Comprehensive analysis of bone tissue in extraction sockets of third molars after leukocyte and platelet rich fibrin and photobiomodulation applications.

OBJECTIVES: The aim of this study was to compare leukocyte and platelet-rich fibrin (L-PRF) and photobiomodulation (PBM) applications, which have been repeatedly reported to be superior to control groups, in terms of pain, soft tissue and bone healing in tooth extraction sockets. MATERIALS AND METHODS: This double-blind, randomized clinical study was completed with 34 patients, who had an indication for extraction of their bilaterally impacted teeth. The right and left teeth of the patients were randomly divided into L-PRF and PBM groups. L-PRF group was treated with the blood product centrifuged for 12 min at 2700 rpm, and the PBM group was treated with a diode laser at different points for 60 s with a wavelength of 940 nm in repeated sessions. Postoperative pain was evaluated using Visual Analogue Scale (VAS), soft tissue healing with Landry Index (LI), tissue healing in the distal region of mandibular second molar by probing depth measurement, and bone healing via panoramic x-ray using the Image J program. RESULTS: No statistically significant difference was found for any variable compared between the groups. CONCLUSION: L-PRF and PBM applications provide similar support in the healing of extraction sockets. Nevertheless, the advantages and disadvantages of both methods determine their usage areas. CLINICAL RELEVANCE: While L-PRF is advantageous in the early healing of extraction sockets, PBM may be preferred in terms of bone trabeculation in the long term.

Deep learning-based prediction of indication for cracked tooth extraction using panoramic radiography.

BACKGROUND: We aimed to determine the feasibility of utilizing deep learning-based predictions of the indications for cracked tooth extraction using panoramic radiography. METHODS: Panoramic radiographs of 418 teeth (group 1: 209 normal teeth; group 2: 209 cracked teeth) were evaluated for the training and testing of a deep learning model. We evaluated the performance of the cracked diagnosis model for individual teeth using InceptionV3, ResNet50, and EfficientNetB0. The cracked tooth diagnosis model underwent fivefold cross-validation with 418 data instances divided into training, validation, and test sets at a ratio of 3:1:1. RESULTS: To evaluate the feasibility, the sensitivity, specificity, accuracy, and F1 score of the deep learning models were calculated, with values of 90.43-94.26%, 52.63-60.77%, 72.01-75.84%, and 76.36-79.00%, respectively. CONCLUSION: We found that the indications for cracked tooth extraction can be predicted to a certain extent through a deep learning model using panoramic radiography.

Multidisciplinary approach to multiple dental anomalies in pediatric patients: a case report with 4-year follow-up.

The objective of this article is to report the clinical case and 4-year follow-up of a 5-year-old child with multiple dental anomalies, emphasizing the importance of early diagnosis and use of combined pediatric surgery and orthodontic approaches. A 5-year-old boy, accompanied by his mother, sought dental care for dental caries and tooth pain. Clinical and radiographic examinations revealed active caries, a supernumerary primary tooth in the region of the mandibular right second premolar, and severe ankylosis of the primary mandibular right second molar. The treatment plan involved extraction of the supernumerary tooth as well as sectioning and extraction of the ankylosed molar. When the patient was 6 years old, the permanent mandibular right first molar showed signs of an altered eruptive process, and orthodontic treatment was initiated. A unilateral band-and-loop space maintainer with coil springs designed to move the permanent first molar was placed on the primary first molar. A new panoramic radiograph, obtained when the patient was aged 7 years, suggested the presence of an odontoma in the apical region of the primary maxillary right canine. Surgical removal and histopathologic examination of the lesion confirmed that it was a developing odontoma. After surgery, due to occlusal anomalies that included transverse maxillary deficiency, deep overbite, and midline deviation, the patient underwent rapid maxillary expansion therapy with a Haas-type appliance. When the patient was 8 years old, orthodontic treatment continued with a removable palatal Hawley expander and a orthodontic mandibular lingual arch. Currently, at the age of 9 years, the child is still undergoing fixed orthodontic treatment after surgical exposure of the impacted permanent maxillary right canine and bonding of an orthodontic attachment to enable traction. A multidisciplinary approach to the management of dental anomalies promotes a favorable prognosis and ensures comprehensive treatment of young patients.

