The prevalence of equine odontoclastic tooth resorption and hypercementosis and the role of interincisal angulation in disease severity in a representative cohort of horses in Switzerland.

INTRODUCTION: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is an increasingly diagnosed degenerative dental disease in aged horses. The primary aim of this retrospective study was to determine the prevalence of EOTRH in horses admitted to the Equine Hospital, University of Zurich, for dental procedures from 2004 to 2017. A secondary goal was to measure and compare interincisal angles on two-dimensional radiographs of horses with EOTRH to determine whether the interincisal angle is associated with age and severity of the disease. Radiographs were assessed for the presence of lysis and/or hypercementosis, and the number and position of the teeth affected were determined. Each tooth was also evaluated using the modified classification system introduced by Rehrl et al. (2018), in which stage 0 indicates no radiographic abnormalities and stage 3 denotes severe abnormalities. The overall stage was defined by the tooth with the most severe lesions. The interincisal angle was determined in horses that had suitable radiographs. The medical records of 838 horses admitted for dental procedures were evaluated, and 85 (10,1 %) had clinical evidence of EOTRH. The mean interincisal angle was 136,06 ° in horses with mild to moderate EOTRH and 135,10 ° (SD = 11,90 °) in severely affected patients. In conclusion, the angle measurements on lateral radiographs were highly reproducible. However, the interincisal angle was not associated with age or the severity of EOTRH. The interincisal angle and the disease pattern were not correlated.

INTRODUCTION: La résorption et l'hypercémentose odontoclastique des dents chez le cheval (EOTRH) est une maladie dentaire dégénérative de plus en plus diagnostiquée chez les animaux âgés. L'objectif principal de cette étude rétrospective était de déterminer la prévalence de l'EOTRH chez les chevaux admis à l'Hôpital équin de l'Université de Zurich pour des interventions dentaires entre 2014 et 2017. Un objectif secondaire était de mesurer et de comparer les angles inter-incisifs sur des radiographies bidimensionnelles de chevaux atteints d'EOTRH afin de déterminer si cet angle est associé à l'âge et à la gravité de la maladie. Les radiographies ont été évaluées pour la présence de lyse et/ou d'hypercémentose, et le nombre et la position des dents affectées ont été déterminés. Chaque dent a également été évaluée à l'aide du système de classification modifié introduit par Rehrl et al. (2018), dans lequel le stade 0 indique l'absence d'anomalies radiographiques et le stade 3 indique des anomalies graves. Le stade global a été défini par la dent présentant les lésions les plus sévères. L'angle inter-incisif a été déterminé chez les chevaux qui avaient des radiographies appropriées. Les dossiers médicaux de 838 chevaux admis pour des interventions dentaires ont été évalués et 85 (10,1 %) présentaient des signes cliniques d'EOTRH. L'angle inter-incisif moyen était de 136,06° chez les chevaux présentant une EOTRH légère à modérée et de 135,10° (écart-type = 11,90°) chez les patients gravement atteints. En conclusion, les mesures d'angle sur les radiographies latérales étaient très reproductibles. Cependant, l'angle inter-incisif n'était pas associé à l'âge ou à la sévérité de l'EOTRH. L'angle inter-incisif et le profil de la maladie n'étaient pas corrélés.

Equine odontoclastic tooth resorption and hypercementosis: Investigating individual incisor disease patterns using radiological classification.

BACKGROUND: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a destructive, painful and underdiagnosed dental disorder. Radiography is necessary to fully assess the disease as early stages occur on clinically normal teeth. OBJECTIVES: To investigate the distribution pattern of appearance of EOTRH within the incisor arcade. In particular, we aimed to determine the influence of tooth position and horse age on the severity of EOTRH as well as on the frequency of the individual severity stages. STUDY DESIGN: Retrospective cross-sectional radiographic case study. METHODS: Digital radiographs of 142 horses (10 years and older) presented for routine dental examination at our Equine Hospital were obtained and evaluated for changes related to EOTRH. Radiological findings were classified in terms of EOTRH severity, and each tooth was evaluated individually (tooth stage). RESULTS: The tooth stages of EOTRH showed a bilateral symmetrical distribution pattern over the entire incisor arcade. There was a significant positive correlation between age and tooth stages (p < 0.001, rho = 0.48, 95% CI 0.43-0.51), and the frequency of higher tooth stages increased from central incisors to middle and corner incisors. MAIN LIMITATIONS: Individual head anatomy in some male horses lead to superimposition of the lower jaw corner incisors and canine teeth. The radiographic technique proved difficult in smaller and uncooperative horses. Differentiating between mild pathological signs of EOTRH and age-related radiological changes was not possible in all cases. CONCLUSION: These results reconfirm an age-correlated progression of EOTRH. EOTRH affects the incisor arcade in a bilaterally symmetrical pattern with the corner incisors being the most severely affected.

