Enhancing subgingival margin restoration: a comprehensive review and meta-analysis of deep margin elevation's impact on microleakage.

INTRODUCTION: Restorative dentistry faces complex challenges with deep proximal surface destruction, requiring novel approaches like DME (Deep Margin Elevation). In order to achieve the best results while treating severe tooth damage, this study examines the advantages, disadvantages, and possible collaborations of different treatments. AIMS: This systematic review investigates the efficacy of DME as an adjunctive procedure in restorative dentistry, specifically focusing on its impact on microleakage. METHODS: The study adheres to PRISMA guidelines and employs the PICOS framework for eligibility criteria. 394 potentially qualifying studies were discovered and thorough literature search was carried out via databases. After applying inclusion criteria, 7 studies were included in the analysis. Articles were selected based on criteria that included indirect restoration and performing DME and were compared with indirect restorations without DME. Composite resin was used for DME. Other materials for DME performing, including GI and composite flow, were systematically reviewed. Data analysis was done by biostat software (α = 0.05). RESULTS: The meta-analysis of selected studies reveals a statistically significant positive effect of DME on reduction of microleakage (p = 0.001). CONCLUSION: The results of this study underscore the potential of DME in addressing subgingival margin challenges and provide valuable insights for restorative dentistry practices.

Evaluation of the Effect of Maternal Education on Toddler Dental Plaque Removal Based on a Health Belief Model.

Objectives: The objective of this study was to investigate the impact of an educational intervention, guided by the Health Belief Model (HBM), on promoting preventive behaviors among mothers to combat early childhood caries (ECC) in toddlers aged 12 to 18 months. Materials and Methods: This single-blind interventional study evaluated 92 toddlers between 12 to 18 months and their mothers, who were selected by stratified random sampling. Data regarding demographic and nutritional factors were collected using a questionnaire. The dental status of children was evaluated by clinical examination and measuring the plaque index (PI) of maxillary central incisors and the dmfs index. A pamphlet designed according to the HBM was used for oral hygiene instruction in both the intervention and control groups. All of the mothers in the intervention group received a music file to listen to when brushing their children's teeth. Data were analyzed using chi-square, Fisher exact, Mann-Whitney, and Wilcoxson tests. P<0.05 was considered significant. Results: No significant correlation was noted between the daily frequency of sugary substance intake and primary PI in the intervention or control group with/without dental plaque (P>0.05). In the intervention group, PI significantly decreased after the intervention compared to baseline (P<0.001). However, there was no significant change in PI after the intervention in the control group compared with baseline (P=0.1). Conclusion: The findings indicate that a combination of educational intervention and incentives, such as using age-appropriate music for toddlers, can significantly enhance mothers' effectiveness in removing dental plaque.

Reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents: a systematic review and meta-analysis of effectiveness.

