Premature Tooth Loss Research Articles

7336 Decades In The Dark: The Long Road To Diagnosing And Treating Hypophosphatasia

Abstract Disclosure: V.A. Mendpara: None. G. Madrigal Loria: None. L.Z. Khan: None. Background: Hypophosphatasia (HPP) is a rare bone disorder that results from deficient activity of the tissue non-specific isoenzyme alkaline phosphatase (ALP).[1] This case highlights a patient whose diagnosis of this treatable genetic condition was significantly delayed for almost two decades, despite receiving care at a prominent academic institution. The patient's persistently low ALP levels in routine lab tests were overlooked by multiple clinicians, leading to a delay in her care and eventual treatment. Case presentation: A 61-year-old Caucasian woman presented at the endocrinology clinic with complaints of severe fatigue, generalized pain, multiple childhood fractures, and ongoing dental issues. The rheumatology clinic to which she was referred for polyarthralgia diagnosed her with Hypophosphatasia (HPP) after noting chronically low alkaline phosphatase (ALP) levels from her previous charts ranging from 15 to 24 U/L (normal range: 34 to 123 U/L) over two decades. Her serum calcium, parathyroid hormone (PTH), and 25-hydroxy vitamin D levels were within normal ranges. A DEXA scan revealed normal bone density, effectively ruling out osteoporosis. Further investigation showed elevated Vitamin B6 levels at 219.6 nmol/L (normal range: 20.0 to 125.0 nmol/L), raising suspicion for HPP. The patient's family history provided additional insight, with her mother having a history of short stature and fractures and her son experiencing premature tooth loss at the age of 2. A genetic evaluation identified a heterozygous pathogenic variant in the ALPL gene (c.881A>C, p.Asp294Ala), confirming the diagnosis of autosomal dominant HPP. Initiating treatment with Asfotase alfa, a medication targeting HPP, resulted in a marked improvement in the patient's symptoms. Discussion: This case shows the diagnostic complexities of HPP, stressing the significance of actively screening for this condition via ALP levels in routine laboratory testing or during osteoporosis evaluations. The diagnostic process is critical to distinguish HPP from primary osteoporosis, as treatment and potential risks differ significantly. Inadvertent use of bisphosphonates can worsen hypomineralization and lead to atypical femoral fractures in HPP patients. Asfotase alfa enzyme replacement therapy, available since 2015, offers a targeted approach by replacing the enzyme defect, thereby mitigating symptoms. Heightened awareness among healthcare providers of HPP in adults holds the potential to enhance diagnosis rates and facilitate improved treatment outcomes for this highly treatable condition.[1] Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, Eighth Edition. ASBMR. Presentation: 6/2/2024

Cost-Effective, Patient-Centric, and Innovative Repurposing of a Broken Lingual Arch Space Maintainer: A Case Report

Abstract Introduction Premature loss of primary teeth due to caries or trauma can cause space discrepancies leading to malocclusion and other dental issues. Space maintainers are essential for preserving the arch space until the eruption of the permanent teeth. This case report presents an innovative modification of an existing space maintainer to address clinical challenges, improve patient outcomes, and reduce costs. Case Report An 8-year-old female presented with a broken lingual arch space maintainer impinging on the lingual mucosa. Clinical examination revealed nonrestorable teeth 84 and 75 that required extraction. Radiographs showed tooth 34 erupting soon and tooth 45 delayed. Owing to financial constraints, the existing appliance was modified by lingually cutting and adapting the wire to the distal surface of the canine. The appliance was cemented using Type I Glass Ionomer Cement in a single visit. After 6 months, tooth 35 erupted normally, without impaction. Conclusion This case demonstrates the effectiveness of modifying existing space maintainers to provide cost-effective patient-centric solutions in pediatric dentistry.

