Lower Front Teeth Research Articles

Rehabilitation of a Severe Anterior Ridge Defect with a Fixed-Removable Prosthesis

Significant anterior ridge abnormalities might be difficult to restore with prosthesis. To attain good speech and aesthetics necessitate not only the restoration of the missing teeth but also the closure of the problematic region. One recommended treatment option for individuals with substantial ridge abnormalities is the Andrews bridge which is a fixed-removable prosthesis. The prosthesis correctly replaces the missing teeth and corrects the ridge defect area and restore speech and appearance. A 35-year-old female patient reported with the principal complaint of spacing in her lower front teeth and difficulty in phonetics and poor appearance. On clinical examination spacing was seen in the maxillary central incisors along with pro-clination and 31,32,33,41,42,43 teeth were missing and the edentulous defect area was coming under Seibert's Class III category. Rehabilitation of such defect with an Andrews bridge described in this case report, which used natural teeth as abutments for its permanent component and a detachable superstructure.

Minimally invasive teeth whitening enhancements after orthodontic treatment with in-office bleaching: two case reports

Background: Teeth discoloration is one of the adverse effects of orthodontic treatment which causes aesthetic issues that effect on a person’s appearance. The management of teeth discoloration can be done with bleaching because it is easier to perform, faster, more effective, and more conservative than other treatments such as crowns and veneers. There are two types of bleaching techniques supervised by dentists: home bleaching and in-office bleaching. In-office bleaching is one of the most conservative and non-invasive treatment options to restore the aesthetics of discolored teeth. Purpose: This case report observes management of tooth discoloration after orthodontic treatment with in office bleaching using hydrogen peroxide 40%. Case 1: A 24-year-old woman came to Universitas Hasanuddin Dental and Oral Hospital with complaints of yellowish upper and lower teeth after removal of her fixed orthodontic appliance. Case 2: A 24 years old woman came to Universitas Hasanuddin Dental and Oral Hospital with complaints of upper and lower front teeth appearing yellowish in color, noticed from 2 years ago and had undergone orthodontic treatment for four years. Case Management: From clinical examination, both patients’ teeth have no history of caries, sensitive tooth and gingival recession. The Teeth were sensitive to vitality test. The discoloration was treated with external bleaching using 40% hydrogen peroxide. Conclusion: External Bleaching using 40% hydrogen peroxide have results in significant discoloration without changing the shape and arrangement of the patient’s teeth

Treatment of Anterior Crossbite with Inverted Bracket Position, Case Report

Background: Anterior crossbite is an abnormality in the sagittal direction of one or more maxillary anterior teeth against the mandibular teeth. Although the incidence of this case is small, it can cause aesthetic problems, tooth abrasion, caries, gingivitis, bone resorption, and gingival recession. Case Report: A 24-year-old female patient presented with her upper front teeth positioned behind her lower teeth and a noticeable gap between her upper front teeth. She exhibited an anterior crossbite involving teeth 22 to 32, a central diastema, and crowding of the upper and lower front teeth. Treatment was carried out using a fixed orthodontic with an MBT system and the bracket placement of 22 in an inverted position to get a labial torque effect on the roots. Conclusion: The use of pre-adjusted brackets with the MBT system and the placement of the lateral incisive bracket in an inverted position successfully corrected the anterior crossbite in these teeth both at the crown and root without additional wire bending or auxiliary spring.

Challenging pitfalls in frozen section pathology: a case of mandible ghost cell odontogenic carcinoma and the literature review