A novel formula for estimating the vertical dimension of occlusion using panoramic radiography.

BACKGROUND: This study aimed to develop a new formula to easily estimate the vertical dimension of occlusion (VDO) by using the distance between the mental foramen on a panoramic radiograph. SUBJECTS AND METHODS: A total of 508 dentulous subjects were selected from outpatient dental clinics at the College of Dental Medicine, Al-Azhar University. The vertical dimension of the occlusion was measured using a single calibrated calliper. For each subject, a digital panoramic radiograph was taken with fixed exposure parameters. The intermental foramina distance (IMFD) was measured. The data were collected and then analysed using the IBM SPSS version 20.0 software package. (Armonk, NY: IBM Corp.). Linear regression was used to determine the relationship between the intermental foramina distance (IMFD) and the vertical dimension at occlusion (VDO). RESULTS: Pearson's correlation analysis revealed that there was a strong correlation between the intermental foramina distance (IMFD) and the VDO. Thus, a novel formula was developed for determining the VDO using panoramic radiography. CONCLUSION: The novel formula developed herein facilitated the determination of the VDO among prosthetic rehabilitation for subjects who lost vertical dimension due to loss of posterior teeth or severe wear of natural posterior teeth. Further studies are needed to determine the clinical applicability of the derived formulae for edentulous subjects.

Detection of the Fixed Prostheses on Panoramic Images: An Artificial Intelligence Based Study.

OBJECTIVE: To investigate the effectiveness of using YOLO-v5x in detecting fixed prosthetic restoration in panoramic radiographs. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Radiology, Eskisehir Osmangazi University, Eskisehir, Turkiye from November 2022 to April 2023. METHODOLOGY: For the labelling of fixed prosthetic restorations, 8,000 panoramic radiographs were evaluated using the YOLO-v5x architecture. In creating the dataset for this study, fixed prosthetic restorations were categorised as dental implant, pontic, crown, and implant-supported crown on dental panoramic radiographs. The labelled images were then randomly split into three groups: 80% for training, 10% for validation, and 10% for testing. The labelled panoramic images constituted the model's training dataset, and leveraging the knowledge acquired during this learning stage, the model generated predictions in the testing phase. RESULTS: The majority of labelling data were dedicated to crown restorations. The precision and sensitivity values of YOLOv5x were 0.99 and 0.98 for crowns, 0.98 and 0.99 for implants, 0.99 and 0.99 for pontics, and 0.99 and 0.99 for implant-supported crowns, respectively. CONCLUSION: The results obtained in this study demonstrate a satisfactory success rate of YOLO-v5x in detecting dental prosthetic restorations. The high precision and sensitivity of the model indicate its strong potential to enhance clinical professional performance and contribute to the development of more efficient dental health services. KEY WORDS: Artificial intelligence, Dentistry, Dental prosthesis, Panoramic radiography.

Genotoxicity and Micronucleus Formation as a Result of Panoramic Radiography in Epithelial Cells of the Buccal Mucosa: A Cross-sectional Study in Adults.

OBJECTIVES: To determine the genetic effects of panoramic radiography on the epithelial cells of the buccal mucosa by examining the micronucleus formation in these cells. MATERIALS AND METHODS: In this cross-sectional study, exfoliative cytology samples were prepared from the buccal mucosa of 36 patients immediately before and 10 days after panoramic radiography. The samples were prepared using liquid-based cytology with Papanicolaou staining. The slides were simultaneously evaluated by two expert pathologists and the ratio of the number of cells with micronuclei to the total number of cells on the slide was reported as a percentage. Data analysis was done using paired-samples T test, Pearson's correlation coefficient, and covariance analysis (α = 0.05). RESULTS: The study sample consisted of 24 (66.67%) males and 12 females (33.33%) with a mean (SD) age of 27.36 (8.19) years. The frequency of cells with micronucleus before and after panoramic radiography was not statistically different (p = 0.468). Additionally, the frequency of micronucleated cells was not correlated with age (p = 0.737) and sex (p = 0.211). CONCLUSION: Panoramic exposure slightly increased the frequency of cells with micronucleus in epithelial cells of the buccal mucosa. However, this increase was not statistically significant.