Betel Eating Culture on Periodontal Health Batak Karo Women

The culture of eating betel has become a strong tradition in Batak Karo society, especially among women. This tradition is not only an ordinary habit, but also has important social, spiritual and identity meaning. However, on the other hand, the ingredients used in eating betel, such as betel leaves, areca nut, lime, and tobacco, are known to have potential risks to oral health, especially periodontal health. This study aims to explore the relationship between betel eating culture and periodontal health status in Batak Karo women. A literature study was carried out to look for previous research and review the results of previous research. The research results show that the practice of eating betel has a very important cultural value in the lives of the Batak Karo people, especially as a symbol of social status, respect and beauty for women. However, it was found that the majority of Karo Batak women experienced poor periodontal conditions, such as gingivitis, periodontitis and premature tooth loss.

Risk of Healing Complications Following Alveolar Process Fractures in the Primary Dentition: A Retrospective Clinical Cohort Study.

Alveolar bone process fractures in preschool children are not well documented in the literature. Alveolar process fractures are located very close to primary teeth and permanent tooth germs. This study investigates the risk of healing complications following alveolar process fractures in the primary dentition and potential sequelae in the permanent dentition. A retrospective cohort study was conducted involving 21 patients with 49 primary teeth involved in an alveolar fracture. The follow-up protocol included clinical and radiographic examinations at specified intervals up to the age of 6 years. Healing complications in the primary teeth such as pulp necrosis, pulp canal obliteration, ankylosis, infection-related resorption and premature tooth loss were examined. Sequelae in the permanent dentition was also registered when the permanent incisors had erupted. Over a 3-year follow-up, the incidence of premature tooth loss was 51.2% [95% CI: 34.1%-68.4%], pulp canal obliteration was 42.5% [95% CI: 27.1%-57.8%], and pulp necrosis was 8.9% [95% CI: 0.6%-17.3%] following an alveolar process fracture. No cases of ankylosis were observed. Sequelae in the permanent dentition primarily included demarcated opacities and hypoplasia with a risk estimated at 24% [95% CI: 13%-39%] and 9% [95% CI: 2%-21%] respectively. Alveolar process fractures in primary dentition are associated with several healing complications in the primary teeth. Although the likelihood of severe complications in the permanent dentition is low, young children are still susceptible to developing sequelae in their permanent teeth. These results highlight the importance of awareness of dental injuries following alveolar process bone fractures in the primary dentition.

Enhancing smile and Altering Thrust using Modified Groper’s Appliance: A Case-Report

Early childhood caries, has a major influence on child’s lifestyle, resulting in child experiencing severe pain, premature loss of teeth, poor nutrition, difficulty chewing, speech, compromised esthetics, development of abnormal oral habits and delay in achieving normal growth and development of child. This paper presents a case report of a Four-year-old child diagnosed with Severe Early Childhood Caries. It explains treatment plan for rehabilitating child's mouth, including caries prevention and restorative procedures using appliances and making special adjustments to a child's feeding habits, combined with maintaining good oral hygiene practices. Early childhood caries is an important oral condition that requires prompt treatment and early intervention. Early diagnosis and awareness of ECC are essential for helping the child maintain a good quality of life.

Optimization of Sodium Iodide-Based Root Filling Material for Clinical Applications: Enhancing Physicochemical Properties.

Premature loss of root canal-treated primary teeth has long been a concern in dentistry. To address this, researchers developed a sodium iodide-based root canal-filling material as an alternative to traditional iodoform-based materials. The goal of this study was to improve the physicochemical properties of the sodium iodide-based material to meet clinical use standards. To resolve high solubility issues in the initial formulation, researchers adjusted component ratios and added new ingredients, resulting in a new paste called L5. This study compared L5 with L0 (identical composition minus lanolin) and Vitapex as controls, conducting physicochemical and antibacterial tests. Results showed that L5 met all ISO 6876 standards, demonstrated easier injection and irrigation properties than Vitapex, and exhibited comparable antibacterial efficacy to Vitapex, which is currently used clinically. The researchers conclude that if biological stability is further verified, L5 could potentially be presented as a new option for root canal-filling materials in primary teeth.

Assessment of Knowledge and Utilization of Prefabricated Band and Loop Space Maintainers in Primary Dentition Among Dentists: A Cross-Sectional Questionnaire Study.

