Normal Dentition Research Articles

Overview of Diagnosis, Management of Mesiodens and Its Impact on Children – A Series of Case Report

Supernumerary teeth are a developmental anomaly having extra teeth in addition to the normal dentition. Mesiodens is a supernumerary tooth present in the midline between the two central incisors. It usually results in oral problems such as malocclusion, food impaction, poor aesthetics, and cyst formation. Malocclusion due to mesiodens has also physical, psychological, and social effects on Quality of Life (QoL). The present overview and series of case reports describes cases of surgical removal of supernumerary teeth (mesiodens) which were detected on clinical or radiographic examination. The article highlights the psychological and social impact of supernumerary tooth on the oral health-related quality of life and need for regular follow-up of permanent teeth eruption in young children.

Non-syndromic supernumerary fourth molar: A report of two cases and review of literature

Background: Supernumerary teeth are excess teeth found in a normal dentition, with a prevalence of 0.1‒3.8% in the permanent dentition and 0.3‒0.6% in the primary dentition. This case series presents two non-syndromic supernumerary fourth molar cases in two male and female patients. Case Report: This study describes two rare supernumerary fourth molar cases. Both cases were asymptomatic and impacted in the maxillary arch. A routine panoramic radiograph revealed the presence of them for the first time. The medical and familial records of the patients were non-contributory, with no abnormalities in the extraoral examination. Conclusion: Well-developed, impacted supernumerary teeth are rare occurrences in individuals with no concurrent diseases or syndromes. Dental practitioners should know the different types of supernumerary teeth and manage them according to their type and possible complications.

3D Printer-Assisted Layered Fabrication of a Novel Appliance for Oral Myofunctional Therapy and Functional Evaluation of Its Effects on Orofacial Muscles During Wear.

Aim Balanced function of the orofacial muscles is important for normal occlusion and dentition; however, patients with malocclusion often present with myofunctional disorder (MFD). Myofunctional therapy (MFT) has received much attention as a method for reducing MFD. Moreover, prefabricated functional appliances (PFAs) have been developed as a method to eliminate abnormal muscle pressure and guide the tongue into the correct position. However, PFAs have disadvantages, such as poor intraoral retention, limited usage time due to discomfort and poor patient compliance, and changes in the axis of the mandibular anterior teeth.Therefore, this study aimed to develop a new custom-made splint-type orthodontic appliance with CAD/CAM technology. Moreover, we evaluated the characteristics of the appliance and conducted functional tests to determine the effects of the appliance on the orofacial muscles and the discomfort associated with its use. Materials and methods Twenty-five volunteers (nine females and 16 males; mean age 28.4 ± 3.4 years) with normal swallowing function were included in the study. Lip-closing strength (LCS), electromyogramduring swallowing, oxygen saturation, and pulse rate were measured and compared when the appliance was not worn and when it was worn. In addition, tongue habits were evaluated, and the maximum tongue pressure was measured when the appliance was not worn. The subjects were asked to answer a questionnaire using a numerical rating scale (NRS) regarding discomfort when wearing the appliance. The evaluation items were swallowing difficulty, speaking difficulty, and breathlessness, which were rated on an 11-point scale ranging from 0 to 10. Statistical tests were conducted using IBM SPSS version 28.0.1 (IBM, Armonk, NY, USA) with the Shapiro-Wilk and Levene's test, followed by the Wilcoxon signed rank sum test. The significance level was set at α = 0.05. The measurement error for each measurement item was evaluated using an intraclass correlation coefficient. Results A new custom-made splint-type orthodontic appliance was fabricated for each subject. The fit and retention of the appliance in the mouth were good when fitted, and a comparison of the functional test measurements of 25 subjects with and without the appliance showed that the LCS decreased significantly (p<0.05) before and after wearing the appliance. However, no statistically significant differences were found for the other items. The Mann-Whitney U test regarding the effects of sex, previous orthodontic treatment, or MFT, and oral habits did not statistically significantly influence the effects of wearing the device. In the NRS results, "difficulty swallowing" was observed in half of the subjects, "difficulty breathing" was rarely observed, and "difficulty speaking" was observed in all subjects. Conclusions A novel custom-made splint-type orthodontic appliance was designed and fabricated using digital workflow and 3D printing technology. This appliance was designed to correct oral habits and was made from a new material classified as a class II medical appliance according to the international harmonized classification.

