Amalgam restoration or just a deposit? A riveting incidental finding- a case report.

BACKGROUND: Parafunctional oral habits are known to cause deleterious effects on maxillofacial structures. One such effect is traumatic injuries secondary to chewing inanimate objects like pencils. Following trauma, the lead of the pencil has been reported to embed in the soft tissue of the oral cavity, appearing as a grayish pigmentation (graphite tattoo). However, such pigmentation has never been reported in the hard tissue (teeth). CASE PRESENTATION: We hereby report an interesting, first of its kind case in a four-year-old female child. She had been misdiagnosed and referred for the management of a carious tooth; which was, in reality, an exogenous deposit. CONCLUSIONS: The authors highlight the impact of comprehensive history taking on arriving at the diagnosis. Counselling of the child and the parents goes a long way in flouting such deleterious habits.

Clinical, Radiographic, and Tumor Characteristics of Solitary Intra-Osseous Neurofibroma of Jaws- A Systematic Review.

Neurofibroma is a benign tumor of the peripheral nervous system affecting Schwann cells as well as neural sheath cells. It is usually considered as a component of Von Recklinghausen's disease, but solitary lesions have also been reported, though not very frequently. It is mostly reported on the skin. In the head and neck region, trigeminal nerve and the cervical nerves are frequently affected; in the oral cavity, tongue is the most commonly affected site. Intra-osseous neurofibromas of the oral cavity are extremely rare and only 22 cases have been reported in the last two decades. The present review is an attempt to know if there is any clinical or radiological feature that can assist in the diagnosis of solitary intra-osseous neurofibroma of the jaws? The literature was reviewed from 01.01.2000 to 05.06.2022 exclusively for case reports, case series, and reviews using the keywords: neurofibroma; neurinoma, maxilla; mandible; jaws, single; solitary; one. Search engines: PubMed Central, Lilac, and Science Direct were used by applying the Boolean operator "OR" and "AND". The review has been submitted for registration in PROSPERO (receipt 340775).

Pycnodysostosis- a rare disorder with distinctive craniofacial dysmorphia. A case report.

Pycnodysostosis is a rare autosomal recessive condition caused by the mutation of CTSK gene. CTSK regulates the activity of Cathepsin K which is responsible for osteoclast-mediated bone resorption. This mutation causes the bones to become dense, sclerotic, brittle, and thus, prone to fracture. Affected individuals have normal cognitive development and life expectancy, however, the quality of life depends on the early diagnosis of the condition. The patient presents with striking clinical (short stature, brachydactyly) and radiological (frontal and parieto-occipital bossing, open sutures, and fontanelles, acro-osteolysis of terminal phalanges) features making the diagnosis clinico-radiographic. In atypical or mild cases with overlapping features, gene mapping is advocated. A plethora of dental anomalies and characteristic craniofacial dysmorphia puts the dentist in a position to diagnose such a case.

Multiple Myeloma with Primary Manifestation in the Mandible.

Multiple myeloma (MM) is a malignant neoplasm of plasma cell origin. It usually has a multicentric origin within the bone. It contributes to about 1% of all malignancies and 15% of all hematologic malignancies. There is a monoclonal proliferation of abnormal plasma cells in this disease that results from a single malignant precursor that has undergone an uncontrolled mitotic division. Later, these cells produce one type of immunoglobulin light chain, either kappa or lambda. We present a case of a 46­year­old male patient who presented with a swelling of the mandible. The punched-out radiolucencies in the skull radiograph and the immunohistochemistry confirmed the case as MM.

Efficacy of various combinations of irrigants and medicaments on Candida albican: An in vitro study.