Preserving primary dentition is essential for maintaining optimal oral health and development in children. Premature loss of primary teeth due to caries, infection, crowding, or trauma can necessitate orthodontic intervention and lead to various complications. Space maintainers are critical for preserving arch space until the eruption of permanent teeth, thereby preventing issues such as ectopic eruption, crowding, and malocclusion. Despite their advantages, prefabricated space maintainers (PSMs) are underutilized. This study aims to evaluate the knowledge, attitudes, and practices of Indian dentists regarding PSMs in primary teeth. A cross-sectional questionnaire survey was conducted among 100 dental practitioners in Chennai. A 10-item self-administered questionnaire, developed based on a comprehensive literature review and expert consultations, assessed demographics, knowledge of PSM indications and techniques, current practices, perceived barriers, and preferences for continuing education. The questionnaire's reliability was confirmed with a Cronbach's alpha value of 0.85. Descriptive statistics, including frequencies andpercentages, were used to summarize the participants' demographic characteristics, knowledge levels, and current practices related to PSMs. Of the 100 respondents, 86 (86%) were males and 14 (14%) were females. Only 19 (19%) reported using PSMs, while 36 (36%) used conventional space maintainers. A significant proportion (42 (42%)) of the respondents held a master's degree in dental surgery, yet only 11 (11%) had participated in Continuing Dental Education (CDE) programs on space maintainers. The perceived benefit of PSMs being a single appointment procedure was acknowledged by 82 (82%) of the respondents, whereas 76 (76%) participants identified cost as a major drawback. Notably, 45 (45%) practitioners did not consider PSMs necessary. This survey highlights notable obstacles in the adoption of PSMs among Indian dentists, emphasizing the need for focused educational initiatives. Improving knowledge and practices related to PSMs can enhance pediatric dental care and oral health outcomes in India.

Assessment of space changes in the lower dental arch after the premature unit loss of a primary molar: A randomized clinical trial.

Premature loss of primary teeth presents a significant challenge in oral health, with conflicting views on using space maintainers. To assess mandibular arch space changes associated with premature lower primary molar (PM) loss with or without a space maintainer. A randomized clinical trial with children (6-9 years old) with premature loss of a lower PM divided into two groups: control group (CG), without a space maintainer, and intervention group (IG), with a space maintainer. Dental casts were measured at baseline, 3 months, and 6 months. Linear distance; intercanine width and length; and arch width, length, and perimeter were measured. ANOVA and t-test were applied (p = .05). Twenty-six patients (mean: 7.3 years; standard deviation [SD]: 0.92) were included: 14 in CG and 12 in IG. CG had a greater space loss (-0.9 mm; SD: 0.45) than IG (-0.4 mm; SD: 0.61) at 3 months (p < .05). No difference between the groups was observed after 6 months (p = .610). CG decreases space at 6 months, especially with the first permanent molars without intercuspation (-2 mm; SD: 0.71; p = .007). Premature lower PM loss resulted in reduced arch space loss after 6 months, regardless of a space maintainer use. CG showed more loss of space when the first permanent molars lacked intercuspal relationship.

Pediatric hypophosphatasia: avoid diagnosis missteps!

Hypophosphatasia (HPP) is the dento-osseous disorder caused by deactivating mutation(s) of ALPL, the gene that encodes the "tissue-nonspecific" isoenzyme of alkaline phosphatase (TNSALP). In HPP, 3 natural substrates of cell-surface TNSALP accumulate extracellularly; phosphoethanolamine (PEA), inorganic pyrophosphate (PPi), and pyridoxal 5'-phosphate (PLP). Hypophosphatasemia together with elevated plasma levels of PEA, PPi, and PLP comprise its biochemical signature. PPi can inhibit mineralization and in extracellular excess can impair bone and tooth hardening and perhaps explain weak muscle. Autosomal dominant or autosomal recessive inheritance from among more than 400 mutations of ALPL largely accounts for HPP's broad-ranging severity, greatest among all skeletal diseases. Pediatric HPP spans life-threatening perinatal and infantile forms, childhood forms, and odonto-HPP selectively featuring premature loss of deciduous teeth. ALPL gene testing and TNSALP supplementation therapy have bolstered familiarity with HPP, but there are new considerations for diagnosis. Herein, diagnosis of a boy's mild childhood HPP was delayed by missteps involving his medical and dental history, physical examination, radiographic findings, and clinical laboratory studies. We review how pediatric HPP is now identified. Prompt diagnosis while appreciating the broad-ranging severity of HPP underlies the safe and effective management of this inborn-error-of-metabolism.

