, the placement of implants may precede the delivery of orthodontic treatment and indeed may function as an adjunctive orthodontic procedure. We discuss the use of both approaches here and illustrate their clinical implementation with two case reports. The first case demonstrates the use of fixed appliances to prepare the mouth for an opposing implant-retained complete denture. A second case demonstrates the use of implant-retained crowns to provide orthodontic anchorage in a partially dentate patient. We propose that complex cases such as these should always be planned and treated by a multi-disciplinary team in order to optimise the delivery of care, patient experience, and treatment outcome. The presented cases add to the body of evidence in this area.

Keywords: orthodontics, dental implantology, hypodontia, multi-disciplinary

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Authors: Abdul M. Khan, Hafiza I. Naz, Ayesha Iqbal, Muhammad Akhtar

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The fossil remains described in this study have been recovered during fieldwork by the authors from the Dhok Pathan Formation of Middle Siwaliks Pakistan in December, 2015. The sample comprises maxillary and mandibular fragments along with isolated upper and lower teeth. The morphometric analysis of the specimens led us to recognize the sample as belonging to Eotragus noyei, which has been considered as the smallest and the oldest bovid in the Siwaliks. Eotragus noyei is characterized by brachydont teeth, finely rugose enamel, more inclined buccal walls of the molars and small lingual cingula. The inclination of the metaconal area has caused rotation of the metastyle in relation to the antero-posterior tooth axis and thus situated more lingually. The protocone in second upper premolar is well developed and situated posteriorly and also has an anterior lingual constriction. The metaconule in the third upper molar is smaller than the protocone. The dentition in Eotragus noyei is smaller in size as compared to Eotragus sansaniensis and Eotragus lampangensis. In Eotragus noyei the buccal walls in molars are more inclined while in Eotragus sansaniensis they are less inclined. The genus Eotragus has been reported previously in the Lower and Middle Siwaliks of Pakistan; however, the recognition of the present sample as Eotragus noyei has extended the range of this species from Lower to the Middle Siwaliks of Pakistan.

Keywords: Boselaphini, Chakwal, Dhok Pathan, late miocene

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Authors: Garba Yusuf, Ibrahim Rakson Muhammad, Bashir Fagge Muhammad, Shehu Ahmad Maigandi

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On-farm data were collected to evaluate reproductive performance of Red Sokoto does reared under small-holder agro-pastoral production system within metropolitan Kano, semi-arid, Nigeria. The effects of age of dams, parity, litter size(s) and sex of kid(s) on pre-weaning growth rate were investigated. Data was obtained from semi-intensively managed herds of twenty four households for a period of six months. Pregnant does were ear tagged and age determined through dentition. Upon kidding, litter size, parity of dam and sex of kid(s) were recorded. Subsequently, daily liveweight changes of kids was monitored and recorded. Results obtained revealed average weight at birth to be 3.18 kg and 2.87 kg for female and male kids with average daily weight gain of 0.11 and 0.13 kg, respectively. Result also showed that male kids gained higher liveweight from 21st day to weaning and single or twin births had higher liveweight changes relative to triplets. Does at third parity produced kids with higher weight gain. From the results of this study, it is concluded that male kids at 21 days of age (single or twin) or dam at third parity or three years of age be selected for a sound breeding programme.

Keywords: agro-pastoral, goats, parity, reproductive, semi-intensive

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Authors: Rasha F. Sharaf

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Treatment of dental caries in young children is considered a great challenge for all dentists, especially with uncooperative children. Recently non-invasive techniques have been highlighted as they alleviate the need for local anesthesia and other painful procedures during management of carious teeth and, at the same time, increase the success rate of the treatment done. Silver Diamine Fluoride (SDF) is one of the most effective cariostatic materials that arrest the progression of carious lesions and aid in remineralizing the demineralized tooth structure. Both fluoride and silver ions proved to have an antibacterial action and aid in the precipitation of an insoluble layer that prevents further decay. At the same time, Moringa proved to have an effective antibacterial action against different types of bacteria, therefore, it can be used as a non-invasive technique for the management of caries in children. One of the important theories for the control of caries is by depriving the cariogenic bacteria from nutrients causing their starvation and death, which can be achieved by applying stainless steel crown on primary molars with carious lesions which are not involving the pulp, and this technique is known as Hall technique. The success rate of the Hall technique can be increased by arresting the carious lesion using either SDF or Moringa and gaining the benefit of their antibacterial action. Multiple clinical cases with 1 year follow up will be presented, comparing different treatment options, and using various materials and techniques for non-invasive and non-painful management of carious primary teeth.

