Dental Anomalies: An Identification Marker in Forensics.

Aim This study aims to evaluate the non-morphological traits of the South Indian population. Introduction Dental morphological traits, also known as non-metric dental traits, exhibit variation in appearance both within and between groups. The study analyzed the non-metric traits among the South Indian population, as few variants can be grouped within the population.  Materials and methods A total of 500 extracted tooth samples were collected. The dental non-metric traits that were evaluated are the cusp of Carabelli (CC), Talon's cusp (TC), shoveled incisor (SI), peg-shaped lateral incisor (PL), protostylid (PR), Dryopithecus pattern groove (DP), hypoconulid (HY), parastyle (PA), multiple parastyle (MPA), paracone (PC), Bushman's canine (BC), interruption groove (IG), tuberculum dentale (TD), tuberculum intermedium (TI), radix entomolaris (RE), fusion (F), radiculous premolar (RP), dilaceration (D), dens evaginatus (DE), and enamel pearl (EP).  Results Out of 20 dental non-metric traits that were evaluated in the study, 14 traits were identified to be common within the population. The prevalence were as follows: cusp of Carabelli (52%), shoveled incisor (8.2%), peg-shaped lateral incisor (7.4%), parastyle (0.8%), multiple parastyle (0.2%), Bushman's canine (0.4%), interruption groove (2.2%), tuberculum intermedium (0.6%), radix entomolaris (39.6%), fusion (2.8%), radiculous premolar (0.2%), dilaceration (58.2%), dens evaginatus (1.2%), and enamel pearl (0.8%) among the South Indian population.  Conclusion The current study was discovered to have more Carabelli traits, shoveled incisors, radix entomolaris, and dilaceration than other non-metric features. This shows that these characteristics are more prevalent in the South Indian population, which could be one of the strategies used to validate human identification in a forensic context.

Homozygosity for a Rare Plec Variant Suggests a Contributory Role in Congenital Insensitivity to Pain.

Congenital insensitivity to pain is a rare human condition in which affected individuals do not experience pain throughout their lives. This study aimed to identify the molecular etiology of congenital insensitivity to pain in two Thai patients. Clinical, radiographic, histopathologic, immunohistochemical, and molecular studies were performed. Patients were found to have congenital insensitivity to pain, self-mutilation, acro-osteolysis, cornea scars, reduced temperature sensation, tooth agenesis, root maldevelopment, and underdeveloped maxilla and mandible. The skin biopsies revealed fewer axons, decreased vimentin expression, and absent neurofilament expression, indicating lack of dermal nerves. Whole exome and Sanger sequencing identified a rare homozygous variant c.4039C>T; p.Arg1347Cys in the plakin domain of Plec, a cytolinker protein. This p.Arg1347Cys variant is in the spectrin repeat 9 region of the plakin domain, a region not previously found to harbor pathogenic missense variants in other plectinopathies. The substitution with a cysteine is expected to decrease the stability of the spectrin repeat 9 unit of the plakin domain. Whole mount in situ hybridization and an immunohistochemical study suggested that Plec is important for the development of maxilla and mandible, cornea, and distal phalanges. Additionally, the presence of dental anomalies in these patients further supports the potential involvement of Plec in tooth development. This is the first report showing the association between the Plec variant and congenital insensitivity to pain in humans.

Floating-Harbor Syndrome: A Systematic Literature Review and Case Report.

Floating-Harbor syndrome (FHS) is an extremely rare genetic disorder connected with a distinctive facial appearance, various skeletal malformations, delayed bone age, and expressive language delays. It is caused by heterozygous mutations in the Snf2-related CREBBP activator protein (SRCAP) gene. The aim of this paper is to describe the case of a 14-year-old male with FHS, referring to a review of the literature, and to collect all reported symptoms. In addition, the orthodontic treatment of the patient is described. For this, the electronic databases PubMed and Scopus were searched using the keyword "Floating-Harbor syndrome". Similar to previous cases in the literature, the patient presented with short stature; a triangular face with a large bulbous nose; deep-set eyes and narrow eyelid gaps; a wide mouth with a thin vermilion border of the upper lip; and dorsally rotated, small ears. They also presented some less-described symptoms, such as macrodontia and micrognathia. Moreover, mild mental retardation, microcephaly, and delayed psychomotor development were found. On the basis of an extraoral, intraoral examination, X-rays, and CBCT, he was diagnosed with overbite, canine class I and angle class III, on both sides. To the best of our knowledge, orthodontic treatment of this disease has not been assessed in detail so far, so this is the first case.