BACKGROUND: The application of rubber dams is a widely accepted method of tooth isolation in dental practice. Placement of the rubber dam clamp might be associated with levels of pain and discomfort, especially in younger patients. The purpose of the present systematic review is to evaluate the efficacy of the methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents. MATERIALS AND METHODS: English-language literature from inception until September 6th, 2022 was searched in MEDLINE (via PubMed), SCOPUS, Web of Science, Cochrane, EMBASE, and ProQuest Dissertations & Theses Database Global for articles. Randomized controlled trials (RCTs) comparing methods of reducing the pain and/or discomfort associated with rubber dam clamp placement in children and adolescents were retrieved. Risk of bias assessment was performed using a Cochrane risk of bias-2 (RoB-2) risk assessment tool and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profile. Studies were summarized and pooled estimates of pain intensity scores and incidence of pain were calculated. The meta-analysis was conducted in the following groups according to type of interventions (LA, audiovisual (AV) distraction, behavior management (BM), electronic dental anesthesia (EDA), mandibular infiltration, inferior alveolar nerve block (IANB), TA), outcome (intensity or incidence of pain), and assessment tool (face - legs - activity - cry - consolability (FLACC), color scale, sounds - motor - ocular changes, and faces pain scale (FPS)): (a) pain intensity using (LA + AV) vs (LA + BM), (b) pain intensity using EDA vs LA (c) presence or absence of pain using EDA vs LA (d) presence or absence of pain using mandibular infiltration vs IANB (e) Comparing pain intensity using TA vs placebo (f) Presence or absence of pain using TA vs placebo. Meta-analysis was conducted using StataMP software, version 17.0 (StataCorp, College Station, Texas). Restricted maximum-likelihood random effect model (REML), Mean difference (MD) with 95% confidence interval, and log odds ratio (OR) with 95% CI were calculated were calculated. RESULTS: Initially, 1452 articles were retrieved. Sixteen RCTs were finally included for reviewing and summarizing. Nine articles with a total of 867 patients were included for quantitative meta-analysis. The differences in pain intensity scores were not significant in any comparison groups (group a: [MD = -0.04 (95% CI = - 0.56, 0.47), P = 0.87, I2 = 0.00%], group b: [MD = 0.25 (95% CI = -0.08, 0.58), P = 0.14, I2 = 0.00%], group c [MD = -0.48 (95% CI = -1.41, 0.45), P = 0.31, I 2 = 0.00%], group d: [MD = -0.67 (95% CI = -3.17, 1.83), P = 0.60, I 2 = 0.00%], group e: [MD = -0.46 (95% CI = -l.08, 0.15), P = 0.14, I 2 = 90.67%], and group f: [MD = 0.61 (95% CI = -0.01, 1.23), P = 0.06, I 2 = 41.20%]. Eight studies were judged as having some concern for risk of bias and the remaining studies were considered as low risk for bias. The certainty of evidence was considered medium for all comparison groups. DISCUSSION: In the present meta-analysis, a considerable difference was obtained between the included studies regarding intervention methods and pain assessment tools and the analysis was performed in groups with small numbers of the studies. Owing to the mentioned variabilities and the small number of studies, the results of the analysis should be interpreted with caution. The indistinguishability of the manifestations of pain/discomfort from fear/anxiety, particularly in children, should also be considered while using the results of the present study. Within the limitations of the current study, no significant differences were found between the proposed methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents. A larger number of more homogenous studies regarding intervention methods and pain assessment tools need to be conducted in order to draw stronger conclusions. TRIAL REGISTRATION: This study was registered in PROSPERO (ID number: CRD42021274835) and research deputy of Mashhad University of Medical Sciences with ID number 4000838 ( https://research.mums.ac.ir/ ).

Food insecurity and dental caries prevalence in children and adolescents: A systematic review and meta-analysis.

BACKGROUND: Food insecurity (FI) is associated with dietary practices, which can act as a risk factor for dental caries. AIM: This study aimed to investigate the relationship between FI and dental caries prevalence in children and adolescents. DESIGN: MEDLINE (via PubMed), EMBASE, SCOPUS, ISI web of knowledge, Cochrane, and ProQuest Dissertations & Theses Global database (up to April 19, 2022) as well as reference lists were searched. Eligible studies compared dental caries prevalence in food-secure and food-insecure individuals younger than 19 years. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using a modified Newcastle-Ottawa Scale. Meta-analysis was performed, and the pooled odds ratio (OR) was calculated at 95% confidence interval (95% CI). RESULTS: Among the 1350 retrieved records, 10 cross-sectional reports were selected for systematic review. Six studies involving 8631 participants were included in the meta-analysis. More than half of the reports were published within the period 2019-2021. All studies except one were judged as low risk of bias. Overall, the prevalence of dental caries was greater among the food-insecure children and adolescents (OR: 2.01, 95% CI: 1.52-2.65, p < .001, I2 : 73.5%). Similarly, all three categories of FI were significantly associated with caries experience (marginal FI: OR: 1.88, 95% CI: 1.56-2.27, p < .001, I2 : 0.0%; low FI: OR: 2.42, 95% CI: 1.42-4.14, p = .001, I2 : 74.4%; very low FI: OR: 2.37, 95% CI: 1.88-3.00, p < .001, I2 : 0.0%). CONCLUSION: The results showed a significant association between FI status and dental caries in both childhood and adolescence; however, there was a lack of longitudinal studies for a better understanding of this association. Health policies leading to reduction in FI may also aim to reduce dental caries.

Comparison of the Success Rate of Filled and Unfilled Resin-Based Fissure Sealants: A Systematic Review and Meta-Analysis.

