Clinicoradiologic features of ameloblastomas: A single-centre study of 155 cases.

BACKGROUND: The purpose of the current study was to report on the clinical presentation and radiologic features of 155 cases of ameloblastoma (AB), representing a detailed, large, single-centre radiologic study. METHODS: Histologically confirmed cases were reviewed over 11 years. Demographic and clinical data were retrieved from the patient's records. Radiologic information was analysed from available radiographs. The radiologic features of ABs were assessed according to the mean age of presentation and the mean duration of the lesion. The distinguishing radiologic features between adults/children and sex were also evaluated. RESULTS: A statistically significant correlation existed between loss of border demarcation and advanced mean age. Multilocular lesions were markedly more common in adults compared to children. Multilocular ABs were associated with increased lesion duration and advanced mean age. Radiologic signs of reactive bony changes associated with the tumour presented at the highest mean duration of all bony effects. Bony expansion and cortical destruction were statistically correlated with lesion duration. Tooth impaction was more common in children. Some mandibular lesions reached a significant size, resulting in impingement of the maxillary sinus, zygoma, orbit and pterygoid plates. CONCLUSION: Due to unfortunate healthcare access constraints, ABs grow to significant sizes and exhibit features not often reported in the literature. The findings of this analysis highlighted the radiologic features of ABs expressed through the mean age and duration of the lesion. This emphasises the significance of timely management of these lesions.

Metric evaluation of the anterior nasal spine to estimate sex and population group in South African individuals.

INTRODUCTION: The anterior nasal spine is a pointed, midline projection of the maxilla. This bony structure dictates the overlying soft tissues providing the phenotypic features of the nose and upper lip and determines the differences in the mid-face morphology. Little data is available on the metric features of the Anterior nasal spine (ANS). This study aimed to perform metric evaluations of the ANS of white and black South African males and females to ascertain if morphological variations exist and if the differences are viable for the use in sex and population identification. MATERIALS AND METHODS: The sample included 100 CBCT images for each population and sex group. Linear and angular measurements of the ANS were recorded in both the sagittal and axial planes. RESULTS: Classification decision trees (pruned) were fitted to ascertain the relationship between population group, sex and the ANS measurements including and excluding age. For population group, all the ANS measurements were statistically significant for females but in males, all the ANS measurements were significant when performed individually. However, when fitted to the classification tree, Sagittal 2 did not show any statistical significance. When considering sex, only 2 of the ANS measurements (Sagittal 2 and Axial 1) were found to be significant. The results did not differ significantly when comparing the decision trees including and excluding age. CONCLUSIONS: White South African individuals presented with a longer ANS that produced a more acute angle whereas black South African individuals presented with a shorter ANS and a more obtuse angle. Additionally, males presented with a longer ANS compared to females. ANS measurements were found to be more relevant for population discernment than for sex.

Fibrodysplasia ossificans progressiva.

Key Clinical Message: Fibrodysplasia ossificans progressiva is a progressively debilitating condition associated with significant morbidity caused by heterotopic ossification. Recognition of the early signs of hallux valgus and painful soft tissue nodules can assist in the early diagnosis of this condition. Periodic radiographic examination is mandatory to monitor the disease progression. Abstract: Fibrodysplasia ossificans progressiva is a rare condition with an estimated prevalence of one in two million individuals. The condition is characterized by widespread heterotrophic ossification of skeletal muscles and ligaments. We report the case of an 8-year-old female patient and show the radiological progression of the condition.

Investigation of mandibular second molar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems.

PURPOSE: To investigate the root and canal morphology of mandibular second molars, including anatomical variations, in a Black South African population using two classification systems. METHODS: Cone-beam computed tomography images of 386 teeth were evaluated. The number of roots and canal configurations were categorized using the classifications of Vertucci (with modifications by Sert and Bayirli) and Ahmed et al. (including the modified Melton classification). Relationships between variables were assessed using Fisher's exact test (P < 0.05). RESULTS: Mandibular second molars were predominantly two-rooted (91.7%). The majority of teeth had three canals including Type IV mesial (41.2%) and Type I (75.1%) distal (Ahmed et al. configuration: 2MDM M2 D1). Three or more canals were present in almost one-fifth of mesial (n = 72/386, 18.6%) and a small number of distal (n = 21/386, 5.4%) roots. Males displayed additional canals more frequently in the distal root (P = 0.02). C-shaped anatomy was found in 5.7%. Among the C-shapes, the most common was Melton's Type III in the coronal (50%), middle (81%) and apical (72%) thirds. CONCLUSION: In this population, mandibular second molar teeth exhibited diverse morphology, which would have clinical significance for endodontic practitioners. The Ahmed et al. classification provided a better description than the Vertucci classification.