BackgroundGhost cell odontogenic carcinoma (GCOC) is a rare malignancy characterized by the presence of ghost cells, preferably in the maxilla. Only slightly more than 50 case reports of GCOC have been documented to date. Due to the rarity of this tumor and its nonspecific clinical criteria, there is a heightened risk of misdiagnosis in clinical examination, imaging findings, and pathology interpretation.Case presentationA 50-year-old male patient presented to the hospital due to experiencing pain in his lower front teeth while eating for the past 2 months. Upon examination, a red, hard, painless mass was found in his left lower jaw, measuring approximately 4.0 cm × 3.5 cm. Based on the malignant histological morphology of the tumor and the abundant red-stained keratinized material, the preoperative frozen section pathology misdiagnosed it as squamous cell carcinoma (SCC). The surgical resection specimen pathology via paraffin section revealed that the tumor was characterized by round-like epithelial islands within the fibrous interstitium, accompanied by a large number of ghost cells and some dysplastic dentin with infiltrative growth. The malignant components displayed marked heterogeneity and mitotic activity. Additionally, a calcified cystic tumor component of odontogenic origin was observed. Hemorrhage, necrosis, and calcifications were present, with a foreign body reaction around ghost cells. Immunoreactivity for β-catenin showed strong nuclear positivity in tumor cells, while immunostaining was completely negative for p53. The Ki67 proliferation index was approximately 30–40%. The tumor cells exhibited diffuse CK5/6, p63, and p40 immunoreactivity, with varying immunopositivity for EMA. Furthermore, no BRAFV600E mutation was identified by ARMS-PCR. The final pathology confirmed that the tumor was a mandible GCOC.ConclusionWe have reported and summarized for the first time the specific manifestations of GCOC in frozen section pathology and possible pitfalls in misdiagnosis. We also reviewed and summarized the etiology, pathological features, molecular characteristics, differential diagnosis, imaging features, and current main treatment options for GCOC. Due to its rarity, the diagnosis and treatment of this disease still face certain challenges. A correct understanding of the pathological morphology of GCOC, distinguishing the ghost cells and the secondary stromal reaction around them, is crucial for reducing misdiagnosis rates.

UNILATERAL EXTRACTION

Crowded teeth have a major negative influence on the dentomaxillary system. This article reports the treatment of crowding with unilateral premolar extraction. A 22-year-old male presented with crowding of the upper and lower anterior teeth and bucally placed 13. The patient had chief complaint of irregular upper and lower front teeth. Clinical examination showed a Class I relationship for the teeth and cephalometric measurements showed a Class I skeletal tendency. The right upper and lower first premolar were extracted for anterior crowding correction and segmented T loop was used for canine retraction in right upper arch . It is concluded that upper first premolar extraction is one of the options in the treatment of crowding. Unilateral premolar extraction treatment can be performed to achieve a functionally stable occlusion and aesthetically pleasing appearance of the patient.

Relapse Correction with Removable Orthodontic

Relapse is when the teeth return to the position before orthodontic treatment. The small gaps between teeth often occur due to relapse conditions. A removable appliance is an orthodontic appliance that the patient can remove and insert themselves. This aims to report a relapse case treated using removable orthodontics. The case, A 26-year-old female patient complained of upper front teeth being gapped and lower front teeth being crowded. Previous dental history showed that the teeth had been treated with a fixed orthodontic appliance one year ago with premolar extraction. The patient did not use a retainer. The removable orthodontic appliance used was an active plate that retracted the maxillary anterior teeth using a labial bow. Orthodontic relapse can occur due to incomplete remodelling. Retraction using a labial bow can close the anterior teeth palatally. Active plates can be used as an alternative treatment in mild cases of relapse after fixed orthodontic treatment

Treatment of Tooth Relapse Using Removable Orthodontics Appliances

At present, fixed orthodontic appliances treatment is extensively utilized with excellent outcome. Nevertheless, complications frequently arise following the conclusion of orthodontic treatment, predominanly relapse. Relapse refers to repositioning teeth to their pre-treatment state; its progression is stochastic, thereby rendering relapse possible for each individual. Patients who fail to wear retainers consistently will relapse of the affected teeth after orthodontic treatment. Therefore, this case report details the successful treatment of tooth relapse with a removable orthodontic appliance. A 22-year-old female patient complained of irregular alignment of her lower front teeth. The patient received two years of treatment with fixed orthodontics; however, she ceased using retainers regularly after treatment concluded. An objective examination indicated that the teeth in the upper jaw teeth remain in a well-aligned position; however, the lower jaw exhibited that tooth 32 was mesiolabiotorsiversion, tooth 33 was distolinguotorsiversion, tooth 41 was labioversion, tooth 42 was mesiolinguotorsiversion, with an overjet of 3 mm and an overbite of 2 mm. Afterward, the malposition of the lower jaw teeth was corrected with an expansion plate for a removable orthodontic appliance. Following 20 follow-up treatments over five months, the malposition of the lower jaw teeth has been corrected. As a result, it can be deduced that removable orthodontic appliances continue to be efficacious in rectifying mild malposition caused by dental relapse, thereby obviating patients' need to reapply costly fixed orthodontic appliances.