Non-syndromic tooth agenesis in Latvian adolescent dental patients: a retrospective study with relevant literature review.

AIM: To investigate the prevalence of tooth agenesis and associated dental anomalies in Latvian adolescent dental patients and compare it to other European countries. DESIGN: Cross-sectional study of 2692 11-to-14-year-old patients (39.9% males and 60.1% females) attending Riga Stradins University Institute of Stomatology with panoramic radiographs taken between August 2020 and September 2021. Patients with any genetic syndromes were excluded. Data on tooth agenesis (excluding third molars) and other dental anomalies were recorded. RESULTS: The prevalence of tooth agenesis in Latvian adolescent dental patients was 9.3% with no statistically significant difference between genders (χ2 test, p = 0.472). The most commonly missing teeth were mandibular second premolars, followed by upper lateral incisors and upper second premolars. There was a statistically significant association with the presence of other dental anomalies in tooth agenesis patients (p < 0.001). CONCLUSIONS: This study found that the prevalence of non-syndromic tooth agenesis in Latvian adolescent dental patients was 9.3% with no statistically significant differences between the genders. Patients with tooth agenesis have a statistically significant possibility of the presence of other dental anomalies (p < 0.001).

Dental anomalies in craniofacial microsomia and condylo-mandibular dysplasia: A retrospective study of 103 patients.

INTRODUCTION: Craniofacial microsomia (CFM) and camel-hump condylo-mandibular dysplasia (CMD) are developmental disorders affecting the mandible that share common clinical features. This study aimed to investigate and compare the dental anomalies (DA) between the two entities for differential diagnosis and to propose appropriate treatment. METHODS: This retrospective cross-sectional study was based on panoramic radiographs of patients diagnosed with CFM or CMD. DA were evaluated using the classification reported by Bilge. Delayed tooth eruption on the affected side was noted based on a comparison with the contralateral side. Nolla's stages of tooth calcification were used to assess dental development. RESULTS: A total of 103 patients were included, 80 subjects (77.7 %) in CFM group and 23 patients (22.3 %) in CMD group. The prevalence of DA among CFM and CMD-affected patients were 80.0 % and 95.7 %, respectively. Tooth ectopia, tooth impaction, dental development delay, and delayed tooth eruption on the affected side exhibited a significant association with the two craniofacial malformations. The overall affected teeth (molars, premolars, canines) differed between the two craniofacial malformations. Dental abnormalities such as oligodontia, hyperdontia, dentin dysplasia, and anomalies of shape were seen only in subjects affected by CFM. CONCLUSION: DA were widely observed in patients with CFM and CMD. The global distribution of affected teeth differed between the two conditions and some DA were detected only in CFM patients. When clinical diagnosis remains uncertain, some specific radiological characteristics of DA can be used to differentiate CFM from CMD.

Sella turcica bridging as a potential diagnostic tool for dental anomalies: A retrospective cross-sectional study at university dental hospital.

