Loss Of Lamina Dura Research Articles

Primary Intraosseous Carcinoma, Not Otherwise Specified, of the Gnathic Bones: Report of Two Cases

Primary intraosseous carcinoma, NOS (PIOC) is a rare central jaw carcinoma, not classified as any other type of carcinoma, with a suggested odontogenic origin. Here, we present 2 additional cases of PIOC. A 39-year-old man presented with an irregular asymptomatic swelling in the anterior upper vestibule and palate and palpable fixed lymph nodes. Periapical radiography analysis revealed an ill-defined unilocular radiolucency in the periradicular region of endodontically treated maxillary incisors with irregular root resorption. The second case involved a 35-year-old man presenting with an asymptomatic, unilocular, ill-defined radiolucency superimposed on the mandibular molars roots, with loss of lamina dura. Microscopically, both the cases showed small islands of neoplastic epithelial proliferation with cellular atypia and keratinization, confirming the final diagnosis of PIOC. Patients were referred to an oncology service. Clinicians should consider PIOC when evaluating an ill-defined radiolucency in tooth-bearing areas of gnathic bones of young adults.

Association of sickle cell haemoglobinopathies with dental and jaw bone abnormalities.

To estimate the association between sickle cell anaemia and trait with dental and jaw bone abnormalities. Subjects (n=369) were allocated to three groups: sickle cell anaemia, trait and control. Dental shape, number, size and position and changes in pulp chamber, root and periapex were analysed by intra-oral periapical radiographs. Integrity of lamina dura, quality of cancellous bone and bone trabeculation were also evaluated. Prevalence ratios (PR) were calculated (α=0.05). Sickle cell anaemia had higher prevalence (PR:8.31) and number of teeth (PR:13.40) with external resorption; higher number of teeth with pulp calcification; partial and total loss of lamina dura; and higher prevalence of changes in trabecular structure of maxilla (PR:6.45) and mandible (PR:5.34). Sickle cell trait showed higher prevalence (PR:1.26) and higher number of teeth (PR:1.98) with partial loss of lamina dura; higher number of teeth with hypercementosis, changes in shape, size, periapex, total loss of lamina dura; and higher prevalence of changes in mandibular trabecular bone (PR:1.43). Pulp calcification and external resorption of the root were the most frequent dental alterations in sickle cell anaemia group, while in trait was higher frequency of changes in shape, size, periapex and root. Jaw bone changes were most prevalent in both homozygous and heterozygous subjects.

Oral and Maxillofacial Manifestations of Mineral and Bone Disorders Associated with Chronic Renal Failure

Chronic kidney disease (CKD) is a multifactorial syndrome and a global health concern. As renal function declines, there is a progressive deterioration of mineral homeostasis. Starting from stage 3 of CKD oral manifestations of mineral disorders can occasionally appear and become more frequent and evident in stage 5. We retrospectively analysed 43 patients diagnosed with end stage renal failure undergoing dialysis, hospitalized in our clinic for different oral and maxillofacial pathologies. The mean dialysis period was 5.43 years. Radiographic alterations afecting the jaws were found in all patients. The most common feature was partial or total loss of lamina dura, followed by alterations of the bony trabeculae. 9 patients presented brown tumors which are considered the final stage of secondary hyperparathyroidism associated with renal failure.

Systematic review of oral manifestations related to hyperparathyroidism.