The radiologic progression of ameloblastomas.

Background: In developing countries, many diagnosed cases of ameloblastoma (AB) have a significant delay in receiving treatment because of patient factors and healthcare facility constraints. Objectives: The radiologic progression of ABs with delayed treatment was analysed using panoramic radiographs and cone-beam computed tomography imaging. Method: Histopathologically confirmed cases of AB with follow-up radiographs indicating no treatment were retrospectively reviewed over a study period of 10 years. Fifty-seven cases with 57 initial and 107 follow-up radiographs were included. Each follow-up radiograph was analysed for changes in borders, locularity, effects on surrounding structures and lesion size. Results: There was a general increase in poorly-demarcated lesions, with seven cases transforming from an initial unilocular to a multilocular appearance. At follow-up, there was an increase in cortical thinning and cortical destruction. Ameloblastomas presented with a three-fold increase in average size from the initial to follow-up visits. Regression analysis showed a statistically significant relationship between lesion duration and length (p = 0.001). A statistically significant relationship existed between duration and overall lesion dimensions when only the first and last observations per patient were used (p = 0.044). Conclusion: Considering the aggressive nature and unlimited growth potential, ABs with delayed treatment may show extensive growth, complicating their eventual management. Contribution: This study aimed to raise awareness of the importance of the timeous management of patients with AB by highlighting the detrimental effects of delayed treatment.

Establishing standards for Yonsei point in a White South African population for the treatment of gummy smile.

INTRODUCTION: The purpose of this study is to establish the efficacy of Yonsei point in the treatment of a gummy smile in a White South African population. The accurate surface anatomy criteria in relation to the underlying musculature for the administration of Botulinum toxin injections in the treatment of gummy smile was determined. MATERIALS AND METHODS: Nineteen (10 males and 9 females) cadavers were selected for facial dissection. Facial profile photographs were taken before and after dissection. The before and after photographs were overlayed to determine where the pin positions should be on the dissected cadaver to determine the Yonsei point. The levator labii superioris (LLS), LLS alaeque nasi (LLSAN), zygomaticus minor, and zygomaticus major muscles were measured using a protractor and ruler, which accounted for the manual measurements. Digital measurements were measured by importing dissected images into ImageJ. Circles with a 2 cm diameter (1 cm radius) were constructed to determine whether the Yonsei point could successfully influence muscles fibers. RESULTS: Digital and manual measurements show comparable results with high correlation and reliability. Results showed that the White South African population had narrower facial musculature angles as compared with the Korean population. CONCLUSION: Based on the selected sample, the Yonsei point is an ineffective injection site for the successful treatment of gummy smile in a White South African population.

Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications.

This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.

A study of mandibular premolar root and canal morphology in a Black South African population using cone-beam computed tomography and two classification systems.

PURPOSE: An investigation of the configurations of mandibular premolar roots and canals in a population of Black South Africans. METHODS: Cone-beam computed tomography analysis of 772 mandibular premolars was performed, and the premolars were classified according to the systems proposed by Vertucci and Ahmed et al. Root number, canal morphology, age, and sex were recorded. Fisher's exact test was used to determine relationships based on age and sex (P < 0.05). RESULTS: Single roots were seen in the majority of mandibular premolars (97.1%). Single canal configurations (i.e., Vertucci Type 1/Ahmed et al. 1MP1) were observed in 48.5% of first and 81.3% of second mandibular premolars. Mandibular first premolars demonstrated multiple canals in more than half of the sample (51.5%), and C-shaped morphology in more than one-tenth (11.1%). A relationship between sex and the presence of radicular grooves was demonstrated (P = 0.049), males being more likely to demonstrate this feature (P = 0.051). Multiple canals in mandibular first premolars also showed a relationship with sex (P = 0.005), a male predilection being evident (P = 0.007). The Ahmed et al. system proved superior to the Vertucci classification for reporting complex configurations and anatomical variations, although a greater number of unique categories were created. CONCLUSION: Diverse mandibular premolar root and canal morphology was observed in the studied population. Clinicians must be aware of common morphological features as well as possible anatomical variations in mandibular premolars, as failure to treat complete root canal systems may negatively impact endodontic treatment outcomes.

