A rare primordial odontogenic tumor in a pediatric patient.

Primordial odontogenic tumor (POT) is a rare, benign pediatric lesion that was first included in the 2017 edition of WHO Classification of Head and Neck Tumours. At that point, only 7 cases had been described in the literature; a total of 23 cases have been reported to date. This case report adds to that total by describing a case of POT in a 12-year-old girl and reviews the characteristics of this neoplasm in order to better characterize its clinical, radiographic, and histologic features and increase dentists' awareness of POT. The presence of calcifications within the lesion was reported in 4 of 23 previous cases, and calcifications were also observed in the current case. The presence of calcifications in POT is uncommon and may make radiographic diagnosis more challenging. Treatment of POT is simple excision, and recurrence after excision is rare. Accurate diagnosis is essential, as there has been at least 1 report of overtreatment involving mandibulectomy.

Digital intraoral imaging: analysis of retakes and reduction in radiation exposure using rectangular collimation.

The purposes of this study were to examine the distribution and extent of retakes with digital intraoral imaging when operators transitioned from using round to rectangular collimators and to determine the effect of collimator shape on radiation exposure to patients. This study was conducted using digital intraoral radiographic data from 2018 to 2019 in a dental school radiology clinic. Digital intraoral radiography was performed with round collimators during 2018 and then with rectangular collimators in 2019 with the same cohort of students. Exposure values were obtained, and effective doses were calculated. Although the number of retakes increased with the transition from round to rectangular collimators, the transition also resulted in a statistically significant reduction in the overall effective dose for patients (P < 0.01; Pearson chi-square test), with an average difference of 60% between round and rectangular collimators. Even with the increase in the number of retakes, a decrease in effective dose was observed when rectangular collimation was used. Most retakes were due to placement errors, defined as missing contact points, missing apices of teeth, or a missing area of interest. As students gained more experience and practice with rectangular collimation, the number of retakes decreased. With proper clinical and didactic training and emphasis on the importance of rectangular collimation, a transition from round to rectangular collimation can be achieved with a minimal initial increase in retakes and subsequent normalization of rates, resulting in a significant reduction of the radiation dose to patients.

Case of Mönckeberg arteriosclerosis in the carotid, facial, and lingual arteries: a potentially serious incidental finding in CBCT.

Calcifications in the tunica media (middle layer of the arterial wall), classified as Mönckeberg arteriosclerosis, are more prevalent in older patients and patients with diabetes and/or chronic kidney disease. Mönckeberg arteriosclerosis has prevalence rates of 13.3% and 6.9% in men and women, respectively, and can be observed as a railroad track pattern on imaging studies. With the advent of cone beam computed tomography in dentistry, Mönckeberg arteriosclerosis is usually observed as an incidental finding. This case report describes a unique presentation of Mönckeberg arteriosclerosis in the carotid, facial, and lingual arteries of a 66-year-old man.

Molar-incisor malformation: Eight new cases and a review of the literature.

BACKGROUND: Molar-incisor malformation (MIM) is a recently described dental abnormality. While MIM mimics dentin dysplasia, it presents in a localized pattern. Furthermore, it is speculated that MIM is caused by significant early-life medical history. AIM: The purpose of this study is to present a series of MIM cases and compare the findings with the literature. DESIGN: An extensive search of all published cases of MIM in the English-language literature was conducted. Additionally, an institutional review board-approved retrospective search was performed within the University of Florida oral pathology biopsy service archives. Radiographic consultation cases were also included. Cases lacking radiographs were excluded. RESULTS: Seventy-nine cases were identified in the literature, and eight cases were identified in our retrospective search. All but one case involved the permanent first molars. The average age at diagnosis was 9 years. Many patients reported significant early-life medical histories. CONCLUSIONS: MIM usually affects the permanent first molars and may be linked to early-life medical conditions or interventions. Oral healthcare providers, especially paediatric dentists, should be aware of MIM to avoid misdiagnosing it as dentin dysplasia. Long-term follow-up studies with thorough medical history documentation are essential to understand the pathogenesis and aetiology and to create treatment guidelines.

Mandibular condylar dimensions: Correlation between 3D tomography and dried skull measurements.

Objective Compare the anatomical dimensions of mandibular condyles with the same CBCT measurements. Methods Four landmarks were identified on the condyles of dried skulls and are measured with their corresponding areas in CBCT images: Right Width of Condyle (RW), Left Width of Condyle (LW), Right Length of Condyle (RL), and Left Length of Condyle (LL). Results With respect to direct measurements on the dry skulls, statistically significant differences were found between sexes (p < 0.001). When the real values were compared with the CBCT, it was observed that the bias depends on the magnitude of the measurement. It means that there is an underestimation for smaller values and an overestimation for larger values. Conclusion CBCT is reliable imaging modality, but when compared real measures of condyle length are more reliable then width.