Congenital Hematological and Metabolic Disorders Causing Intrinsic Discoloration of Pediatric Dentition at Pre-Eruptive Stage

The current review assesses the literature and depicts the hematological and metabolic diseases of newborns resulting in intrinsic stains of primary dentition. The appearance of dentition is an esthetic concern to the child as well as to the caregivers. The correct diagnosis claims prime importance to the dentist as it has profound value in deciding the appropriate treatment protocol and describing it to the patient. The review describes the hematological and metabolic diseases of newborns which can affect the color of normal pediatric dentition. Erythroblastosis fetalis, icterus gravis neonatorum, congenital erythropoietic porphyria, thalassemia, sickle cell anemia, and alkaptonuria are found to have a definite impact on the intrinsic discoloration of deciduous teeth. The article is an overview of those congenital hematological and metabolic disorders and their direct and indirect effects on primary dentition at the pre-eruptive stage resulting in discoloration.

Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 1: epidemiology, etiology, classification and associated complications

Supernumerary teeth develop in addition to the normal dentition and are a therapeutic challenge for pedodontists, orthodontists and oral surgeons alike. Therefore, interdisciplinary treatment concepts are needed for the benefit of the patient. In the present, two-parted literature review on supernumerary teeth, current classification, associated complications, diagnostic steps and different therapeutic approches are presented and discussed. Supernumerary teeth are diagnosed in the primary and permanent dentition. Supernumerary incisors, canines, premolars, and molars, as well as distomolars and mesiodentes can be seen according to the location of the supernumerary teeth. Furthermore, based on the morphology of the supernumeraries four different types can be differentiated: conical, tuberculate, supplemental, and odontoma. Supernumerary teeth often remain asymptomatic, and are only diagnosed incidentally during a routine dental visit on radiographs (often intraoral). Nevertheless, various complications have been reported in the literature for supernumerary teeth such as disturbed eruption, malpositioning/rotation, root resorption of neighbouring teeth, and development of dentigerous cysts in impacted supernumeraries. Root resorption of neighbouring teeth can be radiographically diagnosed in up to 22.8% of the cases.

THU435 Atypical Femur Fractures In Antiresorptive- Therapy-naïve Patient Underscores Knowledge Gaps

Abstract Disclosure: T.L. Cater: None. M. Styner: None. Atypical femur fractures (AFF), so-named due to an unusual diaphyseal location, have been linked to antiresorptives (AR), though this remains unclear. AFF case reports are vital due to a lack of certainty about pathogenic mediators and management. Case: A 52-yr-old-female presented with symptomatic T6/T7/T8 compression sustained while raking acorns. Ten years prior, bilateral knee/thigh pain developed; X-ray showed mild arthritis; bone scan noted slight activity in lateral femoral cortices with later X-ray read as negative for fracture; DEXA indicated lowest T of −1.5 in the spine. She was managed with PT and bracing. Medical history included hip dysplasia s/p casting, endometriosis, infertility, hypothyroidism, and 2 full-term NSVD in her late 30s. She worked as an administrator before becoming a stay-at-home mom and denied alcohol or tobacco use. Family history was notable for hip fracture (mother) and hypermobility termed as Ehlers-Danlos (son). After thoracic healing, at 53, she was referred to endocrinology; exam showed Ht 69 in (175 cm), Wt 185 lb (83 kg), normal dentition, mild thoracic kyphosis without tenderness. Labs indicated normal Ca, Mg, PO4, Creat, 25(OH)D, Alk Phos, and SPEP. She was current on cancer screening including mammograms. She declined osteoporosis therapy, wishing to work on lifestyle, yet, when she returned to our clinic at 55, after new compression (T11/T12/L1), she was amenable to begin abaloparatide. Despite the anabolic, new L2/L3 fracture arose and thigh pain advanced. Genetic Invitae OI/bone fragility panel was negative for causal variants in 46 genes. DEXA showed 20% improved spine BMD: 5-15% in other sites. After 2 years of abaloparatide and 4 months after one-time dose of denosumab, a new L4 deformity arose, and thigh pain remained. She reported legs were giving way under her, prompting X-rays, which were concerning for bilateral AFF (confirmed with bone scan, MRI). In lieu of a 2nd dose of denosumab, romosozumab was started and she was promptly scheduled for prophylactic, orthopedic femoral nailing. Conclusions: This bisphosphonate-naïve-female began experiencing symptoms of AFF &amp;gt;5 years prior to presentation, concomitant with spine fragility. Skeletal deterioration occurred in absence of, as well as contemporaneous with, osteoporosis therapies, anabolic as well as one dose of AR despite improved BMD via DEXA. Her personal history of hip dysplasia might supply clues about geometry that favors AFF as her family history. Notably, long-standing discomfort in the thighs persisted and progressed during anabolic therapy. More research is needed to understand AFF pathogenesis, and this might also shed light on other severe forms of early bone fragility, as demonstrated herein. Our case also highlights a multi-year, sub-clinical period in which fragility progresses until a clinical diagnosis is reached, as well as the clinical conundrum of AFF management. Presentation: Thursday, June 15, 2023