We sought to identify oral symptoms found in hyperparathyroidism and compare their rate of occurrence, as well as potential variations in sequelae between primary, secondary, and tertiary hyperparathyroidism. Database searches were performed through EMBASE and PubMed, with a continual handsearch for relevant articles. PRISMA guidelines were followed. Two hundred five articles including 245 patients were analyzed with data extraction. The average age was 34.02years old (age range 1-83), with 91 male and 154 female patients (1:1.7 M/F ratio). Patients presented with symptoms including facial asymmetry or swelling (167/214 cases; 78.0%), oral pain (30/214; 14.0%), systemic symptoms (25/214; 11.7%), referrals or incidental findings (16/214; 7.5%), and neuropathy (6/214; 2.8%) independently and in combination together. Bony pathology occurred most often in the mandible (100/245 cases; 40.8%), while 72 cases were in the maxilla (29.4%) and 73 cases in both jaw bones (29.8%). Our data collection identifies a wide variation in the presentation of hyperparathyroidism. In order to be more certain of oral maladies from hyperparathyroidism, studies with large patient populations need to be conducted at healthcare centers to clarify the oral outcomes of hyperparathyroidism. What was thought to be a characteristic finding of HPT, mandibular radiolucency occurred in only a minor portion of cases. Furthermore, the pathognomonic sign of HPT on radiograph, loss of lamina dura, was only the third most common presentation. Bone pathology was most commonly reported in literature, but should not be assumed the only oral sequelae of hyperparathyroidism.

Are dental and jaw changes more prevalent in a Brazilian population with sickle cell anemia?

The aim of this study was to analyze the prevalence of dental and jaw changes in individuals with sickle cell anemia (SCA) compared with a control group from a Brazilian population. This was a retrospective cross-sectional study. Participants were divided into 2 groups: SCA and control (123 patients per group). Intraoral periapical radiographs were taken. Changes in bone pattern and dental changes were investigated by using the following radiographic parameters: (1) trabecular bone (step-ladder or spider web); (2) integrity of the lamina dura (loss of sharpness and continuity, partial or complete absence, and increased thickness); and (3) dental changes (pulp chamber, root surface, periapex, dental form, number, and position). Fisher's exact and χ2 tests were used to compare frequencies and the Mann-Whitney test was used to compare medians (P<.05). Step-ladder (P<.001) and spider-web patterns (P<.001) in trabecular bone of the jaw were more common in individuals with SCA than in the control group. Loss of lamina dura was more frequent in those with SCA than in control individuals (P=.021). Dental changes were not different between groups (P>.05), even though the prevalence of hypotaurodontism was twice as high in the SCA group as in controls (P=.086). The prevalence of jaw changes is higher in individuals with SCA.

Radiographic Findings of Peri-Apical Lesions and Its Correlation to Clinical Findings

Aim: The aim of this study is to correlate the radiological and clinical findings of various periapical lesions of the oral cavity. Objective: The objective of the study is to analyse the various radiographic and clinical interpretation and correlate the findings by using radiographs. Around 30 radiographs of patients with periapical lesions was selected irrespective of age, sex and race and was evaluated to find the radiographic and to correlate the radiographic findings with its clinical findings. Materials and method: 30 patients above the age of 18years who were diagnosed with periapical lesions were selected. Clinical and radiographic photographs of these patients were collected and compared. Results: Among the 30 patients, prevalence of periapical abscess was predominant (80%). Radio graphically significant finding was the presence of PDL widening observed in 86% of the cases. Periodontal ligament space was seen in 3% of the cases. Loss of lamina dura was seen in 37% of the cases whereas pulp calcification was observed in 3% of the cases. Clinically, all the lesions were red in colour with regular margins with 27(90%) patients having tenderness on palpation. Around 26(87%) lesions were localised and 23(77%) patients had sinus discharge. Conclusion: The periapical lesions found in the oral cavity are seen to occur predominantly in patients with poor periodontal status irrespective of age, sex and race. It is important to study the progress of the sequelae and provide accurate diagnosis for better prognosis. Hence this study is done to emphasis the importance of correlation between radiographic findings and clinical findings.

Prevalence of apical periodontitis in root filled teeth: findings from a nationwide survey in Finland.