Keywords: SDF, hall technique, carious primary teeth, moringa extract

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Authors: Khizar Samiullah Samiullah, Riffat Yasin, Khurrum Feroz, Omer Draz, Memmona Nazish

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New fossil remains of artiodactyl have been recovered from three Late Miocene localities, Lava, Dhok Bun Ameer Khatoon and Hasnoot. These localities belong to lower and middle Siwalik Hills of Pakistan, the Chinji and Dhok Pathan Formation respectively and are remarkably rich in fossils of artiodactyl. The fauna mainly comprises various families of order Artiodactyla; Cervidae, Equidea, Proboscidea, Giraffidea, Rhinocerotidae, Tragulidea, Suidae and Primates. In Chinji Formation Lava and Dhok Bun Ameer Khatoon are located in district Chakwal while in Upper Dhok Pathan Formation the best fossils exposure site is Hasnoot which is located in District Jhelum, Punjab, Pakistan. Specimens described and discussed here include right and left maxilla, isolated upper premolars and molars which have been collected during extensive fieldwork. After morphological and comparative analysis the collection is attributed to Giraffokeryx, Giraffa, Listriodon, Dorcatherium, Selenoportax and Pachyportax. In this study evolutionary status, taxonomy and biogeographical distribution as well as the relationship of different Artiodactyls have been discussed comprehensively. The Palaeoenvironmental studies reveal the persistence of mosaics of diverse habitats ranging from tropical evergreen forest to subtropical ones, closed seasonal woodlands to wooded savannas during the deposition of these outcrops.

Keywords: Artiodactyla, fossil dentition, late Miocene, lower and middle Siwaliks

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Authors: Marian Agbugui

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The West African Lung fishes are fishes rich in protein and serve as an important source of food supply for man. The kind of food ingested by this group of fishes is dependent on the alimentary canal as well as the fish’s digestive processes which provide suitable modifications for maximum utilization of food taken. A study of the alimentary canal of P. annectens will expose the best information on the anatomy and histology of the fish. Samples of P. annectens were dissected to reveal the liver, pancreas and entire gut wall. Digital pictures of the mouth, jaws and the Gastrointestinal Tract (GIT) were taken. The entire gut was identified, sectioned and micro graphed. P. annectens was observed to possess a terminal mouth that opens up to 10% of its total body length, an adaptive feature to enable the fish to swallow the whole of its pry. Its dentition is made up of incisors- scissor-like teeth which also help to firmly grip, seize and tear through the skin of prey before swallowing. A short, straight and longitudinal GIT was observed in P. annectens which is known to be common feature in lungfishes, though it is thought to be a primitive characteristic similar to the lamprey. The oesophagus is short and distensible similar to other predatory and carnivorous species. Food is temporarily stored in the stomach before it is passed down into the intestine. A pyloric aperture is seen at the end of the double folded pyloric valve which leads into an intestine that makes up 75% of the whole GIT. The intestine begins at the posterior end of the pyloric aperture and winds down in six coils through the whole length intestine and ends at the cloaca. From this study it is concluded that P. annectens possess a composite GIT with organs similar to other lung fishes; it is a detritor with carnivorous abilities.