Objectives: Incorporation of fillers might improve the physical properties of sealants. This systematic review and meta-analysis evaluated the retention and caries development rate of filled and unfilled fissure sealants. Materials and Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Embase, Cochrane Database of Systematic Reviews, and ISI Web of Knowledge were searched until October 24, 2019. The risk of bias (ROB) was assessed for the included studies based on the Cochrane collaboration common scheme for bias, and the meta-analysis was performed through a random effects model. Results: The search resulted in 6,336 unrepeated relevant studies. After the title, abstract and full-text screening, 19 studies with 26 comparing groups were finally included in this systematic review and meta-analysis. According to the included studies, both retention rate and caries development in filled and unfilled resin-based sealants did not significantly differ within 2 years of follow-up. Conclusion: Since there was no significant difference in the retention rate and caries development between filled and unfilled sealants, it seems that the final decision should be made uniquely for each patient according to the type of fissure, patient's age, habits, etc.

Management of primary molars with irreversible pulpitis employing tampon pulpotomy: Report of three cases with 34-month mean follow-up.

This study suggests that tampon-based coronal pulpotomy using a calcium silicate-based biomaterial can be a reliable approach for the treatment of vital primary molars with irreversible pulpitis.

Glass ionomer cements as fissure sealing materials: yes or no?: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate the ability of glass ionomer cements (GICs) and resin-based sealants (RBSs) to prevent the occurrence of caries and their retention in standards-based clinical studies. TYPES OF STUDIES REVIEWED: The authors conducted a literature search (from database inception through September 20, 2017) to identify studies for inclusion in this systematic review. The authors assessed the quality of the evidence with the modified Jadad scale and performed the meta-analysis by using a random-effects model. RESULTS: The authors considered 20 studies on caries prevention and 28 studies on retention that met the inclusion criteria for the meta-analysis. The results of the meta-analysis for caries development showed no significant difference (odds ratio, 0.938; 95% confidence interval, 0.647 to 1.359; P = .734). However, the result for the retention rate showed the advantage of RBSs (odds ratio, 6.006; 95% confidence interval, 3.226 to 11.183; P = .000). CONCLUSIONS AND PRACTICAL IMPLICATIONS: There was no difference between the percentage of caries development with use of GICs as fissure sealing material compared with that for the conventional RBSs, but the retention rate of conventional RBSs was much higher than that of the GICs.

Double Antibiotic Paste for Management of External Inflammatory Root Resorption.

External inflammatory root resorption (EIRR) is one of the common complications following dental trauma which when remained untreated, may lead to tooth loss. Successful treatment outcomes depend on elimination of bacteria from root canal system and apical sealing. This case presents the endodontic management of an EIRR that was nonresponsive to calcium hydroxide (CH) therapy. An 11-year-old boy was referred for management of a traumatized maxillary central incisor. Tooth #8 was symptom-free, nonresponsive to vitality pulp tests and had an immature root with sever EIRR. Using chemomechanical debridement and CH dressing, the treatment was initiated. The tooth was remained asymptomatic; however, after five weeks the size of periradicular lesion increased and intracanal exudate was present, signifying a resistant endodontic infection. In second appointment, double antibiotic paste (DAP; ciprofloxacin/metronidazole) was applied to the canal. Eight weeks later, the tooth continued to be asymptomatic and the size of the lesion decreased. Finally, the root canal was entirely obturated with calcium-enriched mixture (CEM). At 18-month follow-up, the tooth was asymptomatic/functional, EIRR did not further progress and tooth discoloration was not observed. Based on the results, DAP has the potential to be used to manage the CH-resistant endodontic infection. Furthermore, CEM root filling/sealing seems to be an applicable choice in EIRR management.

Effect of Tannic Acid on Bond Strength of Etch and Rinse and Self-etch Adhesive Systems in Dentin of Primary Teeth.

