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Flottes Y, Valleron E, Gogly B, Wulfman C, Dursun E. Full-Mouth Rehabilitation of a 15-Year-Old Girl Affected by a Rare Hypoparathyroidism (Glial Cell Missing Homolog 2 Mutation): A 3-Year Follow-Up. Dent J (Basel) 2024; 12:130. [PMID: 38786528 PMCID: PMC11119232 DOI: 10.3390/dj12050130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE Familial isolated hypoparathyroidism is a rare genetic disorder due to no or low production of the parathyroid hormone, disturbing calcium and phosphate regulation. The resulting hypocalcemia may lead to dental abnormalities, such as enamel hypoplasia. The aim of this paper was to describe the full-mouth rehabilitation of a 15-year-old girl with chronic hypocalcemia due to a rare congenital hypoparathyroidism. CLINICAL CONSIDERATIONS In this patient, in the young adult dentition, conservative care was preferred. Onlays or stainless-steel crowns were performed on the posterior teeth, and direct or indirect (overlays and veneerlays) were performed on the maxillary premolars, canines, and incisors, using a digital wax-up. The mandibular incisors were bleached. The treatment clearly improved the patient's oral quality of life, with fewer sensitivities, better chewing, and aesthetic satisfaction. The difficulties were the regular monitoring and the limited compliance of the patient. CONCLUSION Despite no clinical feedback in the literature, generalized hypomineralized/hypoplastic teeth due to hypoparathyroidism in a young patient can be treated as amelogenesis imperfecta (generalized enamel defects) with a conservative approach for medium-term satisfactory results. HIGHLIGHTS This study provides new insights into the management of enamel hypoplasia caused by familial isolated hypoparathyroidism, helping to improve patient outcomes in similar cases.
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Affiliation(s)
- Yohann Flottes
- UFR Dentistry, Faculté de Santé, Université Paris Cité, 75006 Paris, France; (Y.F.); (E.V.); (B.G.); (C.W.)
- Department of Dentistry, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
- URB2i, Université Paris Cité, 92120 Montrouge, France
| | - Eléonore Valleron
- UFR Dentistry, Faculté de Santé, Université Paris Cité, 75006 Paris, France; (Y.F.); (E.V.); (B.G.); (C.W.)
- Department of Dentistry, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
| | - Bruno Gogly
- UFR Dentistry, Faculté de Santé, Université Paris Cité, 75006 Paris, France; (Y.F.); (E.V.); (B.G.); (C.W.)
- Department of Dentistry, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
| | - Claudine Wulfman
- UFR Dentistry, Faculté de Santé, Université Paris Cité, 75006 Paris, France; (Y.F.); (E.V.); (B.G.); (C.W.)
- Department of Dentistry, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
- URB2i, Université Paris Cité, 92120 Montrouge, France
| | - Elisabeth Dursun
- UFR Dentistry, Faculté de Santé, Université Paris Cité, 75006 Paris, France; (Y.F.); (E.V.); (B.G.); (C.W.)
- Department of Dentistry, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
- URB2i, Université Paris Cité, 92120 Montrouge, France
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Owosho AA, Aguirre SE, Dayo AF, Omolehinwa TT, Shintaku WH. Radiographic Orofacial Findings of Systemic Diseases. Dent Clin North Am 2024; 68:409-427. [PMID: 38417998 DOI: 10.1016/j.cden.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.
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Affiliation(s)
- Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adeyinka F Dayo
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Temitope T Omolehinwa
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Werner H Shintaku
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
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Yu S, Chen WX, Lu W, Chen C, Ni Y, Duan B, Wang B, Wang H, Xu ZM. Novel heterozygous GATA3 and SLC34A3 variants in a 6-year-old boy with Barakat syndrome and hypercalciuria. Mol Genet Genomic Med 2020; 8:e1222. [PMID: 32155322 PMCID: PMC7216807 DOI: 10.1002/mgg3.1222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Barakat syndrome is an autosomal dominant disorder characterized by the triad of hypoparathyroidism, sensorineural deafness, and renal anomalies and is caused by mutations in GATA3 gene. SLC34A3 is the cause gene of hypophosphatemic rickets with hypercalciuria, and heterozygous carriers may have milder clinical symptoms. The aim of this study was to identify the underlying genetic cause of a patient who initially presented with renal failure, hypercalciuria, kidney stone, and bilateral sensorineural deafness. Methods A 6‐year‐old boy with complex clinical presentations was investigated. Comprehensive medical evaluations were performed including auditory function tests, endocrine function tests, metabolic studies, and imaging examinations. Molecular diagnoses were analyzed by trio whole‐exome sequencing. Results One novel de novo deleterious variant (c. 324del) of the GATA3 gene was identified in the patient. The patient can be diagnosed with Barakat syndrome. In addition, one novel variant (c. 589A>G) of the SLC34A3 gene was detected, which was inherited from the father. This heterozygous variant can explain the hypercalciuria and kidney stone that occurred in both the patient and his father. Conclusion This study provides a special case which is phenotype‐driven dual diagnoses, and the two novel variants can parsimoniously explain the complex clinical presentations of this patient.
