Case Report: Crown Resorption in a Patient With Junctional Epidermolysis Bullosa and Amelogenesis Imperfecta With LAMB3 Gene Mutations

Background: Epidermolysis bullosa (EB) corresponds to a series of conditions characterized by extreme fragility of the skin and/or mucous membranes. Of the four main types of EB, junctional EB (JEB) is the most associated with alterations in the teeth. The purposes of this study were to determine the clinical, histopathological, and ultrastructural characteristics of teeth with amelogenesis imperfecta (AI) in a patient with JEB, and compare them with control teeth, and correlate the findings with the mutations present in the patient.Case Report: The study was conducted on a 10-year-old patient with JEB carrier of two recessive mutations in the LAMB3 gene and absence of the laminin-332 protein (LM-332), determined by immunofluorescence on a skin biopsy. The patient presents hypoplastic AI with very thin and yellow-brown colored enamel. Extraction of two permanent molars was performed due to pain and soft tissue covering the crown, resembling pulp polyp or hyperplastic gingiva. Light and scanning electron microscopy (SEM) revealed very thin enamel varying from complete absence to 60 μm, absence of normal prismatic structure, and presence of a cross-banding with a laminated appearance. The histopathological study revealed granulation tissue causing external crown resorption.Conclusion: Although coronary resorption has been reported in patients with syndromic and non-syndromic AI, this is the first clinicopathological report of coronary resorption in partially erupted teeth in patients with JEB with mutations in the LAMB3 gene and hypoplastic AI. In patients with this condition, the presence of partially erupted teeth with soft tissue covering part of the crown, without a periodontal pocket, and with a radiographic image of partial coronal radiolucency should lead to suspicion of external coronary resorption.

Fibrous Epulis: The Reactive Gingival Enlargement to Excise or Not to Excise

The volume thickening of soft tissue covering the alveolar ridges, designed gingival enlargement, is one of the frequent findings in clinical practice. However, they fail under varied presentations and their distinction allows a clinical diagnosis and defines an appropriate treatment to reduce recurrence. Among the diverse types of enlargement, fibrous epulis is the most common one. It is a localized uniform gingival overgrowth caused by tissue oedema and inflammatory hyperplasia in response to local irritations. This report outlines a case of fibrous epulis concerning a 56 years old male patient, in our periodontology department. A careful medical history, examination of the gingival, periodontal health status, and its reevaluation were assessed. Conventional periodontal treatment has been sufficient to minimize the gingival size. After an excisional biopsy, the histopathological examination was the determinants tool to accurate the diagnosis of fibrous epulis. Patient motivation and compliance during and after therapy has been a critical factor in the success of periodontal treatment and a key to prevent the recurrence of such lesions.

Floating Subscapularis Tear: A Variation of the Partial Subscapularis Tear

A variation of subscapularis tear has been identified, named floating subscapularis, where the tendon is completely detached from the lesser tuberosity but is continuous with the tissue covering the bicipital groove. An accurate diagnosis can be made using arthroscopic observation with passive external and internal rotation of the affected shoulder, which shows mismatched movement between the humerus and the subscapularis tendon. The purpose of this study is to examine the prevalence of this particular tear pattern. Clinical records during the study period (from January 2011 to December 2017) were retrospectively examined. Overall, 1295 arthroscopic rotator cuff repair procedures were performed. Among these, the subscapularis tendon was repaired in 448 cases, and 27 cases were diagnosed as floating subscapularis. The prevalence of floating subscapularis was 6% in the subscapularis repair population. This particular tear pattern has not previously been described and it seems to be ignored. The floating subscapularis is thought to be the tear of the deep layer preserving the superficial layer connected to the greater tuberosity by fibrous extension of the soft tissue covering the bicipital groove.