Radiographic and diagnostic approaches for mandibular asymmetries in orthodontic practice: a narrative review.

Mandibular asymmetry refers to dimensional differences between the left and right sides of the mandible in terms of size, form and volume. This condition may result in problems with functionality as well as appearance. Early intervention is often deemed optimal for addressing mandibular asymmetry; however, there is a lack of consensus regarding the diagnostic approach and strategy for identifying asymmetries in developing individuals. The purpose of this narrative review (NR) is to provide a clinician-focused update on the radiographic techniques for identifying mandibular asymmetries in orthodontic patients. Selective database searches were conducted until November 2023 to assess the available literature on mandibular asymmetry diagnosis. A health-sciences librarian developed a search strategy utilizing appropriate terms associated with mandibular asymmetry diagnosis. The databases used were Web of Science, Embase, Scopus, Liliacs and PubMed. Fifty-two studies were included in this review and data regarding the evaluation of mandibular asymmetries were presented with a narrative approach delineating clinical indications based on retrieved findings. There is no unanimous consensus on the method for diagnosing mandibular asymmetries. Cone beam computed tomography emerges as the preferred examination method for diagnosing mandibular asymmetry, thanks to the assessment of a 3D structure with a 3D image. However, the use of only orthopantomography could be advisable as a first-line diagnostic tool in children due to less radiation exposure.

Secular changes in dental development of Korean children aged 4 to 16 years over a 10-year period.

This study evaluated 10-year secular changes in dental maturity and dental development among Korean children. A retrospective analysis of panoramic radiograph samples from Korean children (4-16 years old) taken in 2010 and 2020 was conducted. The 2010 group consisted of 3491 radiographs (1970 boys and 1521 girls), and the 2020 group included 5133 radiographs (2825 boys and 2308 girls). Using Demirjian's method, dental maturity scores and dental developmental stages were assessed. For intra-observer reliability, Weighted Cohen's kappa was used, and Mann-Whitney U tests were performed to compare the 2020 and 2010 groups. A slight acceleration in dental maturity was observed in both boys and girls, with the difference being more noticeable in boys at an earlier age. Statistically significant differences were noted at ages 4, 5 and 7 for boys, and at age 6 for girls. Despite these differences, the individual dental development stages of 2020 and 2010 showed inconsistent trends with limited differences. Generally, girls demonstrate more advanced dental maturity than boys. A slight acceleration in Korean children's dental maturity was observed over a 10-year period when comparing the 2020 groups to the 2010 groups.

Prevalence of tooth agenesis and supernumerary teeth related to different Thai cleft lip and cleft palate populations.

BACKGROUND: Pattern of dental anomalies encountered in cleft patients shows subtle signs of genetic involvement. This study aimed to evaluate the prevalence and pattern of tooth agenesis and supernumerary teeth in Thai cleft population according to the cleft type. METHODS: Data collected from patients with cleft lip and palate, who had been treated at Tawanchai Cleft Center, Khon Kaen University, Thailand, available during year 2012-2022, were investigated. Records from 194 patients with non-syndromic clefts met the inclusion criteria. Standard dental records, and at least either orthopantomogram (OPG) or cone beam computed tomography (CBCT), were examined. Statistical analysis was performed using chi-square and binominal test (p ≤ 0.05). RESULTS: Prevalence of tooth agenesis was higher (77.3%) than that of supernumerary teeth (5.7%) and was more common in bilateral cleft lip and palate (BCLP) (88.1%) than in unilateral cleft lip and palate (UCLP) (72.6%) (p = 0.017). The upper lateral incisor was more frequently affected (46.4%), followed by the upper second premolar. The number of missing teeth observed on the left side was significantly higher. Patients with left UCLP (ULCLP) had the highest prevalence of tooth agenesis. A total of 41 tooth agenesis code (TAC) patterns was found. The prevalence of supernumerary teeth was comparable with 6.6% of ULCLP, 5.1% of BCLP, and 4.5% of URCLP. Tooth-number anomalies were observed more often in the BCLP and were most likely to occur on the left side of the maxilla. Both types of anomalies could be featured in a small proportion of cleft patients. CONCLUSIONS: More than half of the patients with non-syndromic cleft lip and palate in this study, presented with tooth-number anomalies. Tooth agenesis was approximately 10-time more prevalent than supernumerary teeth. Tooth agenesis was likely to appear on the left-side of the maxilla regardless of the laterality of the cleft.

