Jaw Area Research Articles

Case report. Cystic lesions of the maxilla – clinical considerations and differential diagnosis

Abstract Cystic lesions of the maxilla are benign entities with both odontogenic and non-odontogenic origins. The maxillary cyst is a benign tumor of the bones of the jaw, which has a membrane and contains a fluid, semi-solid or mixed (liquid / semi-gaseous) material. These often lead to deformities in the jaw area. Cases are specific by framing pathological rarity, etiology, pathogenesis and clinical symptoms. Considering the large entity of cystic formations that can be found in the maxilla region, we selected two patients with cystic formations of the upper jaw, which were part of different pathological etiology categories, with special rarity occurring, evolutionary appearance and difficult to classify in terms of pathognomonic signs.

Premature primary tooth eruption in cognitive/motor-delayed ADNP-mutated children

A major flaw in autism spectrum disorder (ASD) management is late diagnosis. Activity-dependent neuroprotective protein (ADNP) is a most frequent de novo mutated ASD-related gene. Functionally, ADNP protects nerve cells against electrical blockade. In mice, complete Adnp deficiency results in dysregulation of over 400 genes and failure to form a brain. Adnp haploinsufficiency results in cognitive and social deficiencies coupled to sex- and age-dependent deficits in the key microtubule and ion channel pathways. Here, collaborating with parents/caregivers globally, we discovered premature tooth eruption as a potential early diagnostic biomarker for ADNP mutation. The parents of 44/54 ADNP-mutated children reported an almost full erupted dentition by 1 year of age, including molars and only 10 of the children had teeth within the normal developmental time range. Looking at Adnp-deficient mice, by computed tomography, showed significantly smaller dental sacs and tooth buds at 5 days of age in the deficient mice compared to littermate controls. There was only trending at 2 days, implicating age-dependent dysregulation of teething in Adnp-deficient mice. Allen Atlas analysis showed Adnp expression in the jaw area. RNA sequencing (RNAseq) and gene array analysis of human ADNP-mutated lymphoblastoids, whole-mouse embryos and mouse brains identified dysregulation of bone/nervous system-controlling genes resulting from ADNP mutation/deficiency (for example, BMP1 and BMP4). AKAP6, discovered here as a major gene regulated by ADNP, also links cognition and bone maintenance. To the best of our knowledge, this is the first time that early primary (deciduous) teething is related to the ADNP syndrome, providing for early/simple diagnosis and paving the path to early intervention/specialized treatment plan.

Clinical results of autologous bone augmentation harvested from the mandibular ramus prior to implant placement. An analysis of 104 cases.

Background: The aim of this study was the evaluation of the clinical success and complication rates associated with autologous bone grafts harvested from the mandibular ramus for alveolar ridge augmentation and the identification of possible risk factors for graft failure. Methods: In a consecutive retrospective study 86 patients could be included. In these patients a total of 104 bone grafts from the mandibular ramus were harvested for alveolar ridge augmentation. Medical history, age of patient, smoking status, periodontal status and complications were recorded. The need for bone grafting was defined by the impossibility of installing dental implants of adequate length or diameter to fulfill prosthetic requirements, or for aesthetic reasons. The surgical outcome was evaluated concerning complications at the donor or at the recipient site, risk factors associated with the complications and graft survival. All patients were treated using a two-stage technique. In the first operation bone blocks harvested from the retromolar region were placed as lateral or vertical onlay grafts using augmentation templates and were fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After a healing period of 3–5 months computed tomography scans were performed followed by virtual implant planning and the implants were inserted using guided dental implantation. Results: 97 of the 104 onlay bone grafts were successful. In only 7 patients a graft failure occurred after a postsurgical complication. No long-term nerve damage occurred. Postoperative nerve disturbances were reported by 11 patients and had temporary character only. After the healing period between 4 to 5 months, 155 implants were placed (39 in the maxilla, 116 in the mandible). A final rehabilitation with dental implants was possible in 82 of the 86 patients. Except the 7 graft failures, all recorded complications were minor complications which could be easily treated successfully without any long-term problems. Complications at the donor site were recorded in 3 patients and 17 patients experienced complications at the recipient site. Three of 7 patients with graft failure, were secondarily augmented with a new retromolar graft, harvested from the contra-lateral site and dental implants could be successfully inserted later. No association between complications and smoking habit, age of patient, jaw area, and dental situation (tooth gap or free dental arch) could be detected. Conclusions: Retromolar bone grafts are an effective and safe method for the reconstruction of small- to medium-sized alveolar defects of the maxilla and mandible prior to dental implantation and show a low graft failure rate.

Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Bisphosphonate drugs can be used to prevent and treat osteoporosis and to reduce symptoms and complications of metastatic bone disease; however, they are associated with a rare but serious adverse event: osteonecrosis of the maxillary and mandibular bones. This condition is called bisphosphonate-related osteonecrosis of the jaw or BRONJ. BRONJ is diagnosed when people who are taking, or have previously taken, bisphosphonates have exposed bone in the jaw area for more than eight weeks in the absence of radiation treatment. There is currently no "gold standard" of treatment for BRONJ. The three broad categories of intervention are conservative approaches (e.g. mouth rinse, antibiotics), surgical interventions and adjuvant non-surgical strategies (e.g. hyperbaric oxygen therapy, platelet-rich plasma), which can be used in combination. To determine the efficacy and safety of any intervention aimed at treating BRONJ. We searched the following databases to 15 December 2015: the Cochrane Oral Health Group Trials Register, the Cochrane Breast Cancer Group Trials Register (20 September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, EMBASE via Ovid, CancerLit via PubMed, CINAHL via EBSCO and AMED via Ovid. We scanned the references cited in retrieved articles and contacted experts in the field, the first authors of included papers, study sponsors, other bisphosphonates investigators and pharmaceutical companies. We searched for ongoing trials through contact with trialists and by searching the US National Institutes of Health Trials Register (clinicaltrials.gov) and the World Health Organization Clinical Trials Registry Platform. We also conducted a grey literature search to September 2015. Randomised controlled trials (RCTs) comparing the effects of any treatment for BRONJ with another treatment or placebo. Two review authors independently screened the search results, assessed the risk of bias in the included trials and extracted data. When in dispute, we consulted a third review author. One small trial at high risk of bias met the inclusion criteria. The trial randomised 49 participants, most of whom had cancer. It compared standard care (defined as surgery, antibiotics and oral rinses at the discretion of the oral-maxillofacial surgeon) to standard care plus hyperbaric oxygen therapy (2 atmospheres twice a day for 40 treatments). The trial measured the percentage of participants who improved or healed at three, six, 12 and 18 months and last contact. It also measured mean weekly pain scores.At three months, the study found that the participants in intervention group were more likely to have an improvement in their osteonecrosis than the standard care group participants (risk ratio (RR) 1.94, 95% confidence interval (CI) 1.01 to 3.74). There was no clear difference between the groups for the outcome 'healed' at three months (RR 3.60, 95% CI 0.87 to 14.82). There was no clear difference between the groups for improvement or healing when they were evaluated at six, 12 and 18 months and last contact.The study did not give any information on adverse events.Although the findings suggest adjunctive hyperbaric oxygen improved BRONJ, the quality of the evidence is very low since the only study was underpowered and was at high risk of bias due to lack of blinding, cross-over of participants between groups and very high attrition (50% at 12 months and 80% at 18 months in this study, which was designed for an intended follow-up of 24 months). There is a lack of evidence from randomised controlled trials to guide treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ). One small trial at high risk of bias evaluated hyperbaric oxygen therapy (HBO) as an adjunct to "standard" care and could not confirm or refute the effectiveness of HBO. There are two ongoing trials of teriparatide treatment for BRONJ. We found no randomised controlled trials of any other BRONJ treatments. High quality randomised controlled trials are needed. We provide recommendations for their focus and design.

