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Microleakage of a universal adhesive used as a fissure sealant.

PURPOSE: To evaluate the microleakage of a universal hydrophilic adhesive (OptiBond dual-cure) by itself as a pit and fissure sealant compared to that of an ionomeric product (VariGlass) and two hydrophobic sealants (Delton and Fluroshield). MATERIALS AND METHODS: Sixty-four extracted human third molars were sealed with one of these four materials under either a conventional procedure (free of humidity) or after contamination of the etched surfaces with 3 microliters of human plasma. The sealed teeth were subjected to 1,500 thermocycles (1 min/5-55 degrees C) and to 450,000 mechanical cycles under an 8.5 kgf average load at 37 degrees C. The tooth crowns were partially coated with nail varnish, immersed in a 50% aqueous solution of AgNO3 for 2 h in darkness, washed and then developed for 8 h under fluorescent light. The teeth were sectioned and dye penetration was scored according to a 4-point scale by four trained professionals. RESULTS: An ANOVA suggested that under no humidity conditions, the average score for VariGlass (1.92 +/- 0.36) was significantly higher (P = 0.0006) than that corresponding to the three remaining materials (1.28 +/- 0.20) which were considered equivalent. Under humid (plasma contaminated) conditions, there was complete loss of Delton and Fluroshield in all cases, whereas the average score for VariGlass (1.98 +/- 0.36) was slightly higher (P = 0.0444) than that for OptiBond (1.62 +/- 0.36). These results suggest that OptiBond may be used by itself as a pit and fissure sealant instead of the combination of adhesive plus sealant.

Acrylic Resins↗

Glass ionomer cement used as surgical dressing after radical surgical exposure of impacted teeth.

GPA cement was tested as an alternative to conventional surgical dressings in connection with radical surgical exposure of teeth. The material comprised 29 patients (mean age 14 4/12 years) with 35 impacted maxillary canines in palatinal position. Soft tissue and bone covering one fifth to one quarter of the tooth crown were removed. The enamel was cleaned with physiological saline and dried with gauze pads. Ketac-Fil was applied using the ESPE Aplicap system. Application stopped when the level of intact mucosa was reached. At control after 1-2 weeks (35 teeth) all packs were in place. Healing conditions were normal and soft tissue regrowth was not seen. At control after 1-6 months (23 teeth) 10 dressings were in place. Surrounding mucosa was healthy regardless of the presence of absence of pack. Soft tissue regrowth was not seen. 6-16 months postoperatively (12 teeth) all packs except 1 had been lost. Soft tissue regrowth in combination with eruption failure was seen in 2 patients. In these cases the packs had been lost soon after the first control, i.e. before healing had been completed. The results indicate that GPA cement can be recommended as an alternative to conventional surgical dressings in connection with radical surgical exposure of teeth.

Adolescent↗

A case of oculo-facio-cardio-dental syndrome with integrated orthodontic-prosthodontic treatment.

OBJECTIVE: Oculo-facio-cardio-dental (OFCD) syndrome is a very rare condition that requires comprehensive dental management because of associated multiple dental anomalies such as canine radiculomegaly, delayed dentition, oligodontia, persistent primary teeth, microdontia, and macrodontia. This report presents a case of OFCD in a Japanese girl (13 years 1 month old). We analyzed cephalograms, panoramic roentgenograms, and dental casts and discuss our integrated orthodontic-prosthodontic treatment. DESIGN: The sizes of the tooth crown and root as well as lateral cephalograms were compared with those from a Japanese control group. The outcome of orthodontic treatment was evaluated by comparing cephalograms taken before and after treatment. RESULTS: Radiculomegaly was found not only in the upper and lower canines but also the upper central incisors and lower first premolars. Macrodontia was found in the upper central incisors, upper canines, lower canines, and lower first premolars. Microdontia was found in the upper lateral incisor. Lateral cephalometric analysis showed a remarkable hypoplastic midface in both the sagittal and vertical dimensions, coupled with a significantly decreased cranial base length and an increased gonial angle. Serial lateral cephalograms during orthodontic treatment from 13 to 23 years of age demonstrated only slight maxillary growth and significant downward mandibular growth with clockwise rotation in addition to pronounced labial tipping of the upper central incisors. CONCLUSIONS: Characteristic dental anomalies together with a unique craniofacial dysmorphology were clarified. Successful oral rehabilitation was achieved by integrated orthodontic-prosthodontic treatment.