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Affiliation(s)
- Sha Yu
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China.,Center for Molecular Medicine, Pediatrics Research Institute, Children's Hospital of Fudan University, Shanghai, China
| | - Wen-Xia Chen
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Lu
- Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Chao Chen
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yihua Ni
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bo Duan
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bin Wang
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Huijun Wang
- Center for Molecular Medicine, Pediatrics Research Institute, Children's Hospital of Fudan University, Shanghai, China
| | - Zheng-Min Xu
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China
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Hejlesen J, Underbjerg L, Gjørup H, Sikjaer T, Rejnmark L, Haubek D. Dental anomalies and orthodontic characteristics in patients with pseudohypoparathyroidism. BMC Oral Health 2019; 20:2. [PMID: 31892351 PMCID: PMC6938634 DOI: 10.1186/s12903-019-0978-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/28/2019] [Indexed: 02/05/2023] Open
Abstract
Background Pseudohypoparathyroidism (PHP) is a rare and inherited disease caused by mutations in the GNAS-gene or upstream of the GNAS complex locus. It is characterized by end-organ resistance to PTH, resulting in hypocalcemia and hyperphosphatemia. We aimed to investigate the dental anomalies according to tooth types and the orthodontic characteristics of patients with PHP. Methods Using a cross-sectional design, 29 patients (23 females) with PHP, living in Denmark, were included, and their clinical intraoral photos and radiographs were examined. Results Pulp calcification was found in 76% of the patients. Blunting of root apex was present in 55% and shortening of root in 48% of the examined patients. Blunting and shortening of roots were seen more often in premolars than in other tooth types (pboth < 0.01). Crowding of lower anterior teeth was frequently observed (36%) as well as diastema in the upper arch (25%), midline diastema (18%), and Class III malocclusion (11%). Conclusion In the present study population, the teeth were frequently affected by pulp calcification and/or deviation of the root morphology. Blunting and shortening of root(s) were more often seen in premolars than in other tooth types. Class III malocclusion was relatively prevalent. It is important to pay attention to dental anomalies and occlusion in order to provide adequate care for patients with PHP.
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Affiliation(s)
- Jane Hejlesen
- Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus C, Denmark
| | - Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Gjørup
- Center for Oral Health in Rare Diseases, Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte Haubek
- Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus C, Denmark.
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Hejlesen J, Underbjerg L, Gjørup H, Bloch-Zupan A, Sikjaer T, Rejnmark L, Haubek D. Dental Findings in Patients With Non-surgical Hypoparathyroidism and Pseudohypoparathyroidism: A Systematic Review. Front Physiol 2018; 9:701. [PMID: 29971010 PMCID: PMC6018410 DOI: 10.3389/fphys.2018.00701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Dental aberrations have been mentioned in relation to non-surgical hypoparathyroidism (Ns-HypoPT) and pseudohypoparathyroidism (PHP). However, a systematic review of dental characteristics have not been performed. The present systematic review describes the dental findings in patients with Ns-HypoPT and PHP. Methods: Studies on Ns-HypoPT and PHP reporting dental features were eligible. A systematic literature search was conducted using four bibliographic databases (Web of Science, Scopus, Pubmed, and Embase) and was limited to studies written in English. Reviews, meta-analyses and letters were excluded. Both the research and reporting of results were based on PRISMA (preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Results: Of 88 studies included, nine were cross-sectional, one was a prospective cohort study, 26 were case series, and 52 were case reports. The most frequently reported findings in patients with Ns-HypoPT were enamel opacities, enamel hypoplasia, hypodontia, and eruption disturbances. In patients with PHP, enamel hypoplasia, eruption disturbance, and deviation of the root morphology were the most frequently reported findings. Conclusion: An association between enamel hypoplasia and Ns-HypoPT and PHP is likely. The results should, however, be interpreted cautiously due to the limited number of high-quality studies. The present review confirms the need of further well-designed studies, such as large-scale studies, e.g., multicenter studies, to conclude on the reported associations between Ns-HypoPT/PHP and enamel hypoplasia.