INTRODUCTION: One of the possible mechanisms for the gradual destruction of bond strength in dentin-resin interface, could be due to the demineralized unstable collagen matrix. Use of protease inhibitors, such as tannic acid (TA) could prevent destruction of collagen fibers. The aim of this study was to compare the TA effect on bond strength of etch and rinse and self-etch adhesive systems in the dentin of primary teeth. MATERIALS AND METHODS: This in vitro study was done on 40 extracted primary molar teeth. The teeth were sectioned in the mesiodistal direction, and enamel of buccal and lingual surfaces was removed. Samples were randomly divided into four groups: Single bond (SB) + TA, SB, Clearfil SE Bond (CSB) + TA, and CSB. Then, Z250 and Clearfil AP-X composites were cured on the surfaces of SB and CSB groups respectively. After that, all samples were divided into aging and non-aging groups. For 3 months, samples were placed under 1,000 thermal cycles in aging group. Subsequently, the shear bond strengths of all groups were measured by the International testing machine, and failure mode was evaluated by an optical stereomicroscope. Data were analyzed with paired t-test and independent t-test. RESULTS: Tannic acid induced a significant reduction in the immediate bond strength of adhesive SB. Meanwhile, TA had no significant effect on shear bond strength of the CSB system. CONCLUSION: Based on our findings, use of TA is not recommended with SB and CSB adhesives on primary teeth. CLINICAL SIGNIFICANCE: Tannic acid may not be considered in resin restorations of primary teeth.

Vital Pulp Therapy of a Symptomatic Immature Permanent Molar with Long-Term Success.

Vital pulp therapy (VPT) is the preferred conservative treatment for preservation of symptomatic pulps in immature permanent teeth. The present case report summarizes VPT of an immature permanent molar with irreversible pulpitis associated with apical periodontitis in a 9-year-old boy. Cervical pulpotomy was performed and radicular pulp stumps were covered with calcium-enriched mixture (CEM) cement; the tooth was then restored with stainless steel crown. After a 50-month follow-up period, the pulpotomized molar was clinically functional and asymptomatic. Moreover, radiographic evaluation revealed evidence of complete root development as well as normal periodontal ligament around the roots. The successful outcome achieved through VPT using CEM biomaterial in the reported case suggests that this method may produce favorable outcome for vital immature permanent teeth with irreversible pulpitis and periapical disease.

Preparation before acid etching in fissure sealant therapy: yes or no?: A systematic review and meta-analysis.

BACKGROUND: The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of a preparation method and to compare fissure sealant retention using the preparation-only method before sealant placement with the conventional acid-etching procedure. TYPES OF STUDIES REVIEWED: The authors conducted a literature search (from database inception through June 2, 2016) to identify studies for inclusion in this systematic review. The authors assessed the quality of the evidence with the modified Jadad scale and performed the meta-analysis by using a random-effects model. RESULTS: The authors considered 12 studies (8 for the first part and 4 for the second part) that met the inclusion criteria for the systematic review and meta-analysis. In the analysis of the first part of the systematic review, the authors found that the preparation method before acid etching had a significant positive effect on fissure sealant retention (odds ratio, 3.262; 95% confidence interval, 1.782-5.971; P = .001). In the analysis of the second part of the systematic review, the authors found that there were no significant differences between the preparation-only method and the conventional acid-etching method in terms of fissure sealant retention (odds ratio, 1.241; 95% confidence interval, 0.534-2.888; P = .616). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The use of a preparation method before fissure sealant application can increase sealant retention. However, preparation alone cannot substitute the conventional acid-etching method before sealant placement.

Adhesive systems under fissure sealants: yes or no?: A systematic review and meta-analysis.

BACKGROUND: The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of an adhesive system and to compare fissure sealant retention using etch-and-rinse adhesive systems versus self-etching adhesive systems. TYPES OF STUDIES REVIEWED: The authors conducted a literature search (all articles published through November 1, 2015) to identify studies for inclusion in this systematic review. They assessed the quality of the evidence provided using the modified Jadad scale and performed meta-analyses using a random-effects model. RESULTS: The authors considered 12 studies that met the inclusion criteria for the systematic review. In addition, they used 5 of 9 studies related to the first part of the study and 3 of 4 studies related to the second part of the study that met the inclusion criteria for meta-analysis. In the analysis of the first part of the systematic review, the authors found that adhesive systems had a significant positive effect on fissure sealant (odds ratio, 3.294; 95% confidence interval, 1.292-8.401; P = .013). In the analysis of the second part of the systematic review, the authors found that etch-and-rinse adhesives were superior to self-etching adhesives in the fissure sealant procedure (odds ratio, 14.569; 95% confidence interval, 2.616-81.131; P = .002). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The use of adhesive systems beneath fissure sealants can increase the retention of fissure sealants. Also, when adhesive systems are used with fissure sealants, etch-and-rinse systems are preferable.