Characterization of anatomical structures using panoramic X-rays: Part II: Mandibular incisive canal

IntroductionThe mandibular incisive canal (MIC) is the anterior extension of the mandibular canal which contains the mandibular incisive nerve and blood vessels that provide blood supply and innervation to the mandibular anterior teeth. MethodsIn order to determine the detectability, extent, and position of the MIC, conventional panoramic radiographs of 215 Chilean patients were analyzed. ResultsThe MIC was detected in 35.9% of cases, and was more frequently observed in male patients (37.5% in males and 34.7% in females) and on the right side of the mandible (44.6% in the right side and 27.4% in the left side). The results showed a tendency for the detectability of the MIC to decrease with age. The average extensions of the MIC on the right and left sides of the mandible were found to be 8.16mm and 5.58mm, respectively. The average minimum and maximum distances from the lower limit of MIC to the lower margin of the mandible were 11.7mm and 13.2mm, respectively. DiscussionPanoramic radiographs have limited effectiveness when being used to determine the presence, extent, and precise location of the MIC. Since there are significant differences in detectability, length, and path of the MIC between panoramic radiographs and anatomical studies, the use of cone beam (CT) scans is recommended for invasive treatments of the interforaminal jaw area.

Correlación entre biotipo gingival, ancho y grosor de encía adherida en zona estética del maxilar superior

To perform different dental procedures it is currently necessary to make a correct assessment of periodontal biotype, using the right tools that allow its thickness to be accurately measured. The objective of this study was to evaluate different diagnostic methods and correlating them with direct measurement of width and thickness of attached gingiva in the front upper jaw area. The study included 30 periodontally healthy patients, in whom biotype identification was performed on teeth 1.1, 1.2 and 1.3, using visual parameters, direct measurement of the width and attached gingiva thickness, and transparency of the periodontal probe as an indirect method. According to the transparency of the probe, the thick biotype was the most frequent (53.3%) was observed more in men (62.5%) than women (37.50%). According to the visual parameters, thin biotype was more prevalent (56.7%) than the thick biotype (43.3%). There were no significant differences on comparing the 2 methods. The mean width of attached gingiva was 2.79mm and a thickness of 1.06mm, being greater in the thick biotype (width 2.94mm and thickness 1.10) than in the thin biotype (width 2.67mm and thickness 1.01mm). According to the results, it can be concluded that both the visual diagnosis and transparency of the probe are valid to identify the gingival biotype. However, a lower reproducibility by visual inspection was observed, and the thin biotype showed a higher error rate.

Implants in the Anterior Maxilla: Aesthetic Challenges.

Esthetic outcomes have become key elements that are critical to defining success in implant restorations. Long-term studies have demonstrated that single or multiple implants are highly predictable with high survival rates. However, in the anterior maxillary zone, the aesthetic success of implant therapy is, for many, as important as the implant survival rates. Several factors contribute to this “success” and can be objectively evaluated. These include the patient's healing capabilities, the level and condition of the existing soft and hard tissues, and the provisional and final restorations. In addition to these objective factors, esthetic perception also plays a significant role in achieving this “success.” This special issue contributes to the growing body of existing literature by examining several important issues related to the aesthetic aspects of maxillary implants and their increasingly important role in implant dentistry. These include esthetic perception, surgical techniques for tissue augmentation, and the esthetics of final implant-supported restorations. One of the esthetic determinants occurring after implant placement is the lack of papilla between implants or between teeth and implants. Whether or not the lack of the interdental papilla leads to significant cosmetic deformities depends on whether shorter papillae may be esthetically tolerated under certain circumstances. Y. C. P. Yu et al. investigated the difference in the perception of aesthetics according to dental specialty. To this goal, the authors used computer assisted asymmetric alteration of the papilla length in the esthetic zone. The results of this study showed that asymmetric deficiencies in papilla length of 2 mm or more are more likely to be perceived as “unattractive.” It should be underlined that many dental professionals perceive even minor asymmetric shortening of the papilla as unattractive. The stability and health of the peri-implant soft tissues are necessary for success and long-term maintenance of dental implants. A two-millimeter wide band of keratinized tissue has long been considered clinically desirable to provide a soft tissue seal around natural teeth. The absence of periodontal ligament and supracrestal fiber attachment around dental implants may increase peri-implant tissue susceptibility to the inflammatory process caused by biofilm accumulation. Therefore, creation of a band of keratinized gingiva around implants is desirable. A. Elkhaweldi et al. in a case series presented a novel surgical technique that can be utilized to augment keratinized soft tissue around implant-supported overdentures. The authors concluded that an apically repositioned flap, a relatively simple procedure, provided good esthetic outcomes, with newly formed tissue indistinguishable from the surrounding mucosa. The disadvantages of this technique are also discussed. Full arch implant-supported prostheses have high success rates. A variety of materials have been used for this type of restoration including metal alloy-acrylic, metal alloy-composite, and metal alloy-ceramic. However, with these materials a number of complications may occur. To minimize these, using zirconia for the framework has been proposed. Several studies have shown that zirconia possesses excellent physical, mechanical, biological, and chemical properties. J. Carames et al. discuss this option and provide examples of monolithic zirconia restorations for full arch implant-supported restorations. A. E. Borgonovo et al. investigated the survival and success rates, as well as the marginal bone loss (MBL) and esthetic indices of zirconia implants positioned in the esthetic jaw areas. The results of this study emphasized that one-piece zirconia dental implants show high biocompatibility, low plaque adhesion, and an absence of a microgap that may contribute to their clinical success in the esthetic areas. Finally, A. L. Ioannou et al. provide a review of several surgical techniques aimed at optimizing anterior implant esthetics. Clinicians who practice implant dentistry need to strive for more than just osseointegration. They must also achieve excellent esthetic outcomes. Therefore, with careful treatment planning and use of a variety of esthetically focused techniques, clinicians will be able to meet patients' ever-increasing demands for ideal esthetic outcomes.

