Dental implications of inherited connective tissue disorders in South Africa

The prevalence of Osteogenesis imperfecta type III (OI III) as a category of the inherited connective tissue disorders in South Africa is of paramount importance. Although worldwide, autosomal recessive(AR) OI is rare, it had emerged that the frequency of OI III is relatively high in the indigenous Black African population of South Africa. A review of the literature revealed a paucity of information regarding the dental and craniofacial manifestations of the disorder in this ethnic group. For these reasons, the central theme of this thesis is the identification, documentation and analysis of these features in individuals with OI III in the Black African population of SA. Osteogenesis imperfecta type III (OMIM 259420) is a severe autosomal recessive disorder in which frequent fractures and progressive limb and spinal deformity result in profound physical disability. The condition is heterogeneous and dentin genesis imperfecta (DI) is an important syndromic component of some types of OI III. Other maxillofacial and dental manifestations also have significant implications in terms of management

Incidence, trends of prevalence and pathological spectrum of head and neck lymphomas at national health laboratory services- Tygerberg

Magister Chirurgiae Dentium (MChD)MChD (Oral Pathology) minithesis, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of Western Cape Among malignant lesions, lymphoma ranks second only to squamous cell carcinoma in frequency of occurrence in the head and neck. Lymphomas in HIV patients' are second in frequency to Kaposi's sarcoma as AIDS-defining tumours. About 50% of lymphomas in HIV patients are extranodal and more than half of these occur in the head and neck area. The number, variety and diagnostic complexity of lymphoma cases that have primarily arisen in the head and neck region has steadily increased in the surgical pathology service of the National Health Laboratory Services (NHLS) - Tygerberg. This observation is particularly relevant in the context of increasing HIV infection rates in the population of South Africa as demonstrated by a study in 2006 conducted by the Medical Research Council of South Africa. This is a retrospective study using the records of cases of head and neck lymphomas diagnosed at NHLS-Tygerberg over the last five years. The aim of this study is to investigate the prevalence of head and neck lymphomas (HNL) at NHLS-Tygerberg from January 2002 to December 2006. The objective of this study is to determine the frequency and types of HNL and to determine, if possible, an association between the incidence of HNL and the HIV status of the patients. Trends of prevalence in terms of gender, referral centres, HIV status, age of patients and site of presentation are also examined. The results of this study show an increase in the number of patients with HNL from January 2002 to December 2006. A significant increase is noted in the number of HIV positive patients documented each year, from 17% in 2002 to 33% in 2006. Western Cape- urban (WC-U) remains the largest referral center. A notable increase is seen, each year, in the number of patients referred to Tygerberg-NHLS from the Eastern Cape (EC) and Western Cape- rural (WC-R) areas. A significant number of HIV positive patients are referred from the Eastern Cape and Western Cape rural areas. The average age of disease presentation in the HIV positive group of patients is 35 years with the unknown group being 46 years and the HIV negative group being 54 years. The main categories of lymphoma that presented in HIV positive patients are plasmablastic lymphoma (PBL) and diffuse large B-celllymphoma (DLBCL), which together form 56% of cases. 26% of cases are Hodgkin's lymphoma (HL); the second largest group of HNL cases. Burkitt's lymphoma (BL) consists of 8% of cases. 7% of cases are T-cell lymphomas. 3% of cases are Mantle zone lymphomas. No cases of SLL and Follicular lymphomas (FL) are described in this group of patients. DLBCL and HL form 27% each of the cases in patients with a negative HIV status. A significant number of Follicular lymphomas (15%), small lymphocytic lymphoma (SLL) (9%), MALT (7%), and T-cell lymphomas (8%) are identified. No PBL are seen in this group of patients. The incidence of HNL at NHLS-Tygerberg has increased over the last five years. This trend parallels that seen in other developing countries such as Tanzania, Nigeria, Thailand and India. This increase is possibly due to an increase in the number of referrals to our center, an increase in the overall population of the Western Cape, an increase in the number of HIV positive patients and the high incidence of EBV infection in the general population of the Western Cape. Social issues, such as poverty, lack of adequate education, female dependence on partners, rural communities and the non-availability of anti-retroviral drugs (ARV) and highly active anti-retroviral therapy (HAART) to most of the population that require these drugs, are considered major contributing factors. A trend is noted in the increased number of female patients diagnosed each year with HNL. A predominance of DLBCL was identified in our series. This is consistent with previous reports and studies on HNL. The number of biologically aggressive lymphomas, such as DLBCL, Plasmablastic and Burkitt's lymphomas diagnosed each year, has also significantly increased. These were prevalent mainly in the HIV positive group of patients who were also younger compared to the HIV negative patients. The documented findings of this study will serve as a guideline for the estimation of head & neck lymphoma burden and risk assessment at NHLS- Tygerberg