BACKGROUND: A lateral cephalogram is an essential diagnostic record for an orthodontist. It is used for diagnosis and treatment planning. This can be a prediction tool as well for developing anomalies of the skeletal, dental, and soft tissues of the head and neck. The sella turcica (ST), being a central landmark for cephalometric assessment, has great importance in itself as a diagnostic parameter to predict certain dental problems related to its bridging. AIM OF THE STUDY: 1. To assess and compare the shape, size, and bridging of ST in subjects of Taif with different skeletal classifications. 2. To find whether there is any association between dental anomalies and sella turcica bridging (STB). MATERIALS AND METHODS: The study obtained ethical approval from the research ethics committee of Taif University with application no. 44-354 and with no. HAO-02-T-1 dated June 4, 2023. The study involved 87 study samples, divided as follows: a. Group 1: 49 control records. b. Group 2: 38 case records with STB. RESULTS: The results of our study were promising in relation to STB and the occurrence of dental anomalies in both the case and the control with the frequencies of occurrence being 46.94% and 36.84%, respectively. It was found that the percentage of distribution was more among class I malocclusions and least in class III. It is imperative that impaction (13.8%) is the most associated anomaly, followed by ectopic eruption (11.5%). Supernumerary teeth and gemination were the least associated with STB, and only 1% of the cases showed an association. Statistically significant associations were found for all types of dental anomalies as a result of distribution among cases and controls. CONCLUSION: Orthodontists commonly employ lateral cephalograms as a regular practice to aid in diagnosis and treatment planning. Furthermore, these cephalograms can serve as predictive tools for dental anomalies. Detecting skeletal abnormalities at an early stage can provide insight into the likelihood of future dental anomalies, enabling clinicians to implement preventive measures accordingly.

Orthodontic treatment in children and adolescent patients with X-linked hypophosphatemia: A case-control study.

OBJECTIVES: X-linked hypophosphatemia (XLH) is a rare genetic disease that disturbs bone and teeth mineralization. It also affects craniofacial growth and patients with XLH often require orthodontic treatment. The aim of this study was to describe changes in the dental health of XLH children during orthodontic treatment compared with those in matched controls undergoing similar orthodontic procedures. MATERIALS AND METHODS: For this retrospective case-control study, we included all individuals less than 16 years old diagnosed with XLH, orthodontically treated in our centre from 2016 to 2022 and pair-matched them to patients with no chronic or genetic conditions. Clinical and radiological parameters concerning their malocclusion, craniofacial discrepancy and the characteristics and iatrogenic effects of their orthodontic treatment were analysed. RESULTS: Fifteen XLH patients (mean age: 11.3 ± 2.1), pair-matched to 15 control patients were included. Orthodontic treatment was successfully conducted in XLH patients with slightly shorter duration and similar iatrogenic effects as in the control group, except for the occurrence of dental abscess during and after orthodontic tooth movement. XLH patients did not show more relapse than the controls. CONCLUSION: Despite the presence of oral manifestations of XLH such as spontaneous abscesses, XLH patients can undergo orthodontic treatment with no obvious additional iatrogenic effects.

Dental transpositions: An update for clinicians.

Transposition of teeth may present to the general dental practitioner and in some circumstances transposed teeth may present with other dental anomalies. Although dental transpositions are rare anomalies, management of transposed teeth can often be complex, requiring multidisciplinary management. It is therefore important for dentists to be familiar with the clinical and radiographic presentation of transpositions and understand the aetiology to aid early diagnosis and appropriate management.Clinical relevance: Dentists are best placed to detect transposed teeth and should be familiar with the clinical and radiographic presentation, aetiology, and classification of transpositions in order to aid early diagnosis and their subsequent management.

A Case Series of Three Patients with Cleidocranial Dysplasia: Clinical Presentation and Diagnostic Considerations.

Cleidocranial dysplasia (CCD) is a rare genetic condition that affects the bones and teeth. In our study, we presented three cases of CCD, including one with a new mutation and two with a family history. Case 1 had a unique heterozygous frameshift mutation (NM_001015051,c.762del, p.(Ser256Valfs*2)), while Case 2 and her brother (Case 3) had a common pathogenic missense mutation (NM_001015051,c.674G, p.Arg225Gln), which was also found in their father. The mutation in Case 1 was not reported before. Interestingly, the symptoms in Case 1, with the new mutation, were less severe than the other cases and the previous reports.

Exploring the potential of artificial intelligence in paediatric dentistry: A systematic review on deep learning algorithms for dental anomaly detection.

