Rajiv Desai

Dentigerous cyst associated with permanent central incisor: A rare entity

Dentigerous cyst is one of the most prevalent types of odontogenic cyst and is associated with crown of an unerupted or developing tooth. Dentigerous cyst is more commonly seen with mandibular third molar and maxillary canine and rarely other teeth are involved. Here we report a case of dentigerous cyst involving permanent maxillary central incisor.

Keratocystic odontogenic tumor: systematic review with analysis of 72 additional cases from Mumbai, India

OBJECTIVE The aim of this systematic review was to assess the clinical and imaging findings of keratocystic odontogenic tumor (KOT). This article also attempts to determine the prevalence of KOTs and orthokeratinized odontogenic cyst (OOC) in the western Indian population and to compare demographic and radiographic findings of KOT of our cohort with that of the rest of the world. STUDY DESIGN Relevant publications on KOT were reviewed from the published literature from 1976 to March 2012. Data regarding the 72 additional cases from Mumbai also were analyzed. RESULTS Sixty-five reports were identified for this systematic review. The findings were divided into 4 global groups for analysis. The prevalence of KOT was 0.0173% and that of OOC 0.0012%. Male sex, mandible, and the unilocular variation were predominant for the additional cases. CONCLUSIONS The characterization of the KOT lesions was accomplished, taking into consideration the variations to the western Indian population.

Computer assisted histomorphologic comparision and the expression of AgNORs in the central and peripheral giant cell lesions of the oral cavity and giant cell tumor of the long bone

Objective: Computer-assisted image analysis was attempted to ascertain, if any of the previously described histologic features along with argyrophilic nucleolar organizer regions (AgNORs) could be used to determine the aggressiveness of the central giant cell granuloma of the jaws (CGCG), peripheral giant cell granuloma of the oral cavity (PGCG) and giant cell tumor of the long bones (GCT). Study Design: The study consisted of 20 cases of CGCG, 20 cases of PGCG and 5 cases of GCT. The histological features included were number of giant cells, number of nuclei in each giant cell, number of blood vessels, fractional surface area (FSA) and relative size index (RSI) of giant cells. The histologic parameters were measured using Motic image plus analyzer and AgNORs were evaluated using silver stain. Results: The statistical analysis showed significant differences among various histological parameters between CGCG, PGCG and GCT. A statistically significant difference was noted for the mean number of nuclei, FSA and RSI when GCT was compared with CGCG and PGCG. FSA of histologically aggressive central giant cell granuloma (HA-CGCG) was more compared to histologically non-aggressive central giant cell granuloma (HNA-CGCG). No statistical correlation was observed for AgNORs of multinucleated giant cells and mononuclear cells among CGCG, PGCG and GCT. Conclusion: Based on the present study findings, CGCG and GCT are distinct and separate entities and not a continuum of a single disease process. Histological parameters alone have a little implication on predicting clinical behavior of CGCG. AgNORs alone as a proliferative marker has a limited value in assessing the proliferation potential of giant cell lesions.

Clinical and imaging findings of true hemifacial hyperplasia.

Congenital hemifacial hyperplasia is a rare developmental disorder of unknown etiology, characterized by a marked unilateral facial asymmetry. It involves the hard (bones and teeth) and soft tissues of the face. We report an interesting case of true hemifacial hyperplasia in a 25-year-old male highlighting the clinical and computed tomography imaging findings.

Histomorphometric analysis of vascularity in normal buccal mucosa, leukoplakia, and squamous cell carcinoma of buccal mucosa

