Bone Exostosis Research Articles

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.

Clinical signs of bruxism in CrossFit® practitioners: observational study.

CrossFit® is a physical training method that aims to promote physical fitness through the development of components such as aerobic capacity, strength and muscular endurance. Data regarding bruxism behaviors in CrossFit® practitioners are scarce, but previous studies have shown increased dental clenching behavior during weightlifting practices. The present study aimed to evaluate clinical signs of bruxism in CrossFit® practitioners. The sample comprised a convenience sample of CrossFit® practitioners (n=57), of both genders, aged 19-58 years. Outcome variables were as follows: Oral Behavior Checklist, the International Physical Activity Questionnaire and the Standardized Tool for the Assessment of Bruxism. Data were expressed in terms of absolute values and percentages. Spearman's correlation and Fisher exact tests were used for statistical analysis, and a significance level of 5% was considered. The mean age was 32.82 years, with a female majority (63.15%). CrossFit® practitioners frequently reported clenching their teeth during training practice (61.40%) and presented linea alba (82.45%), lip impression (54.38%), tongue impression (26.31%), bone exostosis (19.29%), tooth wear (61.40%) and non-carious cervical lesions (35.09%). No correlation was found between clinical signs of bruxism, oral behaviors and physical activity intensity; however, the results suggest that individuals who practice CrossFit® training have oral behaviors that can cause morpho-functional changes in the stomatognathic system, especially the habit of clenching their teeth during training. In addition, data emphasize the need for dental health education among CrossFit® practitioners, and more studies with a representative sample are necessary.

Ankyloglossia With Bilateral Mandibular Tori: A Rare Dyad- An Unusual Case

Ankyloglossia is a congenital anomaly in which tongue movements are limited and Mandibular Tori on the other hand is a slow growing bone exostosis with well defined borders. Here we present you a case where 27 years old female reported to our college with cheif complaint of feeling a bulge below the tongue on both the sides. We did clinical and radiographic examination for this case. Intraoral examination revealed a high and thick lingual frenum which restricted tongue movements. On palpation of floor of mouth, it was found that oval swellings were present one on each side below the alveolar crest; these were hard in consistency, with overlying mucosa being firm, non tender and fixed. To further reach to a conclusion, an occlusal radiograph was advised which then revealed the bulging of bone with normal radiographic pattern suggesting a possible Tori. An Unusual Dyad of dental anomalies with ankyloglossia and Bilateral Mandibular Tori has been presented here. Although many syndromes are associated with the above findings individually, it still remains unclear as to whether such combination occurs by chance or it is a true syndrome.

ENDOSCOPIC SURGERY FOR THE TREATMENT AND DIAGNOSIS OF HAGLUND'S DEFORMITY AND ACHILLES BURSITIS

In presented article the history of terminology, the mechanism of occurrence of impingement syndrome with the appearance of bone exostosis and Achilles bursitis, and the first steps in the diagnosis and treatment of Haglund's deformity and Achilles bursitis are considered. The results of endoscopic treatment of 40 patients with Haglund's deformity and achilobursitis are described. Clinical methods and methods of radiation diagnostics were used to examine patients.

Deep dental phenotyping and a novel FAM20A variant in patients with amelogenesis imperfecta type IG.

To identify etiologic variants and perform deep dental phenotyping in patients with amelogenesis imperfecta (AI). Three patients of two unrelated families were evaluated. Genetic variants were investigated by exome and Sanger sequencing. An unerupted permanent third molar (AI1) from Patient1 and a deciduous first molar (AI2) from Patient2, along with three tooth-type matched controls for each were characterized. All three patients harbored biallelic pathogenic variants in FAM20A, indicating AI1G. Of the four identified variants, one, c.1231C > T p.(Arg411Trp), was novel. Patient1 possessed the largest deletion, 7531 bp, ever identified in FAM20A. In addition to hypoplastic enamel, multiple impacted teeth, intrapulpal calcification, pericoronal radiolucencies, malocclusion, and periodontal infections were found in all three patients, gingival hyperplasia in Patient1 and Patient2, and alveolar bone exostosis in Patient3. Surface roughness was increased in AI1 but decreased in AI2. Decreased enamel mineral density, hardness, and elastic modulus were observed in AI1 enamel and dentin and AI2 dentin, along with decreased phosphorus, increased carbon, and increased calcium/phosphorus and carbon/oxygen ratios. Severely collapsed enamel rods and disorganized dentin-enamel junction were observed. We report a novel FAM20A variant and, for the first time, the defective mineral composition and physical/mechanical properties of AI1G teeth.