Abnormalities, Multiple↗

[Growth and developmental patterns in Neandertals].

Growth and development in Neandertals have been focused on in terms of the appearance of the human growth pattern in hominid evolution. Recently, more attention has been drawn to the aspects of growth in human evolution, although their significance was recognized from long before. One recently refined method is to use the perikymata counts on the enamel surface, which provide an absolute duration time of tooth crown development and therefore make possible comparisons in timings of developmental events. Another is to evaluate the relative timing and speed of developmental events from teeth, skull, and postcranial bones. In general, the hominid growth pattern would change from ape-like to human-like during the evolutionary process. It is still uncertain, however, when and where the exact event happened and the developmental pattern changed. As for the growth in Neandertals, it has been suggested that they would have grown relatively slowly in their childhood as modern humans do, while the appearance of the adolescent growth spurt and the duration time of their adolescence or childhood period are still obscure. More concrete and precise data are needed for a reasonable understanding of evolution of hominid growth for both modern humans and fossil hominids, in terms of: 1. more data of individual morphological traits applicable to fossil hominids, which increase the number of available fossil specimens; 2. variation of the traits in modern and archeological specimens, particularly in relation to environmental stress; 3. interaction or interrelationship between dental, cranial and postcranial development.

Animals↗

A principal components analysis of human odontometrics.

It has long been recognized that tooth crown diameters in hominoids are all positively intercorrelated one with another. This study reports on sex-specific correlation matrices derived from 2,650 individuals from the Solomon Islands, Melanesia. Mesiodistal and buccolingual diameters of all permanent teeth from one side are used, excluding third molars. Analysis discloses significant sex dimorphism in the strengths of the intercorrelations, with females being better integrated. Principal components analysis (PCA) provides an objective means of data reduction (shown here to be preferable to simple size summation methods) and decorrelation of the resulting linear combinations. Four components are extracted (with results being virtually identical in the two sexes) and arguments are put forth that varimax rotation to "a simpler solution" may be counterproductive. Before rotation, the four components are 1) overall size, 2) buccolingual widths contrasted with mesiodistal lengths, 3) anterior (I,C) contrasted with posterior (P,M) teeth, and 4) premolars contrasted with molars. Most of the explained (shared) variance (63%) extracted by PCA is in overall size of the dentition. There is a strong urge to view the results of these principal components analyses as reflective of biologically and genetically meaningful entities.

Female↗

Visibility of foreign bodies in soft tissue in plain radiographs, computed tomography, magnetic resonance imaging, and ultrasound. An in vitro study.

We compared conventional plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) with respect to their suitability for detecting foreign bodies in soft tissue in an in vitro model using a cow tongue to simulate orofacial soft tissues. Four samples of different sizes of fractured tooth crown, pieces of amalgam, glass, asphalt, composite, dry wood, and stone were each embedded under a 2-cm-thick flap on the caudal surface of the tongue. Plain radiographs revealed all the materials except wood, and there was some variation in the subjectively evaluated radiopacity of the materials which indicated the nature of the foreign bodies concerned. MRI proved to be the least suitable imaging method, as particles with a metallic content gave rise to powerful interference artifacts. CT and especially US proved to be suitable imaging methods for foreign-body detection in soft tissue. Amalgam produced a metallic streaking artifact in CT, which visualized wood as gas density, and depicted all the other materials as similar hyperdense masses. Ultrasound was both sensitive and specific in detecting foreign bodies in soft tissue. The particles were better defined in form and size with CT and US than with MRI or plain radiography. We conclude that when plain radiographs, history, and clinical examination fail to reveal the presence of superficial foreign bodies, US or CT can serve as an alternative method.

Animals↗

Prevalence and age at development of enamel hypoplasias in Mexican children.