Evaluation of the efficacy of flowable composite as lining material on microleakage of composite resin restorations: A systematic review and meta-analysis.

OBJECTIVE: The efficacy of flowable composite in improving marginal adaptation or reducing microleakage is not fully understood. The purpose of this study was to systematically evaluate existing evidence to verify whether an application of flowable composite as a liner provided less microleakage in Class 2 composite restorations. METHOD AND MATERIALS: PubMed, ISI (Web of Science), and Scopus databases were searched according to the selected keywords, up to 15 Feb 2015, without any restriction on date or language. Full texts of published articles that seemed to meet primary criteria for inclusion in this research were obtained. Data of studies were extracted if they were assessed as high or moderate level of evidence. Due to the variation of methods used in different studies, they were divided into five groups: groups 1 and 2, studies that evaluated the effect of flowable composite as a liner on dentinal or enamel margins and applied flowable composite on all of the cavity wall margins; groups 3 and 4, studies that evaluated the effect of flowable composite as a liner on dentinal and enamel margins and applied flowable composite only on gingival margin; and group 5, clinical studies. RESULTS: The initial search yielded 1,370 publications. After hand searching, six extra studies were included in the review. The abstracts of all were read independently by AB and SG. After methodologic assessment and evaluation of the level of evidence, 18 studies were selected for this study. The results of this study indicate that flowable composite liners have no significant effect on microleakage of composite restorations in all of five groups. CONCLUSION: Application of flowable composite as a liner in composite restorations cannot reduce microleakage or improve clinical performance.

The most-cited articles in dental, oral, and maxillofacial traumatology during 64 years.

BACKGROUND AND AIM: Citation analysis helps to identify the research trends within a research field and helps to identify the most frequently occurring parameters. The aim of this study was to identify the 100 most-cited articles in the field of dental, oral, and maxillofacial traumatology over the past 64 years. MATERIAL AND METHODS: A comprehensive list of the most-cited articles in dental, oral, and maxillofacial trauma was compiled using 'All Databases' section of the ISI Web of Knowledge. Related articles were considered to be those articles in which part or all of the experiment or study was related to dental and/or oral and maxillofacial trauma. In case reports, if a part of a treatment plan was related to the topic, that article was considered to be relevant. The characteristics analyzed included number of citations, authors, journals, institution, country of origin, publication year, article type, study material, and topic. RESULTS: The number of citations for each article ranged from 69 to 229. The journal Dental Traumatology was the most represented, followed by the journal Oral and Maxillofacial Surgery. Of the 100 articles, 83% were original articles, 15% were review articles, and 2% were case report/case series. Therapy and prognosis-related topics were the most common topics. Most articles came from institutions in the United States, followed by the Scandinavian countries. University Hospital of Copenhagen was the source of the highest number (34) of the most-cited articles; the same author wrote or co-wrote 22 of the 100 most-cited articles. CONCLUSION: The list of most-cited articles in the field of dental, oral, and maxillofacial traumatology gives a good scientometric picture of trauma research in the world. A large number of the most-cited articles are mainly from the field of dental traumatology and originate from a few research teams.

Comparison between Impact factor, SCImago journal rank indicator and Eigenfactor score of nuclear medicine journals.

Despite its widespread acceptance in the scientific world, impact factor (IF) has been criticized recently on many accounts: including lack of quality assessment of the citations, influence of self citation, English language bias, etc. In the current study, we evaluated three indices of journal scientific impact: (IF), Eigenfactor Score (ES), and SCImago Journal rank indicator (SJR) of nuclear medicine journals. Overall 13 nuclear medicine journals are indexed in ISI and SCOPUS and 7 in SCOPUS only. Self citations, Citations to non-English articles, citations to non-citable items and citations to review articles contribute to IFs of some journals very prominently, which can be better detected by ES and SJR to some extent. Considering all three indices while judging quality of the nuclear medicine journals would be a better strategy due to several shortcomings of IF.