Acute Osteomyelitis in Torus of Systemically Compromised Patients: Case Series

The torus are benign bony prominences that generally do not require treatment, however, they can occasionally present osteomyelitis (OM). The objective of this article is to describe the timely management of torus osteomyelitis through a series of clinical cases. Three patients with OM are reported. Two cases of men aged 66 and 69, diabetics, as well as a 57-year-old woman with a history of basal cell carcinoma of the nose. All had torus ulcers associated with trauma and without resolution of the same. In the three cases, a biopsy was performed to confirm the diagnosis and they were treated with anti-inflammatory drugs and antibiotic therapy, achieving complete resolution. Uncontrolled diabetes mellitus and trauma can favor the development of OM in patients with bone exostoses, therefore, when there are signs of infection in these structures, it is imperative to suspect the condition and offer treatment.

Early enzyme replacement therapy prevents dental and craniofacial abnormalities in a mouse model of mucopolysaccharidosis type VI.

Mucopolysaccharidosis VI (MPS VI) is a hereditary lysosomal storage disease caused by the absence of the enzyme arylsulfatase B (ARSB). Craniofacial defects are common in MPS VI patients and manifest as abnormalities of the facial bones, teeth, and temporomandibular joints. Although enzyme replacement therapy (ERT) is the treatment of choice for MPS VI, the effects on the craniofacial and dental structures are still poorly understood. In this study, we used an Arsb-deficient mouse model (Arsb m/m ) that mimics MPS VI to investigate the effects of ERT on dental and craniofacial structures and compared these results with clinical and radiological observations from three MPS VI patients. Using micro-computed tomography, we found that the craniofacial phenotype of the Arsb m/m mice was characterized by bone exostoses at the insertion points of the masseter muscles and an overall increased volume of the jaw bone. An early start of ERT (at 4 weeks of age for 20 weeks) resulted in a moderate improvement of these jaw anomalies, while a late start of ERT (at 12 weeks of age for 12 weeks) showed no effect on the craniofacial skeleton. While teeth typically developed in Arsb m/m mice, we observed a pronounced loss of tooth-bearing alveolar bone. This alveolar bone loss, which has not been described before in MPS VI, was also observed in one of the MPS VI patients. Interestingly, only an early start of ERT led to a complete normalization of the alveolar bone in Arsb m/m mice. The temporomandibular joints in Arsb m/m mice were deformed and had a porous articular surface. Histological analysis revealed a loss of physiological cartilage layering, which was also reflected in an altered proteoglycan content in the cartilage of Arsb m/m mice. These abnormalities could only be partially corrected by an early start of ERT. In conclusion, our results show that an early start of ERT in Arsb m/m mice achieves the best therapeutic effects for tooth, bone, and temporomandibular joint development. As the MPS VI mouse model in this study resembles the clinical findings in MPS VI patients, our results suggest enzyme replacement therapy should be started as early as possible.

Unusual complications at the recipient site following periodontal plastic surgery procedures: a systematic review.