Zirconia Implants in Esthetic Areas: 4-Year Follow-Up Evaluation Study.

Objectives. The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes of zirconia implants positioned in the esthetic jaw areas. Materials and Method. 13 patients were selected and 20 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge in the esthetic jaw areas. Six months after surgery and then once a year, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. Results. The survival and success rates were 100%. The average marginal bone loss from baseline to 48 months after surgery was +2.1 mm. Four years after surgery, the median and the mode for visible Plaque Index and Bleeding On Probing resulted 1 whereas Probing Pocket Depth amounted to 3 mm (SD = ±0.49 mm). Conclusion. One-piece zirconia dental implants are characterized by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants even in the esthetic areas.

Odontogenic Keratocystof The Jaw: Case Report

Keratocystic odontogenic tumor (KOT) is a lesion that affects the gnathic bones, mainly in the posterior jaw area. Clinical and radiographic characteristics include asymptomatic volumetric increase and lack of cortical bone expansion and are related to an impacted tooth. However, the diagnosis can be confused for others when the lesion presents in other areas, such as the periapical region. In these cases, different management is recommended. This paper reports a case of KOT that demonstrated clinical and radiographic findings resembling those of radicular cyst and is designed to educate professionals who may see this lesion, such as endodontists and pathologists, about the possibility of a periapical presentation.

RETROBULBARINIS PSEUDOTUMORAS DĖL SKRUOSTE UŽSILIKUSIO SMULKAUS METALINIO SVETIMKŪNIO: KLINIKINIO ATVEJO APRAŠYMAS IR LITERATŪROS APŽVALGA