Prevalence of Zygomatic Air Cell defects in a sample of 6-18-year-old patients in Saudi Arabia and Yemen: a retrospective study.

OBJECTIVES: This study aimed to comprehensively analyze the prevalence and influencing factors of Zygomatic Air Cell Defects (ZACD) among pediatric and adolescent populations in Saudi Arabia and Yemen. MATERIALS AND METHODS: A cross-sectional retrospective study was conducted, utilizing digital panoramic radiographs of dental outpatients aged 6 to 18 years. The data were collected from registered digital databases of dental clinics in Al-Qassim, Saudi Arabia, and an oral and maxillofacial radiology center in Sana'a, Yemen, covering the period from July 2018 to September 2022. The radiographs were evaluated based on inclusion and exclusion criteria, and ZACD was assessed using standardized descriptions. Statistical analysis, including logistic regression, was employed to examine the impact of the associated factors. RESULTS: The study encompassed a total of 3,169 participants, revealing an overall ZACD prevalence of 28.5%. Age emerged as a significant predictor (p ≤ 0.0001), with the likelihood of ZACD increasing as the age of the individual advances. Gender and geographic region did not exhibit statistically significant differences in ZACD prevalence. CONCLUSION: This study provides crucial insights into the prevalence of Zygomatic Air Cell Defects among pediatric and adolescent populations in Saudi Arabia and Yemen. It underscores the prevalence of ZACD and the notable influence of age on its occurrence. Additionally, the research challenges prior notions of gender and regional variations in ZACD prevalence, emphasizing the complexity of the factors involved. Early detection is essential to avoid unwanted complications during any surgical intervention in this area.

Prevalence and Pattern of Tooth Impaction: A Radiographic Study in a Trinidadian Population.

OBJECTIVE: The aim of this retrospective study was to determine the prevalence and patterns of impacted third molars in a Trinidadian population. METHODS: A total of 1500 orthopantomograms (OPG) taken at the School of Dentistry, University of the West Indies, from 2008 to 2019 in patients between 15 and 67 years old were evaluated. From the data collected, the prevalence of third molar impaction, the parameters of gender, angulation, level of impaction, and associated pathologies were evaluated. Other types of impacted teeth were also recorded. RESULTS: Of the 1500 OPG viewed, 408 (27.2%) of the study sample presented with at least one impacted third molar. 161 (39.5%) were males and 247 (60.5%) were females, with a male-to-female ratio of 1:1.5. There was a greater incidence of mandibular third molars versus maxillary third molars, which had a frequency of 77.9% and 22.1%, respectively. The most common type of impaction (Winter's classification) was horizontal in the mandible and distoangular in the maxilla. The most common level of impaction in the mandible (Pell and Gregory classification) was level 1A. The total number of impacted teeth was 775, and of these, 75 (9.7%) showed other impacted teeth besides the third molars. Canines and second premolars were the most prevalent with 7.6% and 1.5%, respectively. Caries on the second molar (49.3%) and third molars (40%) were the most frequently associated pathologies identified. CONCLUSION: The prevalence of impacted wisdom teeth in this study was 27%. These results raise awareness and provide insight among dental professionals in Trinidad as to the prevalence of impacted third molars, their patterns, as well as commonly associated pathologies, and the need for screening within the population.

Root resorption of primary molars and dental development of premolars in children with Osteogenesis Imperfecta medicated with bisphosphonates, grouped according to age and gender.