Root and canal morphology of the permanent anterior dentition in a Black South African population using cone-beam computed tomography and two classification systems.

PURPOSE: This study investigated the root and canal morphology of the permanent anterior dentition in a Black South African population. METHODS: In total 2,343 permanent anterior teeth were evaluated using cone-beam computed tomography images and described according to the Vertucci and Ahmed et al. classifications. Demographic information, root number and internal canal morphology were recorded. Age and sex associations were made using Fisher's exact test (P < 0.05). RESULTS: All anterior teeth were single-rooted (100%). The most frequent configuration in maxillary anteriors was a single canal (Vertucci Type I/1MXA1). In mandibular anteriors, single canal configurations (Type I/1MDA1) predominated, however 36.6% of mandibular central and 33.9% of lateral incisors displayed two canals. Older subjects (>40 years) demonstrated single canals more than younger subjects (P = 0.0004). Females displayed variations more compared to males (P = 0.002). The two classifications were found to be comparable for evaluation of permanent anterior teeth. Complex configurations were better described using the newer system. CONCLUSION: The permanent anterior teeth of this population exhibited exclusively single roots and diverse internal characteristics. Clinicians should be aware of anatomical variations, particularly in mandibular incisors, as these may result in adverse endodontic outcomes if not taken into consideration by the treating practitioner.

Radiological spectrum of metastasis to the oral and maxillofacial region.

OBJECTIVE: Oral and maxillofacial metastasis may be the first indication of an undiscovered malignancy in a significant number of cases. Therefore, the rationale of this article is to highlight the clinical and radiological presentation of metastatic lesions involving the oral and maxillofacial region. This will serve as a reference for clinicians, who may first encounter patients with possible metastatic lesions in this region. METHODS: Histologically confirmed cases of oral and maxillofacial metastasis were retrospectively reviewed over a 30-year period. Twenty-three patients were included in the study. The following clinical information was reviewed: age at diagnosis, gender, medical history, main complaint, site of metastatic tumour, radiological features, preliminary clinical diagnosis and final histological diagnosis. RESULTS: Females were twice as commonly affected, with metastatic lesions three times more likely to occur in the mandible. Common clinical presentations included swelling, pain and paraesthesia, with non-specific dental-related symptoms occurring in a few cases. Fifteen cases presented radiologically with an osteolytic lesion with poorly demarcated margins. Four cases presented with well demarcated lesions with additional signs of destruction. Additionally, four cases showed an osteogenic radiological appearance. In the current population sample, metastasis to the oral and maxillofacial region most commonly originated from the breast. CONCLUSION: Lesions with poorly demarcated margins with cortical destruction, accompanied by clinical signs of swelling, pain and paraesthesia in the absence of any inflammatory process, should raise suspicion for metastasis. Considering the poor prognosis of these metastatic lesions, the responsibility lies with the clinician to identify these lesions and make appropriate referrals.

Validation of Roberts' method using root canal width patterns as a mandibular maturity marker in determining the 18-year threshold.

The South African Bill of Rights and the Children's Act define a 'child' as a person under the age of 18 years. The age of 18 years is therefore significant for legal purposes in South Africa. The third molar is an important indicator in determining the 18-year threshold. Human biological growth markers are accepted indicators of a subject attaining the age of 18 years. A recent study by Roberts et al. suggested that the relative width of the distal root canals (RCW) of the lower left permanent molars (Fédération Dentaire Internationale notation 36, 37 and 38) as visualised on dental panoramic radiographs can be used as such a growth marker. This study aimed to validate this human biological growth marker in both black and white populations living in South Africa according to Roberts' method. The findings of this validation study were in agreement with this method which showed that individuals with Demirjian stage H left molars and category RCW-C were indeed over the 18-year threshold. Important aspects regarding the rationality and application of Roberts' method are discussed. The authors conclude that this method should not be used in isolation but as an adjunct with other age estimation methods.

Multiple adenomatoid odontogenic tumours associated with eight impacted teeth.