Aim: to present a patient’s clinical case; to demonstrate how important is to suspect rertrobulbar pseudotumor timely, why it is necessary to remove even the smallest metal foreign bodies from the jaw area; to show the importance of an integrated simultaneous clinical delivery on the spot during the investigation of a complex illness. Case report: presenting the clinical case – patient MA (66 years of age) right eye vision started to deteriorate 6 years ago, a small defect of a pupil (abnormal pupil shape) was found; after the remove a cataract operation, the vision improved (during the week after the operation the patient has not used prescribed corticosteroid drops in the eye, this incompliance with prescription caused the uveitis anterior, which went away in 2 months after relevant treatment started). One year after surgery a pain appeared in the area of the right cheek, teeth and beneath the right eye, manifested hearing weakness dextra side. Several dentists treated this patient. Also rhinologist, mouth, face, jaw surgeons and oncologists were involved. Diagnosis: alveolitis, sinusitis, osteomielitis sinus maxilaris dextra, a foreign body in a right maxillary sinus projection. Patient was examined for TBC, sarcoidosis, fungal illness, syphilis, all with negate results. Gradually right eye became blind. After the vision of the left eye began to deteriorate, further cataract surgery was undertaken. The further sudden deterioration in the general condition of the patient was treated in the neurological and supportive therapy departments for several months. Diagnosis: cerebellar degeneration and chronic polyneuropathy ataxia, unspecified dementia, extraocular palsies, metabolic hepatitis, chronic pancreatitis, bladder disturbance. During that time a protrusion of the right eye gradually enlarged and became more exposed. The left eye became blind several months later. KT and MRT: right eye’s retrobulbar tumor spread through eyehole slots intracranial and to left orbit; a small metal foreign body was found subcutaneously in the right cheek. A biopsy was taken from the para- and retrobulbar tissues: fibromatosis was diagnosed. Half a year later a sphenoorbital meningioma was suspected and the surgery aimed to partially remove a tumor from the right orbit was performed. During this stay under the neurosurgeons care it becomes clear that episodes of psychomotor agitation were also present. The eyelids of the right eye were sutured to protect the cornea against perforation. Histologic diagnosis: retrobulbar pseudotumor of both eyes. Metal foreign body remained untouched. The ophthalmologist removed the foreign metal body, which was situated in the cheek subcutaneously, close to N. infraorbitalis with capsule in a local polyclinic soon afterwards. The composition of the foreign metal object was investigated: it was found that 95% of it was iron with small amounts of rare metals usually found in steel alloy, calcium. Histology detected hemosiderosis in connective tissue of capsule. Patient was examined by a rheumatologist on the basis of the suspicion of Wegener granuliomatosis. Data to confirm Wegener’s granulomatosis was not enough; internal organs without lesions, it was diagnosed cholelithiasis and fibrotic lesions in the lungs. It was confirmed systemic transgression of connective tissue with retrobulbar pseudotumor diagnosis. Corticosteroid treatment was given for 1 month. Patient was examined 8, 15 and 27 month after foreign body removal later: the skin of the face was free of scars, eyelids of the right eye has been sutured; the left eye had no inflammation, refracto- and keratometry findings were the same, like 4 years before; levels of immunoglobulins G and E in blood decreased - normal; the systemic transgression of connective tissue remained. Patient walks with a wide-based gait, he becames totally dependent on care (he is blind and desorientated at place and time, his personality has changed; Mini Mental State Examination 13/30). This story showed, how it is important to have a complete understanding of the patients health from various medical specialists at the same physical place and at the same time. The case shows surprising differences of results of radiologic examination of the same case.

Odontogenesis in the Veiled Chameleon (Chamaeleo calyptratus)

ObjectiveReplacement teeth in reptiles and mammals develop from a successional dental lamina. In monophyodont (single generation) species such as the mouse, no successional lamina develops. We have selected a reptilian monophyodont species – the Veiled Chameleon (Chamaeleo calyptratus) – to investigate whether this is a common characteristic of species that do not have replacement teeth. Furthermore, we focus on the sequence of tooth initiation along the jaw, and tooth attachment to the bones. DesignEmbryos of the Veiled Chameleon were collected during the first 6 months of incubation (from the 5th to 24th week) at 7-day intervals. ResultsAfter five weeks of incubation, an epithelial thickening was present as a shallow protrusion into the mesenchyme. A week later, the epithelium elongated more deeply into the mesenchyme to form the dental lamina. The formation of all tooth germs along the jaw was initiated from the tip of the dental lamina. Development of a successional dental lamina was initiated during the pre-hatching period but this structure became markedly reduced during juvenile stages. MicroCT analysis showed the presence of a heterodont dentition in young chameleons with multicuspid teeth in the caudal jaw area and simpler monocuspid teeth rostrally. Unlike the pleurodont teeth of most reptilian species, chameleon teeth are acrodontly ankylosed to the bones of the jaw. Odontoblasts produced a layer of predentine that connected the dentine to the supporting bone, with both tooth and bone protruding out of the oral cavity and acting as a functional unit. ConclusionsChameleons may provide new and useful information to study the molecular interaction at the tooth–bone interface in physiological as well as pathological conditions.