Impacted Supernumerary Mandibular ‘Distomolar’ – An unique identification Tool in Forensic Crime Investigation

A supernumerary tooth is an odonto-stomatologic anomaly which is characterized by an excess number of teeth that are present compared to what is expected in the normal dentition. The prevalence rates of supernumerary teeth, reported in literature, varybetween 0.1% to 3.8% of the general population, and are seen more commonly in the permanent dentition. Due to this rarity,supernumerary teeth can be a useful tool in forensic odontology particularly focusing on identification and sorting of individuals both clinically and radiological assessment in forensic evaluation.

Correlation of the Stature with Arch and Chord Dimensions in Young Subjects using Carrea's Index- An Anthropometric Study.

Forensic identifications have utilized the height or stature of an individual in their field. Teeth and dentition can act as reliable tools to estimate the stature in cases where the only skull is presented as evidence. The Carrea's index assesses the stature in a subject from the lower anterior teeth dimensions. The present study was aimed to judge the reliability of Carrea's index in Indian subjects. From 80 subjects who were undergraduate students, plaster models were made and each was assessed individually making 160 hemiarches. These hemiarches were divided based on the teeth alignment into normal, diastema, and crowded forms. This was followed by measurement with a vernier caliper into chord and arch. In both genders, the difference seen was statistically significant between dental arch types concerning various alignments with 95.23% and 83.75% success for males and females in normal dentition and 92.30% and 85.71% in crowded dentition. Also, a significant difference was seen for the type of arch with P ≤ 0.001 and 0.003, respectively. Lesser success was seen for spacing in both the genders and arches. The present study concludes that Carrea's index is a dependable and efficient tool for estimating height in subjects having arches with crowded and normal dentition which is functional for both the gender on the left and right side of the dental arches. However, in hemiarches with diastema, this method is not reliable.

Morphological and radiological mapping of dental cusps in relation to spatial constraints on tooth shape of one-humped camel (Camelus dromedarius)

A significant number of researches in veterinary study have been focused on dental structure; however, there are few on the orientation and identification of their cusps. Therefore, the present article aimed to spotlight the arrangement pattern of dental cusps in the camel as a folivorous and graminivorous animal. This study was conducted on eight heads of adult, healthy camels of both sexes, collected from slaughter houses. To determine the exact orientation of cusps of molar teeth, additional radiological and CT scans were performed on the mandible as a landmark that should facilitate the reading of the cusps map. It was evident that the cusps are arranged in crescentic appearance, selenodontal form, with two cusps on each side, paracone and hypocone on the lingual surface and protocone and metacone on the vestibular aspect. Thus, camels cannot wear bite like equines, which would interfere with their constant chewing method. The camels’ dental cusps provide some of the finest examples of convergent evolution, which offer insights both into correlates between form and function, and into the ability of euthomorphic cusps in intrapability and stabilization of food items and their comminution between formidable cusps and occlusal spillway in between. Further studies should be done on the brachydont teeth and tropospheric cusps to fill the functional anatomy gap of teeth, in addition to diversity of cusps form. This study is considered a basic comparative anatomical study for normal healthy dentition and forensic practice, in addition to its importance in detection of more local aspects of dental problems in camels.