Histological Change in Soft Tissue Surrounding Titanium Plates after Jaw Surgery

The aim of this study was to evaluate the microscopic structure of soft tissue covering titanium plates and screws used in jaw surgery (mandible fracture and orthognathic surgery), after a minimum period of 12 months from insertion, and to quantify the presence of any metallic particles. Periosteum covering the osteosynthesis plates was removed from 20 patients and examined by light microscopy in order to assess the cell morphological changes and the possibility of metal particles presence in the soft tissue. Local signs of tissue toxicity or inflammation were taken into consideration when evaluating the routine removal of titanium maxillofacial miniplates. No signs of screw loosening or acute inflammation were detected on the osteosynthesis site, but de-coloration of the periosteum was seen, and metallic particles were observed to have migrated into the soft tissues. Even if the titanium is well-tolerated by the human body in time, without severe local or general complications, our findings suggest that plate removal should be considered after bone healing has occurred.

Histological characterization of denticulate palatal plates in an Early Permian dissorophoid

Denticles are small, tooth-like protrusions that are commonly found on the palate of early tetrapods. Despite their widespread taxonomic occurrence and similar external morphology to marginal teeth, it has not been rigorously tested whether denticles are structurally homologous to true teeth with features such as a pulp cavity, dentine, and enamel, or if they are bony, tooth-like protrusions. Additionally, the denticles are known to occur not only on the palatal bones but also on a mosaic of small palatal plates that is thought to have covered the interpterygoid vacuities of temnospondyls through implantation in a soft tissue covering; however, these plates have never been examined beyond a simple description of their position and external morphology. Accordingly, we performed a histological analysis of these denticulate palatal plates in a dissorophoid temnospondyl in order to characterize their microanatomy and histology. The dentition on these palatal plates has been found to be homologous with true teeth on the basis of both external morphology and histological data through the identification of features such as enamel and a pulp cavity surrounded by dentine. In addition, patterns of tooth replacement and ankylosis support the hypothesis of structural homology between these tiny teeth on the palatal plates and the much larger marginal dentition. We also provide the first histological characterization of the palatal plates, including documentation of abundant Sharpey’s fibres that provide a direct line of evidence to support the hypothesis of soft tissue implantation. Finally, we conducted a survey of the literature to determine the taxonomic distribution of these plates within Temnospondyli, providing a broader context for the presence of palatal plates and illustrating the importance of maintaining consistency in nomenclature.

Development of a bioactive implant for repair and potential healing of cranial defects

The repair of complex craniofacial bone defects is challenging and a successful result is dependent on the size of the defect, quality of the soft tissue covering the defect, and choice of reconstruction method. The objective of this study was to develop a bioactive cranial implant that could provide a permanent reconstructive solution to the patient by stimulating bone healing of the defect. In this paper the authors report on the feasibility and clinical results of using such a newly developed device for the repair of a large traumatic and therapy-resistant cranial bone defect. The patient had undergone numerous attempts at repair, in which established methods had been tried without success. A mosaic-designed device was manufactured and implanted, comprising interconnected ceramic tiles with a defined calcium phosphate composition. The clinical outcome 30 months after surgery revealed a restored cranial vault without postoperative complications. Computed tomography demonstrated signs of bone ingrowth. Examination with combined 18F-fluoride PET and CT provided further evidence of bone healing of the cranial defect.

Measuring Skeletal Kinematics With Accelerometers on the Skin Surface

Gait analysis is an area within biomechanics that quantifies the motion of an animal. The most common motion analysis method uses cameras to track the position of markers on bodily surfaces over time. Although each species has a common skeletal frame to reference recorded motions, the soft tissue covering each is not rigid. Markers, therefore, experience motion relative to the bone and do not accurately portray underlying bone activity. This limits clinical use of motion studies and the understanding of joint motion.

Maxillofacial surgery: maxillary osteosynthesis craneomaxillofacial CMS-titanium plates

SummaryA maxillary fracture is presented which we classified as Le Fort Type III. Treatment was by the application of two craniomaxillofacial CMS titanium plates placed intrabuccally and paramedially on both sides of the palatal suture.This technique was used as an alternative to the classical treatment using interdental wires or intermaxillary fixation.A clinical case was diagnosed with a craniofacial fracture caused from being bitten by another dog. This was successfully treated using CMS titanium plates. Many methods exist for maxillofacial fixation, from the cyanocrylates to interdental wires, etc. The indications for these plates are similar to other methods of fixation. Due to their small mass they are ideal for use in fragile bones with little soft tissue covering.