Keywords: gastrointestinal tract, incisors scissor-like teeth, intestine, mucus, Protopterus annectens, serosa

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Authors: Alison Ryan, Himani Chhabra, Mohammed Dungarwalla, Judith Jones

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Background: Impacted and ectopic teeth present in 1-2% of orthodontic patients and often require joint surgical and orthodontic management. The authors present two patients undergoing orthodontic treatment, where the impacted teeth, in a hopeless position, spontaneously erupted during the period of cessation of general anaesthetic lists during the COVID-19 pandemic. Patient information: A healthy 11-year-old boy was referred to the Department of Oral and Maxillofacial Surgery for the management of a mesioangular impacted LR7. The patient was seen by the joint oral surgery/orthodontic team, who planned for the removal of the LR7 under general anaesthetic. A healthy 13-year-old boy was referred to the same Department and team for surgical extraction of unerupted and buccally impacted UL3 and UR3 under general anaesthetic. Management and outcome: The majority of elective dental-alveolar work ceased as a result of the global pandemic. On resumption of activity, the first patient was reviewed in July 2021. The LR7 had spontaneously erupted in a favourable position, and following MDT review, a decision was made to forgo any further surgical intervention. The second patient was reviewed in July 2021. The UL3 had clinically erupted, and there was radiographic evidence of favourable movement of UR3. Due to the nature of the patient’s malocclusion, the decision was made to proceed with the extractions as previously planned. Key Learning Points: Severely impacted teeth do have a prospect of spontaneous eruption or alignment without clinical intervention, and current literature states the initial location, axial inclination, degree of root formation, and relation of the impacted tooth to adjacent teeth roots may influence spontaneous eruption. There is potential to introduce a period of observation to account for this possibility in the developing dentition, with the aim of reducing the unnecessary need for surgical intervention. This could help prevent episodes of general anaesthetic and allocate theatre space more appropriately.

Keywords: spontaneous eruption, impaction, observation, hopeless position, surgical, orthodontic, change in treatment plan

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Authors: Maliha Ahmed Suleman, Sidra Ahmed Suleman

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Introduction: The use of pacifiers is common amongst infants and young children as a comforting behavior. These non-nutritive sucking habits can be detrimental to the developing occlusion should they persist while the permanent dentition is established. Orthodontic pacifiers have been recommended as an alternative to conventional pacifiers as they are considered to have less interference with orofacial development. However, there is a lack of consensus on whether this is true. Aim and objectives: To review the prevalence of malocclusion associated with the use of orthodontic pacifiers. Methodology: Literature was identified through a rigorous search of the Embase, Pubmed, CINAHL, and Cochrane Library databases. Articles published from 2000 onwards were included. In total, 5 suitable papers were identified. Results: One study showed that the use of orthodontic pacifiers increased the risk of malocclusion, as seen through a greater prevalence of accentuated overjet, posterior crossbites, and anterior open bites in comparison to individuals who did not use pacifiers. However, this study found that there was a clinically significant reduction in the prevalence of anterior open bites amongst orthodontic pacifier users in comparison to conventional pacifier users. Another study found that both types of pacifiers lead to malocclusion; however, they found no difference in the mean overjet and prevalence of anterior open bites amongst conventional and orthodontic pacifier users. In contrast, one study suggested that orthodontic pacifiers do not seem to be related to the development of malocclusions in the primary dentitions, and using them between the ages of 0-3 months was actually beneficial as it prevents thumb-sucking habits. One of the systemic reviews concluded that orthodontic pacifiers do not seem to reduce the occurrence of posterior crossbites; however, they could reduce the development of open bites by virtue of their thin neck design. Whereas another systematic review concluded that there were no differences as to the effects on the stomatognathic system when comparing conventional and orthodontic pacifiers. Conclusion: There is limited and conflicting evidence to support the notion that orthodontic pacifiers can reduce the prevalence of malocclusion when compared to conventional pacifiers. Well-designed randomized controlled trials are required in the future in order to thoroughly assess the effects of orthodontic pacifiers on the developing occlusion and orofacial structures.