BACKGROUND: Osteogenesis imperfecta (OI) is an inherited disorder characterized by bone fragility and skeletal alterations. The administration of bisphosphonates (BPs) to patients with OI reduces pain, thereby improving their quality of life. The main mechanism of action of BPs is the inhibition of osteoclast action. In the oral cavity of children with OI during growth and development, physiological processes that require the function of osteoclasts occur. The aim of this investigation was to study the dental development of premolars and the root resorption of primary molars in children with OI medicated with BPs according to age and sex. METHODS: An observational and analytical study was designed. The study sample consisted of 26 6- to 12-year-old children with a confirmed diagnosis of OI treated with BPs with available panoramic radiographs. The control group consisted of 395 children with available panoramic radiographs. Both groups were divided into subgroups according to sex and age. The third quadrant was studied, focusing on the first left temporary molar (7.4), the second left temporary molar (7.5), the first left permanent premolar (3.4) and the second left permanent premolar (3.5). The Demirjian method was used to study the dental development of 3.4 and 3.5, and the Haavikko method was used to study the root resorption of 7.4 and 7.5. The Mann‒Whitney U test was used for comparisons, and p < 0.05 indicated statistical significance. RESULTS: The mean chronological age of the 421 patients was 9.21 years (95% CI 9.05-9.37). The sample was reasonably balanced by sex, with 52.5% (221 patients) boys versus 47.5% (200 patients) girls. Delayed exfoliation and tooth development were described in children with OI (p = 0.05). According to sex, the root resorption of primary molars and tooth development were significantly lower in boys in both groups and in girls in the OI group, but the differences between the age groups were not significant. CONCLUSIONS: Children with OI treated with BPs exhibit delayed dental development of the premolars and delayed root resorption of the primary molars. Boys exhibited delays in both variables, but the differences by age subgroup were not significant. These clinical findings support the importance of clinically and radiographically monitoring the dental development and root resorption of primary teeth in children with OI treated with BPs to avoid alterations of the eruptive process.

Radiological Evaluation of the Accuracy of Demirjian, Nolla, and Willems Methods for Dental Age Estimation in 3-17-Year-Old Iranian Children.

Background: The stage of tooth formation is one of the most reliable indicators for predicting a patient's developmental age by radiographs. This study compared the accuracy of three distinct dental age estimation methods (Demirjian, Nolla, and Willems) in children aged 3-17 in the northern Iranian population. Methods: This cross-sectional study examined panoramic radiographs of 434 children aged 3-17 from Mazandaran Province, Iran, who had teeth 31-37 present on the left mandible. This study employed the Demirjian, Nolla, and Willems methods to estimate the dental age of the sample and compare it with the chronological age. The data were analyzed using SPSS v16. A paired t-test was used to compare chronological and dental ages. The Pearson correlation was used to correlate the chronological and dental ages. The errors of different methods were compared using the Wilcoxon test. P values < 0.05 were considered significant for all tests except Wilcoxon. For Wilcoxon, a P value < 0.017 was considered significant. Results: The three methods presented differing mean estimated ages. The Demirjian method delivered the highest mean, and all three methods differed significantly when compared in pairs. The results showed that the Demirjian method overestimated chronological age by 0.25 years (P < 0.001) in girls and 0.09 years (P = 0.28) in boys. The Willems method underestimated chronological age by 0.05 years (P = 0.47) in girls and 0.12 years (P = 0.13) in boys. The Nolla method underestimated chronological age by 0.41 years (P < 0.001) in girls and 0.40 years (P < 0.001) in boys. The accuracy of each method varied with the patient's age. Conclusion: According to the findings, the Willems method outperformed the Demirjian method, and the Demirjian method exceeded the Nolla method for estimating dental age in Iranian children aged 3-17. Overall, the Demirjian method overestimated the age of the study population, whereas the other two underestimated it.

YOLO-V5 based deep learning approach for tooth detection and segmentation on pediatric panoramic radiographs in mixed dentition.