Enamel hypoplasias, deficiencies in enamel thickness resulting from disturbances during the secretory phase of enamel development, are generally believed to result from nonspecific metabolic and nutritional disruptions. However, data are scare on the prevalence and chronological distributions. of hypoplasias in populations experiencing mild to moderate malnutrition. The purpose of this article is to present baseline data on the prevalences and chronological distributions of enamel hypoplasias, by sex and for all deciduous and permanent anterior teeth, in 300 5 to 15-year-old rural Mexican children. Identification of hypoplasias was aided by comparison to a published standard (Federation Dentaire Internationale: Int. Dent. J. 32(2):159-167, 1982). The location of defects, by transverse sixths of tooth crowns, was used to construct distributions of defects by age at development. One or more hypoplasias were detected in 46.7% (95% CI = 40.9-52.5%) of children. Among the unworn and completely erupted teeth, the highest prevalence of defects was found on the permanent maxillary central incisors (44.4% with one or more hypoplasias), followed by the permanent maxillary canine (28.0%) and the remaining permanent teeth (26.2 to 22.2%) Only 6.1% of the completely erupted and unworn deciduous teeth were hypoplastic. The prevalence of enamel defects on the permanent teeth was up to tenfold greater than that found in studies of less marginal populations that used the FDI method. The prevalence of defects in transverse zones suggests a peak frequency of hypoplasias during the second and third years for the permanent teeth, corresponding to the age at weaning in this group. In the deciduous teeth, a smaller peak occurs between 30 and 40 weeks post gestation. The frequency of defects after three years of age is slightly higher in females than males, suggesting a sex difference in access to critical resources.

Adolescent↗

The effect of continuous intrusive force on human pulpal blood flow.

The purpose of this study was to examine the effect of continuous intrusive force application on human pulpal blood flow (PBF). Recordings were made of 13 vital upper left central incisors in 13 healthy participants (experimental group, n = 8; control group, n = 5) who had clinically healthy tooth crowns and periodontal tissues. PBF was recorded by means of a laser Doppler flow meter (LDF) with an opaque rubber dam applied to the teeth. The basal blood flow in the pulp (BBFP) was compared during three observation periods: (1) before orthodontic archwire engagement; (2) during wire engagement (control group: no application of force; experimental group: continuous intrusive force of 0.5 N); and (3) after the removal of the wire. In the experimental group, brief intrusive forces (magnitude 0.5, 1.0, and 2.0 N) were applied to the incisal edge of the examined teeth to determine their effect on acute changes in PBF. The results obtained were as follows: (1) the BBFP in the experimental group was significantly reduced during the period of continuous intrusive force application (P < 0.05), which was followed by recovery after the removal of the wire. (2) Brief intrusive force produced a significant reduction of PBF (P < 0.05), but the reduction rate (percentage) did not differ significantly during the observation periods. The results indicate that the measurement technique shown in this study could detect PBF change produced by continuous orthodontic force application.

Adult↗

CO2 laser inhibitor of artificial caries-like lesion progression in dental enamel.

Several studies during the last 30 years have demonstrated the potential of laser pre-treatment of enamel or tooth roots to inhibit subsequent acid-induced dissolution or artificial caries-like challenge in the laboratory. The overall objective of ongoing studies in our laboratories is to determine, systematically, the optimum sets of parameters for carbon dioxide laser irradiation that will potentially effectively inhibit dental caries in enamel and tooth roots. The aim of the present study was to examine the roles of wavelength and fluence in the prevention of caries progression in vitro in enamel by means of a pH-cycling model. The hypothesis to be tested was that the highly absorbed 9.3- and 9.6-microm wavelengths would be efficiently converted to heat, creating a temperature sufficiently high to reduce the acid-reactivity of the mineral and inhibit caries-like lesion progression in dental enamel. One hundred and sixty caries-free tooth crowns were cleaned and varnished with acid-resistant varnish, leaving one exposed window of enamel. Twelve groups of 10 enamel samples were irradiated in their individual windows by one of the four wavelengths (9.3, 9.6, 10.3, or 10.6 microm) of a tunable CO2 laser. Energy per pulse was 25, 50, 100, 200, or 250 mJ (25 pulses). Repetition rate was 10 Hz, and beam diameter was 1.6 mm. Fluence conditions of 1 to 12.5 J/cm2 per pulse were produced. All teeth, including 40 non-irradiated controls, were subjected to pH-cycling to produce artificial caries-like lesions. Results were assessed by cross-sectional microhardness testing. Inhibition of caries progression of from 40% to 85% was achieved over the range of laser conditions tested. At 9.3 and 9.6 microm, 25 pulses at absorbed fluences of 1 to 3 J/cm2 produced inhibition on the order of 70% with minimal subsurface temperature elevation (< 1 degree C at 2 mm depth), comparable with inhibition produced in this model with daily fluoride dentifrice treatments. Safety and efficacy studies will be required in animals and humans before these promising laboratory results can be applied in clinical practice.

