Background and aimRadiographic assessment is an important diagnostic tool in dental practice. Cone beam computed tomography (CBCT) is among the most important imaging examinations. By providing multiplanar visualization of the maxillofacial region, CBCT enables practitioners to assess various conditions threedimensionally. CBCT is utilized in different fields within dentistry, including oral and maxillofacial surgery, endodontics, orthodontics, periodontics, implant dentistry, and others. Having access to accurate 3D images is crucial in implant dentistry. This study aimed to measure the crestal bone height loss and facial alveolar bone thickness in the maxillary anterior teeth using CBCT to investigate its effect on surgical planning for dental implant placement in adult patients.
Material and methodsCBCT scans (N = 119) of adults, aged 18-65 years, with bilateral permanent maxillary anterior teeth present were included in this retrospective study. The mean alveolar bone plate thickness and crest bone height loss adjacent to the maxillary anterior teeth were measured and differences were examined.
ResultsThe results suggest that additional care and assessment of dental implant placement should be considered when replacing the permanent lateral incisors and canines. The frequency of fenestrations and dehiscence is higher in older adults. Possible management includes guided bone regeneration or "pink restorative solutions."
ConclusionCBCT analysis to assess the bone morphology surrounding "hopeless" maxillary anterior teeth is important to ensure proper diagnosis and management, including the use of dental implants.
Patient: Female, 65-year-old
Final Diagnosis: Multiple myeloma
Symptoms: Palatal lesion
Medication: —
Clinical Procedure: Biopsy and CBCT • laboratory investigations
Specialty: Dentistry
Objective:
Unusual clinical course
Background:
Multiple myeloma is a hematological malignancy characterized by monoclonal plasma cell proliferation. Jaw lesions are found in nearly 35% of patients with symptomatic myeloma, and lesions occur in the mandible more often than in the maxilla. However, maxillary or mandibular lesions are rarely found as a primary manifestation of the disease. This report describes a case of a 65-year-old Palestinian woman with lytic lesions in the maxilla due to undiagnosed multiple myeloma identified incidentally on cone beam computed tomography (CBCT).
Case Report:
A 65-year-old Palestinian woman presented to the Oral Maxillofacial Surgery Clinic with an expansion of the maxilla which was initially thought of as an infection. CBCT imaging revealed diffuse osteolytic lesions involving multiple osseous structures. The patient was biopsied. Histopathological examination was suspicious for plasmacytic neoplasm. She was directly referred to the Hematology Department for further laboratory tests. These included complete blood count, liver function test, bone profile, protein electrophoresis, flow cytometry, and bone marrow biopsy, which were performed to confirm the diagnosis of multiple myeloma. The patient was treated with chemotherapy including zoledronic acid, dexamethasone, bortezomib, and cyclophosphamide. She went into remission for a year but unfortunately died 2 years later.
Conclusions:
Primary myeloma of the maxilla is a rare presentation. The present report illustrates the role of CBCT imaging supported by a multidisciplinary approach to the diagnosis and management of myeloma. Consequently, it is recommended that dental practitioners be aware of radiographic features and possible oral manifestations to avoid any delay in medical intervention.
Mucolipidosis Type III, or pseudo-Hurler polydystrophy, is a rare genetic abnormality, the result of a mutation to one of two genes that encode the hexameric protein N-acetylglucosaminyl-1-phosphotransferase (Glc-NAc-PT). The abnormality results in the accumulation of unprocessed macromolecules in cell and tissue compartments throughout the body. In this case report, we describe the clinical and radiographic findings of a 15-year-old male with this disorder. He presented with bilateral ectopically developing mandibular molar teeth with enlarged follicles and multiple joint involvement, including the temporomandibular joints. The patient underwent surgical removal of the molar teeth and curettage of the associated follicles. The subsequent histopathological examination of the tissues revealed hyperplastic follicles suggestive of dentigerous cysts. This report presents the plain film and cone beam CT examinations of the patient.
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