To assess the prevalence of apical periodontitis in the Finnish population aged 30years and older and relate it to the technical quality of root filling by the type of tooth. As part of the Finnish nationwide Health 2000 study, panoramic radiographs were used of the dentate subjects (n=5335) aged 30-95years (mean 50.2years) to assess the apical and endodontic status of their teeth (n=120635). Apical periodontitis (AP) was recorded when the periodontal ligament space was more than double in width, or loss of lamina dura or a periapical radiolucent lesion was seen. Technically, adequate root fillings had a gap of 0-3mm from the apex; all others were defined as inadequate. Statistical methods included chi-square tests and anova. Risk of AP was estimated as cross-product odds ratio and its 95% confidence interval. Teeth with AP occurred in 27% of the dentate subjects being more prevalent in subjects with root filled teeth than in those without (39% vs. 9%; P<0.001; OR=6.3; 95% CI 5.3, 7.4). AP was more prevalent in men than in women (31% vs. 23%). At a tooth level, AP was most frequent in mandibular molars with inadequate root fillings. For all root filled teeth, an inadequate root filling doubled the risk of AP for both women (OR=2.0; 95% CI 1.7, 2.4) and men (OR=2.5; 95% CI 2.1, 2.9). AP occurred principally in subjects and teeth with root fillings. Inadequate root fillings doubled the risk of AP. An improvement in the technical quality of root canal treatment is essential.

Rheumatoid Arthritis Exacerbates the Severity of Osteonecrosis of the Jaws (ONJ) in Mice. A Randomized, Prospective, Controlled Animal Study.

Rheumatoid arthritis (RA), an autoimmune inflammatory disorder, results in persistent synovitis with severe bone and cartilage destruction. Bisphosphonates (BPs) are often utilized in RA patients to reduce bone destruction and manage osteoporosis. However, BPs, especially at high doses, are associated with osteonecrosis of the jaw (ONJ). Here, utilizing previously published ONJ animal models, we are exploring interactions between RA and ONJ incidence and severity. DBA1/J mice were divided into four groups: control, zoledronic acid (ZA), collagen-induced arthritis (CIA), and CIA-ZA. Animals were pretreated with vehicle or ZA. Bovine collagen II emulsified in Freund's adjuvant was injected to induce arthritis (CIA) and the mandibular molar crowns were drilled to induce periapical disease. Vehicle or ZA treatment continued for 8 weeks. ONJ indices were measured by micro-CT (µCT) and histological examination of maxillae and mandibles. Arthritis development was assessed by visual scoring of paw swelling, and by µCT and histology of interphalangeal and knee joints. Maxillae and mandibles of control and CIA mice showed bone loss, periodontal ligament (PDL) space widening, lamina dura loss, and cortex thinning. ZA prevented these changes in both ZA and CIA-ZA groups. Epithelial to alveolar crest distance was increased in the control and CIA mice. This distance was preserved in ZA and CIA-ZA animals. Empty osteocytic lacunae and areas of osteonecrosis were present in ZA and CIA-ZA but more extensively in CIA-ZA animals, indicating more severe ONJ. CIA and CIA-ZA groups developed severe arthritis in the paws and knees. Interphalangeal and knee joints of CIA mice showed advanced bone destruction with cortical erosions and trabecular bone loss, and ZA treatment reduced these effects. Importantly, no osteonecrosis was noted adjacent to areas of articular inflammation in CIA-ZA mice. Our data suggest that ONJ burden was more pronounced in ZA treated CIA mice and that RA could be a risk factor for ONJ development. © 2016 American Society for Bone and Mineral Research.

Abberant Root Morphology in the Permanent First Molars : Case Reports

The developmental mechanism of root formation is a complex process. Hereditary and environmental factors may affect the morphology of the developing root. A total of 12 cases was presented with permanent first molars with abberant root morphology. Clinically, these teeth appeared as a normal crown. However, radiographically, the root was slender, twisted and characterized by irregular lengths. In addition, root trunk length was shorter and pulp chamber was obliterated. In these cases, periapical radiolucency and loss of lamina dura were often observed. In 6 cases, an abnormal root of the primary second molars were also present, as well as root malformation of permanent first molars. In 3 cases, permanent central incisors also had a dysmorphic crown. These cases almost all had medical history, such as premature birth, brain infection or congenital heart disease in infants. The present paper describes cases of permanent first molars with an abnormal root that are rarely reported in literature. This case may intensify the variation in the permanent first molar and is intended to reinforce the clinician’ s awareness of rare morphology of the roots.