Absorption↗

Immuno-scanning electron microscope characterization of large tubules in human deciduous dentin.

BACKGROUND: This study was undertaken to elucidate the type and origin of collagen fibrils which construct the large tubules in deciduous coronal dentin by scanning electron microscope and anti-types I and III collagen antibody procedures. METHODS: The studies were performed on human deciduous teeth. The teeth were fixed in 4% paraformaldehyde solution and then fractured either mesio-distally parallel to the long axis of the tooth or transversely perpendicular to the long axis of the tooth crown. The specimens were three-dimensionally observed employing the scanning electron microscope to distinguish the content of large tubules. Polyclonal antibodies of anti-type I and anti-type III collagen with 20 nm colloidal gold, and secondary electron imaging and backscatter electron imaging of high-resolution field emission scanning electron microscopy were used to examine the types of collagen fibrils. RESULTS: The large tubules extended from the vicinity of the incisal edge of the dentino-enamel junction to the pulp cavity. Inside the large tubules, fibers in compact bundles run parallel to the longitudinal axis of the tubules. The fiber bundles consisted of collagen fibrils which were 50-150 nm in diameter with typical cross striation. Immuno-scanning electron microscopy showed type I collagen-labelling gold particles and type III collagen-labelling gold particles to be abundant on the fibrils. Types I and III collagen-labelling gold particles were present on the banded collagen fibrils regardless of their diameter. CONCLUSIONS: It was found that type III collagen is present together with type I collagen on the fibrils constructing the large tubules of the human deciduous dentin. This immunohistochemical study suggested that the fibrils constructing the large tubules were derived from the von Korff fibers, and types I and III collagens formed copolymers.

Child↗

Dental eruption sequence among colobine primates.

Dental development is one aspect of growth that is linked to diet and to life history but has not been investigated among colobines since the work of Schultz [1935]. This study establishes the dental eruption sequence for several colobine species and compares it to that of other catarrhines. The mandibles and maxillae of two hundred and four juvenile colobine specimens were scored for presence or absence of permanent teeth and for stages of partial eruption. Eruption was defined as ranging between tooth emergence (any part of a tooth crown above the alveolar margin) and full occlusion, with three intermediate levels manifest between these boundaries. In African colobines, represented by C. guereza, C. angolensis and P. badius, M2 erupts before I2, and in C. angolensis it also erupts before I1. The canine is delayed, erupting after the premolars in females and after M3 in males. Asian colobines show greater diversity in eruption sequences. Nasalis shows no early eruption of the molars and is very similar to Macaca. In Trachypithecus and Pygathrix M(2) erupts before I(2). The canine in Trachypithecus is delayed, erupting after the premolars and, in some males, after M3. In Presbytis M2 erupts before both incisors; M3 erupts before C in both sexes, and often before both premolars. Although the actual timing of eruption is unknown, all colobine species examined except N. larvatus showed some degree of relatively early eruption of M2 and M3. The lack of this tendency in Nasalis sets this genus apart from all other colobines represented in this study. Dental eruption sequence is thought to reflect life history patterns. Early molar eruption in colobines was thought by Schultz (1935) to be a primitive character reflecting shorter life history. Faster growth rates found in folivorous primates have been interpreted as being related to an adaptation to folivory (Leigh 1994), and early eruption of molars may be part of this dietary specialization. The relationships between dental development and both diet and life history are investigated.

Animals↗

Threshold of tactile sensitivity perceived with dental endosseous implants and natural teeth.

The aim of this study was to determine the threshold of tactile perception of endosseous dental implants and to assess the relative difference of that threshold between implants and teeth. Twenty-two subjects with implants of the ITI Dental Implant System were included in the study. All implants served as abutments for single tooth crowns and had been in function for a minimum of 1 year. A strain gauge glued to the shaft of an amalgam plugger served as a force sensor. It transformed the elastic deformation exerted onto the shaft into an electronic signal for recording. By use of the amalgam plugger, a continuously increasing force was exercised on the implants or teeth until the first sensation of touch was indicated by the patient. Statistical analysis revealed threshold values for the implants ranging from 13.2 to 189.4 g (1 g = 0.01 N) (mean 100.6; SD 47.7), while a range of 1.2 to 26.2 g (mean 11.5; SD 11.5) was found for control teeth. Thus, the mean threshold values for implants were 8.75 times higher than for teeth. This difference was highly statistically significant. A general linear models procedure was applied to determine the influence of patient age, jaw, implant position and the threshold values of teeth on the measurements obtained for implants. Only gender and the threshold values for contralateral teeth had a significant influence. These 2 parameters together explained 27% of the variability in threshold measurements. It is concluded that a more than 8-fold higher threshold value for tactile perception exists for implants compared with teeth.