Management of physiological hyperpigmentation of oral mucosa by cryosurgical treatment: a case report.

Melanin hyperpigmentation is the result of melanin granules. "Black gums" may cause esthetic problems. Different treatment modalities have been used with the aim of removing pigmentations for esthetic reasons, all of which have some advantages and disadvantages. Recurrent lesions are the most important concept in all of these treatments. Cryotherapy is a method of tissue destruction by rapid freezing. It is an atraumatic, cost-effective and simple method for treating oral pigmentation. This report presents the effects of cryotherapy on physiologic pigmentations of oral mucosa in a 9-year-old boy. In this case no recurrent lesions were observed after 12 months.

A rare case of multiple talon cusps in three siblings.

Talon cusp is an uncommon anomaly, whose etiology may be disturbances in the morphodifferentiation stage. Dens in dente is also a rare anomaly that is challenging in clinic as it may cause pulp necrosis or periapical lesions due to the communication with the oral cavity. This article reports multiple talon cusps on permanent maxillary and mandibular incisors and molars in 3 siblings. A 9-year-old boy presented with structures like nodules, shaped as cylindrical cones with a sharp point or a raindrop with deep developmental fissures on the palatal aspect of the maxillary central incisors, lingual aspect of the mandibular central incisors and labial aspect of both mandibular first molars. The buccal surface of the maxillary right central incisor was also affected. Some of them exhibited dens in dente. His 15-year-old sister had prominent talon cusps on the palatal surface of maxillary central incisors and buccal surface of the mandibular first molars and mandibular left second molar. His 7-year-old brother had only one trace talon on the maxillary left central incisor. No syndrome was identified in the patients. In conclusion, genetic inheritance may be a causative factor in talon cusp.

A rare case of multiple talon cusps in three siblings

Talon cusp is an uncommon anomaly, whose etiology may be disturbances in the morphodifferentiation stage. Dens in dente is also a rare anomaly that is challenging in clinic as it may cause pulp necrosis or periapical lesions due to the communication with the oral cavity. This article reports multiple talon cusps on permanent maxillary and mandibular incisors and molars in 3 siblings. A 9-year-old boy presented with structures like nodules, shaped as cylindrical cones with a sharp point or a raindrop with deep developmental fissures on the palatal aspect of the maxillary central incisors, lingual aspect of the mandibular central incisors and labial aspect of both mandibular first molars. The buccal surface of the maxillary right central incisor was also affected. Some of them exhibited dens in dente. His 15-year-old sister had prominent talon cusps on the palatal surface of maxillary central incisors and buccal surface of the mandibular first molars and mandibular left second molar. His 7-year-old brother had only one trace talon on the maxillary left central incisor. No syndrome was identified in the patients. In conclusion, genetic inheritance may be a causative factor in talon cusp.

Cúspide em garra (talon cusp) é uma anomalia incomum, cuja etiologia pode estar relacionada a distúrbios no estágio de morfo-diferenciação. Dens in dente é também uma anomalia rara que impõe desafios na prática clínica, uma vez que pode causar necrose pulpar ou lesões periapicais devido à comunicação com a cavidade oral. Este artigo relata múltiplos casos de cúspide em garra em incisivos e molares superiores e inferiores permanentes em 3 irmãos. Um menino de 9 anos apresentou-se com estruturas nodulares em formato de cone cilíndrico com uma ponta aguda ou de "gota de chuva", com fissuras de desenvolvimento profundas na face palatina dos incisivos centrais superiores, e face lingual dos incisivos centrais e vestibular de ambos os primeiros molares inferiores. A face vestibular do incisivo central superior esquerdo também foi afetada. Alguns dentes apresentavam dens in dente. Sua irmã de 15 anos apresentava cúspides em garra proeminentes na face palatina dos incisivos centrais superiores e face lingual dos primeiros molares inferiores e segundo molar inferior esquerdo. Seu irmão de 7 anos apresentava apenas uma cúspide em garra vestigial no incisivo central superior esquerdo. Nenhuma síndrome foi identificada nos pacientes. Conclui-se que a herança genética pode ser um fator causativo da cúspide em garra.