The osseous and dental changes of patients with chronic renal failure by CBCT.

The aim of the present study was to evaluate the osseous changes of the jaws of patients with chronic renal failure (CRF) by CBCT. On CBCT scans obtained from 15 patients with CRF and 15 control patients (7 males and 8 females), the mean was calculated for the antegonial index (AI), mental index (MI), panoramic mandibular index (PMI) and mandibular cortical index (MCI). The MI, AI and PMI, pulp chamber size, number of teeth with pulp calcification and lamina dura loss were compared using the paired t-test, and the MCI values were analysed using the χ(2) test. There were no statistically significant differences in the PMI, MI and AI values in patients with CRF and the control group. With regard to MCI, the cortical margins of the mandible were more porous in patients with CRF than in the control group, and also soft-tissue calcifications, lamina dura loss and radiolucent defects were more common in patients with CRF. There were no statistically significant differences in pulp chamber size and pulp calcifications between patients with CRF and the control group. Radiographic changes in the jawbones of patients with CRF may be commonly seen. CBCT is a valuable diagnostic tool for the evaluation of osseous findings, pulp chamber, soft-tissue calcifications and MCIs and allows indices measurement in three dimensions without any superposition.

Pulp polyp - A periapical lesion: Radiographic observational study

Introduction: Pulp polyp (PP) is a chronic hyperplastic condition resulting in formation of granulation tissue and proliferative mass. The radiographic appearance of PP has innumerable presentations. Diagnosing and treatment planning of periapical lesions, heavily relies on the radiographic changes surrounding the root structures. Objective: To evaluate different radiographic periapical changes in clinically detected PP patients. Materials and Methods: Patients reporting to Department of Oral Medicine and Radiology and who were clinically diagnosed with PP by an oral diagnostician were subjected to radiographic examination. Digital intraoral periapical radiographs of 50 patients with PP were taken. Various periapical changes in the digital radiographs were recorded by a skilled oral radiologist. The data obtained was subjected to statistical analysis using SPSS ver 17.0 and P-value was set at <0.05 as significant. Result: Periapical changes like periodontal space widening (PDLW), loss of lamina dura, periapical abscess, periapical granuloma, hypercementosis, condensing osteitis and root resorption were noted. Periodontal space widening was seen in all patients (100%), loss of lamina dura was noted in 72%, periapical rarefying osteitis in 56%, condensing osteitis in 8%, hypercementosis, periapical granuloma, and root resorption were seen in 4% of PP patients. Majority of PP were asymptomatic (66%). Pulp polyp was commonly seen in mandibular first molar followed by mandibular second molar and maxillary first molar. Statistically significant difference was noticed between periapical changes in PP patients (P value <0.0001). All PP patients showed definite periapical changes suggesting it to be a periapical lesion. Conclusion: Pulp polyp is confined to the pulpal portion of the tooth which, may or may not cause changes in periapical region. The results of the present study showed that majority of the PP patients were associated with definite periapical changes. This observation suggests that clinically detected PP are radiographically associated with definite periapical changes suggesting it to be a periapical lesion.

Paget's Disease in Mandible: A Rare Occurrence in an Indian Sub-Continent.