Early incisor lesions and Equine Odontoclastic Tooth Resorption and Hypercementosis: Reliability of radiographic findings.

BACKGROUND: In clinical practice, early diagnosis of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) and other resorptive incisor diseases is difficult to achieve. The radiographic appearance of subtle pathological changes has not been described in detail and might be confused with age-related changes. OBJECTIVES: The study was performed to define typical radiographic signs of early incisor lesions and to evaluate the reliability of the radiographic findings. STUDY DESIGN: Descriptive and comparative study using post mortem clinical, radiographic, macroscopic and µCT examination. METHODS: The incisor region of 20 cadaveric horse heads, divided into three different age groups, was examined visually and by palpation. Intraoral radiographs were taken. After extraction, each incisor was macroscopically evaluated. Micro-computed tomography (µCT) scans were obtained. These scans were processed with Scry (v6.0, Kuchel & Sautter GbR) to obtain surface meshes which then were transferred to Meshlab (ISTI-CNR, version 2016.12). Attached tissues were virtually removed and surface curvature was computed to visualise and evaluate the quantity of unevenness (roughness) of the teeth's surface. Scoring systems for each diagnostic modality were developed. Scores were compared to describe and evaluate the radiographic appearance of early incisor lesions. RESULTS: The prevalence and severity of incisor lesions increased with age. Early, subtle lesions develop on the palatal/lingual side of incisors. While radiographically detected lesions were confirmed macroscopically and on the µCT scans, numerous teeth which were radiographically classified as healthy displayed lesions by macroscopic inspection (13.7%) and µCT analysis (58.1%). MAIN LIMITATIONS: Cadavers were studied and dental history was unknown. CONCLUSIONS: The detection of early and subtle incisor lesions indicating first signs of EOTRH on dorsoventral intraoral radiographs is limited due to the typical localisation of the lesions on the palatal/lingual side of the incisors.

Selection of Filtering and Image Texture Analysis in the Radiographic Images Processing of Horses' Incisor Teeth Affected by the EOTRH Syndrome.

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is one of the horses' dental diseases, mainly affecting the incisor teeth. An increase in the incidence of aged horses and a painful progressive course of the disease create the need for improved early diagnosis. Besides clinical findings, EOTRH recognition is based on the typical radiographic findings, including levels of dental resorption and hypercementosis. This study aimed to introduce digital processing methods to equine dental radiographic images and identify texture features changing with disease progression. The radiographs of maxillary incisor teeth from 80 horses were obtained. Each incisor was annotated by separate masks and clinically classified as 0, 1, 2, or 3 EOTRH degrees. Images were filtered by Mean, Median, Normalize, Bilateral, Binomial, CurvatureFlow, LaplacianSharpening, DiscreteGaussian, and SmoothingRecursiveGaussian filters independently, and 93 features of image texture were extracted using First Order Statistics (FOS), Gray Level Co-occurrence Matrix (GLCM), Neighbouring Gray Tone Difference Matrix (NGTDM), Gray Level Dependence Matrix (GLDM), Gray Level Run Length Matrix (GLRLM), and Gray Level Size Zone Matrix (GLSZM) approaches. The most informative processing was selected. GLCM and GLRLM return the most favorable features for the quantitative evaluation of radiographic signs of the EOTRH syndrome, which may be supported by filtering by filters improving the edge delimitation.

Generalised Hypercementosis in a Young Female Seeking Extraction: Revision and Update of Surgical Technique.