Adenomatoid odontogenic tumour (AOT) is a benign tumour that arises from odontogenic epithelial remnants. AOTs usually present as innocuous lesions with limited growth potential. Multiple AOTs are frequently reported in the literature, with reports of tumours associated with up to seven impacted teeth. Multiple AOTs have also been described in association with Schimmelpenning syndrome. This case report highlights the rare occurrence of multiple AOTs involving eight impacted teeth in a 9-year-old male patient. Radiographic examination showed features of enamel hypoplasia and multiple prominent dilated gubernaculum dentis associated with some of the impacted teeth. The patient also presented with a linear epidermal nevus involving the left face and intraoral mucosal papillomatous growths, clinical features highly compatible with Schimmelpenning syndrome.

Age estimation in the living: cervical ring apophysis development in a Turkish sample using CT.

With increases in migration across borders, age estimation in living individuals of not (reliably) documented identity becomes all the more important. Unfortunately, there are not many age indicators that can be used for this purpose, and human variation requires specific methodical approaches. In this paper, a recently proposed age marker to assess the age around the critical age limit of 18 completed years is tested. The method uses apophyseal development of cervical vertebrae 2, 3 and 4. Here CT scans of a large sample of Turkish individuals (n = 1276) were assessed, and likelihoods of being 18 years at a given stage were calculated. The likelihood of being at least 18 years for stages 0, 1 and 2 were zero or close to zero in both males and females. By the time that stage 4 was reached, the likelihood to be 18 years were between 65 and 70% (depending on the vertebra) in females and 81 and 90% in males. In comparison to South Africans, the Turkish individuals developed earlier, but the likelihoods of being 18 years were lower at stage 4 as some individuals were still judged to be in stage 3 well into their twenties. Although fairly variable, this method is a valuable new addition to the modalities that can be used for age assessment in the living. CT scans seemed to provide good visualization of the structures in question, although in actual forensic cases the high radiation dose may be problematic.

An anatomical investigation into the blood supply of the proximal humerus: surgical considerations for rotator cuff repair.

BACKGROUND: The purpose of this study was to investigate the blood supply of the humeral head (HH) originating from the anterior (ACHA) and posterior circumflex humeral arteries (PCHA). METHODS: Formalin preserved specimens were used to measure ACHA length, ACHA length in the bicipital groove (BG), the length of the ascending branch of the ACHA, the penetration point of the ascending branch of the ACHA at the greater tuberosity (GT), and the penetration point of the ascending branch PCHA at the GT. Fresh specimens were used to identify the intraosseous vascular network by both the ACHA and PCHA by injecting a contrast medium using a high-resolution microfocus computed tomography. Specimens were then dissected to expose where the branches of the ACHA and PCHA penetrate the bone, and a small section of the medial head was removed to visualize dye penetration of the cancellous bone. RESULTS: Seven variations for the course of the ACHA were observed. In 36%, the ACHA runs posterior to the BG and posterior to the long head of biceps tendon, and splits into the anterolateral ascending and descending branch. The ascending branch enters the medial wall of the GT. Microfocus computed tomography demonstrated that the intraosseous branch of the ascending branch of the ACHA runs within the GT in a medial direction from its penetration point just along the lateral edge of the BG. Intraosseous accumulation of contrast within the GT supply occurs more toward the inferior aspect of the HH, and the anterior-superior and superior-medial aspect of the HH is not perfused. This region is a high-risk zone for avascular necrosis. CONCLUSION: The results of this study suggest that 7 variations for the course of the ACHA exist. These variations and the interruption of the intraosseous arterial network in the GT with surgery and suture anchor placement result in a high-risk zone in the superomedial aspect of the humeral head overlapping with the area where early aseptic necrosis is identified.

Estimating age and the probability of being at least 18 years of age using third molars: a comparison between Black and White individuals living in South Africa.

Third molar development of 705 White and 563 Black South African individuals aged between 15 and 25 years was assessed from panoramic radiographs obtained from the School of Dentistry, University of Pretoria, South Africa. The maxillary and mandibular left third molars were scored according to a ten-stage scoring system. Ancestry and sex differences in dental maturity were assessed, and the likelihood of an individual being 18 years of age was determined for each developmental stage. Statistically significant differences were noted among ancestry groups for most developmental stages, with South African Black individuals consistently maturing earlier than the White individuals. Statistically significant differences were noted among sex groups for some of the stages, mostly those near the final stages of root development. The results indicate that male third molars completed their development faster than that of females. The likelihood of an individual being 18 years of age based on the third molar development stage for the maxilla and mandible on its own was also determined. Combined likelihood results, for the maxillary and mandibular left third molars for stage H, increased the likelihood of being 18 years to 95% for all the studied ancestry and sex groups.

