it is also known as keratocystic odontogenic tumor ( KOT)
also known as osteogenic sarcoma
An 11-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern with reduced vertical dimensions complicated by an increased overjet (11mm), increased overbite, generalized spacing and bi-maxillary proclination.
The aetiology of this malocclusion is multi-factorial.
The moderate skeletal class II discrepancy resulted in an increased overjet and class II molar relationship. The overjet was exacerbated by the presence of a lower lip trap. The generalized spacing was a result of an underlying dento-alveolar disproportion. This was compounded by bi-maxillary proclination, which arose due to resting soft tissue pressures and dento-alveolar compensation.
• Integration of twin block functional and sectional lower fixed Herbst appliancee
• Continuation of functional appliance wear at night
• Use of headgear
• Inter-arch class II elastic traction following fixed
The prognosis for long-term stability of class II correction is good in this case, as the new maxillary incisor position will be controlled by the lower lip following the achievement of lip competence.
A 12-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern, with increased vertical dimensions complicated by an increased overjet (12mm), crowding of both dental arches and teasing in relation to her dento-facial appearance.
What is treatment plan?
1) Functional appliance like Dynamax or Twin block (more preffered as overjet reduction is more effective) = maxillary retroclination, mandibular incisor proclination, guides the eruption of posterior dentition.
2) Need of Headgear with torqueing spurs = restricts maxillary forward growth and tipping of maxillary incisors.
3) Extraction of four second premolars followed by edge to edge appliances for stability of class II correction.
Highly elevated alkaline phosphatase is a good marker of Paget’s disease of bone in the appropriate clinical setting. Bone sequestration is often secondary to chronic osteomyelitis in the jaws. Bisphosphonates are used to treat Paget’s disease and also have been linked to jaw osteonecrosis.
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Dentowesome | @drmehnaz
Study the two radiographs which are of the same
patient at (a) 19 years and (b) 34 years of age.
1 . What is the most likely periodontal diagnosis at 34
years of age?
Generalised aggressive periodontitis. The severity
of bone resorption and the radiographic absence of
signs of resorption at 19 years preclude a diagnosis of
2 . What does the initial phase of treatment involve?
Initially conventional cause-related treatment
is instigated: instruction in toothbrushing and
use of adjunctive aids for interproximal and
subgingival cleaning, RSI, prophylaxis. Ultimately,
treatments such as surgery and the adjunctive use of
antimicrobials might be indicated, but conventional
treatment is first in line.
3 . The patient has a sister who is aged 29 years. What
advice might you offer?
Periodontal screening and radiographic examination.
There is evidence that certain subjects are at high risk
from developing aggressive periodontitis and this
risk may be under genetic control. Siblings should
be screened and affected individuals with children
warned that early signs may develop from around
A 35-year-old man presents with gross loosening of both his lower left premolar teeth. The gingiva around them looks swollen and is purple–brown in colour. A radiograph shows irregular bone destruction to the apices. Incisional biopsy shows multinucleated osteoclast-like giant cells in a haemorrhagic fibrous stroma.
- Which investigations should now be performed?
The serum calcium level should be measured and radiographs reviewed to exclude hyperparathyroidism.
- If these prove negative, what treatment should be undertaken?
The lesion should be treated by local removal with curettage.
- Which other lesions in the jaws contain multinucleate giant cells of this type?
Osteoclast-like giant cells are found in
- giant-cell granuloma
- brown tumour of hyperparathyroidism
- Pagetʼs disease of bone
- aneurysmal bone cyst
- some fibro-osseous lesions, particularly cherubism.
Concepts of Health & Disease
Health is a basic human need and better health improves your quality of life.
There are various changing concepts of Health . Absence of disease being the traditional concept – Biomedical concept . Health is perceived in different ways nowadays giving rise to following concepts:
1. Biomedical concept
2.Ecological concept : Health is perceived as balance between man and his environment and one who cannot adjust is not fit to be called healthy.
3. Psychosocial concept : Health is also influenced by social, psychological , cultural , economic and political factors of the people concerned.
4.Holistic concept : is an integrated approach towards wellbeing of the human being.
This was keypoints about concepts of Health. I hope it helps .
A 60-year-old man has been treated for a T2N0M0 squamous-cell carcinoma by radical radiotherapy. He has a history of chronic alcoholism and was a heavy smoker. Six years after treatment, he develops a painful ulcer in the alveolar mucosa in the treated area following minor trauma. His pain worsens and the bone became progressively exposed. He is treated by a partial mandibular resection with graft.
- What diagnosis is most likely?
The features suggest osteoradionecrosis. Recurrent carcinoma is possible but less likely.
- How does radiotherapy damage tissues and what structural features might be seen in the bone?
Radiotherapy damages tissues by producing free radicals. DNA damage may prevent cell division and repair. Endoarteritis obliterans results in reduced vascular supply to the tissues. Bone may become necrotic, showing osteocyte death, sequestration and breakdown of the matrix. Infection may result in osteomyelitis
- What changes may arise in irradiated connective tissues 10 years after exposure?
Mutations and other genetic damage may lead to neoplasia in irradiated tissues. Osteosarcoma can arise in this way.