Hypercementosis is an excessive cementum deposition at the tooth root apex which occurs pathologically and represents as a body reaction to various stimulating factors including infection or endodontic treatment in most cases. Although hypercementosis mostly complicates teeth extraction, it is rare in daily dental practice. In the present case report, a generalised maxillary and mandibular hypercementosis in a young female patient is represented with a detailed description of its histologic, radiographic, and clinical characteristics followed by a review of surgical technique. It is clinically relevant to correlate hypercementosis of teeth, the feasibility of the best surgical method, in order to achieve a safe uncomplicated extraction.

Radiographic evaluation and determination of hypercementosis patterns in Al-Madinah Al-Munawwarah, Saudi Arabia: A retrospective cross-sectional study.

OBJECTIVES: Hypercementosis (HC) is an asymptomatic excessive cementum deposition at the dental root apex. There is a lack of research that determines the pattern and associated factors of HC in Saudi Arabia. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on a random sample of 815 Orthopantomograms (OPGs) that was obtained from a total of 14003 female patients archived OPGs. The OPGs were retrieved from the Kodak Carestream-R4 database for the period between 2015 and 2017 at Taibah University Dental College and Hospital (TUDCH), Al-Madinah Al-Munawwarah, Saudi Arabia. Width and radiodensity of HC were measured and the distribution was calculated. Association between HC and factors including age and nationality were explored. Descriptive and inferential analyses were performed. RESULTS: The mean/SD age of HC affected patients (9.8%) was 30.16 ± 13.1 years, of whom 55% were Saudis. The mean/SD width and radiodensity of the hypercementosed roots were 4.14 ± 1.2 mm and 119.86 ± 29.83, respectively. The mandibular teeth were more frequently associated with hypercementosis (65%) specifically first molars (47.5%), while the majority (64%) had a single unilateral distribution pattern. There was a non-significant association between nationality, age, and HC (P = 0.921, P = 0.633, respectively). CONCLUSION: Hypercementosis observed in 9.8% of female patients attending TUDCH which was primarily unilateral and prominently confined to the mandibular teeth roots. The complication of teeth extraction among female patients in Almadinah region should be anticipated.

Prevalence of hypercementosis in a saudi arabian population: a cone beam computed tomography study

Objective: to determine the prevalence of hypercementosis in a Saudi Arabian population. material and methods: a total of 642 CBCT scans from patients comprising 4471 teeth were incorporated in the study sample. all teeth were analyzed for the presence of hypercementosis in sagittal, axial and coronal plains by two qualified and experienced observers. the characteristics of the involved tooth in terms of gender, jaw and location were recorded from the CBCT scans. the obtained data were statistically analyzed using SPSS 21.0. the reliability of measurements was evaluated by kappa statistics. results: out of total 642 subjects hypercementosis was observed in 31 patients (4.82 percent) and 43 teeth (0.96 percent). Eight (2.68 percent) maxillary 1st molars, 6 (1.88 percent) mandibular 1st molars, 5 (1.46 percent) maxillary second molars, 7 (1.95 percent) mandibular 2nd molars, 9 (4.76 percent) maxillary 3rd molars and 8 (3.58 percent) mandibular 3rd molars were observed to have hypercementosis. among males, 4.76 percent were affected with hypercementosis as compared to 4.86 percent of females (p=0.97). likewise, no significant difference in the occurrence of hypercementosis was observed between maxillary and mandibular arches or between sides (p>0.05). conclusion: the prevalence of hypercementosis in a Saudi population was found to be 4.82 percent with respect to patients and 0.96 percent with respect to teeth. No significant propensity for gender, jaw and arch side was noted.

Hypercementosis Associated with ENPP1 Mutations and GACI.