OBJECTIVE: To evaluate the efficacy of 3% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), calcium hydroxide [Ca (OH)2], and 2% chlorhexidine in various combinations on Candida albicans in root canals for 48 h and 10 days. MATERIALS AND METHODS: In this in vitro study, 95 extracted teeth were instrumented. MTCC 183 strain of C. albicans was introduced into the root canals and after 7 days, the average value of colony forming units (CFUs)/ml was determined in all the roots. Then the teeth were randomly divided into three groups: Group I (n = 15) was the control group and only saline was added to it. In group II (n = 40), 3% NaOCl was used as the irrigant and in group III (n = 40), 3% NaOCl and 17% EDTA were used as irrigants. Groups II and III were further divided into two subgroups (A and B) having 20 teeth each. After irrigation, Ca (OH)2 was placed in subgroup A and 2% chlorhexidine digluconate (CHX) solution in subgroup B of both groups as intracanal medicament. After 48 h, the CFUs/ml was determined in 45 teeth (5 from the control group and 10 from each subgroup). After 10 days, the CFUs/ml was determined in the remaining 50 teeth (10 from the control group and 10 from each subgroup). For statistical analysis, Statistical Package for Social Sciences (SPSS version 15, Chicago IL, USA) was used. RESULTS: A decrease in CFUs/ml of C. albicans was noted in all subgroups at 48 h, but the combination of NaOCl, EDTA, and CHX (group IIIB) was the most effective showing value of 0.095 × 10(5) CFUs/ml. On the 10(th) day, the CFUs/ml of C. albicans was further decreased in all subgroups; but again, subgroup IIIB was the most effective showing a value of 0.025 × 10(5) CFUs/ml. There was statistically significant difference in CFUs/ml of C. albicans at 48 h and on 10(th) day in all study groups. CONCLUSION: The antimicrobial activity of irrigant and intracanal medicament has a positive role in controlling the growth of C. albicans.

A new technique to determine vertical dimension of occlusion from anthropometric measurement of interpupillary distance.

BACKGROUND: A number of techniques are being practiced for the evaluation of VDO, but none of them is scientifically more accurate than other. Each method advocated has its own limitations. OBJECTIVES: The purpose of this study was to find correlation between vertical dimension of occlusion (VDO) and interpupillary distance (IPD). MATERIAL AND METHODS: A cross-sectional study was conducted on 400 dentate subjects comprising of 200 males and 200 females. Anthropometric measurement of VDO was recorded clinically using modified digital vernier caliper. Also, a standardized digital photograph of face was generated from the frontal aspect using a digital camera for the measurement of IPD in millimeters. Correlation between VDO and IPD was studied using Spearman's coefficient. For the execution of regression command and preparation of prediction equations to estimate VDO, Statistical Package for Social Sciences (SPSS) Software Version 11.5 was used. RESULTS: VDO and IPD was more in males compared to females. VDO was significantly and positively correlated with IPD only in males whereas females showed a weak correlation. Hence, regression equation was derived only for males. VDO estimation using regression equation for IPD had a standard error of ± 3.94 in males. CONCLUSIONS: Since the variations between VDO and IPD are within the range of 2-4 mm, VDO prediction through this method is reliable and reproducible for male patients. Also, the method is simple, economic, and non invasive; hence it could be recommended for everyday practice to determine vertical dimension of occlusion in case of male patients. Key words:Anthropometry, interpupillary distance, jaw relation, vertical dimension of occlusion.

Coexistence of two talon cusps and two dens invaginatus in a single tooth with associated radicular cyst-a case report and review of literature.

Talon cusp (TC) and dens invaginatus (DI) are relatively rare developmental anomalies which affect the shape of teeth. TC is an additional cusp that projects predominately from the lingual surface of anterior teeth. DI is a deep surface invagination of the crown or root which is commonly detected on routine radiographic examination. Both of these anomalies are observed more frequently in permanent maxillary lateral incisor. Isolated cases of single TC and DI are extensively reported in dental literature. Occasionally two talon cusps (TCs) in the same tooth as well as double and triple invaginations in one tooth are reported separately. Coexistence of these two anomalies in a single tooth is considered extremely rare, but still there are few reported cases. However, coexistence of two TCs and double DI in a single tooth is not reported till date. We hereby report the first case of coexistence of two TCs and double DI in a single tooth of a 23 year old female and use of platelet-rich fibrin (PRF) in the management of associated radicular cyst. Also, literature on coexistence of these two anomalies in a single tooth is reviewed. Key words:Coexistence, dens invaginatus, radicular cyst, talon cusp.

Malignant fibrous histiocytoma of maxillary alveolar ridge extending to the hard palate.