Supernumerary Maxillary Canine along with Transposition: A Case Report

Introduction: Tooth transposition is considered as the anomaly of tooth position in two adjacent teeth; the most frequent locations include canine and first maxillary premolar. Transposition may happen along with hypodontia, supernumerary teeth, or the persistence of a deciduous predecessor. Supernumerary teeth are considered as the teeth in excess of the normal dentition. Supernumerary teeth can happen in any region of the dental arch. Nevertheless, having supernumerary tooth accompanied by transpositions in the canine area is a rare condition. The aim of this report was introducing a patient with supernumerary maxillary canine along with transposition. A 14-year-old boy without any skeletal, systemic, metabolic and mental problems was referred to the Orthodontic Department of Yazd Dental School, Yazd, Iran. In the clinical study of displacement of the upper canine in the anterior region of the upper jaw, which has led to crowding and buccal protrusion of the main canine of the upper jaw. This supernumerary canine tooth with displacement was discovered based on routine radiological examinations.&#x0D; Conclusion: The presence of a supernumerary tooth with transposition usually causes occlusion and functional problems in patients. In these cases, a complete clinical and radiographic examination along with a detailed history should be done in order to plan the appropriate surgical, orthodontic, and restorative treatment plan. Early detection is essential to prevent these problems.

A Comparative Analysis Of Depth of Curve Of Spee Between Individuals with Normal Dentition And Individuals With Occlusally Worn Out Dentition

Introduction: The curve of spee plays an important role to create Christensen’s phenomenon in natural dentition. This study was performed to assess the difference in depth of the curve of Spee between normal and attrited dentition.&#x0D; Methods: An analytical cross-sectional study was performed to measure the depth of curve speed in a total of 80 willing participants who met the inclusion criteria, of which 40 had normal dentition and 40 had attrited dentition. Measurements were done on stone casts by using a rigid metal scale and a digital vernier caliper. Analytical statistical analysis (independent t-test) was done using SPSS Statistical Software Package (version 21.0).&#x0D; Results: There was a statistically significant difference in the depth of the curve of Spee between the two groups.&#x0D; Conclusions: The depth of the curve of spee decreases with the advancing of the age of human as attrition of the teeth occurs with age. Although there is a decrease in the depth of the curve of spee it should be maintained and created while performing full mouth rehabilitation and other extensive prosthodontic treatments.

Sürnümerer Diş Gözlenen Çocuklarda Diş Gelişiminin Değerlendirilmesi: Olgu Kontrol Araştırması

Objective: The term supernumerary tooth is one of the important dental anomalies affecting children and is used to describe excess teeth in the dental arch. Knowledge of changes in tooth development accompanying supernumerary teeth provides information about both orthodontic problems and changes in bone and teeth. This study aims to evaluate the relationship between the presence of supernumerary teeth and dental development in children and to raise awareness about the conditions associated with the presence of supernumerary teeth. Material and Methods: 175 (114 males and 61 females) children with supernumerary teeth were examined and compared to 175 normal control subjects matched for sex and age. Dental development was evaluated from panoramic radiographs using the dental age estimation method of Demirjian et al. Data were statistically analyzed using the Shapiro-Wilk test. Results: Significant differences were found in the mean of dental age and chronological age difference between case controls and children with supernumerary teeth (0.4±0.7 and 0.8±0.7 years, respectively). The mean differences between dental age and chronological age in hyperdontic males and females were 0.77±0.7 years and 0.96±0.7 years, respectively, and the results of the controls were 0.39±0.7 for males and 0.47±0.8 years for females. The differences between the hyperdontic and control groups were significant for both genders (p<0.001). Conclusion: Children with supernumerary teeth appear to have advanced dental development compared to children with normal dentition. The presence of supernumerary teeth in children is a condition that affects dental development.

Evaluation of the proximal contact and comparison of methods for measuring in normal dentition

Evaluation of the proximal contact and comparison of methods for measuring in normal dentition

Prevalence of canine impaction in the western province of Saudi Arabia: A cross-sectional survey.