Periodontal Health Knowledge Levels among Libyan Adult Patients Attending Public and Private Dental Clinics: A Comparative Study

Background: Periodontal diseases can result in premature tooth loss; However, early detection, adherence to oral hygiene practices, and regular prophylaxis can help prevent or minimize the severity of periodontal diseases. Additionally, increased awareness and knowledge about periodontal health can positively influence behaviors related to oral health. Objectives: This study aimed to assess and compare the level of knowledge about periodontal oral health among patients attending public and private dental clinics and to investigate the relationship of their knowledge with Socio-demographic factors. Methods: A cross-sectional study was conducted to assess periodontal health knowledge among Libyan adults. Researchers interviewed 180 adults aged 18 years and older face-to-face. The study focused on demographic factors such as age, gender, education level, occupation, and clinic type. Additionally, a chi-square test was used to explore differences in periodontal health knowledge between patients attending public and private dental clinics, considering age, gender, education, and occupation Results: Socioeconomic status correlates with knowledge about periodontal signs, symptoms, etiology, and prevention. Females, those with higher education, and better economic status had significantly higher periodontal health knowledge. Knowledge increased with occupation level. The 41-60 age group and university-educated individuals demonstrated higher periodontal health knowledge. Females in public clinics were more aware of etiology than males. In private clinics, both genders showed an inverse association regarding the same question, with higher periodontal knowledge found among males. Conclusion: The study showed differences in periodontal knowledge among patients attending different types of dental clinics, with variations based on age, gender, education, and occupation. Better socio-economic status is associated with better knowledge.

Outcomes of apexification in immature traumatised necrotic teeth and risk factors for premature tooth loss: A 20-year longitudinal study.

To evaluate the long-term survival of immature traumatized incisors with pulp necrosis and apical periodontitis after endodontic treatment with two apexification techniques (calcium hydroxide apexification and MTA-apical plug) and to identify major factors affecting the survival of these teeth. Records of 2400 children and adolescents were screened for presence of traumatic dental injuries to immature incisors where endodontic treatment with the two apexification techniques was performed during January 2003 and December 2022, compared to a control group of mature teeth treated with conventional endodontic techniques. The studied variables were age; sex; apexification technique, presence of luxation and hard tissue injuries; preoperative root development stage (RDS), preoperative and postoperative periapical index (PAI), the time-point for tooth loss, and overall survival time in years. Kaplan-Meier estimates were used to graphically present the survival functions and Cox proportional hazard model to calculate hazard ratios (HR, 95% CI). The median survival time was 10 years for calcium hydroxide apexification, 16.1 for MTA-apexification, for luxation injuries other than intrusions and avulsions 15.5 years, for intrusions 12.5 years and for avulsions 6.8 years. The variables with significant negative impact on tooth survival were calcium hydroxide apexification, avulsion and postoperative PAI 3-5. No significant relationships were found for the variables MTA apexification, concussion; subluxation; lateral luxation; extrusion, intrusion, hard tissue injuries, preoperative RDS and PAI scores and postoperative PAI 1-2. After adjustment, the risk for premature tooth loss was 13.5 times higher in calcium hydroxide apexification, approximately 2 to 4 times higher in PAI 3-5, and 5.6 times higher in avulsions. Calcium hydroxide apexification, avulsion, and postoperative PAI 3-5 were identified as prognostic variables with significant negative impact on the risk for premature tooth loss.