BACKGROUND: Artificial intelligence (AI) based on deep learning (DL) algorithms has shown promise in enhancing the speed and accuracy of dental anomaly detection in paediatric dentistry. AIM: This systematic review aimed to investigate the performance of AI systems in identifying dental anomalies in paediatric dentistry and compare it with human performance. DESIGN: A systematic search of Scopus, PubMed and Google Scholar was conducted from 2012 to 2022. Inclusion criteria were based on problem/patient/population, intervention/indicator, comparison and outcome scheme and specific keywords related to AI, DL, paediatric dentistry, dental anomalies, supernumerary and mesiodens. Six of 3918 initial pool articles were included, assessing nine DL sub-systems that used panoramic radiographs or cone-beam computed tomography. Article quality was assessed using QUADAS-2. RESULTS: Artificial intelligence systems based on DL algorithms showed promising potential in enhancing the speed and accuracy of dental anomaly detection, with an average of 85.38% accuracy and 86.61% sensitivity. Human performance, however, outperformed AI systems, achieving 95% accuracy and 99% sensitivity. Limitations included a limited number of articles and data heterogeneity. CONCLUSION: The potential of AI systems employing DL algorithms is highlighted in detecting dental anomalies in paediatric dentistry. Further research is needed to address limitations, explore additional anomalies and establish the broader applicability of AI in paediatric dentistry.

Caries experience in children with molar-incisor hypomineralisation in Fujairah, United Arab Emirates and its association with hypomineralised teeth number.

BACKGROUND: Molar-incisor hypomineralisation (MIH) has been found associated with an increase in dental caries. Studies utilising the recent MIH diagnosis and calibration criteria recommended by the EAPD in 2021 are very scarce. Additionally, the available data in literature about the relationship between the hypomineralised teeth number (HTN) and caries come from only one study. PURPOSE: To assess the relationship between MIH and caries experience among children in the city of Fujairah, UAE, utilising the recent criteria recommended by the European Academy of Paediatric Dentistry (EAPD) in 2021, and to assess the relationship between the number of teeth affected with MIH, and dental caries. METHODS: One hundred and sixty-two children were included in this cross-sectional study, aged 7-9 years old. Children were examined for MIH according to Ghanim et al. (Eur Arch Paediatr Dent 16:235-246, 2015. 10.1007/s40368-015-0178-8) criteria and Ghanim et al. (Eur Arch Paediatr Dent 18:225-242. 10.1007/s40368-017-0293-92017) training manual. Caries experience was assessed with decayed, missing, filled (dmft, DMFT) scoring system. RESULTS: dmft mean was 6.56 (SD ± 3.78) and DMFT mean was 0.91 (SD ± 1.23). Children with MIH had significantly higher dmft (p = 0.003) scores. Children with higher HTN had significantly higher dmft (p = 0.008) scores. CONCLUSION: Children in Fujairah have extremely high caries scores. Children with MIH have more decayed, missing and filled teeth. Hypomineralised teeth number was positively associated with caries experience.

Oculo-facio-cardio-dental (OFCD) syndrome: a case report.

BACKGROUND: Oculo-facio-cardio-dental (OFCD) syndrome is a rare condition that affects the eyes, face, heart, and teeth of patients. One notable dental characteristic of OFCD is radiculomegaly, or root gigantism, which highlights the role of dentists in detecting this syndrome. OFCD is an X-linked dominant syndrome that results from a variant in the BCOR gene. Our study presents the first documented case of OFCD in Vietnam and reports a novel BCOR gene variant observed in this case. CASE PRESENTATION: A 19-year-old Vietnamese female patient with an extremely long root with an abscess was clinically examined for the expression of OFCDs. The radiograph and the variant in BCOR gene were also evaluated. We identified abnormalities in the teeth, as well as ocular, facial, and cardiac features, with radiculomegaly of the canines being a specific symptom for OFCDs. The patient's genetic analysis revealed a pathogenic heterozygous deletion at intron 11 of the BCOR gene, representing a novel variant. CONCLUSION: Oculo-facio-cardio-dental syndrome (OFCD) is an extremely rare condition characterized by abnormalities in the eyes, face, heart, and teeth, often caused by variants in the BCOR gene. Radiculomegaly, or enlarged dental roots, is a key diagnostic feature of OFCD, and early detection is crucial for preventing future dental complications.

Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies.

BACKGROUND: Panoramic radiographs (PRs) are used in the detection and diagnosis of developmental dental anomalies and pathologies (DDAPs) in children. AIM: The primary objective of this observational cohort study was to evaluate the age-based prevalence of DDAP on PRs, whereas the secondary objective was to determine a threshold age for the detection of DDAP to provide supportive evidence for the prescription of PR in paediatric dental practice. DESIGN: The study examined diagnostic PRs from 581 subjects aged 6 to 19 years. All PRs were reviewed by experienced, calibrated, masked examiners for the identification or presence of anomalies in size, shape, position, structure, and other developmental anomalies and pathologies (ODAP) of the face-neck region in a standardized condition. The data were statistically analyzed for interpretation. RESULTS: Overall, 74% (n = 411) of the cohort had at least one anomaly (shape anomaly: 12%, number anomaly: 17%, positional anomaly: 28%, structural anomaly: 0%, and ODAP: 63%). The optimal Youden index cutoff for any anomaly was 9 years. Twelve and 15 years also showed predictive ability. CONCLUSION: The results suggest that PRs should be prescribed at ages 9, 12, and 15 years for the diagnosis of DDAP.

Orofacial Deformities in 3 Related Rhesus Monkeys (Macaca mulatta) Resembling Human Binder's Syndrome.

Binder's syndrome is a rare congenital deformity characterized by midface hypoplasia, particularly around the nasomaxillary area. Genetic etiology or developmental failure caused by prenatal exposure to teratological agents has been considered. In this article, we present 3 related rhesus monkeys born with orofacial deformities similar to those found in infants with the Binder phenotype. For the first time, a primate biomodel for this condition is presented. The clinical description and association with management and environmental factors are discussed. These findings reinforce the knowledge about the relationship between possible vitamin K metabolism interference and Binder's syndrome.

Multidisciplinary Aesthetic Management of a Dentition in a Patient with Cleft Lip and Palate with a High Smile Line: A Clinical Report.

The aesthetic management of a case involving a high smile line in a patient with a cleft lip and palate can be difficult. In this report, we look at a complex case of a patient with a unilateral cleft lip and palate which required a multidisciplinary approach involving crown lengthening, extraction of a maxillary right central incisor and fabrication of a 4-unit fixed partial denture to replace this tooth and the adjacent absent maxillary right lateral incisor with use of gingival porcelain in order to improve the aesthetics of the patient's smile.

Altering maternal calcium and phosphorus dietary intake induces persistent sex-specific changes in the dentition of the offspring.

BACKGROUND: The maternal diet is essential to offspring development, but the specific effects on tooth morphology are still unknown. The aim of this study was to evaluate the effects of altering maternal calcium (Ca) and phosphorus (P) supplementation during gestation and lactation on offspring dentition. METHODS: Pregnant mice were fed an experimental diet containing a threefold increase in Ca and a threefold decrease in P compared to the standard mouse chow diet at embryonic Day 0.5 (E0.5). Offspring mice were maintained on standard or experimental diets from post-natal Day 0 to weaning, then fed control diets until 6 weeks of age. Six-week-old offspring heads were collected and scanned using micro-computed tomography. Dental morphometrics of offspring maxillary and mandibular first and third molars (n = 5-6 per diet/per sex) were determined. A two-way ANOVA test was employed to verify the existence of any significant differences between groups. The significance level was set at P < .05. RESULTS: A two-way ANOVA revealed a statistically significant interaction between the effects of diet and sex on the upper and lower dentition. Moreover, experimental diet-fed female offspring exhibited smaller molars with shorter mesiodistal width and larger pulp chambers relative to controls, while experimental diet-fed male offspring possessed larger molars with wider mesiodistal width and smaller pulp chambers. CONCLUSION: Our findings reveal that altering the maternal and offspring dietary Ca:P ratio during gestation, lactation and weaning led to significant, sex-specific changes in the offspring dentition. The differences in dentition appeared to be correlated with the sex-specific changes in the craniofacial skeleton.

Delayed eruption of permanent maxillary first molars among Saudi children: A cross-sectional study.