Review of the radiographic modalities used during dental implant therapy - A narrative

The introduction of digital x-ray receivers which replaced conventional films was a significant radiographic development that is commonly used in daily dental practice. Dental implant therapy (DIT) is a sought after dental therapeutic intervention and dental radiography is an essential component contributing to the success of treatment. Dental radiographs taken in daily practice are generally conventional two-dimensional images and/or three-dimensional images. Ideally, the choice of radiographic technique should be determined after a thorough clinical examination and comprehensive consideration of the advantages, indications, and drawbacks. Digital three-dimensional modalities that have emerged over the last decade have been incorporated into DIT with the assumption that treatment outcomes will be improved. These modalities are constantly being reassessed and improved but there is a paucity of published information regarding the assessment of variables such as dosages and dimensional accuracy, suggesting that further research in these matters is necessary. This is crucial in order to obtain evidence-based information that may influence future radiographic practices. In this narrative, the authors present the most commonly used dental radiographic modalities currently used in DIT

Sella turcica morphology in patients with genetic syndromes: Protocol for a systematic review

Background: The sella turcica is an important anatomical reference used in orthodontics and the evaluation of craniofacial growth. Studies have found an association between variations in sella turcica morphology in patients with certain syndromes affecting the craniofacial complex. It is hypothesized that each related syndrome or pathological condition is associated with a specific pattern of malformation of the sella turcica. Objective: This study outlines the protocol for a systematic review that aims to determine if genetic syndromes involving the craniofacial complex are associated with abnormal radiographic sella turcica morphology and if there is a pattern of malformation that is consistent with each syndrome. Methods: An electronic database search was conducted using a planned search strategy to identify relevant studies. We included primary studies evaluating the morphology of the sella turcica based on imaging from a lateral view. Specifically, only studies with postnatal human participants with genetic syndromes involving the craniofacial complex were included in this review. We placed no restrictions on the language or time frame of these studies. Based on the search findings, studies were further screened for relevance and eligibility by two independent reviewers. Data were extracted from the selected studies. We assessed the selected studies for risk of bias and quality by using risk of bias tools from the Joanna Briggs Institute

Dental implant imaging: What do South African dentists and dental specialists prefer?

To document the types of imaging modalities that are commonly prescribed during dental implant therapy in South Africa. The radiographic preferences were obtained from practitioners via an electronic survey that was disseminated during local dental conferences, electronic channels (e.g., email lists) of multiple dental schools and local dental scientific societies, and personal interviews. The survey consisted of multiple-choice questions which were designed to investigate the most common radiographic prescriptions during various treatment phases of implant therapy. The responses of one hundred and forty-two participants (General practitioners and dental specialists) practising in different South African provinces were collected and assessed. Principally, panoramic radiographs combined with cone beam computed tomography (PAN + CBCT) followed by CBCT, as a single examination (ASE), were the most preferable modalities during the implant planning phase (39% and 29%, respectively). During and directly after the surgery, periapical radiographs (ASE) were the most preferred (87% and 65%, respectively). The most widely preferred radiographic examination during the planning of implants was panoramic radiographs combined with CBCT. Periapical radiographs (ASE) were favoured during, directly after the treatment, and during the follow-up of asymptomatic patients by the majority of participants. However, CBCT (ASE) was preferred in the follow up of symptomatic patients. Factors related to extra anatomical information and superior dimensional accuracy provided by three-dimensional volumes (e.g., CBCT volumes), were the most indicated influencing factors on the radiographic prescriptions during implant planning