Mineralization of bones and teeth is tightly regulated by levels of extracellular inorganic phosphate (Pi) and pyrophosphate (PPi). Three regulators that control pericellular concentrations of Pi and PPi include tissue-nonspecific alkaline phosphatase (TNAP), progressive ankylosis protein (ANK), and ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1). Inactivation of these factors results in mineralization disorders affecting teeth and their supporting structures. This study for the first time analyzed the effect of decreased PPi on dental development in individuals with generalized arterial calcification of infancy (GACI) due to loss-of-function mutations in the ENPP1 gene. Four of the 5 subjects reported a history of infraocclusion, overretained primary teeth, ankylosis, and/or slow orthodontic tooth movement, suggesting altered mineral metabolism contributing to disrupted tooth movement and exfoliation. All subjects had radiographic evidence of unusually protruding cervical root morphology in primary and/or secondary dentitions. High-resolution micro-computed tomography (micro-CT) analyses of extracted primary teeth from 3 GACI subjects revealed 4-fold increased cervical cementum thickness ( P = 0.00007) and a 23% increase in cementum density ( P = 0.009) compared to age-matched healthy control teeth. There were no differences in enamel and dentin densities between GACI and control teeth. Histology revealed dramatically expanded cervical cementum in GACI teeth, including cementocyte-like cells and unusual patterns of cementum resorption and repair. Micro-CT analysis of Enpp1 mutant mouse molars revealed 4-fold increased acellular cementum thickness ( P = 0.002) and 5-fold increased cementum volume ( P = 0.002), with no changes in enamel or dentin. Immunohistochemistry identified elevated ENPP1 expression in cementoblasts of human and mouse control teeth. Collectively, these findings reveal a novel dental phenotype in GACI and identify ENPP1 genetic mutations associated with hypercementosis. The sensitivity of cementum to reduced PPi levels in both human and mouse teeth establishes this as a well-conserved and fundamental biological process directing cementogenesis across species (ClinicalTrials.gov NCT00369421).

Radiological prevalence of equine odontoclastic tooth resorption and hypercementosis.

BACKGROUND: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a painful and progressive dental disease that mainly affects the incisors and canine teeth of aged horses. Diagnosis is based on radiographs to detect early stages of the disease. EOTRH is probably underdiagnosed and its prevalence in Germany unknown. OBJECTIVE: This study was performed to determine the radiological prevalence of EOTRH in a large horse population in Berlin-Brandenburg, Germany. STUDY DESIGN: Prevalence study. METHODS: The study population (142 horses) consisted of all horses 10 years and older that were presented at the Equine Hospital for a routine dental examination. The horses were either presented as clinical cases (CC population) or belonged to a riding school (RS population). Digital radiographs of the incisor dentition were taken and evaluated for changes related to EOTRH, leading to an overall classification for each horse. RESULTS: The mean age of the study population was 21 years and ranged from 10 to 37 years. Overall, 94% of all horses had at least minor and 62% had moderate to severe radiological changes of the incisor teeth associated to EOTRH. No horse older than 14 years was without radiological signs of EOTRH and all horses over 28 years of age had at least moderate radiological changes of the incisor teeth. MAIN LIMITATIONS: The clinical cases group might have a bias towards horses with existing dental problems such as EOTRH, because they were presented explicitly for dental care to a clinic. CONCLUSION: Focusing on radiological changes, this study shows that EOTRH is a common condition of horses in Berlin-Brandenburg. With older age, disease is more frequent and radiological changes become more severe. Since no horse older than 14 years was without radiological findings, it is likely that mild changes may be associated with the normal tooth ageing process.

Evaluation of the frequency and characteristics of hypercementosis in the turkish population with cone-beam computed tomography.

AIMS: The aim of this study was to evaluate the frequency and characteristics of hypercementosis in the Turkish population using cone-beam computed tomography (CBCT). SETTINGS AND DESIGN: A retrospective study was performed using CBCT (I-CAT Vision TM Imaging Science International) in 1263 patients admitted to the Faculty of Dentistry at the University of Dicle (Diyarbakir, Turkey) between January 2013 and January 2015. SUBJECTS AND METHODS: A total of 1152 patient and 29,606 teeth were evaluated with CBCT. The age, gender, location (left vs. right side, maxillary vs. mandibular teeth, incisors, premolars, and molars), and missing teeth were recorded for all patients. STATISTICAL ANALYSIS USED: The Pearson Chi-squared test was used to determine the potential differences. RESULTS: Hypercementosis was observed with a frequency of 2.4%. Of these, 18 of 28 (64.3%) had only 1 tooth with hypercementosis and 10 (35.7%) had more than 1 tooth. It was identified in 42 of the 29,606 teeth examined (0.14%). The lesion was found in 2.47% (n = 14) of females and 2.38% (n = 14) of males. The lesion was detected in 28 molars and 14 premolars, but hypercementosis was not detected in incisors. Of the 42 teeth, 12 (28.6%) maxillary and 30 (71.4%) mandibular teeth were associated with hypercementosis. Of the 28 cases, 20 (59.0%) were unilateral and 8 (41.0%) were bilateral. Of the 20 unilateral cases, 12 (69.6%) were on the right and 8 (30.4%) were on the left side. CONCLUSIONS: In our study, the prevalence of hypercementosis has been found 2.4% in the Turkish population. Besides, the lesion has been found more in the mandible than the maxilla, in the molars than the premolars and in the unilateral distribution than the bilateral distribution.