Female patient aged 50-year-old reported an extra oral swelling of lower jaw since 7 months. Broadening and widening of lower third of the face, with thick & incompetent lower lip seen [Table/Fig-1]. Swelling was nontender in the anterior alveolar bone with expanded cortical plates & no mobility of tooth felt after palpation [Table/Fig-2]. Orthopantomogram (OPG) showed irregular radiolucent areas with interspersed radio opacities confined to the anterior and body of mandible, hypercementosis of lower anterior teeth and resorption of roots [Table/Fig-3]. CT scan showed enlarged entire mandible with irregular intra medullary lytic lesion suggestive of fibrous dysplasia/ Paget’s disease [Table/Fig-4]. Incisional biopsy showed features of PD. The presence of irregular areas of bone formation with osteoblastic rimming of bone seen with haematoxylin and eosin stain at 10x and 20x magnifications [Table/Fig-5a,b]. The haematoxyphilic reversal lines seen within most of the areas of bone formation with vascular fibrous connective tissue with amount of inflammatory cell infiltrate at 10X and 20X magnifications [Table/Fig-6a,b]. Whole body bone scintigraphy performed using injection of 20m Ci Tc-99m MDP confirming increased tracer uptake in the mandible only [Table/Fig-7]. Mild increase in alkaline phosphatase (173 IU/L) seen. Based on these facts diagnosis of PD rendered and referred to an endocrinologist for medical management. Treatment was started with Tab. Risedronic acid 35mg orally once every day for two months. Posttreatment scintigraphy showed decreased tracer uptake in the mandible suggestive of good response to treatment [Table/Fig-8]. Patient followed up for more than 20 months successfully. Every six months patient asked for further follow up. [Table/Fig-1]: Pre-treatment frontal photograph showing facial asymmetry [Table/Fig-2]: Pre-treatment Intraoral view showing expanded cortical plates [Table/Fig-3]: Orthopantomogram showing irregular radiolucent areas with inter­spersed radio opacities [Table/Fig-4]: Computerised tomography scan of axial view of mandible showing irregular intra medullary lytic lesion [Table/Fig-5a&b]: Haematoxylin and eosin staining of Biopsy specimen at 10X & 20X magnification showing irregular areas of bone formation respectively [Table/Fig-6a&b]: Microscopic picture of biopsy specimen showing haematoxyphilic reversal lines with fibrous vascular connective tissue. At 10X & 20 X magnification respectively [Table/Fig-7]: Pretreatment bone scintigraphy showing increased tracer uptake [Table/Fig-8]: Post-treatment bone scintigraphy showing reduced tracer uptake PD is disorder of the skeleton results in enlarged & deformed bones. PD showed predilection of male-to-female (3:2) ratio. PD is rare in India, China and Malaysia [1]. Some studies suggested an association of Vitamin D deficiency [2] & viral infection inclusion bodies resembling paramyxovirus nucleocapsid particles in Paget’s osteoclasts [3]. It may present as a coincident with hyperparathyroidism. The bone shows ground glass appearance during early osteolytic stage, later during osteoblastic stage bone gives ‘cotton wool ’ appearance on X-ray film [3]. Pulp chambers of tooth may be calcified, loss of lamina dura and hypercementosis of roots seen [4]. On the other hand during lytic phase of PD root resorption may occur associated with loosening of teeth [5]. Diagnosis is based on clinical, radiographic, bone scintigraphy and histologic features. Deformity involving skull or bowing of long bones which may result in fracture and neurological signs like deafness, cranial nerve palsies and even neoplastic transformation should be examined by plain radiographs [6]. The biochemical values of total plasma alkaline phosphatase activity is elevated in 85% of patients with untreated PD [7] but in our case marginal increase seen. Management mainly aimed at symptomatic (pain control) and specific treatment (Calcitonin, Bisphosphonates). Intravenous bisphosphonates pamidronate, oral alendronate, oral residronate [8] normalize high levels of bone alkaline phosphatase. In our patient residronate 30mg/day for 2months was advised followed by whole body bone scan which showed marked decrease uptake of isotope and biochemical values are within normal limits. Residronate appeared to have excellent safety profile and well-tolerated [8]. PD is considered to be very rare in Indian subcontinent. Its typical clinical features when it involves the maxillofacial region should lead to a high degree of suspicion to arrive at a diagnosis with unknown aetiology. Residronate appeared to have excellent results. Physicians should be aware of the potential for hypocalcemia when patients with polyostotic PD and markedly elevated indicators of bone remodelling are initiated with powerful anti-resorptive therapy.

Central giant cell granuloma of posterior maxilla: first expression of primary hyperparathyroidism.