OBJECTIVES: In the interpretation of panoramic radiographs (PRs), the identification and numbering of teeth is an important part of the correct diagnosis. This study evaluates the effectiveness of YOLO-v5 in the automatic detection, segmentation, and numbering of deciduous and permanent teeth in mixed dentition pediatric patients based on PRs. METHODS: A total of 3854 mixed pediatric patients PRs were labelled for deciduous and permanent teeth using the CranioCatch labeling program. The dataset was divided into three subsets: training (n = 3093, 80% of the total), validation (n = 387, 10% of the total) and test (n = 385, 10% of the total). An artificial intelligence (AI) algorithm using YOLO-v5 models were developed. RESULTS: The sensitivity, precision, F-1 score, and mean average precision-0.5 (mAP-0.5) values were 0.99, 0.99, 0.99, and 0.98 respectively, to teeth detection. The sensitivity, precision, F-1 score, and mAP-0.5 values were 0.98, 0.98, 0.98, and 0.98, respectively, to teeth segmentation. CONCLUSIONS: YOLO-v5 based models can have the potential to detect and enable the accurate segmentation of deciduous and permanent teeth using PRs of pediatric patients with mixed dentition.

Micronuclei as an indicator of genotoxic change in epithelial cells of buccal mucosa after panoramic radiographs.

BACKGROUND: The radiation released at the time of dental panoramic radiographs causes genotoxic and cytotoxic effects on epithelial cells. OBJECTIVE: This research aimed to evaluate the changes in the frequencies of micronucleated cells in patients' buccal epithelial cells following dental panoramic radiography. METHODS: 74 patients were recruited for the study who were advised for panoramic radiographs. Using a wooden spatula, the buccal epithelial cells were scraped from both cheeks before to panoramic radiation exposure and ten days after the panoramic radiation exposure. Giemsa stain was used to stain the cells, and 500 cells were scored on a slide to determine the frequency of micronuclei. To determine the difference between the frequency of micronuclei before and after radiation exposure, a paired t-test was used in the statistical analysis. RESULTS: The proportion of micronuclei cells was 0.11% before radiation exposure and 0.57% following radiation exposure after 10 days. A statistically significant increase in the frequencies of micronuclei was noted after radiation exposure values. CONCLUSION: This study revealed the genotoxicity of epithelial cells with dental panoramic radiation exposure. It is advised to reduce the use of such radiographs and to use only when there is no other diagnostic tool that is helpful or when absolutely essential.

Accuracy of automated forensic dental age estimation lab (F-DentEst Lab) on large Malaysian dataset.

When a disaster occurs, the authority must prioritise two things. First, the search and rescue of lives, and second, the identification and management of deceased individuals. However, with thousands of dead bodies to be individually identified in mass disasters, forensic teams face challenges such as long working hours resulting in a delayed identification process and a public health concern caused by the decomposition of the body. Using dental panoramic imaging, teeth have been used in forensics as a physical marker to estimate the age of an individual. Traditionally, dental age estimation has been performed manually by experts. Although the procedure is fairly simple, the large number of victims and the limited amount of time available to complete the assessment during large-scale disasters make forensic work even more challenging. The emergence of artificial intelligence (AI) in the fields of medicine and dentistry has led to the suggestion of automating the current process as an alternative to the conventional method. This study aims to test the accuracy and performance of the developed deep convolutional neural network system for age estimation in large, out-of-sample Malaysian children dataset using digital dental panoramic imaging. Forensic Dental Estimation Lab (F-DentEst Lab) is a computer application developed to perform the dental age estimation digitally. The introduction of this system is to improve the conventional method of age estimation that significantly increase the efficiency of the age estimation process based on the AI approach. A total number of one-thousand-eight-hundred-and-ninety-two digital dental panoramic images were retrospectively collected to test the F-DentEst Lab. Data training, validation, and testing have been conducted in the early stage of the development of F-DentEst Lab, where the allocation involved 80 % training and the remaining 20 % for testing. The methodology was comprised of four major steps: image preprocessing, which adheres to the inclusion criteria for panoramic dental imaging, segmentation, and classification of mandibular premolars using the Dynamic Programming-Active Contour (DP-AC) method and Deep Convolutional Neural Network (DCNN), respectively, and statistical analysis. The suggested DCNN approach underestimated chronological age with a small ME of 0.03 and 0.05 for females and males, respectively.