Canine tooth impaction could have a negative influence on the stomatognathic system and could make it difficult for clinicians to manage malocclusions. The aim of this retrospective study was to investigate the prevalence of canine impaction, which could be a cause of malocclusion, in the population in the western province of Saudi Arabia. A retrospective analysis of digital orthopantomograms (OPGs) of 400 patients aged 12-40 years, who are citizens of Saudi Arabia residing in the western province and who presented for treatment at the dental clinics of Batterjee Medical College, Jeddah, Saudi Arabia were included. The OPGs and dental records of these patients were reviewed for canine impaction and were categorized based on age, gender, and type of impaction. The prevalence of patients that exhibited canine impaction was found to be 4%. Males had a significantly higher percentage of prevalence than females (P < 0.016), and impaction was significantly higher among patients aged below 18 years (P < 0.001). Moreover, the most commonly observed impaction was mandibular canine impaction (87.5%). Prevention of malocclusion and maintenance of a normal dentition (better aesthetics and chewing) necessitates early detection of impacted canines.

Stress Reduction Effects during Block-Tapping Task of Jaw in Healthy Participants: Functional Near-Infrared Spectroscopy (fNIRS) Measurements of Prefrontal Cortex Activity.

The purpose of this study was to explore the influence of simple jaw opening and closing task of chewing movements on the activities of the prefrontal cortex (PFC) from the viewpoint of stress reduction. We measured cerebral blood flow (CBF) in the PFC during a block-tapping task of the jaw in healthy participants. Eleven young healthy individuals with normal dentition (7 males and 4 females, mean age 28.0 ± 3.7 years) volunteered for this study. CBF was measured using a wearable, functional near-infrared spectroscopy device. Measurements were taken using the central incisors and first molars at interocclusal distances of 5 and 10 mm. The participants were asked to bite a hard/soft block. CBF in all conditions showed limited variability or decreasing trend compared to resting state before the task. The main effect was observed for interocclusal distance (p = 0.008), and there were no significant differences for measurement area of the PFC, tooth type, and material type. An interaction was found between tooth type and material type. In conclusion, these results suggest that simple and rhythmical chewing motion has an effect of reducing CBF in the PFC and resting the PFC, which is an especially notable aspect of periodontal sensory information in the molar.

Developing a three-dimensional statistical shape model of normal dentition using an automated algorithm and normal samples

The statistical shape model (SSM) is a model of geometric properties of a set of shapes based on statistical shape analysis. The SSM develops an average model of several objects using an automated algorithm that excludes the operator's subjectivity. The aim of this study was to develop a three-dimensional (3D) SSM of normal dentition to provide virtual templates for efficient treatment. Dental casts were obtained from participants with normal dentition. After acquiring the 3D models, the SSMs of the individual teeth and whole dental arch were generated by an iterative closest point (ICP)-based rigid registration and point correspondences, respectively. Then, the individual tooth SSM was aligned to the whole dental arch SSM using ICP-based registration to generate an average model of normal dentition. The generated 3D SSM showed specific morphological features of normal dentition similar to those previously reported. Moreover, on measuring the arch dimensions, all values in this study were similar to those previously reported using normal dentition. The 3D SSM of normal dentition may increase the diagnostic efficiency of orthodontic treatments by providing a visual objective. It can be alsoused as a 3D template in various fields of dentistry. Our SSM of normal dentition provides both quantitative and qualitative information on the 3D morphology of teeth and dental arches, which may provide valuable information on 3D virtual-setup, bracket fabrication, and aligner treatment.

Determination of Marginal bone Level in the Normal Primary Dentition

The aim of the present study was to establish the normal range for the radiographic distance between cemento-enamel junction and the marginal bone level in the primary dentition using bitewing digital images. The samples examined in this study were 120 Iraqi children 7 and 8 years old (60 male and 60 female). The parameters were measured using the DIXI2 configuration software, which is automatically installed from Dimaxis software. Results showed that the mean of marginal bone height of the normal primary molars was (1.37 ± 0.48 mm). In addition, individual surfaces displayed distance ranging from (0.5-2.5). It was concluded that the normal marginal bone level in posterior primary dentition was (0.0-2.0) and bone loss occured when the distance between cemento-enamel junction and the marginal bone level more than 2 mm.