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma occurring in adults. This entity was first described by O'Brian and Stout in 1964. Apart from the soft-tissues, this tumor has been reported to occur in all other parts of the body including bone. It has male predilection and is usually noticed in the fifth to seventh decades of life. It commonly affects extremities and retroperitoneum, whereas involvement of the head and neck region is comparatively rare. However, when the head and neck region is affected, the most common sites are the maxillary sinus and the nasal cavity, in which case, later involvement of the maxillary alveolar bone can happen. The oral cavity is a relatively less common site for MFH. This article describes clinical, computed tomographic and microscopic features of a MFH of the maxillary alveolar ridge extending to the hard palate in a 46-year-old female patient. Histogenesis, advanced imaging features, differential diagnosis, and management of MFH are also discussed.

Transcutaneous electric nerve stimulation (TENS) in dentistry- A review.

Transcutaneous electric nerve stimulation (TENS) is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions. Similarly, it can be utilized for the management of pain during various dental procedures as well as pain due to various conditions affecting maxillofacial region. This review aims to provide an insight into clinical research evidence available for the analgesic and non analgesic uses of TENS in pediatric as well as adult patients related to the field of dentistry. Also, an attempt is made to briefly discuss history of therapeutic electricity, mechanism of action of TENS, components of TENs equipment, types, techniques of administration, advantages and contradictions of TENS. With this we hope to raise awareness among dental fraternity regarding its dental applications thereby increasing its use in dentistry. Key words:Dentistry, pain, TENS.

Benign fibrous histiocytoma of the maxilla: a case report and review of literature.

Benign fibrous histiocytoma (BFH) is a mesenchymal tumor which commonly affects the skin of extremities. Histologically, BFH of soft tissues and bone shows similar features, but BFH of the bone is rare with less than 100 cases reported worldwide and usually it involves tibia, femur, and pelvic bone. As far as the oral cavity is concerned, majority of the BFHs are found in the soft tissues of the buccal mucosa, gingiva, lower and upper lips, soft palate, and floor of the mouth. Occurrence of this tumor in the jaw bones is extremely rare as only one case of the maxilla and six cases of the mandible have been reported so far . Hence, the purpose of this article is to report the second case of BFH of the maxilla in a 23-year-old female patient and to review the literature of this entity affecting the jaws.

A new technique to determine vertical dimension of occlusion from anthropometric measurements of fingers.

PURPOSE: The purpose of this study was to find the correlation between vertical dimension of occlusion (VDO) and length of fingers. MATERIALS AND METHODS: A cross-sectional study was conducted on 400 dentate subjects comprising of 200 males and 200 females. Anthropometric measurements of VDO, length of index finger, length of little finger, and distance from tip of thumb to tip of index finger of right hand were recorded clinically using modified digital vernier caliper. Correlation between VDO and length of fingers was studied using Spearman's coefficient. For the execution of regression command and preparation of prediction equations to estimate VDO, Statistical Package for Social Sciences Software Version 11.5 was used. RESULTS: VDO was significantly and positively correlated with all the parameters studied. In males, correlation of VDO was strongest for length of index finger (r-0.406) whereas in females, it was strongest for length of little finger (r-0.385). VDO estimation using regression equation had a standard error of ± 3.76 in males and ± 2.86 in females for length of index finger, ±3.81 and ± 2.74 in males and females respectively for length of little finger, ±3.99 and ± 2.89 in males and females respectively for distance from tip of thumb to tip of index finger. CONCLUSIONS: Since the variations between VDO and finger lengths are within the range of 2-4 mm, VDO prediction through this method is reliable, and reproducible. Also the method is simple, economic, and non-invasive; hence, it could be recommended for everyday practice.

Dentigerous cyst associated with an ectopic third molar in the maxillary sinus: A case report and review of literature.

Dentigerous cysts are the most common type of developmental odontogenic cysts arising from the crowns of impacted, embedded, or unerupted teeth. They constitute about 20% of all epithelium-lined cysts of the jaws. The teeth involved most often are mandibular third molar and maxillary canines. About 70% of dentigerous cysts occur in the mandible and 30% in the maxilla. Dentigerous cysts associated with ectopic teeth within the maxillary sinus are fairly rare, and only 20 cases had been reported in Medline since 1980. In the present paper, we report an additional case of dentigerous cysts associated with ectopic third molar in the right maxillary sinus. Also, pathogenesis of ectopic tooth, role of advanced imaging, differential diagnosis, and management are discussed.