To identify and describe unusual soft tissue complications of periodontal plastic surgery procedures at the recipient site after periodontal grafts. Two independent reviewers performed a comprehensive search in MEDLINE, Cochrane, periodontics journals, reference lists, and grey literature for articles dated up to July 2021. Publications related to surgical interventions only around the teeth with an unusual complication at the recipient site were selected. No restrictions were made in the number of cases, follow-up period, or language. The Cochrane Collaboration's tool for assessing risk of bias, the Newcastle-Ottawa Scale (NOS), and two validated case report/series checklists were used to critically appraise the studies. A total of 1434 articles were examined, of which 28 met the inclusion criteria: one RCT, two cohort studies, and twenty-five case reports/series. The periodontal plastic surgery procedures described in these articles were conducted to treat lack of attached gingiva and gingival recessions. The following unusual complications were found: bone exostosis, epithelial inclusion, root resorption, abscess, overgrowth, "liver clot" formation, and oroantral communication. Bone exostosis and epithelial inclusions were the most prevalent unusual complications following treatment with subepithelial connective tissue graft, free gingival graft, and acellular dermal matrix allograft. Due to the nature of the reports, the clinical recommendations for diagnosis and treatment cannot be homogenized. Clinical studies reporting complications are required to develop management protocols (PROSPERO CRD42021230875). Clinicians need to know the main complications that can occur in mucogingival surgeries as well as their clinical management to provide a successful and predictable treatment.

First phalanx exostosis in traditional equestrian horses in Western Libya.

Background:Orthopedic diseases involving the forelimb fetlock joint of horses other than those used in professional racing have not been widely reported in the literature. One of these problems is the exostosis on the proximal forelimb phalanx (P1), which has not been reported previously in Western Libya.Aim:The study aimed to investigate the prevalence of P1 exostosis in traditional equestrian horses (known locally as Sarj horses) of different breeds in Libya that participated in a special social event and described its clinical findings radiographic appearance.Methods:The current study involved 60 horses admitted to private veterinary clinics with varied fetlock orthopedic problems. The studied horses were aged between 6 and 11 years old and galloped on hard grounds. Clinical and radiographic examinations were carried out on all horses. Lateromedial radiographs for one or both forelimb fetlock joints were acquired for each horse.Results:Clinical examination revealed that 21 horses (35%) had hard non-painful swelling on the dorsal aspect of fetlock with joint stiffness during flexion. In 19 of them, the swelling was bilateral. No forelimb lameness was noticed. Radiographically, hard swelling was diagnosed as bone exostosis, with various sizes, on the proximo-dorsal aspect of P1. There was also a new bone formation on the disto-dorsal part of third metacarpal bone in two cases.Conclusion:This study has documented the first report on bone exostosis on the proximo-dorsal aspect of the forelimb proximal phalanx as a common problem in Sarj horses that galloped on hard grounds in Western Libya. Although this bone lesion did not cause lameness in all reported cases, further investigations are warranted to identify its histopathological nature, potential etiology, and proper treatment.

Exeresis of bilateral mandibular torus due to speech impairment – case report

Mandibular torus is a slow-growing bone exostosis with well-defined borders, usually oval and bilateral in shape. Diagnosis is made through clinical and radiographic findings. Surgical removal is necessary when there is a prosthetic indication, recurrent trauma, and in rare cases, due to phonetic disorders. The interference in speech caused by the torus, is due to its size and location, which interferes with the usual positioning of the tongue, changing the articulation points, and thus making pronunciation difficult. Therefore, the aim of this study is to report a clinical case of excision of a bilateral mandibular torus due to speech impairment. A 47-year-old male patient sought dental care complaining of bone growth in the mandible. The clinical examination showed a bilateral increase in the lingual region of the mandible, which was unilobular on the right side and trilobular on the left side, measuring approximately 20x20mm. The patient underwent a surgical procedure to remove the torus under local anesthesia. In the 7-day postoperative period, suture dehiscence was observed, as well as traumatic ulcers and pain complaints. The patient reported that he did not pay attention to postoperative care. As a method of treatment of suture dehiscence, a metronidazole paste was used, as well as a laser therapy protocol, ensuring soft tissue healing. After complete healing, in the clinical evaluation, the patient did not present difficulties in pronunciation. Therefore, it is concluded that, although uncommon, the torus, due to its growth, can interfere with the positioning of the tongue and, consequently, with phonetics, which is a plausible indication for the surgical procedure. Once, the normal bony contours of the mandible are re-established, as well as repositioning and lingual function.

Bone exostosis lesions in distal limb of equines (17 cases; 10 horses, 7 donkeys): A clinical study.