Age estimation based on Willems method versus new country-specific method in South African black children.

AIM: The aims of our study were to develop new maturity scores for dental age estimation in South African black children according to the Willems method, which was developed based on Belgian Caucasian (BC) reference data (Willems et al. J Forensic Sci 46(4):893-895, 2001), and to compare age prediction performance of both methods. SUBJECTS AND METHODS: A total of 986 panoramic radiographs of healthy South African black (SAB) children (493 males and 493 females) in the age range of 4.14 to 14.99 years (mean age 10.06 years) were selected for obtaining developmental staging scores (according to Demirjian et al. Hum Biol 45(2):211-227, 1973). Willems BC methodology was applied to develop new country-specific maturity scores (Willems SAB). Age prediction performance of Willems BC and Willems SAB was compared. RESULTS: On average, Willems BC renders acceptable results with an overestimation of chronological age of 0.06 years (SD 0.88 years) in SAB children. Compared to Willems SAB, the overall mean absolute error was slightly higher with Willems BC (0.62 and 0.68 years, respectively), but this was not significant in males. Also, the root mean squared error was marginally higher in Willems BC. CONCLUSION: The new age prediction method developed in South African black children was found to be better compared to Willems BC, although the difference seems to be small and clinically not relevant, especially in males.

Clinical, demographic, and radiographic analysis of 82 patients affected by florid osseous dysplasia: an international collaborative study.

OBJECTIVE: The aim of this study was to correlate the clinical, demographic, and radiographic aspects of 82 cases of florid osseous dysplasia (FOD) from four countries assessed by five reviewers. STUDY DESIGN: Retrospective data of patients diagnosed with FOD were obtained from archives of five institutes and analyzed according to clinical and radiographic criteria. RESULTS: A total of 82 cases of FOD were included in the study. In the majority (77.5%) of FOD cases, black women were affected. The disease mainly affected the mandible (100%), and the stage of the lesion was directly correlated with the age (P < .05). The rates of convergence showed confluence of assessment in the mandible (posterior), and the highest rate of divergence between the reviewers was in assessing involvement in the maxilla. There were no differences among the characteristics of the lesion provided by the five institutions, except for the variable proportion of black patients affected by the disease. CONCLUSIONS: FOD mostly affects the mandible of middle-aged black women, and its stage is correlated with patient age. Although panoramic radiography is used for diagnosis, the divergence in assessment of the maxilla might indicate that this method is not the most suitable to evaluate this area.

Questing ixodid ticks on the vegetation of sable antelope and multi-herbivore enclosures in Thabazimbi.

This survey of ixodid ticks was the first to compare the species composition and population dynamics of free-living ticks in intensive, sable antelope breeding enclosures, now commonplace in commercial wildlife ranching in South Africa, with those of multi-herbivore enclosures. The species composition, abundance and seasonal abundance of questing ixodid ticks on the vegetation in intensive breeding enclosures for sable antelope (Hippotragus niger), on which strategic tick control is practised, were compared with those of ticks in a multi-species herbivore enclosure surrounding the breeding enclosures in which no tick control is practised. A total of eight ixodid tick species were collected by drag-sampling the woodland and grassland habitats in each enclosure type monthly from July 2011 to July 2013. Rhipicephalus decoloratus, a potential vector of fatal tick-borne disease in sable antelopes, was the most abundant, accounting for 65.4% of the total number of ticks collected in the sable enclosures, whilst representing only 25.4% of number of ticks collected in the multi-species herbivore enclosure. Rhipicephalus decoloratus and R. evertsi evertsi were more abundant than R. appendiculatus (both p < 0.05) and Amblyomma hebraeum (p < 0.001 and p < 0.01, respectively). Rhipicephalus decoloratus larvae were collected throughout the year, with peak collections in November 2012 and October to December 2013 in the sable enclosures; and in April/May 2012 and February/April 2013 in the multi-species herbivore enclosure. More R. decoloratus were recovered in the second year than in the first year in the grassland habitat of the sable enclosures (V = 7.0, p < 0.05) possibly as a result of acaricide resistance. The apparent temporal over-abundance of R. decoloratus in sable antelope breeding enclosures, in the face of strategic tick control, is of concern and requires further investigation.