Epigastric Abdominal Pain In Elite Soccer Player

Epigastric Abdominal Pain in Elite Soccer Player Richard J. Edgar, MD Crozer Sports Medicine Springfield, PA Kevin DuPrey, DO (Crozer Sports Medicine Springfield, PA David Baxter, DO Crozer Sports Medicine Springfield, PA Thomas Kaminski, PhD, ATC, FACSM University of Delaware (Sponsor) HISTORY: A 24-year-old male professional soccer player presented with acute on chronic epigastric abdominal pain worsening over the last 2 weeks prior to presentation. Associated symptoms included nausea and sour taste in mouth. Denied constitutional symptoms, vomiting, jaundice, dysphagia, chronic cough, diarrhea, constipation, hematochezia, melena, and loss of appetite. He took NSAIDs for prior knee injury, but is unsure of which medication he has taken or the doses. He failed one prior trial of Ranitidine 150 mg BID, and two prior trials of Omeprazole 40 mg BID. Patient is from Africa with recent travel to Africa prior to presentation. PHYSICAL EXAMINATION: General: No acute distress.Eyes: PERRL, EOMI, conjunctiva normal, no icterusHENT: Normocephalic, atraumatic, no mouth ulcers, normal dentition. Cardiovascular: Regular rate and rhythm, no murmursLungs: Clear to auscultation bilaterally. Abdomen: Soft, non-distended, tenderness to palpation of epigastrium, bowel sounds present, no masses, no hepatosplenomegaly. DIFFERENTIAL DIAGNOSIS:1. Gastroesophageal Reflux Disease2. Peptic Ulcer Disease3. Helicobacter Pylori Infection4. Pancreatitis 5. Strongyloides stercoralis TEST AND RESULTS:Given the persistence of symptoms despite H2-blocker/PPI treatment, the patient underwent esophagogastroduodenoscopy (EGD) after cessation of H-2 blocker and PPI for 2 weeks. The EGD showed erosive gastropathy with no bleeding and no stigmata of recent bleeding. Biopsies taken during the EGD were consistent with Helicobacter Pylori infection. FINAL/WORKING DIAGNOSIS: Helicobacter Pylori Infection with Erosive Gastropathy TREATMENT AND OUTCOMES:The patient was treated with Clarithromycin triple therapy: Amoxicillin 1000 mg BID, Clarithromycin 500 mg BID, and Omeprazole 40 mg BID for 14 days. Patient had resolution of symptoms. He continued full sport participation throughout work-up and treatment.

Masticatory Performance and the Related Factors in Korean Children and Adolescents

This study aimed to evaluate the masticatory performance of Korean children and adolescents and to investigate related factors. Early loss of primary molars, degree of occlusion of first molars, occlusal relationship of first molars, and presence of anterior crossbite were considered. From March 2020 to July 2021, 56 children and adolescents between the ages of 6 and 12 were included. The mixing ability index (MAI) was calculated to evaluate the masticatory efficiency of children and adolescents. The subjects were classified into three groups according to the number of early lost primary molars; normal dentition, 1 - 2 teeth lost, more than 3 teeth lost. The number of participants are 23, 18, and 15, respectively. There was no difference in the MAI values between the normal dentition group and the group has 1 - 2 teeth lost. However, when 3 or more primary molars were lost, the MAI value decreased and a significant difference was observed. This study is the first study to evaluate the masticatory performance of children and adolescents in Korea, and it will be helpful to pediatric dentists who evaluate the masticatory performance of children and adolescents and strive to improve the masticatory efficiency of children and adolescents in clinical practice.

EP272: Familial pathogenic variant causing osteogenesis imperfecta identified in the Puerto Rican population

Osteogenesis imperfecta (OI) is the most common hereditary etiology for bone fragility. It is characterized by fractures with minimal trauma, hearing loss, and variable dentinogenesis imperfecta. It represents a spectrum that ranges from perinatal lethality and individuals with severe skeletal deformities to asymptomatic individuals with a mild predisposition to fractures, normal dentition, stature, and life span. The diagnosis is established through molecular genetic testing by identifying a heterozygous pathogenic or likely pathogenic variant in the COL1A1 or COL1A2 genes.