Class III malocclusion: Insights and current perspectives

Class III malocclusion is a complex orthodontic challenge characterized by the lower front teeth being positioned ahead of the upper front teeth, often resulting in functional and social difficulties. This review explores the etiology, classification, diagnosis, and treatment options for Class III malocclusion, emphasizing the genetic inheritance and skeletal growth patterns that influence its manifestation. Orthopedic appliances and orthognathic surgery are key treatment approaches, with early intervention favored to optimize outcomes. This article also discusses the role of temporary anchorage devices in treatment, retention protocols, and the importance of long-term follow-up to ensure stability and patient satisfaction. Advances in orthodontic technology and ongoing research into the genetic basis of Class III malocclusion promise continued improvements in treatment strategies, offering more predictable and patient-centered care.

TREATMENT OF SEVERE CROWDING WITH SELF-LIGATING FIXED ORTHODONTIC APPLIANCE

Introduction: Crowding in orthodontics presents a discrepancy between tooth size and dental arch length. Crowding of teeth is more often diagnosed in mandibular dental arch. Crowding was classified as moderate (-5.1 mm or more of discrepancy), mild (-0.1 and -5 mm) of discrepancy, and no crowding (zero or a positive discrepancy) by W. Proffit. Over the last few years, the use of self-ligating brackets in orthodontics has progressed considerably. According to some authors, selfigating appliances are more ef- fective in treating moderate crowding. Aim: To present the treatment of cevere crowing of both dental arches without premolar extractions, using self-ligating fixed orthodontic appliance. Material and method: Male patient 12 years old was diagnosed with severe crowding in both upper and lower dental arches. Study cast analysis showed severe crowding of 8 mm in the upper and 9 mm in the lower dental arch with dental class I. Lateral cephalometric analysis showed slight mandibular retrogna- thism (SNB 78°) with skeletal class I (ANB 4°). There were no significant vertical skeletal deviations (SpP/ MP 20°, Bjork’s sum 389°, Jarabak 67,7%). Both upper and lower central incisors were retroinclined (I/SpP 102°, IMPA 95°). There were no deviations in maxillar corpus and mandibular corpus and ramus length. Treatment with self-ligating fixed orthodontic appliance was indicated. The active phase of the treatment lasted 26 months. During the treatment, interproximal reduction (IPR) was performed on upper and lower front teeth. Results and conclussion: Stable class I occlusion was acheieved. Both upper and lower dental arches were slightly expanded. Severe crowding was treated successfully Treatment result was stable, with no signs of relapse, with the overjet of 2 mm and overbite of 3 mm. Severe crowding in young patients can be succsess- fully treated without extractions with self-ligating fixed orthodontic appliance in cases of horizontal growth pattern ,with retroinclined upper and lower incisors.

Anterior Open Bite Malocclusion: From Clinical Treatment Strategies towards the Dissection of the Genetic Bases of the Disease Using Human and Collaborative Cross Mice Cohorts.

Anterior open bite malocclusion is a complex dental condition characterized by a lack of contact or overlap between the upper and lower front teeth. It can lead to difficulties with speech, chewing, and biting. Its etiology is multifactorial, involving a combination of genetic, environmental, and developmental factors. Genetic studies have identified specific genes and signaling pathways involved in jaw growth, tooth eruption, and dental occlusion that may contribute to open bite development. Understanding the genetic and epigenetic factors contributing to skeletal open bite is crucial for developing effective prevention and treatment strategies. A thorough manual search was undertaken along with searches on PubMed, Scopus, Science Direct, and Web of Science for relevant studies published before June 2022. RCTs (clinical trials) and subsequent observational studies comprised the included studies. Orthodontic treatment is the primary approach for managing open bites, often involving braces, clear aligners, or other orthodontic appliances. In addition to orthodontic interventions, adjuvant therapies such as speech therapy and/or physiotherapy may be necessary. In some cases, surgical interventions may be necessary to correct underlying skeletal issues. Advancements in technology, such as 3D printing and computer-assisted design and manufacturing, have improved treatment precision and efficiency. Genetic research using animal models, such as the Collaborative Cross mouse population, offers insights into the genetic components of open bite and potential therapeutic targets. Identifying the underlying genetic factors and understanding their mechanisms can lead to the development of more precise treatments and preventive strategies for open bite. Here, we propose to perform human research using mouse models to generate debatable results. We anticipate that a genome-wide association study (GWAS) search for significant genes and their modifiers, an epigenetics-wide association study (EWAS), RNA-seq analysis, the integration of GWAS and expression-quantitative trait loci (eQTL), and micro-, small-, and long noncoding RNA analysis in tissues associated with open bite in humans and mice will uncover novel genes and genetic factors influencing this phenotype.