A case of 19-year-old male patient reported with the chief complaint of slowly growing diffuse painless swelling over the right part of the face from last 6 months. Intraoral examination revealed a swelling on right side of palate in relation to molar region with buccal cortical plate expansion. Radiographic examination (orthopantograph and 3DCT) showed large multilocular radiolucency in right maxilla with generalized loss of lamina dura. Incisional biopsy was done and specimen was sent for histopathological examination which showed multinucleated giant cells containing 15–30 nuclei. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated. Radiographic examination of long bones like humerus and femur, mandible, and skull was also done which showed osteoclastic lesions. Considering the clinical, radiographic, histopathological, and blood investigation findings, final diagnosis of brown tumour of maxilla was made. The patient underwent partial parathyroidectomy under general anaesthesia to control primary hyperparathyroidism. Surgical removal of the bony lesion was done by curettage. The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.

Dentomaxillofacial Radiographic Changes in a Group of Iranian Patients with End Stage Renal Disease Undergoing Hemodialysis

Introduction: This study aims to evaluate the dentomaxillofacial radiographic changes in end stage renal disease (ESRD) patients who were on hemodialysis. Methods: Parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) measurements, as well as Panoramic and periapical radiographs were obtained from seventy four patients with a history of end stage renal disease (ESRD). Results: 74 patients examined with age range of 15 to 68 years, and a mean age of 41.4±14.6 years. The duration of dialysis ranged between 3 to 156 months with a mean duration of 40.4 months. Thinning or loss of lamina dura was observed in 16 patients (51.4%) and calcification of the pulp in 28 patients (40%). Changes in trabecular pattern was observed in 30 patients (40.6%), alterations in jaw bone density in 29 patients (39.2%) and bilateral calcification of stylohyoid ligaments in 13 patients (17.6%). We did not notice any non periapical origin radiolucent lesion. There was a significant relationship between bone trabecular pattern with P level, age and duration of dialysis. Changes in bone density showed significant relationship with frequency and hours of dialysis per week. Conclusion: No correlation was found between the radiographic changes and Ca level. Although changes in trabecular pattern and density were observed mostly in those who were on hemodialysis for a relatively long time, but we could not establish a definitive relation of radiographic manifestations in ESRD patients with the duration and frequency of dialysis.

Brown Tumor of Hyperparathyroidism: Case Report

Brown tumor related to hyperparathyroidism rarely affects facial bones. The oral radiographic manifestations of brown tumor of hyperparathyroidism (BTH) include root resorption and loss of lamina dura. Woman, 39, had swelling of the mandible extending from tooth #43 to #45, leathery consistency, and mobility of the involved teeth. A well-defined radiolucent area, the presence of the lamina dura, and root resorption were found. An incisional biopsy revealed giant cell lesion. It was decided not to explore the mandibular lesion surgically. Blood biochemistry analysis revealed increased parathormone level. The patient was referred for a surgical procedure to remove the parathyroid adenoma. Follow-up at 24 months showed hormonal regulation and regression of the BTH. The treatment in this case was conservative and the lamina dura was not lost. Clinicians should be aware that this unusual finding indicates a rare manifestation of BTH. Acknowledgment: FAPEMIG.