Adolescent↗

[The extraction of the lower third molars: germectomy or late avulsion?].

INTRODUCTION: Lower third molars show the highest incidence of impaction and have been held responsible for pathologies such as pericoronitis, periodontitis, second molars tooth-crown resorption, pain, cysts or odontogenic tumors, primary or secondary crowding of the dentition. Early removal of these teeth to prevent the overmentioned problems is widely acknowledged, as many studies demonstrated a direct correlation between age and incidence of complications. These studies mostly refer to adult patients, while studies about germectomies are few. Because recent contributions showed that the risk of development of these pathologies in presence of impacted third molars is quite low while a certain morbidity associated to this procedure may be expected, a very careful risk to benefit ratio must be considered. The purpose of this study was therefore to compare the incidence of complications and side effects in three age groups, in order to obtain some informations about the choice of the best moment for operation. MATERIALS AND METHODS: The patients, 462 females and 406 males, were divided, according to age, in the following three groups: group A included patients from 9 to 16 years; group B included patients from 17 to 24 years; group C included patients over 24 years. All patients were treated under local anesthesia; surgical procedure and instruments were standardized. RESULTS: In group A, formed by 500 germectomies, the incidence of complications was 2.6% (10 instances of secondary infections, 2 instances of trismus, 1 instance of excessive postoperative bleeding). Group B included 570 procedures and the incidence of complications was 2.8% (3 instances of alveolar osteitis, 7 instances of secondary infections, 2 instances of excessive postoperative bleeding, 2 instances od second molar lesions, 1 instance of inferior alveolar nerve paresthesia, 1 instance of trismus). Group C included 430 procedures and the incidence of complications was 7.4% (2 instances of second molar lesions, 9 instances of alveolar osteitis, 8 instances of secondary infections, 4 instances of excessive postoperative bleeding, 6 instances of inferior alveolar nerve paresthesia, 3 instances of trismus). All complications were transient; in one instance only of mandibular nerve paresthesia in group C symptoms were still present 25 months after the operation. DISCUSSION AND CONCLUSIONS: This study has shown no significant differences between group A and B, while complications significantly increase in group C. Recent researches have shown that: a) there is a low risk of development of pathologies correlated to third molar impaction; b) nowadays there are not valid criteria to evaluate the future eruption of the impacted tooth; c) a direct correlation between third molar impaction and anterior dental crowding hasn't been demonstrated yet; d) morbidity of the procedure is relevant. Therefore germectomy should be performed: a) if morphostructural alterations or ectopic impactions are present; b) in case eruption is not allowed for dysplastic alterations of the germs or pathological processes of the mandible; c) to gain space in the posterior segments of the lower jaw when distalization of first and second molars is necessary; d) in case of excessive anterior-posterior mandibular growth.

Adolescent↗

Dental metric assessment of the omo fossils: implications for the phylogenetic position of Australopithecus africanus.

The discovery of Australopithecus afarensis has led to new interpretations of hominid phylogeny, some of which reject A. africanus as an ancestor of Homo. Analysis of buccolingual tooth crown dimensions in australopithecines and Homo species by Johanson and White (Science 202:321-330, 1979) revealed that the South African gracile australopithecines are intermediate in size between Laetoli/hadar hominids and South African robust hominids. Homo, on the other hand, displays dimensions similar to those of A. afarensis and smaller than those of other australopithecines. These authors conclude, therefore, that A. africanus is derived in the direction of A. robustus and is not an ancestor of the Homo clade. However, there is a considerable time gap (ca. 800,000 years) between the Laetoli/Hadar specimens and the earliest Homo specimens; "gracile" hominids from Omo fit into this chronological gap and are from the same geographic area. Because the early specimens at Omo have been designated A. afarensis and the later specimens classified as Homo habilis, Omo offers a unique opportunity to test hypotheses concerning hominid evolution, especially regarding the phylogenetic status of A. africanus. Comparisons of mean cheek teeth breadths disclosed the significant (P less than or equal to 0.05) differences between the Omo sample and the Laetoli/Hadar fossils (P4, M2, and M3), the Homo fossils (P3, P4, M1, M2, and M1), and A. africanus (M3). Of the several possible interpretations of these data, it appears that the high degree of similarity between the Omo sample and the South African gracile australopithecine material warrants considering the two as geographical variants of A. africanus. The geographic, chronologic, and metric attributes of the Omo sample argue for its lineal affinity with A. afarensis and Homo. In conclusion, a consideration of hominid postcanine dental metrics provides no basis for removing A. africanus from the ancestry of the Homo lineage.