Treatment of an adolescent patient with class ii division 1 malocclusion by extraction and forsus fatigue resistant device: Case report

Treatment of a patient presenting with Class II malocclusion requires careful diagnosis and treatment planning to resolve esthetic, occlusal, and functional problems. Over the decades numerous treatment options have been presented to treat class II malocclusions. Orthodontic camouflage being a cost-effective, non-surgical treatment option has been well accepted by patients to mask their underlying skeletal discrepancy, while providing acceptable facial esthetics and occlusion.This case report presents the treatment by four first premolar extractions followed by Forsus Fatigue Resistant Device (FFRD) therapy in a 14 years old female patient with skeletal Class II base due to the retrognathic mandible, proclined upper and lower front teeth with an overjet of 5 mm, and unwilling for surgery in the future.After undergoing the treatment, an optimal static and functional occlusion was attained, yielding a favorable outcome.

Comprehensive Deciphering the Complexity of the Deep Bite: Insight from Animal Model to Human Subjects.

Deep bite is a malocclusion phenotype, defined as the misalignment in the vertical dimension of teeth and jaws and characterized by excessive overlap of the upper front teeth over the lower front teeth. Numerous factors, including genetics, environmental factors, and behavioral ones, might contribute to deep bite. In this study, we discuss the current clinical treatment strategies for deep bite, summarize the already published findings of genetic analysis associated with this complex phenotype, and their constraints. Finally, we propose a comprehensive roadmap to facilitate investigations for determining the genetic bases of this complex phenotype development. Initially, human deep bite phenotype, genetics of human deep bite, the prevalence of human deep bite, diagnosis, and treatment of human deep bite were the search terms for published publications. Here, we discuss these findings and their limitations and our view on future strategies for studying the genetic bases of this complex phenotype. New preventative and treatment methods for this widespread dental issue can be developed with the help of an understanding of the genetic and epigenetic variables that influence malocclusion. Additionally, malocclusion treatment may benefit from technological developments like 3D printing and computer-aided design and manufacture (CAD/CAM). These technologies enable the development of personalized surgical and orthodontic guidelines, enhancing the accuracy and effectiveness of treatment. Overall, the most significant results for the patient can only be achieved with a customized treatment plan created by an experienced orthodontic professional. To design a plan that meets the patient's specific requirements and expectations, open communication between the patient and the orthodontist is essential. Here, we propose to conduct a genome-wide association study (GWAS), RNAseq analysis, integrating GWAS and expression quantitative trait loci (eQTL), micro and small RNA, and long noncoding RNA analysis in tissues associated with deep bite malocclusion in human, and complement it by the same approaches in the collaborative cross (CC) mouse model which offer a novel platform for identifying genetic factors as a cause of deep bite in mice, and subsequently can then be translated to humans. An additional direct outcome of this study is discovering novel genetic elements to advance our knowledge of how this malocclusion phenotype develops and open the venue for early identification of patients carrying the susceptible genetic factors so that we can offer early prevention and treatment strategies, a step towards applying a personalized medicine approach.

Assessment of oral tissue alterations in patients diagnosed with SARS-CoV-2.

The aim of this study was to investigate oral mucosal changes in patients with confirmed moderate-scale severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed 85 COVID-19 patients (50 males, 35 females) with an average age of 53.6 years, treated at the prehospital infectious disease center and Aldent University Clinic in Tirana, Albania, from May 2021 to June 2022. Elevated C-reactive protein levels were observed in 82 patients (±44.20), with 20 patients showing significant fibrinogen increase (mean ± 5.85 g/L), and 22 patients having elevated D-Dimer (mean ± 336.6 mg/mL). Despite the absence of anticoagulant history, 13 patients exhibited bleeding. Xerodermia, xerostomia, and angular cheilitis were noted, with 41 patients displaying angular cheilitis. In 82 patients, oral mucosal and tongue examinations revealed color changes from white to bright yellow, with brown edema. Pigmentation in the fixed gingiva of upper and lower front teeth was observed in 35 patients. Oral mucosal changes during COVID-19 appear more influenced by drug treatment and disease progression than the infection itself, suggesting that secondary factors play a significant role. Despite the oral cavity's potential for viral entry, these changes seem connected to other underlying causes.