턱관절의 골관절염을 동반한 신성골이영양증 환자 증례보고

신성골이영양증 (Renal osteodystrophy)은 만성 신질환 환자에서 관찰되는 골격성 변화를 특징으로 하는 질환으로 칼슘과 인 대사의 변화, 그리고 이차성 부갑상선 기능항진증의 결과로 나타난다. 방사선학적으로 지골의 말단, 장골과 악골 부위의 골막하 부위의 침식을 흔하게 관찰할 수 있다. 악안면 영역에서 골변화는 골밀도의 감소, 방사선 투과성 병소 (갈색 종양 : brown tumor), 피질골의 비박화와 치조백선의 소실을 보인다. 그러나 이러한 골변화가 악관절에 발생하는 것은 흔치 않은 일이다. 본 증례는 양측 하악 과두의 골변화를 보인 신성골이영양증 환자를 보고하고자 한다. 지난 10년 간 혈액 투석 치료와 3개월 전 신장암 수술 병력이 있는 41세 남자 환자가 좌측 턱의 통증을 주소로 2011년 2월 단국대학교 치과대학부속 치과병원 구강내과에 내원하였다. 양측 악관절의 골관절염과 유사한 방사선학적 소견을 보였고, 전치부 개방교합이 관찰되었다. CBCT를 이용한 방사선학적 특징과 생화학적 지표를 통해 신성골이영양증으로 인한 양측 턱관절의 골관절염으로 진단 되어 환자는 내과에서 신성골이영양증의 치료 방법의 하나인 칼슘 및 비타민 D 복용고 부갑상선 절제술을 시행 받았고, 그 동안 턱관절의 통증 조절을 위해 본원에서는 행동 요법과 약물 치료, 물리치료만 시행하였다. 약 1년 3개월 후 재검사에서 하악골의 골밀도와 피질골 두께가 증가하였고, 하악 과두 외형이 비교적 명확하게 바뀌었다. 골변화는 만성 신장 질환의 초기 단계부터 시작되므로 치과의사는 이러한 질환의 징후 및 가능성을 신속히 감별할 수 있어야 한다. 또한 골관절염과 신성골이영양증의 치료 프로토콜이 다르기 때문에 두 질환을 감별하는 것이 중요하다. Renal osteodystrophy(RO) is characterized by skeletal changes in patients with renal disease and developed as a result of alterations in the metabolism of calcium, phosphate and secondary hyperparathyroidism. Bony changes in the craniofacial region include decreased bone density, radiolucent lesions(brown tumors), depletion of cortical bone and loss of lamina dura, but such changes rarely occur in the temporomandibular joint(TMJ). We report an uncommon case of bony changes and pain of both TMJs in a patient with RO. A 41-year-old man with RO came to our clinic due to TMJ pain and sounds. Occlusal change was also reported. Radiographs revealed degenerative changes of the both condyles. The patient had medical history of renal cancer therapy and hemodialysis. The patient was diagnosed with TMJ arthritis of RO and referred for systemic management through medication of calcium and vitamin D and parathyroidectomy. At 15-month follow-up, most of TMD symptoms disappeared and second radiographs revealed that bone density and cortical thickness of the mandible increased and the skeletal outline of the both condyles became relatively clear. As bony changes may begin in the early stage of the renal disease, dentists should be alert to detect the sign of the disease. In addition, it is important to differentiate TMJ arthritis of systemic cause because the treatment protocol is quite different.

급성림프모구성 백혈병의 조기진단 시 구강병변 양상을 통한 감별의 중요성

Abstract Differential Diagnosis of Oral Lesions for the Initial Diagnosis of Acute Lymphoblastic Leukemia Mi Hyun Seo, Ji Young Ha, Kyung Hoe Huh 1 , Young Ah Cho 2 , Soung Min Kim, Jin Young Choi Departments of Oral and Maxillofacial Surgery, 1 Oral and Maxillofacial Radiology, 2 Oral Pathology, School of Dentistry, Seoul National UniversityCareful examination of the oral cavity may reveal findings indi cative of an underlying systemic condition, and allow for early diagnosis and treatment. Examination should include evaluation for mucosal changes, periodontal inflammation and bleeding, and general condition of the teeth. A 12-year-old man visited f or molar pain during 3 months. He was diagnosed with having a possibility of hematopoietic malignancy, showing the loss of lamina dura, destruction of bony crypt, and high attenuation in the bone marrow. He was referred to department of pediatrics , additional study, including peripheral cell morphology and bone marrow exam, were performed, and diagnosed as acute ly mphoblastic anemia. Despite chemotherapy to cure leukemia, he was expired 8 months after initial diagnosis. The purpose of this report is to promote and evoke the awareness regarding an initial examination of the dentist to make an effort to acqu ire accurate knowledge and information about life-threatening disease in usual dental practice.Key words:Acute leukemia, Dentists, Early diagnosis, Life-threatening dis ease

