Double talon cusps on supernumerary tooth fused to maxillary central incisor: Review of literature and report of case.

Human tooth development is a continuous process begin at the sixth weeks in utero and extends to about sixth months after birth for the primary dentition and from sixteenth week in utero to late adolescence for permanent dentition. There is no other organ of the human body which takes so long to attain its ultimate morphology as dentition. Several physiologic growth processes participate in the progressive development of the teeth including: initiation, proliferation, histodifferentiation, morphodifferentiation, apposition, calcification, and eruption. Aberrations in different stages of tooth development can result in unique manifestations both in primary and permanent dentitions. The fact that premaxilla is the predilection site for the occurrence of supernumerary teeth, talon cusp, dens invaginatus, and geminated teeth may suggest that the embryological development of premaxilla differ from other sites of the jaws. The dental abnormalities presented in this review are of great concern to dentist and parents because they create clinical, pathological and esthetic problems. Dental practitioner should be aware of the clinical sign, associated problems and treatment options for a given case. Key words:Double talon cusps, fusion, supernumerary, case report.

Remineralisation of carious lesions and fluoride uptake by enamel exposed to various fluoride dentifrices in vitro.

PURPOSE: To evaluate the relative performance of fluoride (F) dentifrices to promote remineralisation and enamel F acquisition using an in vitro pH-cycling model. Enamel surface morphology was investigated. MATERIALS AND METHODS: Thirty-six white spot lesions and 36 sound enamel sections from extracted premolars and molars were randomly assigned to 8 experimental groups and a placebo group. Eight commercially available brands of Fdentifrices were used: A. 0.8% monofluorophospate (MFP)-silica; B. 0.8% MFP-calcium carbonate and calcium phosphate; C. 0.8% MFP-calcium carbonate and calcium phosphate; D. 0.76% MFP-aluminium hydroxide; E. 0.24% sodium fluoride (NaF)-silica and sodium pyrophosphate; F. 0.24% NaF-silica and sodium pyrophosphate; G. 0.76% MFP and 0.10% NaF-dicalcium phosphate and sodium pyrophosphate (1450 ppm F); H. 0.76% MFP and 0.33% NaF-silica (2500 ppm F). The placebo (I) contained non-fluoridated silica. The cycling regimen comprised the following: three 2-min and one 4-min daily treatments with dentifrice slurries, rinsed with water and stored in fresh whole saliva at 37°C until the next experimental day, when specimens were activated in acid buffer solutions prior to each dentifrice treatment. This pH cycling continued for 21 consecutive days. Lesion depths and size were measured using a polarising microscope and enamel F uptake was determined using the acid-etch biopsy technique. The morphology of enamel surfaces was examined using scanning electron microscopy. The data were statistically analysed using Student's t-test, analysis of variance (ANOVA) and Pearson's correlation coefficient (r). RESULTS: All tested fluoride dentifrices significantly enhanced remineralisation by reducing the lesion depths from 6.4 to 17.1 µm and lesion sizes by 10% to 34% relative to the pre-cycling measurements. Overall, the degree of remineralisation was as follows: NaF-silica-pyrophosphate dentifrices (1000 ppm F) averaged 41%; NaF/MFP-silica (1500/1000 ppm F) 38%; MFP/NaF-dicalcium phosphate (1000/450 ppm F) 30%; MFP dentifrices (1000 ppm F) ranged from 15 to 23%. Enamel F uptake by NaF and NaF/MFP was significantly greater than MFP dentifrices (P < 0.05 to P < 0.001), with the area under the depth curve being 2.4 and 2.2 times greater, respectively. At all enamel depths, fluoride dentifrices significantly increased F concentrations relative to the control (P < 0.001). A strong correlation was found between ionic F levels in dentifrices and their efficacy. Dentifrices produced different enamel surface morphologies. CONCLUSIONS: The present study demonstrates that commercially available dentifrices vary in their degree of effectiveness and mode of action depending on formulations.

Patterns of physical growth and dental development in Jordanian children and adolescents with thalassemia major.