Lameness is an important clinical sign for the problems of locomotor system. When, visual inspection and diagnostic analgesia are not enough for reaching out the accurate diagnosis of the lesion, diagnostic imaging including radiology helps to determine the problem in a specific area. This study investigated the role of radiography as a crucial step for clinical diagnosis of bone exostosis lesions in equines. Between July 2019 and December 2020, seventeen animals were involved in this study 10 horses and 7 donkeys. These animals (age, 4.1±3.8 years; weight, 199±98 Kg) were suffered from lameness with prominent bone exostosis on the distal limb, then were subjected to radiographic examination with lateromedial and dorsopalmar/dorsoplantar views. The most detected cases were more prevalent in the fore limb (76.5%) than the hind limb (23.5%). The most prevalent lesions recorded in this study were ring bone (9 cases; 52.9%), Degenerative joint disease of the carpal joint and sore shins (3 cases; 17.64%) for each, and then bone spavin and side bone were the lowest prevalent one (1 case; 5.88%) for each. There was no treatment for all cases except sore shins which was improved thoroughly by topical iodine compounds with systemic administration of phenylbutazone. X-ray radiography is still beneficial for equine industry especially in the lesions related to the joints and bone exostosis that appeared on the distal limb.

Tricho-rhino-phalangeal syndrome: a rare case of disharmonious short stature

Tricho-rhino-phalangeal syndrome (TRPS) is a genetic disease characterized by craniofacial and skeletal malformations including short stature, brachydactyly, with ulnar or radial deviation of the fingers, clinodactyly and early joint dysplasia, especially of the hips. The most remarkable craniofacial features are slow growing, sparse and brittle hair, pear-shaped nose with a bulbous tip, flat philtrum with thin upper lip, micrognatia and large low-set ears. The radiological hallmarks include cone-shaped phalangeal epiphyses, typical of all TRPS patients, but usually not present until 2 years of age, while bone exostoses appear only in TRPS II individuals. Management is primarily supportive. We describe a case of a male child with disharmonious short stature, affected by TRPS I. The diagnosis was established on the basis of clinical features and genetic testing

Exercise induced neuropathic lower leg pain due to a tibial bone exostosis

ABSTRACT Objectives: The differential diagnosis of chronic exercise induced lower leg pain in sporters includes compartment syndrome and medial tibial stress syndrome. However, severe discomfort may also be caused by nerve entrapment. Methods: Here we present a marathon runner who reports pain day and night in the lower leg. Deep palpation suggested the presence of a bony tumor deep in the calf musculature, and digital pressure on the soleal sling was painful and elicited paresthesias in the foot. A swab test indicated a hypo-esthetic sole of the foot. Imaging revealed the presence of a tibial exostosis that was hypothesized to narrow the soleal tunnel and irritate the tibial nerve. Results: Via a medial infragenual approach, the soleal tunnel was opened. A bony prominence was found in direct contact to the tibial nerve. Resection of the exostosis with tibial nerve neurolysis completely abolished all of his symptoms. Conclusion: An awkward lower leg discomfort that is present at night and worsens during exercise combined with altered foot sole skin sensation in the presence of a tibial bone exostosis may suggest tibial nerve neuropathy. If conservative therapies fail, resection and neurolysis is advised.

Complications in the Use of Deepithelialized Free Gingival Graft vs. Connective Tissue Graft: A One-Year Randomized Clinical Trial.

In the treatment of gingival recession, different surgical options have been described: free gingival grafts (FGG), connective tissue Grafts (CTG), and a more recent technique, de-epithelialized free gingival graft (DFGG). They are not procedures exempt from the appearance of complications. Most publications refer to postoperative complications, and there is limited literature regarding the development of late complications (weeks or months). Our working group carried out a study to describe the development of late complications associated with the use of DFGG in comparison with CTG, providing an incidence rate and a classification. Sixty-eight patients with mucogingival problems were selected, and divided into two groups: the Test Group, for which we used DFGG + Coronal Advancement Flap (CAF), and the Control Group (CTG + CAF). All patients were treated at the University of Seville’s dental school to solve mucogingival problems for aesthetic and/or functional reasons. A classification is proposed based on its severity; Major and Minor. Major complications included reepithelialization of the graft, epithelial bands, cul-de-sac, epithelial cysts, and bone exostoses. Minor complications included the graft´s color changes and superficial revascularization. Late major complications were only associated with the use of the DFGG, and the late minor complications developed with the use of the DFGG were much higher than those associated with CTG. CTG appears to be a safer procedure than DFGG in terms of late complications.