A comparative study of pulp vitality following vital pulpotomy using calcium hydroxide-based sealants in beagle dogs

Vital pulpotomy is very useful method for disarming of canine tooth, tooth fracture, periodontitis, and malocclusion in veterinary dentistry. And calcium hydroxide is the commonly used material as liner during vital pulpotomy. This creates a mineralized barrier by stimulating osteoblastic hard tissue repair, arrests the inflammatory response, and soothes dentin. However, the powder or mix type calcium hydroxide materials have many disadvantages because of complicating procedure to use and are hard to be handled when vital pulpotomy is followed under general anesthesia in animals. This study was performed to compare the effect of mix and premixed paste type calcium hydroxide as liner on vital pulpotomy. Six beagle dogs had hemisection on mesial root of mandibular first molar and were performed vital pulpotomy on distal root of first molar. On the distal root of left and right mandibular first molar, mix type (DYCAL ® , Dentsply, USA) and premixed paste type calcium hydroxide (VITAPEX ® , Morita, Japan) were used as liner, respectively. The radiological evaluation performed at immediate, 4, 12 and 20 weeks after vital pulpotomy. In results, all teeth had dentinal bridges formed well, there were no periradicular lucency, lamina dura loss and anomalies of pulp cavity. Following this results, on vital pulpotomy in animals, premixed paste type calcium hydroxide was easy to handle and decrease the anesthesia period by more convenient application procedure. Further study is needed for many clinical cases to inspect side effects and other problems.

Oral manifestations associated with systemic complications of prune belly syndrome

Prune belly syndrome (PBS) is a rare congenital malformation of unknown etiology characterized by congenital abnormalities including abdominal wall flaccidity, urinary tract alterations, and bilateral cryptorchidism. The incidence of the syndrome is between 1/35000 and 1/50000 live births and there is little information about the oral findings. The present case describes the oral manifestations of a 15-year-old boy diagnosed with PBS. The findings include enamel hypoplasia associated with generalized hypocalcemic dental lines. In the radiographic exam, pronounced demineralization of the trabecular bone of the jaws, loss of lamina dura in all the teeth, and discontinuity of the mandibular cortical bone were observed. Prune belly syndrome is a rare disease, whose clinical dental aspects are not pathognomonic of the syndrome. The comprehension of the systemic mechanism of PBS and its comorbidities enable an understanding of the systemic etiologic factors associated with oral manifestations.

Oro-mandibular manifestations of primary hyperparathyroidism

To determine the effects of Primary Hyperparathyroidism on oral cavity in a symptomatic contemporary Indian population by taking note of the following parameters: (1) Radiological alteration of lamina dura, (2) mandibular cortical width, (3) prevalence of brown tumor, and (4) mandibular tori. Twenty-six patients of Primary Hyperparathyroidism were examined clinically and radiologically for extra- and intraoral abnormalities. Loss of lamina dura, mandibular cortical width, presence of mandibular tori, and brown tumors were assessed and correlated with serum Calcium, Phosphate, Parathormone, and Alkaline phosphatase. The results were compared with twenty-six age- and gender-matched control subjects. The data was expressed as mean ± SD, and a probability (p) value of < 0.05 was considered significant. Pearson's statistical method was used to assess the significant correlation between radiological measurements and biochemical values. Generalized absence of the lamina dura was the most consistent finding and there was a significant correlation between its loss and altered parathormone, alkaline phosphatase, and inorganic phosphate, but not with serum calcium or the duration of the disease. Mean values (in mm) for the cortical indices were significantly lower in the patients compared to the controls and correlated significantly with parathormone and alkaline phosphatase. None of the patients had mandibular tori and only one patient had a brown tumor. Loss of lamina dura, ground glass appearance, and mandibular cortical width reduction are common findings in primary hyperparathyroidism and these are significantly correlated with elevated parathormone and alkaline phosphatase. However, the presence of brown tumors and oral tori are less commonly encountered features.