Dental development and physical growth are of particular interest in pediatric dentistry and orthodontics. This study evaluated these variables in patients with thalassemia major (TM). Physical growth was assessed in 54 patients (31 males and 23 females) aged 5.5 to 18.3 years and dental development was analyzed using panoramic radiographs from 39 of the 54 patients. The Demirjian system was used to characterize dental development of the seven left mandibular permanent teeth. Chronologic age (CA) and dental age (DA) were compared using the paired t-test, and the correlation between CA and extent of delay in dental development (DA minus CA) was assessed using Pearson's correlation coefficients. Growth retardation (< 10th percentile for height and weight) was present in 75.9% of TM patients. Height less than the third percentile was noted in 41.9% (13/31) of males and 34.8% (8/23) of females. Mean (SD) body mass index was 16.5 ± 2.2 kg/m(2). The extent of growth retardation increased with advancing age. Patient radiographs revealed a delay in dental development in 31 of 39 (79.5%) of participants (mean delay, 1.12 years in males and 0.81 years in females; range, 0.1 to 2.7 years). The mean difference between CA and DA was 0.97 years (P < 0.001). CA was significant correlated with extent of dental developmental delay (r = 0.64, P < 0.01). The results show that, among children and adolescents with TM, the proportions of those who had short stature, were underweight, and had a low growth rate increased with age. In addition, participants had significant delays in dental development.

Mesiodistal crown diameters and tooth size discrepancy of permanent dentition in thalassemic patients.

OBJECTIVES: To provide a description of mesiodistal crown diameters (MD) and tooth-size discrepancy (TSD) of the permanent dentition in patients with thalassemia major (TM) and to compare the results with those of unaffected control group. STUDY DESIGN: The sample consisted of 46 thalassemic patients, 25 males and 21 females aged 7.3 to 23.7 years (mean ± SD = 11.2 ± 3.9 years) and control group matched by age and sex. Dental casts of the participants were measured for MD, using a digital sliding caliper. Descriptive statistics were computed for each individual tooth. Student t-test was used for comparison of mean values between males and females as well as between thalassemic and control groups. The differences between sets of data were evaluated by analysis of variance (ANOVA). RESULTS: All means for MD of thalassemic males and females were smaller than their controls, with 20 of the 24 comparisons being statistically significant (ranged from P<0.05 to P<0.001). In both thalassemic and control groups, males exhibited significantly larger MD than females in most instances. Canines displayed the most sexual dimorphic teeth in the dentition. Lateral incisors showed the greatest variability indicated by the coefficient of variation, while the first molars were the least variable teeth (7.6% vs. 5.3%). There were no statistically significant differences in the anterior and overall tooth-size discrepancy ratios between sexes or between thalassemic and control groups. The mean anterior ratio (79.5%) and overall ratio (92.4%) of the control group were significantly larger than of Bolton ratios; P< 0.001 and P<0.05, respectively. CONCLUSIONS: The present study demonstrated that thalassemic males and females exhibited significantly smaller MD than the control group. The TSD ratios in both thalassemic and control groups were significantly larger than those of Bolton sample. These findings should be taken into account when planning orthodontic treatment for thalassemic patients. Key words:Permanent dentition, tooth size, thalassemia major.

Dental arch dimensions in subjects with beta-thalassemia major.