Keywords: orthodontics, pacifier, malocclusion, review

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Authors: Omid Allan

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The advent of ultra-narrow diameter implants initially offered an alternative to wider conventional implants. However, their design limitations have restricted their applicability primarily to overdentures and cement-retained fixed prostheses, often with unpredictable long-term outcomes. The introduction of the new Miniature Implants has revolutionized the field of implant dentistry, leading to a more streamlined approach. The utilization of Miniature Implants has emerged as a promising alternative to the traditional approach that entails the traumatic sequential bone drilling procedures and the use of conventional implants for full and partial arch restorations. The innovative "BioMiniatures Implant System serves as a groundbreaking bridge connecting mini implants with standard implant systems. This system allows practitioners to harness the advantages of ultra-small implants, enabling minimally invasive insertion and facilitating the application of fixed screw-retained prostheses, which were only available to conventional wider implant systems. This approach streamlines full and partial arch rehabilitation with minimal or even no bone drilling, significantly reducing surgical risks and complications for clinicians while minimizing patient morbidity. The ultra-narrow diameter and self-advancing features of these implants eliminate the need for invasive and technically complex procedures such as bone augmentation and guided bone regeneration (GBR), particularly in cases involving thin alveolar ridges. Furthermore, the absence of a microcap between the implant and abutment eliminates the potential for micro-leakage and micro-pumping effects, effectively mitigating the risk of marginal bone loss and future peri-implantitis. The cumulative experience of restoring over 50 full and partial arch edentulous cases with this system has yielded an outstanding success rate exceeding 97%. The long-term success with a stable marginal bone level in the study firmly establishes these implants as a dependable alternative to conventional implants, especially for full arch rehabilitation cases. Full arch rehabilitation with these implants holds the promise of providing a simplified solution for edentulous patients who typically present with atrophic narrow alveolar ridges, eliminating the need for extensive GBR and bone augmentation to restore their dentition with fixed prostheses.

Keywords: mini-implant, biominiatures, miniature implants, minimally invasive dentistry, full arch rehabilitation

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Authors: Ariyan S. Araghi, Guy C. Jackson, Stephen J. Bonsor

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Materials & Methods: A systematic literature search was undertaken using pre-determined inclusion and exclusion criteria. This review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement. Several databases were used to search for randomised control trials and longitudinal cohort studies, which were published less than thirty years ago. A total of 54 studies met the predefined inclusion criteria. Four studies reviewed the success, survival, and failure characteristics of zirconia framework resin retained bridges, whilst two reviewed non-precious metal resin retained bridges. Results: The analysis of the studies revealed an overall survival rate of 95.9% for zirconia-based restorations compared to 90.7% for non-precious metal frameworks. Non-precious metal resin retained bridges displayed a higher overall failure rate of 11.9% compared to 4.6% for zirconia-based restorations in the analysed papers. The most frequent complications were wing debonding for the non-precious metal wing group, whereas substructure fracture and veneering ceramic fracture were more prevalent for the zirconia arm of the study. Conclusion: Both types of resin retained bridges provide effective medium to long-term survival. Zirconia-based frameworks will provide marginally increased success and survival and greatly improved aesthetics. However, catastrophic failure is more likely with zirconia-based restorations. Non-precious metal is time tested but performs worse than its zirconia counterpart with regards to longevity; it does not exhibit the same framework fractures as zirconia. Cement choice and attention to the adhesive bonding systems used appear to be paramount to restoration longevity with both restoration subtypes. Furthermore, improved longevity can be seen when air particle abrasion is incorporated into the adhesive protocol. Within the limitations of this study, it has been determined that zirconia-based resin retained bridges can be effectively used in anterior cantilever bridges. Clinical Significance: Zirconia-based resin retained bridges have been demonstrating promising results in terms of improved success and survival characteristics, together with improved aesthetics when compared to non-precious metal winged resin retained bridges. Their popularity is increasing in the age of digital dentistry as many restorations are manufactured using such technology. It is essential that clinicians understand the limitations of each material type and principles of adhesion to ensure restoration longevity.

Keywords: resin retained bridge, fixed partial denture, zirconia bridge, adhesive bridge

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Authors: Anna Ghosh, Dominic Shields, Ceri McIntosh, Stephen Crank

