Gardner syndrome

A 58-year-old male patient was referred for a panoramic radiograph after having presented with a hard swelling of the right mandible. Panoramic radiographic examination (Fig. 1) demonstrated multiples dental anomalies and variable bone densities in both jaws prompting clinicians to “dig” further. Teeth 17, 12, 11, 26 and 27 were missing. Teeth 13, 23, 24, 25, 38, 34, 33 and 43 were unerupted. An unerupted supernumerary left mandibular molar appeared in the region of the mandibular coronoid process. Multiple, small, well-defined radiopacities of density comparable to odontogenic material were evident in the anterior maxilla and mandible. These opacities often demonstrated radiolucent borders consistent with the finding of multiple odontomas. Both jaws demonstrated variable bone density. Cottonwool like opacities partially blending into adjacent trabeculae were evident in the mandible and maxilla posteriorly. The contour of the inferior border of the mandible bilaterally in proximity to the angle was irregular with multiple, well-defined, smooth, lobulated homogenous radiopacities suggestive of osteomas. The radiographic features of multiple osteomas, odontomas, variable bone density, supernumerary and unerupted teeth warranted the referral of the patient for gastroenterological investigation to exclude Gardner Syndrome.

Monitoring enlarged dental follicles: case report and literature review of an unusual presentation of a unicystic ameloblastoma

An ameloblastoma is a benign, yet locally aggressive odontogenic tumour. The vast majority (80%) of ameloblastomas arise in the mandible, and unicystic ameloblastomas are commonly found in relation to an unerupted lower third molar. We present the case of a 39-year-old patient with an incidental finding of an enlarged dental follicle around an unerupted lower third molar that progressed to an extensive unicystic ameloblastoma. This ameloblastoma was decompressed and marsupialized before enucleation to reduce the risk of pathological fracture due to the extensive size of the tumour. CPD/Clinical Relevance: The case is relevant to general dental practitioners when considering monitoring dental follicles of unerupted teeth because the enlarged dental follicle described progressed to an extensive odontogenic tumour.

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

Interception of developing anterior malocclusion due to supernumerary tooth by “2 x 4 Appliance”: A clinical case report

Interceptive orthodontics in mixed dentition period of children is practiced to prevent the severity of incurred malocclusion at an incipient juncture of life. Identifying malocclusion at a very early phase and diagnosing it at right age can help the pediatric dentists to achieve stability as far as the treatment is concerned. Mesiodens is a common type of supernumerary tooth which is found commonly in the incisor region of oral cavity. This anomalous occurrence can lead to varied complications like unerupted teeth, displaced teeth etc. This case report deciphers a case of mesiodens causing anterior teeth malocclusion and its management by 2 x 4 Orthodontic appliance.

Reconstruction Using Free Vascularized Fibular Grafts after Wide Resection of Humerus Chondrosarcoma in a Patient with Cleidocranial Dysplasia

Cleidocranial dysplasia is characterized by hypoplasia of the clavicles, unerupted teeth, narrow pelvis, short stature, and craniofacial malformations. A cause of this skeletal dysplasia is heterozygous mutations of the runt-related transcription factor 2 gene (Runx2), a master regulator for bone and cartilage development. Chondrosarcoma is a primary malignant bone tumor that is usually treated by wide resection surgery. This report shows a case of a 25-year-old female patient with cleidocranial dysplasia who was affected with chondrosarcoma of the left humerus. We performed wide resection of the tumor and reconstruction of the large bone defect of the humerus using free vascularized fibular grafts. The patient preserved the hand function and activity of daily life as the same level as preoperative condition more than five years after the surgery.