Fibroma ameloblástico asociado a un odontoma compuesto. La importancia del estudio histopatológico

The ameloblastic fibroma is a benign mixed, rare odontogenic tumour, which accounts for 2% of all odontogenic tumours. It is slow growing, and more common in children and young adults. It is composed of embryonic fibrous connective tissue and early odontogenic epithelium, and characterised by the proliferation of epithelial and mesenchymal tissue. It appears most frequently in the jaw area of molars and premolars of young patients with no sex predilection, and is sometimes associated with an impacted tooth.This article aims to describe a clinical case of a child in the second decade of life, with apparent anodontia in the maxilla, which was asymptomatic and later diagnosed as an ameloblastic fibroma in the left side maxilla incisors area. A brief review of the literature and differential diagnoses was carried out, including an analysis of its clinical and histological features, and the therapeutic approach to take.Conservative surgical excision followed by curettage seems to be the most appropriate treatment option. It should be noted that the recurrence rate is 18.3%, mainly due to incomplete excision of the lesion. Radiographic controls should be performed six months postoperatively, and every year for the following five years.

Bone mineral density measurements performed by cone-beam computed tomography in the bisphosphonate-related osteonecrosis-affected jaw

The aims of this study were to determine the bone mineral density (BMD) in bisphosphonate-related osteonecrosis of the jaw (BRONJ) by cone-beam computed tomography (CBCT) measurements and to correlate these measurements with the current stages recommended by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Bone mineral density measurements of various areas in 24 bisphosphonate-related osteonecrosis (BRON) jaws were evaluated by CBCT. Another 24 age- and sex-matched patients without any bone pathologies served as the control group. Data acquisition was highly standardized to ensure maximum reliability in the comparisons of BMD measurements by CBCT. Compared with the control group, the bisphosphonate patients had significantly higher (p ≤ 0.01) BMDs in the non-affected jaw areas ipsilateral and contralateral to the BRON within the maxilla and mandible. The highest BMDs within the BRON jaws were observed in the BRON-adjacent areas relative to the non-affected ipsilateral and contralateral areas. Regarding the correlation with the AAOMS stages, the BMDs of the evaluated areas of BRONJ showed no significant differences (p ≥ 0.05) between the stages. Bisphosphonate-related bone pathologies can be detected by CBCT and are associated with increased BMDs, not only in clinically obvious BRONJ areas, but also in clinically unapparent areas, suggesting a subclinical general osteosclerosis of the jaw. The data transferability to other CBCT devices needs to be further elucidated and compared with multislice CT.

얼굴 영상 및 음성신호 측정을 통한 신장 수지침 효과 분석 기법의 제안

In this paper, we would like to propose techniques to analyze effect according to stimulation kidney associated hand acupuncture by applying technique to measure changes of facial image and voice signal. To this end, we measured color change of JIGAK(jaw) area associated kidney in facial image and voice signal stimulation before and after of kidney associated hand acupuncture. In addition, we measured changes of the first formant frequency bandwidth and Shimmer to element of voice signal analysis in connection with kidney in experiment. We can be measured reduction of the first formant frequency bandwidth and Shimmer, black of JIGAK area according to stimulation of kidney associated hand acupuncture. Finally, we would like to demonstrate objective effect of kidney associated hand acupuncture through the analysis of statistical significance by measurement techniques of facial image and voice signal.

Oral Cavity and Systemic Diseases—Langerhans Cell Histiocytosis

ABSTRACTLangerhans cell histiocytosis (LCH), previously known as histiocytosis X is a rare disease of unknown ethiology, characterized by intense and abnormal proliferation of bone marrow-derived histiocytes (Langerhans cells). It can present both local and systemic manifestations involving bone, skin and mucosal tissues and internal organs.Oral manifestations could be the first or the only signs of this disease. The oral changes may be presented as single or multiple unspecific lesions—this is the reason for undetected symptoms in a lot of cases and the reason for the late diagnosis. Therefore early symptoms that are manifested on the oral mucosa and in jaw area can be first recognized by dental professionals.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

The worm eel, Muraenichthys okamurai Machida and Ohta 1996, a junior synonym of Muraenichthys borealis Machida and Shiogaki 1990

The worm eels, Muraenichthys okamurai Machida and Ohta 1996 and M. borealis Machida and Shiogaki 1990, both from Japanese waters, have been distinguished by the difference in dentition on the upper jaw and palatal area, and regarded as valid species of Scolecenchelys. A detailed examination of the dentition of the type specimens and recently caught specimens revealed that the difference in the dentition described in the original descriptions is actually intraspecific variation. Apparently M. okamurai represents the juvenile of M. borealis, and the former is its junior subjective synonym.