Comparative Evaluation of Shear Bond Strength of Bonded Space Maintainers Using Ormocers, Nanofilled and Glass Fiber-reinforced Adhesive Composites.

Space maintainers (SMs) are used to preserve the space created by premature loss of primary teeth. The most commonly used is the band and loop (B&L) SM. As this SM has several drawbacks, such as poor esthetics and gingival health, laboratory procedures for fabrication, and multiple seating procedures, various bonded SMs were introduced. This study aims to compare the shear bond strength of bonded SMs using ormocer, nanofilled, and short glass fiber-reinforced adhesive composites with the conventional B&L SM luted with type I glass ionomer cement (GIC). Sixty intact extracted primary molars were randomly divided into four groups (n = 15). In group I (control), conventional B&L SMs were luted with type I GIC, whereas ormocer, nanofilled, and glass fiber-reinforced composites (GFRC) were used to bond the SMs in groups II, III, and IV, respectively. Shear bond strength of all the specimens was analyzed using a universal testing machine, and the obtained data were subjected to statistical analysis. The highest shear bond strength, that is, 68.82 ± 16.81 MPa, was exhibited by GFRC, followed by 51.04 ± 23.28 MPa with nanofilled composite, 45.3 ± 18.27 MPa with ormocer, and the least in the control group, that is, 42.17 ± 17 MPa. Glass fiber-reinforced resin composite has better resistance against shear force than the other three study materials, and this was significantly higher (p = 0.001) than conventional B&L SMs. Barathi D, Jampanapalli SR, Patloth T, et al. Comparative Evaluation of Shear Bond Strength of Bonded Space Maintainers Using Ormocers, Nanofilled and Glass Fiber-reinforced Adhesive Composites. Int J Clin Pediatr Dent 2024;17(6):695-701.

Diagnosis and initial management of children presenting with premature loss of primary teeth associated with a systemic condition: A scoping review and development of clinical aid.

Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists. To identify systemic conditions associated with PLPT and develop a clinical aid. OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English-language full text. Seven hundred and ninety-one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty-one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon-Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach. A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral.

Comparative evaluation of stress generation in primary teeth restored with zirconia and BioFlx crowns: A finite element analysis

Background: Maintaining the functional integrity of primary teeth is important, as these teeth are integral in vital functions such as mastication, speech development, and space maintenance for permanent teeth; hence, premature loss of primary teeth can affect a child’s quality of life. Various restorative materials are available to restore the function of grossly decayed teeth. Stainless steel crowns and zirconia crowns are widely used in pediatric dentistry; however, there are certain disadvantages associated with these materials. Recently introduced BioFlx crowns provide acceptable esthetics with a conservative approach. Nevertheless, there is a lack of evidence regarding their strength and clinical acceptability. Finite element analysis measures the physical response of teeth and assesses the stress generation, which is important to estimate the integrity of the restorations and crowns. Purpose: The aim of this in vitro study was to evaluate and compare stress generation in primary teeth restored with zirconia and BioFlx crowns using finite element analysis. Methods: Models of extracted teeth restored with zirconia and BioFlx crowns were used for the study. The finite element analysis of these models was carried out through Analysis of Systems (ANSYS) software. The models were subjected to a simulated occlusal loading force of 245 N. Results: Von Mises stress generated in BioFlx crowns along with underlying dentin was much less compared to that which was generated in zirconia crowns. Conclusion: Restoring the functional integrity of carious teeth is essential. BioFlx crowns can be used as full coverage restorations and can be a suitable alternative to zirconia crowns and traditional stainless steel crowns.

Chairside digital design and manufacturing method for children's band and loop space maintainers.