Radiographic evaluation in clinical practice of the types and stage of incisor tooth resorption and hypercementosis in horses.

BACKGROUND: There are several reports of incisor tooth resorption and hypercementosis in horses but, to date, studies have been limited in case numbers and to advanced lesions. Tooth resorption in other species is a radiographic diagnosis of types of resorption that are often identified before clinical signs. Our goal was to evaluate radiographically incisor tooth resorption in a large population of horses, utilising interpretation criteria from canine and human dentistry. OBJECTIVE: To document and classify incisor tooth resorption and hypercementosis. STUDY DESIGN: Retrospective descriptive case series. METHODS: Horses presented for routine dental care >5 years old were included only if owners were unaware of incisor pathology. Radiographs (three views) were obtained of the incisor teeth and incisor teeth resorption was classified according to the radiographic criteria described for man and dogs. Hypercementosis and its location were recorded. RESULTS: Tooth resorption was detected in 149 of 169 (88.2%) horses and 951 of 1952 (48.7%) of incisor teeth. The classification system used was applicable in 926 (97.2%) of 951 affected teeth. Hypercementosis was detected in 34 (20.1%) horses and 148 (7.6%) teeth. As horses increased in age, resorption and hypercementosis was more frequent; no significant differences were found among sex or breed categories. All horses with hypercementosis had resorption, but only 23.4% of horses with resorption had hypercementosis. Advanced (stage ≥3) resorption was detected in 159 (8.1%) teeth and 54 (32.0%) horses in an otherwise clinically healthy population. MAIN LIMITATIONS: Certain horses' anatomy precluded isolation of the mandibular third incisor teeth from the canine teeth due to superimposition. CONCLUSIONS: Incisor tooth resorption, in particular external replacement resorption and external inflammatory resorption, is common in horses. Hypercementosis is consistently associated with resorption, but the inverse association is inconsistent.

Hypercementosis: a rare finding in a patient with systemic lupus erythematosus.

Hypercementosis is excessive deposition of non-neoplastic cementum over normal root cementum, which alters root morphology. This cementum may be either hypocellular or cellular in nature. The aetiopathogenesis of hypercementosis is ambiguous. Although most of the cases are idiopathic, several local and systemic factors are also linked to this condition, such as Paget's disease, acromegaly, vitamin A deficiency, etc. We report two rare cases of hypercementosis associated with systemic lupus erythematosus, not previously described in the literature, and also discuss the possible aetiopathogenesis.

Concrescence: assessment of case by periapical radiography, cone beam computed tomography and micro-computed tomography.

The aim of this article was to describe imaging aspects of concrescence analyzed by three imaging modalities. A second molar joined together with a third molar was imaged using digital periapical radiography, cone beam computed tomography (CBCT) and micro-computed tomography (Micro-CT). On periapical radiograph, the mesial root of the third molar is superimposed on the distal root of the second molar. On CBCT images, a large cementum union between bulbous roots was detected, confirming the diagnosis of concrescence. On micro-CT images, the cementum union appeared limited to the apical third of the roots. In conclusion, both computed tomography modalities allowed for the diagnosis of concrescence. However, only micro-CT provided the real extension of the cementum union.

Lobodontia: the unravelling of the wolf teeth.