Depigmentasi Gingiva Menggunakan Teknik Bedah Scalpel pada Pasien dengan Hiperpigmentasi Gingiva : Sebuah Laporan Kasus

Background: Gingival hyperpigmentation is a physiological pigmentation genetically, appearing with brown to black pigment on the gingiva and oral mucosa which is an aesthetic problem for patients. Purpose: This case report aims to discuss gingival depigmentation procedure using scalpel surgical techniques in patients with gingival hyperpigmentation. Case presentation: A 27-year-old female patient reported brown discoloration on the gums of her upper and lower front teeth which she had noticed ten years ago. Gingival depigmentation using scalpel surgical technique is performed to remove the pigment. Conclusion: Gingival hyperpigmentation is an aesthetic problem that is of concern to patients and requires surgical intervention to remove the pigment, one of them are gingival depigmentation with a scalpel surgery.
 Keywords: gingival depigmentation, gingival hyperpigmentation, scalpel surgery

Prosthodontic management for loss of periodontal support in the anterior region with a lower immediate denture

An immediate denture is a denture that could replace the teeth immediately after the teeth are extracted. Therefore patient doesn’t experience an edentulous period. This study aims to assess the ability of lower immediate removable partial dentures as a prosthodontic treatment for cases in which anterior teeth have lost their periodontal support. A 35-year-old male patient complained of difficulty eating because his lower front teeth were loose, and the patient did not want to appear edentulous. Intraoral examination showed grade 3 mobility in the lower anterior teeth region. Case management involves anamnesis, clinical examination, and prosthodontics rehabilitation using lower immediate removable partial dentures. This case report concludes that immediate removable partial dentures can be used in anterior teeth that have lost periodontal support.

Conservative Management of a Case of Lateral Periodontal Cyst Mimicking a Periodontal Abscess

Abstract Lateral periodontal cyst (LPC) is a relatively uncommon, usually asymptomatic developmental odontogenic cyst occurring on the lateral aspect of a vital tooth. The present case reports one such lesion. The patient had pain in gums along lower front teeth with occasional pus discharge since two month. Lingually, the tooth 41 had a periodontal pocket of 6 mm. It was vital and grade II mobile. The distinct radiographic picture changed the management plan. The radiograph showed a distinct well defined radiolucency on the middle third portion of the root. A provisional diagnosis of LPC was made. Conservative surgical curettage and enucleation of the cyst was performed under local anesthesia. Autogenous bone graft was harvested from the parasymphyseal region and placed in the defect. Lower anterior teeth were splinted and periodontal dressing was placed. Histopathological report was suggestive of a developmental odontogenic cyst. The patient is regularly followed up with no recurrence yet and an improving bone-fill of the defect. The case could have been easily misdiagnosed and managed as an abscess draining through the periodontal pocket. A seemingly routine case was managed conservatively after proper diagnosis by thorough clinical, radiographic, and histopathological examination improving the prognosis of the involved tooth.

THE COLOBOMAEYE SYNDROME - A RARE CASEREPORT

The COLOMBOMA EYE which means a lash less eye becomes one of the striking features of a rare disorder called TREACHER COLLINS SYNDROME. It may be a condition that affects the development of facial bonesand other tissues of the face. This condition features a wide range of signs and symptoms,from hardly perceptible to severe. Treacher Collins syndrome also called as Franceschettisyndrome is an autosomal dominant disorder of craniofacial development with variableexpressivity. Its named after E Treacher Collins who described the essential components ofthe condition in 1900. It is caused by the mutation of particular gene of which 81-90% of cause will be due to the mutation of TCOF1 gene. Incidence of this syndrome is approximately one in fifty thousandlive births and it affects both genders equally. It affects structures which are derivatives of theprimary and second brachial arches. The foremost common manifestations of TCS are theantimongloid slanting of the palpebral fissures, colobomas of the lower eyelid, hypoplasia ofzygoma and mandible and a spread of ear abnormalities. People with Treacher Collinssyndrome usually have normal intelligence.This article describes clinical and radiographicfeatures of TCS in a 29 yr old male who had reported to the department of Oral Medicineand Radiology with the complaint of forwardly placed upper and lower front teeth since birth.Alsopathogenesis, diagnostic procedure, diagnosis based onscore, management andpreventive aspects are discussed.