This study proposes a chairside digital design and manufacturing method for band and loop space maintainers and preliminarily validates its clinical feasibility. Clinical cases of 10 children requiring space maintenance caused by premature loss of primary teeth were collected. Intraoral scan data of the affected children were also collected to establish digital models of the missing teeth. Using a pediatric band and loop space maintainer design software developed by our research team, a rapid personalized design of band and loop structures was achieved, and a digital model of an integrated band and loop space maintainer was ultimately generated. A chairside space maintainer was manufactured through metal computer numerical control machining for the experimental group, whereas metal 3D printing in the dental laboratory was used for the control group. A model fitting assessment was conducted for the space maintainers of both groups, and senior pediatric dental experts were invited to evaluate the clinical feasibility of the space maintainers with regard to fit and stability using the visual analogue scale scoring system. Statistical analysis was also performed. The time spent in designing and manufacturing the 10 space maintainers of the experimental group was all less than 1 h. Statistical analysis of expert ratings showed that the experimental group outperformed the control group with regard to fit and stability. Both types of space maintainers met clinical requirements. The chairside digital design and manufacturing method for pediatric band and loop space maintainers proposed in this study can achieve same-day fitting of space maintainers at the first appointment, demonstrating good clinical feasibility and significant potential for clinical application.

Accuracy of Extraoral Bitewing Compared with Histopathology in Proximal Caries Detection of Primary Molar Teeth

An accurate diagnosis of dental caries leads to a suitable treatment plan and prevents premature loss of primary teeth. Intraoral bitewing radiography helps caries determination but has limitations in pediatric patients with severe gag reflexes while the extraoral bitewing radiograph resolved the patients who refused to undergo intraoral radiographs. The research objective was to compare the accuracy of extraoral bitewing radiography and the gold standard histopathological examination for proximal caries detection in the primary molars. Twenty-four extracted primary molars with and without proximal caries were divided into three groups and arranged in the mimetic alveolar sockets of a 3D-printed skull and mandible. Two observers evaluated extraoral bitewing images separately twice at one-week intervals. The weighted kappa coefficients showed excellent intra-observer and inter-observer agreements between each session of the extraoral bitewing radiographic assessments. The Mann-Whitney U test showed no difference between the radiographic grading scores of extraoral bitewing images and the gold standard. The sensitivity, positive predictive value (PPV), negative predictive value (NPV), and the area under the receiver operating characteristic (ROC) curve in cavitated carious lesions were higher than in non-cavitated carious lesions. In conclusion, extraoral bitewing is an alternative radiography for pediatric patients who are either uncooperative or intolerant to intraoral radiography.

Dental Implants in 18 Patients with Systemic Scleroderma: A Retrospective Radiographic Analysis Over a 5-Year Period with Focus on Marginal Bone Loss.

Patients with systemic scleroderma (SSc) often suffer from premature tooth loss. The aim of this study was to radiologically investigate bone loss at dental implants in patients with SSc and compare it with data from the literature on healthy patients. Mesial and distal bone level changes at implants were independently determined on panoramic and intraoral radiographs. They were double-checked after determination of evaluability by three different raters. Cohen's kappa was used to test for interrater reliability. Mean bone loss was estimated using linear regression analysis considering the patient as a random-effect implant and performed separately in predefined implant regions for different time points and for the mesial and distal sides of the implants. Mesial and distal bone level changes were analyzed in 61 implants using periapical and panoramic radiographs. In total, 114 radiographs from 18 patients were evaluable in both the mesial and distal regions. After a maximum observation period of 60 months, the mean peri-implant bone loss was 1.68 mm (range: 0.83 to 2.54 mm) at the distal aspect and 1.65 mm (range: 0.81 to 2.48 mm) at the mesial aspect in the right posterior mandible (region 44 to 47 [FDI numbering system]), whereas in the left posterior maxilla (regions 24 to 27), the mean peri-implant bone loss was 0.61 mm (range: 0.32 to 0.91 mm) at the distal aspect and 0.59 mm (range: 0.16 to 1.03 mm) at the mesial aspect. The mean bone loss 60 months after surgery was 1.05 mm (range: 0.85 to 1.25 mm). Marginal bone loss at implants in patients with SSc is comparable to data from the literature collected in healthy subjects.