Orthodontic tooth movement into edentulous ridge areas--a case series

The aim of this case series was to analyse dimensional alterations of the alveolar ridge and tooth-supporting structures, as well as root resorption, following orthodontic tooth movement into edentulous areas with reduced ridge dimensions. The study involved six subjects (30-70 years) with 10 edentulous jaw areas in the premolar regions. Clinical and radiographic examinations and 3D measurements on scanned study casts were performed at baseline, at retention, and after 1 year of (i) the edentulous area into which the tooth was moved and (ii) the established edentulous area from which the tooth was moved. The orthodontic tooth movement into an edentulous area resulted in most individuals in only minor dimensional alterations of the periodontal tissues. With regard to the width of the alveolar process, the results indicated a decreased width in the newly established edentulous area, whereas in the area into which the tooth had been moved, the width increased. In all cases, the moved tooth showed lateral root resorption on its pressure side at the level of the bone crest at time of retention, but signs of repair were noticed at the 1-year follow-up. Within the limitations of the study, it can be concluded that orthodontic tooth movement results in dimensional alterations of the edentulous ridge and that lateral root resorption is an inevitable side-effect.

Temporomandibular Disorders and Associated Clinical Comorbidities

Temporomandibular joint and muscle disorders (TMJD) are ill-defined, painful debilitating disorders. This study was undertaken to identify the spectrum of clinical manifestations based on self-report from affected patients. A total of 1511 TMJD-affected individuals were recruited through the web-based registry of patients maintained by The TMJ Association, Ltd, a patient advocacy organization, and participated in the survey as well as 57 of their nonaffected friends. Results were also compared with US population for questions in common with the National Health and Nutrition Examination Survey. The TMJD-affected individuals were on average 41 years of age and predominantly female (90%). Nearly 60% of both men and women reported recent pain of moderate-to-severe intensity with a quarter of them indicating interference or termination of work-related activities. In the case-control comparison, a higher frequency of headaches, allergies, depression, fatigue, degenerative arthritis, fibromyalgia, autoimmune disorders, sleep apnea, and gastrointestinal complaints were prevalent among those affected with TMJD. Many of the associated comorbid conditions were over 6 times more likely to occur after TMJD was diagnosed. Among a wide array of treatments used (46 listed), the most effective relief for most affected individuals (91%) was the use of thermal therapies--hot/cold packs to the jaw area or hot baths. Nearly 40% of individuals affected with TMJD patients reported one or more surgical procedures and nearly all were treated with one or many different medications. Results of these treatments were generally equivocal. Although potentially limited to the most severe TMJD affected individuals, the survey results provide a comprehensive dataset describing the clinical manifestations of TMJD. The data provide evidence that TMJD represent a spectrum of disorders with varying pathophysiologies, clinical manifestations, and associated comorbid conditions. The findings underscore the complex nature of TMJD, the need for more extensive interdisciplinary basic and clinical research, and the development of outcome-based strategies to more effectively diagnose, prevent, and treat these chronic, debilitating conditions.

The 3D Chinese head and face modeling

Perfect fit for people has always been a target for product design. Designers commonly use traditional anthropometric dimensions for 3D product design thus creating a lot of fitting problems when dealing with the complexities of human body shapes. The development of recent 3D anthropometric survey has created an opportunity for complex shape analysis on human model by collecting 3D scan data. Using 3D point cloud data from the SizeChina survey, a methodology of creating a homologous 3D head and face model was demonstrated in this study. Anatomical and virtual landmarks, and surface modeling algorithm based on point cloud data were applied in building the model. The head and face models for all scans had the same amount of vertices with consistent features. The average Chinese models showed obvious differences between male and female. The variations of head and face shapes were analyzed using Principal Component Analysis and the results showed that the largest variations among people were general size, especially for width and depth. However face height, forehead, back of the head, chin and jaw area were also important when describing the 3D shape. The results from this study may be useful in the design of head and facial products.