Multiple bilateral supernumerary mandibular premolars in a non-syndromic patient with associated orthokeratised odontogenic cyst- A case report and review of literature.

Multiple supernumerary teeth are very rare, accounting for less than 1% of cases. They are commonly associated with syndromes like Gardner's syndrome and cleidocranial dysostosis and cleft lip and palate. Non-syndromic multiple supernumerary teeth have a predilection to occur in the mandibular premolar region. Orthokeratinized odontogenic cyst (OOC) is a relatively uncommon developmental cyst comprising about 10% of the cases that had been previously implied as odontogenic keratocysts. More than half of the cases of OOC are associated with impacted tooth; but not a single case of OOC associated with supernumerary teeth is reported. Hence, the purpose of this article is to report the first case of multiple supernumerary mandibular premolars associated with OOC in a 35-year-old male and to review the literature associated with multiple bilateral supernumerary mandibular premolars.

Franceschetti syndrome.

Franceschetti syndrome is an autosomal dominant disorder of craniofacial development with variable expressivity. It is commonly known as Treacher Collins syndrome (TCS). It is named after E. Treacher Collins who described the essential components of the condition. It affects both genders equally. This article reports a case of TCS in an 18-year-old female.

Variations in impacted mandibular permanent molars: Report of three rare cases.

The impaction of permanent teeth is not uncommon, but few permanent teeth are rarely impacted like mandibular first and second molars. Though third molars are commonly impacted, inversely impacted mandibular third molars are very rare. Here, we report three unusual cases of impacted mandibular molars accidentally diagnosed on conventional radiographs.

Orthodontic management of an impacted maxillary incisor due to odontoma.

Odontomas are a heterogeneous group of jaw bone lesions, classified as odontogenic tumors which usually include well-diversified dental tissues. Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Two types of odontomas are described: compound and complex based on either the appearance of well-organized tooth-like structures (compound odontomas) or on a mass of disorganized odontogenic tissues (complex odontomas). Compound odontomas have a predilection for the anterior maxilla, whereas complex odontomas have a predilection for the posterior mandible. Odontomas frequently interfere with eruption of teeth leading to their impaction. This is a case report of a 14-year-old girl with an unerupted maxillary right central incisor due to a complex composite odontoma a rare occurrence in anterior maxilla. Surgical excision of the odontoma and orthodontic treatment to get the impacted maxillary right central incisor into alignment is discussed.

Age estimation in 25-45 yrs. old females by physical and radiological methods.

AIM: The purpose of this study was to estimate the age in living females in the later years (25 to 45 years) from general physical features and radiographic changes in the sternum and the mandible. MATERIALS AND METHODS: A cross-sectional study was conducted on 64 females (32 subjects in each study and control group). All the subjects were physically examined for graying of scalp, body, pubic hair, and for wrinkling of skin of the forehead, temporal region, and below the eyes. A right lateral view of the chest was taken to determine fusion of the components of the sternum. Combined Hair Score, Combined Skin Score, and Combined Bone Fusion Score were calculated. An orthopantomogram of each patient was traced for lower jaw, mandibular canal and teeth, and D(1), D(2), A values were calculated. SPSS Software Version 10.1 was used for the execution of the regression command on the 32 cases of the control group, whose ages were known. RESULTS: Combined skin score, mandible right D(2), mandible right angle, and mandible left angle turned out significant in the prediction of age. Using the regression equation obtained, the age of the 32 subjects in the study group was estimated. In 9.3% of cases, the predicted ages exactly matched the actual ages. A variation of 1-4 years was seen in 75% of the cases. A variation of 6-7 years was seen in 15.6% of the cases. CONCLUSION: This study succeeded in most instances in predicting the ages of the study group and in arriving at a formula for age estimation between the ages of 25 and 45 years without using any invasive, costly, time - consuming, or troublesome method.