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Affiliation(s)
- Jane Hejlesen
- Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Gjørup
- Center for Oral Health in Rare Diseases, Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Agnes Bloch-Zupan
- Faculté de Chirurgie Dentaire, Institut d'Etudes Avancées, USIAS, FMTS, RARENET Interreg V, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et Chirurgie Bucco-Dentaires, Centre de Référence des Maladies Rares Orales et Dentaires, O-Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire and Cellulaire, Centre Européen de Recherche en Biologie et en Médecine, Université de Strasbourg, Centre National de la Recherche Scientifique UMR7104, Institut National de la Santé et de la Recherche Médicale U964, Illkirch, France
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte Haubek
- Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
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Gallacher AA, Pemberton MN, Waring DT. The dental manifestations and orthodontic implications of hypoparathyroidism in childhood. J Orthod 2017; 45:46-50. [PMID: 29191124 DOI: 10.1080/14653125.2017.1406685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The presence of short dental roots can present challenges to the orthodontist both in terms of identifying its aetiology and in subsequent treatment planning. Uncommon causes include hypoparathyroidism and pseudohypoparathyroidism, where short roots may be seen in combination with other oral manifestations including enamel hypoplasia secondary to low calcium levels. This case report highlights these features and the orthodontic treatment proposed.
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Affiliation(s)
- Amy Arora Gallacher
- a a Department of Orthodontics , University Dental Hospital of Manchester , Manchester , UK
| | - M N Pemberton
- b b Department of Oral Medicine , University Dental Hospital of Manchester , Manchester , UK
| | - D T Waring
- a a Department of Orthodontics , University Dental Hospital of Manchester , Manchester , UK
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Merheb R, Arumugam C, Lee W, Collin M, Nguyen C, Groh-Wargo S, Nelson S. Neonatal Serum Phosphorus Levels and Enamel Defects in Very Low Birth Weight Infants. JPEN J Parenter Enteral Nutr 2016; 40:835-41. [DOI: 10.1177/0148607115573999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Roula Merheb
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Chitra Arumugam
- Department of Pediatrics, Division of Neonatology, University of Louisville, Louisville, Kentucky, USA
| | - Wonik Lee
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marc Collin
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Caroline Nguyen
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Suchitra Nelson
- Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Microscopic analysis of molar--incisor malformation. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:544-52. [PMID: 25544405 DOI: 10.1016/j.oooo.2014.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/10/2014] [Accepted: 10/19/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Molar-incisor malformation (MIM) is a newly discovered type of dental anomaly that involves a characteristic root malformation of the permanent first molars. The aim of this study was to reveal the microstructure of MIM teeth in order to determine their origin. STUDY DESIGN Four MIM teeth were extracted from a 9-year-old girl due to severe mobility. The detailed microstructure of the teeth was determined by examinations with micro-computed tomography (micro-CT), hematoxylin and eosin (H&E) staining, immunohistochemical staining, and scanning electron microscopy to reveal the detailed microstructure. RESULTS Micro-CT and H&E staining revealed the pulpal floor comprising three layers: upper, middle, and lower. Amorphous hard tissues and hyperactive cells were observed in the middle layer of the pulpal floor, and the cells stained positively for dentin sialoprotein and osteocalcin, but not for collagen XII. CONCLUSION The results of the present study imply that MIM-affected molars probably result from inappropriate differentiation of the apical pulp and dental follicle.
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Abstract
Idiopathic hypoparathyroidism (IHP) is a rare endocrinopathy, characterized by the disturbances in calcium and phosphorous metabolism, owing to deficiency in parathyroid hormone, which leads to tetanic manifestations. Onset of the clinical features occurs early in life, and the severity depends on the extent of chemical imbalance. This article describes a case of 22-year-old patient undiagnosed for 12 years with this endocrinopathy (IHP). Over retained deciduous teeth, delayed eruption, impacted tooth and short roots probably resulting from untreated hypocalcemia during the developmental phase of dentition enabled us to unearth this endocrinopathy through a series of investigations. Thus the article emphasizes the importance of dental findings of this endocrinopathy.