VERBAL MOTIVATION: OPTIONS FOR PREVENTING DENTOFACIAL MALOCCLUSIONS AT THE AGE OF GROWTH

Good communication between dentists and patients will create success in the patient care process and help patients to improve their understanding of medical information, perceptions, and expectations. Interpersonal relationships between children, parents, and operators (Dentists), are part of the basic pattern of behavior management or orthodontic treatment in children. Treatment of anterior crossbite in mixed dentition is highly recommended because this malocclusion cannot be corrected with growth or age. Case Report: A 9-year-old child came with a complaint that her right upper front tooth was growing behind her lower front teeth, so she felt insecure when smiling and uncomfortable when biting. The patient's mother and the patient want a treatment that can return the teeth into a good and normal position. The patient had no history of disease either in childhood or at present. Dental history such as normal tooth eruption, premature loss, and dental trauma was denied but the patient stated that the permanent teeth had grown before the baby teeth fell out. The patient has no bad habits. In this case, education was carried out to the patient and his mother regarding the use of a tongue blade to push tooth 11 toward the labial direction to correct the palatoverted tooth 11. Conclusion: Cases of anterior crossbite in permanent teeth are quite common in children who are growing and developing, so early treatment to stimulate growth balance and occlusal development is needed to modify the growth direction to prevent further malocclusion.

Non-extraction orthodontic treatment in a patient with severe anterior crowding

A 12 years 6 months old Indian male presented with a chief complaint of irregular upper and lower front teeth. Patient exhibited a mild convex profile on Class l skeletal base with slightly decreased vertical proportions. This was complicated by severe upper and lower labial segment crowding. Also the molar relationship was half unit class ll bilaterally. Since the patient did not want to go for extraction of premolars, treatment involved use of Pendulum appliance along with upper and lower pre-adjusted edgewise appliance (0.022x0.028” slot) with MBT prescription. Various elastics and overlay wires were used along with proximal stripping for the correction of severe crowding in upper and lower anterior teeth.: Clinically Angle’s Class I occlusion was achieved bilaterally with good intercuspal relationship. Vertical growth continued throughout the treatment.

Hereditary Sensory and Autonomic Neuropathy Type VIII: Congenital Insensitivity to Pain with Anhidrosis.

Hereditary sensory autonomic neuropathy type VIII (HSAN VIII) is a rare genetic disorder that characterized by insensitivity to pain, anhidrosis, self-mutilation, and absence of corneal reflex. We here report a 2-year-old female child presented with corneal opacity and was diagnosed HSAN VIII by its typical clinical features confirmed by gene analysis revealing the presence of homozygous mutation in the PRDM12 gene. Case Summary A 2-year-old female child was presented with complaint of corneal opacity in both eyes noticed 4 months ago [Figure 1a]. The mother also complained of missing both upper and lower front teeth [Figure 1b]. Frequent history of trauma either unknown or self-mutilated without any sign of discomfort was revealed. No lacrimation during cry, lack of sweating with dry skin, and recurrent episodes of unexplained fever were also noticed [Figure 1c]. She was the only child of consanguineous marriage with no similar disease in the family. General examination revealed evidence of mutilation such as multiple scars, well-defined nontender ulcers over face and limbs, and shortening of distal phalanges [Figure 1d-f]. Ocular examination showed absence of corneal sensation with corneal scar. Neurologic examination found generalized absence of pain and temperature perception with loss of reflexes. Gene analysis revealed the presence of homozygous mutation in the PRDM12 gene confirming the diagnosis of HSAN VIII.Figure 1: Composite picture depicting various manifestations of a child with hereditary sensory and autonomic neuropathy type VIII: (a) bilateral corneal scarring, (b) missing upper and lower front teeth, (c) dry skin, (d) painless ulcer on the right ankle, and (e and f) mutilated distal phalanges of hand and feetHSAN type VIII comprises a group of genetic disorders involving sensory and autonomic dysfunctions, described as a rare autosomal recessive disorder caused by homozygous mutation in the PRDM12 gene on chromosome 9q34.[12] It is characterized by insensitivity to pain and thermal stimuli, altered sweat and tear formation, self-mutilation behavior, absence of the corneal reflex resulting in corneal scarring and presence of repeated infections of the skin and bone that are also common [Table 1].[34] The diagnosis of HSAN is challenging due to its rarity and lack of simple diagnostic tests. The affected persons are vulnerable to severe complications and self-mutilation. Therefore, early identification and appropriate management are necessary to avoid severe injuries and its consequences.[5]Table 1: Reported cases of hereditary sensory autonomic neuropathy type VIII (HSAN VIII)Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.