Employing the London Atlas in the age estimation of a select South African population

Dental age estimation in the living and deceased is a fundamental aspect of forensic sciences, civil cases, medico-legal proceedings and clinical dentistry. Accordingly, this study aimed to validate the accuracy and reproducibility of the London Atlas in a select South African sample of KwaZulu-Natal. In this cross-sectional study, 760 digital panoramic radiographs (n = 760) aged between 5.00 and 23.99 years were retrospectively reviewed through consecutive sampling. Each radiograph was assessed and assigned a dental age in accordance with the London Atlas of Human Tooth Development and Eruption by AlQahtani et al. (2010)

The application of the Cameriere’s methodologies for dental age estimation in a select KwaZulu-Natal population of South Africa

The estimation of an individual’s age is a fundamental component of forensic odontology. Literary reports found that the efficiency of Cameriere methodology for age estimation varied among many population groups. Therefore, this study aimed to determine the applicability of the Cameriere methods to a select South African population of the KwaZulu-Natal (KZN) province.This cross-sectional retrospective study was conducted on 840 digital panoramic radiographs that met the inclusion criteria

Craniofacial, dental, and molecular features of Pyle disease in a South African child

Pyle Disease (PD), or familial metaphyseal dysplasia [OMIM 265900], is a rare autosomal recessive condition leading to widened metaphyses of long bones and cortical bone thinning and genu valgum. We detail the oro-dental and molecular findings in a South African patient with PD. The patient underwent clinical, radiographic and molecular examinations. An exfoliated tooth was analysed using scanning electron microscopy and was compared to a control tooth. The patient presented with marked Erlenmeyer-flask deformity (EFD) of the long bones and several Wormian bones. His dental development was delayed by approximately three years. The permanent molars were mesotaurodontic. The bones, including the jaws and cervical vertebrae, showed osteoporotic changes

A morphometric assessment of developing permanent dentition for age and sex estimation in a select South African sample

Dentition plays a crucial role in the fields of forensic science, forensic odontology and anthropology for age and sex estimation. The aim of this study was to determine the degree of sexual dimorphism and age prediction capabilities of permanent dentition using morphometric analysis. Six hundred digital panoramic radiographs (n = 600), belonging to 300 South African Black and 300 South African Indian, aged between 5.00 and 19.99 years were retrospectively examined using a cross-sectional design. The Pearson Correlation Coefficient tests were conducted to determine if a correlation exist between age, sex and each morphometric parameter

Taurodontism in dental genetics

Taurodontism is a dental anomaly defined by enlargement of the pulp chamber of multirooted teeth with apical displacement of the pulp floor and bifurcation of the roots. Taurodontism can be an isolated trait or part of a syndrome. A study was conducted to document the dental and craniofacial aspects of genetic thin bone disorders in South Africa. Sixty-four individuals with Osteogenesis imperfecta (OI), one individual with Pyle disease and one with Torg-Winchester syndrome respectively, were assessed clinically, radiographically and at a molecular level. Ten patients with OI XI and those with Pyle disease and Torg-Winchester syndrome had taurodontism. Taurodontism has been identified in several genetic disorders necessitating cognizance of the possible existence and implications of this characteristic when managing patients in the dental environment. Further studies should be directed toward identifying the incidence, etiology, and molecular pathways leading to taurodontism and its relationship to genetic syndromes