TMJ arthrosis: does the occlusal relationship really interfere? A comparison between cone beam computed tomography and dried skulls.

The aim of this study was to investigate the association between condylar bone morphological characteristics with occlusal conditions. Besides the study will compare the tomography images with the real condition in 122 temporomandibular joints from 61 skulls. The occlusal conditions were evaluated by number of teeth missing, measurement of overjet and overbite, in millimeters, and presence or absence of crossbite, openbite and dental rotation. The condylar bone morphological conditions were classified in five types (normal, presence of erosion, presence of osteophytes, flattening and/or deformation). This classification was used in real skulls and in Cone Beam Computed tomography (CBCT) images. The data were submitted to statistical analysis with a level of significance of 0.05. Occlusal variables have no association to morphologic data (p > 0.05). Normal condylar bone was seen in 62 CBCT versus 53 in real skulls while morphological alterations were seen in 60 CBCT versus 67-real condyles. The clinical and tomographic measurements were compared, demonstrating an important difference in the classification demonstrating poor association between detection methods (k - 0.3, p < 0.001). The occlusal conditions appear to have no correlation with the morphological condyle conditions. The CBCT is a reliable diagnostic method, although it may present divergences of findings when compared with clinical raw examination to morphologic condylar conditions.

Garlic burn of the oral mucosa: A case report and review of self-treatment chemical burns.

BACKGROUND AND OVERVIEW: Inappropriate self-treatment with topically applied therapeutic or nontherapeutic agents frequently results in mucosal burns. Although such chemical burns typically are associated with misuse of analgesics, investigators also have reported them in conjunction with topical application of a variety of other agents. CASE DESCRIPTION: The authors report an unusual case of a 49-year-old man seeking care for maxillary tooth pain who had an oral mucosal burn of the maxillary vestibule caused by topical application of crushed raw garlic. The patient believed this treatment would alleviate his dental pain. Localized tissue necrosis was visible at the site of application. The authors instructed the patient to cease self-treatment with raw garlic but deemed treatment was otherwise unnecessary. To the best of the authors' knowledge, this is the second reported case of a garlic burn of the oral mucosa. The authors discuss the history of garlic as a naturopathic remedy, as well as the development of chemical burns associated with its topical use. The authors also review the literature on chemical burns caused by inappropriate self-treatment. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Dentists should consider the possibility of an oral chemical burn when a patient has a destructive or necrotic mucosal lesion located near a painful tooth. In this report, the authors highlight the importance of obtaining a detailed clinical history to establish a proper diagnosis and proper patient education to prevent future mucosal injury from inappropriate self-treatment. Awareness and early recognition of this condition also will help diminish the probability of overtreatment.

Intraoral Pseudo-Onion Bulb Intraneural Proliferations in a Patient with Hemimandibular Hyperplasia: A Case Report and Review of the Literature.

This report and review of the literature describes a case of benign intraoral lesions of perineurial origin in a patient with symptomatic hemimandibular hyperplasia causing partial denture soreness. Perineuriomas are a benign peripheral nerve sheath tumor composed of perineurial cells. Intraoral perineuriomas are an extremely rare entity. Two main types of perineuriomas have been described: intraneural and extraneural perineuriomas. A third, similar entity, called an intraneural pseudoperineuriomatous proliferation, has recently been proposed in the literature as a separate and distinctive diagnosis. This report describes the histologic and clinical presentation of intraneural pseudoperineuriomatous proliferations in a patient with hemimandibular hyperplasia.

Cervicofacial subcutaneous emphysema: a clinical case and review of the literature.

Cervicofacial subcutaneous emphysema is a known, rare complication of both dental and surgical procedures. Cervicofacial subcutaneous emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes. This report presents a case of cervicofacial subcutaneous emphysema in a patient who had undergone surgical extraction of the mandibular right first molar. The dentist in this case used a compressed air-driven handpiece to section the tooth. This forced air, under high pressure, into the subcutaneous tissue spaces. The patient presented with severe hemifacial swelling and crepitus on palpation. Computed tomographic examination revealed air subcutaneously, and a diagnosis of cervicofacial subcutaneous emphysema was made.

Mixed radiopaque and radiolucent lesion of the maxillary sinus: a radiographic challenge.

This article describes 3 patients, each of whom presented with an asymptomatic mixed radiopaque and radiolucent lesion of the maxillary sinus associated with a nonvital tooth. Based on the radiographic findings, a diagnosis of a collapsed (ruptured) radicular cyst was rendered in each case. A tissue biopsy was performed in 1 case, and the results supported the diagnosis. The radiographic and histopathological features, etiology, pathophysiology, and radiographic differential diagnosis of this condition are discussed.

The reliability of tablet computers in depicting maxillofacial radiographic landmarks.

PURPOSE: This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5). MATERIALS AND METHODS: A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images. RESULTS: Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs. CONCLUSION: Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.