Context: Angiogenesis, the process that leads to the formation of new blood vessels, continues to be a topic of major scientific interest. There is an increasing hope that new discoveries will lead to newer therapies that target angiogenesis as a reliable option for disease therapy. Aims: The objective of this study was to assess the role of vascularity, correlation of morphometric aspects of vascularity, investigate its usefulness in the histopathological classification and prognosis in normal buccal mucosa (NBM), leukoplakia and squamous cell carcinoma (SCC) of buccal mucosa. Materials and Methods: The study sample consisted of 15 cases of NBM, 30 cases of leukoplakia, and 30 cases of SCC of buccal mucosa. The 75 archival samples were stained by hemotoxylin and eosin (H and E) and Massons trichrome (MT). The stained sections were analyzed using image analysis software. Statistical analysis used: Statistical Package for Social Sciences (SPSS) 12.0 statistical software. Results: The combined mean vessel density (MVD) of all the cases in H and E was 0.1112 and for MT it was 0.2150. The difference of MVD between H and E and MT was statistically significant. The mean MVD in SCC (0.3455) for MT was higher than NBM (0.1314) and leukoplakia (0.1263). The mean MVD increased from stage III (0.3563) to IV (0.5312). It also increased from NBM (0.1314) to hyperkeratosis (0.1505) and decreased from grade I (0.3556) to II (0.2795) of oral SCC (OSCC). Conclusions: MVD can be used as an adjunct with other diagnostic modalities. Further studies are needed to standardize baseline levels for different sites and age groups.

Florid osseous dysplasia

The concept of ‘fibro-osseous lesions’ of bone has evolved over the last several decades and now includes two major entities, viz., fibrous dysplasia and ossifying fibroma, as well as other less common entities such as periapical dysplasia, focal osseous dysplasia, florid osseous dysplasia and familial gigantiform cementoma. Florid osseous dysplasia is a central lesion of the bone and periodontium, which has caused considerable controversy because of confusion regarding terminology and criteria for diagnosis. This paper reports a rare case of florid osseous dysplasia affecting maxilla and mandible bilaterally in a 14-year-old Indian male patient.

Cone-beam computed tomographic and histological investigation of regenerative endodontic procedure in an immature mandibular second premolar with chronic apical abscess

AIM The aim of the present study was to investigate the tissue generated after regenerative endodontic procedure (REP) in the root canal space of an immature mandibular second premolar with pulp necrosis and chronic apical abscess using cone-beam computed tomographic (CBCT) and histological methods. METHODS REP was performed in an immature mandibular second premolar. At the 3-year follow up, CBCT scans were taken to evaluate the outcome of treatment. As the tooth was not restorable to function, it was extracted and processed for histological examination. RESULTS CBCT showed a reduction in size of the periradicular radiolucency, with a marginal increase in root length. Apical closure and thickening of the root canal walls were apparent. Histologically, the root canal space was filled with minimally-inflamed fibrous connective tissue. Some cementum-like mineralized connective tissue was evident on the internal canal walls. The apical third showed cementum-like deposits at the apex and the outer canal walls, without dentin formation. CONCLUSIONS The present study of a structurally-failed tooth with prior REP demonstrates that the tissue formed within the root canal space was fibrous connective tissue with cementum-like deposition in the canal space. No evidence of dentin- or pulp-like tissue was found.

Accidental separation and lodgment of rotary endodontic file into the dentist's thumb

Separation of the endodontic instrument within the root canal system and sharp injuries to the dentist is not an uncommon event in endodontic practice. Although root canal instruments can fracture at any stage of endodontic treatment, its fracture within the dentists hand is a very rare event. An unusual case of accidental separation and lodgment of rotary endodontic file in the dentists thumb is presented along with its management. A 33-year-old dentist reported with an accidental lodgment of rotary endodontic file into his thumb. The fractured instrument was removed successfully by a surgeon. The present case describes a rare event of occupational risk in endodontic practice.

Toxic epidermal necrolysis in a 5-year-old boy - case report

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are considered a spectrum of acute life-threatening mucocutaneous reaction that differ only in severity, often induced by drugs. Varicella-zoster virus has been rarely reported as an etiological agent in TEN. Our case report highlights the association of varicella-zoster virus and TEN in a 5-year-old boy. Keywords: Life-threatening, Toxic epidermal necrolysis (TEN), Varicella-zoster virus.

Peripheral myxoma of the infratemporal region: An unusual case report

Odontogenic myxoma (OM) is a rare locally invasive benign neoplasm, almost exclusively occurring in the jawbones, comprising 3-6% of all the odontogenic tumors. The mandible is more commonly involved than the maxilla. Intraoral soft tissue myxoma is an extremely rare lesion and only few reports are available in the literature. We present probably the first of its kind in literature a soft tissue OM occurring in an unusual location: the infratemporal fossa.