Dyskeratosis congenita: beyond the triad and beyond the cause

Introduction: Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding the proteins responsible for maintaining the telomere length. It is defined by the presence of three clinical features: nail dystrophy, abnormal skin pigmentation, and oral leukoplakia. We herein report a typical case of DC with all three classical features along with pancytopenia, osteopenia, and epiphora but with no identifiable pathogenic mutations of DC-associated genes. Case presentation: Cutaneous examination revealed areas of hypopigmented and hyperpigmented macules forming a reticular pattern all over the body but mainly over the neck and upper chest, with relative sparing of the face. Skin atrophy with hypopigmentation was observed on the knuckles. The nails showed dystrophy in the form of pterygium, anonychia, and brittleness. The palms showed mild wrinkling with hypopigmented macules. Examination of the oral cavity revealed a white non-removable coating over the tongue and bilateral buccal mucosae (oral leukoplakia); the teeth were normal. Syringing of both eyes was performed by an ophthalmologist, and the patient was diagnosed with punctual stenosis (occlusion of the opening of the lacrimal canaliculus). Discussion: DC is a genodermatosis caused by germline mutations in genes encoding telomerase-associated components, shelterin proteins, and other regulators of telomere length and replication. Depending upon the gene involved, the mode of inheritance can be X-linked autosomal dominant or autosomal recessive. DC is characterized by the clinical triad of abnormal skin pigmentation, dystrophic nails, and oral leukoplakia. Patients with DC are also known to develop other rare clinical features at later stages, including epiphora, early graying of the hair, premature tooth loss, enteropathy with malabsorption, immune deficiency, esophageal stricture, cardiomyopathy, liver cirrhosis, osteoporosis and avascular necrosis of the bone. Patients with DC are predisposed to the development of malignancies, especially hematological malignancies and head/neck cancer. Management of DC involves a multidisciplinary approach and includes genetic counseling of family members at risk, regular surveillance of the patient for bone marrow failure and malignancies, and treatment of the associated features and any complications. Conclusion: Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding telomerase complex. We present a typical case of DC with all three classical features but with no pathogenic mutations of existing DC-associated genes thus raising the possibility of new unidentified genes in the pathogenesis of DC.

Occlusion development after premature loss of deciduous anterior teeth: preliminary results of a 24-month prospective cohort study.

This study aimed to evaluate occlusion development after premature loss or extraction of deciduous anterior teeth, by means of a prospective cohort study. Fifteen infants and children aged 1 to 5 years old were longitudinally assessed (with loss or extraction of deciduous anterior teeth [n = 9], and without tooth losses [n = 6]). Photographs and dental casts at the baseline and after 24 months of follow-up were performed. Dental casts were scanned, and linear measurements were made on the digitalized models (missing tooth space, arch perimeter, arch length, arch width, intercanine length and intercanine width). The t-test was used for groups comparisons (α = 0.05). Individuals' mean age at baseline was 2.93 (± 1.18) years. No statistically significant differences were observed in the missing tooth space in the group with tooth loss during the 24 months of follow-up (p > 0.05). Arch perimeter, arch length, arch width, intercanine length and intercanine width did not show differences between the groups (p > 0.05). Qualitative photographic evaluation revealed other changes in the dental arches and occlusion, such as exfoliation and eruption of deciduous teeth, eruption of permanent teeth, self-correction or establishment of malocclusion, among others. The results suggest that the premature loss of deciduous anterior teeth does not affect the perimeter, length and width of the dental arches; however, other alterations that lead to malocclusion could be established.

Pre-prosthetic Schuchardt Osteotomy: The contribution of computer-assisted surgical planning

Premature loss of teeth leads to an inevitable egression of opposing teeth. Schuchardt osteotomy is a quick and efficient alternative to create a prosthetic space compatible with prosthetic rehabilitation. Its planning and execution are now facilitated by the rise of digital technology and specialized softwares. Through virtual simulation of the osteotomy and the creation of surgical guides, they offer enhanced safety and predictability. Communication between the practitioner and the laboratory, as well as between the practitioner and the patient, is strengthened. In this clinical case, we will detail the key steps in digital planning, and the surgical protocol for a segmental Schuchardt osteotomy for preprosthetic purposes.