Aim: This retrospective cross-sectional study aimed to determine the prevalence of delayed development and eruption of permanent maxillary first molars (U6) and associated dental anomalies in a sample of Saudi children. Material and methods: In total, 10,232 panoramic radiographs from 9,672 patients were screened for delayed U6 eruption. Radiographs showing delayed U6 eruption were further examined for associated dental anomalies. The dental age of participants was estimated using The London Atlas of Human Tooth Development and Eruption. Result: Twenty cases of delayed U6 eruption were found, with a prevalence of 0.2%. Of these patients, 3 and 17 were males and females, respectively; 9 and 11 cases were unilateral and bilateral, respectively. Congenital absence of the adjacent permanent second molar was observed in 8 cases, and the congenital absence of permanent teeth, except the adjacent second permanent molar and third molar, was observed in 6 cases. Peg-shaped lateral incisors were observed in 6 females. No significant associations were observed between delayed U6 eruption and dental anomalies. Overall, the average delayed U6 eruption was 2.3 years for males and 2.8 years for females. Conclusion: Among a sample of Saudi children, the prevalence of delayed U6 eruption was 1 in 483 (0.2%) and five times higher in females. No significant associations were found between delayed U6 eruption and dental anomalies; however, congenital absence of the adjacent permanent second molar was observed in 40% of cases.

Prevalence and Severity of Ectopic Eruption of First Permanent Molars in Pediatric Patients in Makkah, Saudi Arabia.

Background Early detection and management of ectopic eruption (EE) of first permanent molars (FPMs) are crucial to avoid complicated treatments later. Aim This study aimed to assess the prevalence and severity of EE of FPMs among children in Makkah, Saudi Arabia. Methods This retrospective study was based on a radiographic evaluation of 1,008 dental panoramic radiographs performed for children attending the Dental Educational Hospital at Umm Al-Qura University and the Security Forces Hospital in Makkah. Patients' age, sex, tooth location, and severity of EE were assessed. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies.  Results Of the 1,008 reviewed cases, 18 (1.79%) were diagnosed with EE of FPMs. Among the 11 male patients, 81.82% showed severe EE, while 57.14% exhibited moderately severe EE among the seven female patients. The prevalences of EE in the maxilla and mandible were 1.59% and 0.20%, respectively. In contrast, the occurrence of EE of FPMs was similar between the right and left sides. Conclusion In this study, the prevalence of EE of FPMs among children in Makkah was 1.79%. The frequency and severity were both greater in male patients compared to female patients. While significantly more EE of FPMs was observed in the maxilla than in the mandible, there was no significant difference between the right and left sides.

Is there an association between molar incisor hypomineralization and developmental dental anomalies? A case-control study.

BACKGROUND: The aim of this study was to determine whether there is any association between molar incisor hypomineralization and developmental dental anomalies. METHODS: Two pediatric dentists evaluated panoramic radiographs of 429 children aged 8-14 years with molar incisor hypomineralization (study group) and 437 children without molar incisor hypomineralization (control group) in terms of developmental dental anomalies. Twelve different developmental dental anomalies were categorized into four types: size (microdontia, macrodontia); position (ectopic eruption of maxillary permanent first molars, infraocclusion of primary molars); shape (fusion, gemination, dilaceration, taurodontism, peg-shaped maxillary lateral incisors); and number (hypodontia, oligodontia, hyperdontia) anomalies. RESULTS: No significant difference was observed in the frequencies of developmental dental anomalies between the study and control groups in total, females, and males (p > 0.05). A statistically significant difference was found between the distribution of developmental size, position, shape, and number anomalies between the study and control groups (p = 0.024). The most common anomaly in both groups was hypodontia (6.3% and 5.9%, respectively). There was a significant difference between the study and control groups in terms of subtypes of shape anomaly in all children and females (p = 0.045 and p = 0.05, respectively). CONCLUSIONS: While a significant difference was observed between the distributions of types of developmental dental anomalies between individuals with and without molar incisor hypomineralization, there was no difference in terms of the frequency of developmental dental anomalies.