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A 29-year-old male was a referral to the maxillofacial unit following a referral from his general dental practitioner via a routine pathway regarding a large periapical lesion on the LR4 with root resorption. The patient was asymptomatic, the LR4 vital and unrestored, and this was an incidental finding at a routine check-up. The patient's past medical history was unremarkable. Examination revealed no extra or intra-oral pathology and non-mobile teeth. No focal neurology was detected. An orthopantogram demonstrated a well-defined unilocular corticated radiolucency associated with the LR4. The root appeared shortened with the radiolucency between the root and a radio-opacity, possibly representing the displacement of the apical tip of the tooth. It was recommended that the referring general practitioner should proceed with orthograde root canal therapy, after which time exploration, enucleation, and retrograde root filling of the LR4 would be carried out by a maxillofacial unit. The patient was reviewed six months later where, due to the COVID-19 pandemic, the patient had been unable to access general dental services for the root canal treatment. He was still entirely asymptomatic. A one-year review was planned in the hope this would allow time for the orthograde root canal therapy to be completed. At this review, the orthograde root canal therapy had still not been completed. Interestingly, a repeat orthopantogram revealed a significant reduction in size with good bony infill and a significant reduction in the size of the lesion. Due to the ongoing delays with primary care dental therapy, the patient was subsequently internally referred to the restorative dentistry department for care. The patient was seen again by oral and maxillo-facial surgery in mid-2022 where he still reports this tooth as asymptomatic with no focal neurology. The patient's history was fully reviewed, and noted that 15 years previously, the patient underwent open reduction and internal fixation of a left angle of mandible fracture. Temporary IMF involving IMF screws and fixation wires were employed to maintain occlusion during plating and subsequently removed post-operatively. It is proposed that the radiolucency was, as a result of the IMF screw placement, penetrating the LR4 root resulting in resorption of the tooth root and development of a radiolucency. This case highlights the importance of careful screw size and physical site location, and placement of IMF screws, as there can be permeant damage to a patient’s dentition.

Keywords: facial trauma, inter-maxillary fixation, mandibular radiolucency, oral and maxillo-facial surgery

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Authors: Nouha Bouayed Abdelmoula, Rim Louati, Nawel Abdellaoui, Balkiss Abdelmoula, Oldez Kaabi, Walid Smaoui, Samir Aloulou

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Background and Aims: Cardiofaciocutaneous syndrome (CFC) is an autosomal dominant disorder with the vast majority of cases arising by a new mutation of BRAF, MEK1, MEK2, or rarely, KRAS genes. Here, we report a rare Tunisian case of CFC syndrome for whom we identify SOS1 mutation. Methods: Genomic DNA was obtained from peripheral blood collected in an EDTA tube and extracted from leukocytes using the phenol/chloroform method according to standard protocols. High resolution melting (HRM) analysis for screening of mutations in the entire coding sequence of PTPN11 was conducted first. Then, HRM assays to look for hot spot mutations coding regions of the other genes of the RAS-MAPK pathway (RAt Sarcoma viral oncogene homolog Mitogen-Activated Protein Kinases Pathway): SOS1, SHOC2, KRAS, RAF1, KRAS, NRAS, CBL, BRAF, MEK1, MEK2, HRAS, and RIT1, were applied. Results: Heterozygous SOS1 point mutation clustered in exon 10, which encodes for the PH domain of SOS1, was identified: c.1655 G > A. The patient was a 9-year-old female born from a consanguineous couple. She exhibited pulmonic valvular stenosis as congenital heart disease. She had facial features and other malformations of Noonan syndrome, including macrocephaly, hypertelorism, ptosis, downslanting palpebral fissures, sparse eyebrows, a short and broad nose with upturned tip, low-set ears, high forehead commonly associated with bitemporal narrowing and prominent supraorbital ridges, short and/or webbed neck and short stature. However, the phenotype is also suggestive of CFC syndrome with the presence of more severe ectodermal abnormalities, including curly hair, keloid scars, hyperkeratotic skin, deep plantar creases, and delayed permanent dentition with agenesis of the right maxillary first molar. Moreover, the familial history of the patient revealed recurrent brain malignancies in the paternal family and epileptic disease in the maternal family. Conclusions: This case report of an overlapping RASopathy associated with SOS1 mutation and familial history of brain tumorigenesis is exceptional. The evidence suggests that RASopathies are truly cancer-prone syndromes, but the magnitude of the cancer risk and the types of cancer partially overlap.

Keywords: cardiofaciocutaneous syndrome, CFC, SOS1, brain cancer, germline mutation

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