Proximal resection of the fourth metatarsal bone in combination with partial removal of metatarsal bone exostoses as alternative treatment for severe chronic proximal suspensory ligament desmopathy in a horse

Proximal resection of the fourth metatarsal bone in combination with partial removal of metatarsal bone exostoses as alternative treatment for severe chronic proximal suspensory ligament desmopathy in a horse

Radiographic Description of a Bone Exostosis Lesion on the Caudal Aspect of the Proximal Tibia in Three Thoroughbred Yearlings (2014–2019)

This manuscript describes exostosis lesions originating from the caudal aspect of the proximal tibia identified in three Thoroughbred yearlings as part of the routine review of presale radiographic images. These lesions are hypothesized to be osteochondromas. The identification of bony exostoses on the proximal tibia has not been reported before in current literature. As they have not been described, the future effect on performance or soundness is unknown. Although these cases were not lame at the time of detection, the future growth of the lesion and its impact on surrounding soft tissues is unknown.

Hoof deformity and its influence on the occurrence of chronic aseptic pododermatitis in cows

It is known that deformity of the hooves is one of the most common lesions, the main cause of which is a violation of the relationship between the speed of regrowth and abrasion of the hoof horn. It develops gradually and initially does not cause changes in the organism of cows, but later leads to various diseases, including orthopedic. It is determined that in alimentary osteodystrophy (results of multifactorial mass-volume analysis and prolonged osteotendinitis of the finger flexors) and irregular corrective cleaning of the hooves and formed triggered deformation of the hooves, which leads to a violation of the support-force interactions contributes to the emergence and development of aseptic subdermatitis of chronic genesis, which is clinically appeared by lameness animals addiction, careful stepping from limb to limb, fatigue, shortening of step, etc. Simultaneously, there are changes from a bone tissue. Thus, in the area of the sole of the hoof bone, single or multiple osteophytes and exostoses are formed, which are formed in the process of ossification and metabolic disorders. According to chronic aseptic pododermatitis in cows there is a deterioration in the quality of the hoof horn, as indicated by the results of biochemical and biophysical searches. In particular, there is a decrease in calcium, sulfur, an increase in the concentration of SH-groups, a decrease in the concentration of copper, zinc, cobalt, which leads to a decrease in the density and hardness of the hoof horn, as well as an increase in abrasion resistance and a decrease in the intensity of abrasion of the horn of the animal sole, which leads to an accruing in the horn of the sole and dysfunction of the musculoskeletal system.

Unusual Appearance of Multiple Exostosis: Case Report

Unilateral mandibular bone exostosis located in the buccal region is a rare condition. A 25-year-old female, who presented unilateral mandibular bone exostosis whose clinical diagnosis was confirmed using cone beam computed tomography. Additionally, a nodular torus palatinus was foud in the midline of the palate. Wear faces in the vestibular cusps of 46 as well as the thickening of the periodontal ligament space were present. Both are signs of occlusal trauma. The presence of mandibular tori could indicate other underlying conditions such as the presence of parafunctional activity or systemic health conditions. Mandibular exostosis can remain for life without needing to be surgically removed unless it compromises the prosthetic rehabilitation.

Rare Case of Bilateral Maxillary buccal exostosis in the anterior region of Libyan female patient: Case Report & Literature Review

The buccalexostoses are broad-based, non-malignant surface growth occurring on the outer or facial surface of the maxilla and/or mandible, found usually in the premolar and/or molar regions, and rarely in the anterior region. A 35-years-old female patient seeks the dentist for a carious anterior tooth. On examination, bone exostosis on the buccal aspect of both quadrants of the maxillary arch was found. They are painless and may increase patient concern about poor esthetics, inability to perform oral hygiene procedures, and compromised periodontal health by causing food lodgment. The following article presents a very rare case of bilateral buccal-sided maxillary exostosis in the anterior region.