Animals↗

[Three-dimensional change of the occlusal facets in primary dentition before and after the eruption of first permanent molars].

A system to measure the three-dimensional architecture of the occlusal surface was developed to clarify the three-dimensional change of the morphology of occlusal facets that was considered as the trace mark of the chewing function. The three-dimensional measuring and analyzing system of the occlusal surface was composed of two components, the measuring system to obtain the three-dimensional coordinates on the surface contour of the tooth crown and the analyzing system to calculate the minute morphology in the three dimensions. The reproducibility of this system was evaluated with use of the standard block of stainless steel designed for this purpose and was shown to be very accurate. By application of this system, the three-dimensional changes of the occlusal facets on primary canines and primary second molars were investigated on the serial primary dental casts taken before and after the eruption of the first permanent molars from eleven children (seven boys and four girls). The results were as follows: On the primary second molars of the maxilla and mandible, before the eruption of the first permanent molars, the occlusal facets were distributed mainly on the functional cusps. The occlusal facets were found also on the non-functional cusps after the eruption of first permanent molars. As a consequence, the increase in the number of occlusal facets from before to after the eruption of first permanent molars was statistically significant for both maxillary and mandibular primary second molars. In regard to the morphological change in three dimensions, the occlusal facets that were facing mesially or distally before the eruption of first permanent molars changed its direction buccally or lingually and became almost parallel to the datum plane of the mandibular dental arch after the eruption of the first permanent molars. It was also found that the occlusal facets of both jaws in the occlusal relationship were almost parallel to each other. In addition, the amounts of angular change before and after the eruption of first permanent molars were significantly correlated between the maxillary and mandibular occlusal facets. It can be concluded that the coordinating change of the occlusal facets in three dimensions may exist between both jaws during the development of chewing function.

Child↗

Pulsed Nd:YAG laser irradiation of the tooth pulp in the cat: I. Effect of spot lasing.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to evaluate physiologically pulpal nerve responses and to elucidate histopathologically the pulp tissue reactions to "spot irradiation" with a pulsed Nd:YAG laser. STUDY DESIGN/MATERIALS AND METHODS: Antidromic compound action potentials and the pulpal blood flow (PBF) were recorded from the canine tooth of a sodium pentobarbitone-anesthetized cat. The laser irradiation-induced pulp tissue changes were histologically investigated. RESULTS: The coronal antidromic compound action potentials disappeared in all the teeth tested during lasing, and the time needed to erase them was significantly shortened with increases in lasing power (P < 0.05). The radicular PBF increased when spot irradiation was performed, and the coronal PBF also temporarily increased with low-powered lasing. Histologic investigation revealed that spot irradiation with the laser produced severe damage in the pulp tissue in a dose-dependent manner. CONCLUSION: The present study suggests that spot irradiation with a pulsed Nd:YAG laser risks producing nerve injury and irreversible tissue damage in the pulp with lasing for the purpose of desensitizing hypersensitive dentin.

Action Potentials↗

Dental findings in the Schimke immuno-osseous dysplasia.

Schimke immuno-osseous dysplasia is a rare autosomal recessive disorder that affects primarily bone, T lymphocytes, kidneys, and skin. The patients have a triangular face, broad nasal bridge, bulbous nose tip, small palpebral fissures, short neck, long upper lip, and low hairline. Dental abnormalities of affected patients have not been discussed in detail. The patient described in this clinical report presented with clinical and radiographic abnormalities that may constitute a diagnostic characteristic in this condition.

Child↗