Is the third molar the most frequently extracted tooth? A population-based study utilizing dental panoramic radiographs in adults.

OBJECTIVES: The study aimed to examine the authenticity of the often-mentioned statement that the third molar is the most frequently extracted tooth. This finding has not been shown previously in a large population-based sample. MATERIALS AND METHODS: Data comprised a nationally representative sample of 6082 panoramic radiographs taken from adults in the cross-sectional Health 2000 Survey. From the radiographs, all missing teeth were recorded. Information on congenital agenesis of individual teeth was retrieved from two published meta-analyses. Primary outcome was the frequency of missing teeth by tooth type. Explanatory variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression. RESULTS: Mean age of participants (46% men, 54% women) was 53 years (SD 14.6; range 30‒97 years). Missing teeth occurred more often in women than in men (P < 0.001). The third molar was most frequently missing and the canine least frequently. In the maxilla and mandible, the third molar was missing more often than each of the other tooth types up to the age of 80 years (P < 0.01). CONCLUSIONS: When considering the rates of congenital agenesis of individual teeth, it is concluded that the third molar remained the most common tooth extracted up till the age of 80 years. CLINICAL RELEVANCE: The third molar is the most common target for extraction, but also the most common tooth associated with malpractice claims, and therefore, calls for skills, adequate equipment, and other resources for a successful extraction.

Evaluation of dental manifestations in X-linked hypophosphatemia using orthopantomography.

BACKGROUND: X-linked hypophosphatemia (XLH) is the most common inherited form of rickets. The presence of sequence variations in the phosphate regulating endopeptidase homolog X-linked (PHEX) gene is associated with increased production of fibroblast growth factor 23 (FGF23). This results in renal phosphate wasting and impaired skeletal mineralization. Spontaneous dental abscesses, caused by endodontic infections resulting from hypomineralization of dentin, are a known dental complication of XLH. There is no objective method to evaluate the severity of dentin dysplasia. The purpose of this study was to develop a quantitative method to evaluate dentin dysplasia using orthopantomography that would allow the values in patients with XLH to be compared with the values in healthy participants of the same age. METHODS: The severity of dentin dysplasia was analyzed by measuring the pulp cavity area of the tooth using orthopantomographic images. The teeth analyzed were mandibular second primary molars and mandibular first permanent molars with complete root formation. Teeth with dental caries, restorations, or root resorption were excluded. RESULTS: This retrospective observational study included a total of 200 images of healthy participants (aged 2-15 years) divided into five age groups and 42 images of 17 patients with XLH. There was a significant tendency for the pulp cavity area to decrease with increasing age in primary and permanent teeth. The pulp chambers of patients with XLH were larger than those of healthy participants in primary and permanent teeth. CONCLUSION: We have established a method of using orthopantomography for quantitative assessment of dentin dysplasia in XLH from the primary dentition to the permanent dentition. Evaluating the severity of dentin hypomineralization by this method is useful in the diagnosis of the dental manifestations of XLH. Early diagnosis of XLH enables oral management and leads to prevention of dental abscesses.

Unwarranted intrusion of odontogenic cyst into the maxillary antrum.

During the early growth phase, every individual is involved in a prolonged series of developmental processes in the maxillofacial region. Formation of cysts associated with such three-dimensional growth of the maxillofacial skeleton as well as deciduous and permanent tooth development. The origin of cystic jaw lesions may be odontogenic or non-odontogenic, developmental, or inflammatory and they are epithelial-lined or non-epithelial-lined cysts in nature. These cysts are considered to be aggressive cysts when they tend to grow rapidly and can cause significant damage to the surrounding bone and tissues if left untreated. Aggressive cystic lesion of the jaw needs special attention in order to prevent recurrences or even worsen and widespread disease. The management of the maxillary sinus requires individualisation based on its clinical and histopathological characteristics. Here, we report a case of an aggressive odontogenic cyst in a 30s-aged female patient in the left maxillary sinus with the literature review.