AIM: Thalassemia is a group of inherited hemoglobinopathies with thalassemia major representing the severe form of the disease characterized by craniofacial deformities. The aim of this study is to provide a detailed description of dental arch dimensions in subjects with thalassemia major. SUBJECTS AND METHODS: The sample consisted of 43 thalassemic subjects, 24 males and 19 females, aged 7.3 to 15.4 years (mean ± SD = 10.6 ± 3.5 years) and control group matched by age and sex. Dental casts of the participants were measured for arch lengths, arch widths, using a digital sliding caliper. Student t-test was used for comparison of mean values between males and females as well as between thalassemic and control groups. RESULTS: The results show that all means of maxillary and mandibular arch dimensions in thalassemic males and females were smaller than their controls, with 14 of the 16 comparisons being statistically significant (ranged from p < 0.05 to p < 0.001).The segmental arch lengths in the maxilla and mandible of thalassemic group were reduced by an average of 2.59 and 2.55 mm respectively, compared with the control group. The mean maxillary and mandibular arch depths (lengths) in the thalassemic group were shorter by 3.21 and 2.63 mm respectively, relative to the controls (p < 0.001). All arch widths thalassemic patients were significantly reduced by an average ranged from 1.33 to 1.90 mm in the maxilla and 1.37 to 1.77 mm in the mandible. CONCLUSION: The present study showed that the maxillary and mandibular dental arches dimensions are significantly reduced in patients with thalassemia major compared with healthy control subjects. CLINICAL SIGNIFICANCE: Changes in the size of dental arches and tooth dimensions in thalassemic patients have an impact on the occlusal relationships.These changes should be taken into account when planning orthodontic treatment and orthognathic surgery.

Papillon-Lefèvre syndrome with albinism: a review of the literature and report of 2 brothers.

BACKGROUND: Papillon-Lefèvre syndrome (PLS) is a very rare autosomal recessive disorder characterized by palmoplantar hyperkeratosis and severe early onset of destructive periodontitis leading to premature loss of both primary and permanent dentitions. The etiopathogenesis of the condition suggests that there is a genetic basis for susceptibility to specific virulent pathogens. Variation in the clinical presentation of PLS has recently been observed. OBJECTIVE: The objective was to present the first report, which describes the concurrence of PLS and albinism. The etiology, pathology, and management of the condition were reviewed and genetic analysis was performed. SUBJECTS AND CLINICAL PRESENTATION: The probands are Jordanian brothers aged 13 and 20 years on their initial presentation. The parents were second cousins and not affected. The patients exhibited the typical clinical features of PLS with type 1 oculocutaneous albinism (OCA1). They also had increased susceptibility to infection manifested in recurrent tonsillitis, respiratory tract infection, pyoderma, onychogryphosis, and other pathosis. Skin biopsy demonstrated hyperkeratosis, focal parakeratosis, hypergranulosis, and acanthosis. Ectopic calcification of the dura was noticed in one of the probands. Hematological parameters tested were within the normal limits. The probands were tested for mutations in the causative genes of PLS and OCA1, cathepsin C (CTSC), and tyrosinase, respectively. Independent mutations (c.318-1G>A and c.817G>C/p.W272C) were identified in CTSC and tyrosinase, respectively. The probands were homozygous and their sister who had only PLS was homozygous for the same (CTSC) mutation but heterozygous for tyrosinase gene. CONCLUSION: We hope that this report of coinheritance PLS and albinism will initiate further investigations to disclose other possible variations that may enhance our knowledge on gene mutations of this intriguing syndrome.

Cephalometric measurements and facial deformities in subjects with beta-thalassaemia major.

This study was performed to identify cephalometric and facial features of patients with beta-thalassaemia major. A total of 54 thalassaemic subjects were examined for craniofacial deformities, including 37 patients (24 males and 13 females, aged 5-16 years) who had lateral cephalometric radiographs. The thalassaemic groups were compared with a normal control group matched for sex and dental age, using a t-test. All thalassaemic patients had a Class II skeletal base relationship. The average ANB angle was significantly larger than the controls in dental stages 2 and 3 (P < 0.05). Mandibular base length (Ar-Gn) was significantly less in thalassaemic patients than in controls, with the greatest differences (P < 0.001) found in the younger age group. The maxilla was of normal length (PNS-ANS, Ptm'-ANS') and appeared prominent (3.3 mm in males and 5.1 mm in females) due to a reduced cranial base length (Ar'-S') and a short mandible (Ar'-P'). Vertically, thalassaemic patients showed a significantly increased maxillary/mandibular planes angle in all groups, with differences ranging between 6.19 and 12.55 degrees (P < 0.001). Thalassaemic patients also showed a reduced posterior facial height (S-Go, Ar-Go) and increased anterior facial proportions. Of the 54 thalassaemic patients examined, 17 per cent had severe facial disfigurements (grade 3).