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Affiliation(s)
- Nagaraju Kamarthi
- Nagaraju Kamarthi, MD, Virbhadra Road, Po Pashulok, Rishikesh 249203,, Uttaranchal, India, T: +91-9720114173, F: +91-135-2453743,
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Ponranjini VC, Jayachandran S, Kayal L, Bakyalakshmi K. Autoimmune polyglandular syndrome type 1. J Clin Imaging Sci 2012; 2:62. [PMID: 23230544 PMCID: PMC3515937 DOI: 10.4103/2156-7514.103018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/18/2012] [Indexed: 12/03/2022] Open
Abstract
Autoimmune Polyglandular Syndrome (APS) Type 1 is a rare hereditary disorder that damages organs in the body. This disease entity is the result of a mutation in the AIRE gene. It is characterized by three classic clinical features - hypoparathyroidism, Addison's disease, and chronic mucocutaneous candidiasis. For a patient to be diagnosed as having APS Type 1 syndrome at least two of these features needs to be present. The third entity may develop as the disease progresses. We report a case of a 35-year-old female patient with a history of seizure from the age of 11 years, who was managed with anticonvulsant drugs. With worsening of the seizure episodes, patient was diagnosed to have hypoparathyroidism together with the manifestations of oral candidiasis, nails dystrophy, enamel hypoplasia, and hypogonadism. A diagnosis of APS-1 was considered. The facility for genetic analysis of the AIRE gene mutation was not accessible, as the test costs were prohibitive and not affordable for the patient. Patient management was directed to treating individual disease components. However, cerebral and dental changes were irreversible.
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Jindal G, Pandey RK, Kumar D. Generalised stunting of roots in an epileptic child: is long-term phenytoin therapy the cause? BMJ Case Rep 2012; 2012:bcr-03-2012-6042. [PMID: 22761220 DOI: 10.1136/bcr-03-2012-6042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Long-term phenytoin therapy is known to cause disturbance in calcium and bone homeostasis. Dental tissues being calcified tissues can also be affected by this derangement of mineral metabolism, especially during developmental phases. This report describes a case of an epileptic child who presented with short roots, enlarged pulp chambers, blunt apices and delayed eruption of permanent dentition, which might be attributed to long-term phenytoin therapy. The purpose of this case report is to increase awareness among the clinicians about its possible dental implications and emphasise upon the need of regular dental check-ups in epileptic children.
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Affiliation(s)
- Garima Jindal
- Department of Pediatric and Preventive Dentistry, CSMMU, Lucknow, Uttar Pradesh, India.
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Pinzon ML, Gong SG. Arrested root formation of 4 second premolars: Report of a patient. Am J Orthod Dentofacial Orthop 2012; 141:652-6. [DOI: 10.1016/j.ajodo.2010.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 09/01/2010] [Accepted: 09/01/2010] [Indexed: 11/30/2022]
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Case report: Management of severe posterior open bite due to primary failure of eruption. Eur Arch Paediatr Dent 2010; 11:155-8. [PMID: 20507816 DOI: 10.1007/bf03262733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Primary failure of tooth eruption (PFE) is a rare condition affecting any or all posterior quadrants. Unilateral involvement of maxillary and mandibular quadrants causes a dramatic posterior open bite that requires complex management strategies. CASE REPORT An 8 year-old boy attended the Dublin Dental School and Hospital regarding infra-occlusion of his right maxillary and mandibular primary molars. Both right first permanent molars had also failed to erupt. All permanent teeth were present radiographically. Facial appearance and soft tissues were normal and oral function was not affected. The patient had no significant medical history and his siblings had no similar dental abnormalities. TREATMENT The infra-occluded right first and second primary molars were extracted, and the right first permanent molars were surgically exposed. FOLLOW UP Eruption of the premolars and molars was monitored over the next 2 years. The premolars showed signs of eruption and continued root development. Exfoliation of the remaining primary teeth proceeded as usual. The right first permanent molars did not erupt and were subsequently extracted. Continued eruption of the canines and premolars reduced the inter-arch separation. A removable tongue shield appliance was suggested but declined by the patient. At age 13 years, orthodontic extrusion was used to further reduce the inter-dental distance between the canine and premolars. The reduction was from 5 mm to 1.5 mm between the right first premolars and from 10 mm to 5 mm between the right second premolars. Extrusion of the canine teeth was also attempted to improve the smile line. The canine extruded 1 mm to give a 2 mm overlap. There were no changes in centric occlusion and the midline was unaffected. In the 2 years since orthodontic treatment, the spaces have reopened slightly to 3 mm between first premolars and 6 mm between second premolars. The patient is now aged 16 years and is aware that an improved aesthetic smile line may be achieved by use of onlay restorations. CONCLUSION In this unique case, a profound unilateral posterior open bite occurred due to primary failure of eruption of the maxillary and mandibular teeth on the affected side. Orthodontic therapy was used to modify the position of the permanent canines and premolars to reduce the posterior open bite.
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