Abnormalities of tooth shape and size generally coexist, as both are determined during the morphodifferentiation stage of odontogenesis. This report describes a case of lobodontia exhibiting multiple dental anomalies of which, "fang like" cuspids, multituberculism of molars, hypodontia along with severe generalized microdontia are distinctive. Radiographic features, diagnostic convolutions, differential diagnosis and clinical significance have also been highlighted.

Hypercementosis and odontogenic epithelial hyperplasia associated with a tooth root remnant mimicking a neoplasm. A case report.

Hypercementosis presents as painless, single or multiple non-neoplastic cementum formation beyond the physiological limits of the tooth. It often occurs in the apical area of the involved tooth following infection, chemical or mechanical trauma. We report on radiographic and histopathological findings in a single case of late intraosseous hypercementosis and odontogenic epithelial hyperplasia associated with a minute apical tooth root remnant years after its extraction, mimicking a tumour.

Effect of HIP/ribosomal protein L29 deficiency on mineral properties of murine bones and teeth.

Mice lacking HIP/RPL29, a component of the ribosomal machinery, display increased bone fragility. To understand the effect of sub-efficient protein synthetic rates on mineralized tissue quality, we performed dynamic and static histomorphometry and examined the mineral properties of both bones and teeth in HIP/RPL29 knock-out mice using Fourier transform infrared imaging (FTIRI). While loss of HIP/RPL29 consistently reduced total bone size, decreased mineral apposition rates were not significant, indicating that short stature is not primarily due to impaired osteoblast function. Interestingly, our microspectroscopic studies showed that a significant decrease in collagen crosslinking during maturation of HIP/RPL29-null bone precedes an overall enhancement in the relative extent of mineralization of both trabecular and cortical adult bones. This report provides strong genetic evidence that ribosomal insufficiency induces subtle organic matrix deficiencies which elevates calcification. Consistent with the HIP/RPL29-null bone phenotype, HIP/RPL29-deficient teeth also showed reduced geometric properties accompanied with relative increased mineral densities of both dentin and enamel. Increased mineralization associated with enhanced tissue fragility related to imperfection in organic phase microstructure evokes defects seen in matrix protein-related bone and tooth diseases. Thus, HIP/RPL29 mice constitute a new genetic model for studying the contribution of global protein synthesis in the establishment of organic and inorganic phases in mineral tissues.

Generalised hypercementosis: a case report.

The following case report describes the clinical and radiographical presentation of a female who attended a general dental practice as a new patient. The patient was diagnosed with generalised hypercementosis, possibly attributable to oral neglect. Hypercementosis is associated with a number of aetiological factors, which may be local or systemic in nature. It is important that the general dental practitioner is aware of these factors and is able to distinguish presentation due to a local cause from that of a systemic disease process. The aims of this paper are to illustrate an unusual presentation of hypercementosis and to discuss the radiographic differentiation that led to diagnosis.

Anatomic variations of the root canal of the rat according to age

El conducto mesial del primer molar inferior de la rata se ha utilizado como modelo en estudios experimentales de endodoncia. Se plantea un análisis pormenorizado de las variaciones estructurales en función de la edad, que sirve de base para la caracterización y utilización como modelo. Se estudiaron 60 molares de ratas Wistar de diferente peso: grupo 1: 300-399 g n=22, grupo 2: 400-499 g n=16, grupo 3: 600-700 g N=22.). Las piezas se radiografiaron con un sistema estandarizado. Se realizaron proyecciones aumentadas y sobre los perfiles de la proyección se efectuaron mediciones de la longitud total y del volumen del conducto. Se determinaron los diámetros del conducto en tres niveles: coronario, medio y apical. A partir de estos diámetros se estimó el área de la sección transversal como índice de caudal o posibilidad de intercambio metabólico. Se encontró que a partir del segundo grupo se produce una hipercementosos que aumenbta la longitud del conducto y conduce a la formación de un complejo delta apical. El diámetro del conducto disminuye muy significativamente en el tercio apical. La estimulación del caudal, a partir del área de la sección transversal disminuye de 1.2 mm2 (de proyección) en el grupo 1, a 0,05 mm2 en el grupo 2, valor que no cambia significativamente en el grupo 3. Los resultados indican que en los estudios experimentales de endodoncia en la rata, deben tenerse en cuenta las variaciones anatómicas espontáneas producidas por la edad. (AU)