Objectives: To compare the precision of two cephalometric landmark identification methods, namely a computer-assisted human examination software and an artificial intelligence program, based on South African data. Methods: This retrospective quantitative cross-sectional analytical study utilized a data set consisting of 409 cephalograms obtained from a South African population. 19 landmarks were identified in each of the 409 cephalograms by the primary researcher using the two programs [(409 cephalograms x 19 landmarks) x 2 methods = 15,542 landmarks)]. Each landmark generated two coordinate values (x, y), making a total of 31,084 landmarks. Euclidean distances between corresponding pairs of observations was calculated. Precision was determined by using the standard deviation and standard error of the mean. Results: The primary researcher acted as the gold-standard and was calibrated prior to data collection. The inter- and intrareliability tests yielded acceptable results. Variations were present in several landmarks between the two approaches; however, they were statistically insignificant. The computer-assisted examination software was very sensitive to several variables. Several incidental findings were also discovered. Attempts were made to draw valid comparisons and conclusions. Conclusions: There was no significant difference between the two programs regarding the precision of landmark detection. The present study provides a basis to: (1) support the use of automatic landmark detection to be within the range of computer-assisted examination software and (2) determine the learning data required to develop AI systems within an African context.

Background: Osteosarcoma of the jaws is a rare primary malignant tumor of bone. The clinical, radiological and histopathological features of a case associated with cemento-osseous dysplasia is presented. Case Report: A 57-year-old mixed-race female presented with a large, progressive, swelling of the right mandible. Radiographic examination revealed two associated lesions. Partially defined irregular radiopacities were noted in the left mandible, extending from the premolar to the molar region. The lesion had a cotton-wool appearance and resembled a fibro-osseous lesion; i.e. cemento-osseous dysplasia. A second large, expansive and irregular, radiopaque lesion was noted on the right angle of the mandible, extending beyond the inferior cortex of the mandible. The internal structure was heterogeneous and resembled irregular bone formation. The classic “sunburst” appearance of radiating bony spicules can be seen in the posterior–anterior view and the CBCT 3D reconstruction, indicating the outgrowth of the tumor matrix. Histopathological exam confirmed a final diagnosis of osteosarcoma closely associated with cemento-osseous dysplasia. The patient underwent a fludeoxyglucose-18 (FDG) positron emission tomography (PET) scan which indicated metastasis in the left lung and increased uptake in the right mandible. Chemotherapy was initially administered with a plan to resect the tumor, however, the patient demised as a result of medical complications. Conclusion: The question in the literature remains whether these two entities are coincidentally found or arise from each other. Nevertheless, it is important for clinicians to closely monitor patients with cemento-osseous dysplasia and biopsy any suspicious lesions that may develop into osteosarcoma.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare side-effect of certain drugs, mainly those used in regimens treating specific cancers and in the initial treatment for non-neoplastic conditions. The first cases of jaw osteonecrosis were reported over 2 decades ago in patients taking bisphosphonates (BPs). Since its identification, the nomenclature has changed from bisphosphonate-related osteonecrosis of the jaw (BRONJ) to MRONJ, as other drugs can elicit the same reaction. Invasive dental treatments, such as extractions, are known risk factors. Therefore, the importance of routine dental care before and during such drug therapy cannot be overemphasized. MRONJ is a challenging condition to diagnose early as the radiographic features are subtle and easily overlooked. This case report presents 3 female patients with multiple myeloma, emphasizing the chronological radiologic evolution of MRONJ. Notably, 1 case illustrates a transition from Stage 0 to Stage 2 over a 17-month period, documented through serial panoramic radiographs and a positron emission tomography (PET) scan. Another case highlights the role of cone beam computed tomography (CBCT) in identifying sequestra and pathological fractures. An additional noteworthy case illustrates that conservative dental management avoided the potential development of MRONJ. While histopathology confirmed necrotic bone in 2 cases, early radiologic indicators such as sclerosis and nonhealing sockets provided key diagnostic insights. This case report underscores the importance of regular dental monitoring and interdisciplinary care in at-risk patients and contributes to the growing discourse on the critical role of radiologic evaluation in the early detection and management of MRONJ.

Objectives: Poor oral hygiene is a risk factor for bacteremia and infective endocarditis (IE). The purpose of this study was to determine the relationship of bacteria commonly associated with dental disease in native valve and prosthetic valve endocarditis patients at a tertiary center in Missouri. Methods: This retrospective cross-sectional analysis reviewed the electronic medical records of patients diagnosed with definite IE, per the modified Duke criteria, at the University of Missouri Hospital between September 2015 and April 2019. Medical records were screened using International Classification of Diseases, Tenth Edition, code for IE (I 33) and further validated by screening echocardiography for intracardiac vegetations. Demographics, type of IE, echocardiographic findings, blood culture results, and relevant medical and dental data were recorded, and a descriptive analysis performed. Results: One hundred twenty-seven patients with 134 episodes (mean = 51.1 years, SD ± 17.7 yrs; M: F = 1:1) satisfied the criteria. Of these, 19 (14.2%) episodes were identified to have blood culture results positive for bacteria associated with the oral cavity. Seventy-seven (57.5%) episodes were related to Staphylococcus aureus. Staphylococcus aureus is a constituent of normal oral flora and can contribute to oral disease and IE, but the connection between the 2 remains contentious in both medical and dental practice. Remarkably, 72 (53.8%) medical records lacked documentation of dental history and oral examination. Conclusions: A significant proportion of IE cases are from bacteria associated with the oral cavity, advocating for routine dental evaluation and treatment as an essential component of care of patients with IE.

A 15-year-old male presented to the dental clinic after noticing a mild swelling in his lower jaw. Radiographic examination (Figure 1) revealed a well-defined, non-corticated, unilocular radiolucency with scalloped margins in the anterior mandibular symphyseal region. Notably, no root resorption or displacement was noted on this view. All associated teeth were vital, and the patient had no history of trauma. During surgical exploration, no cystic lining was discovered in the lesion; instead, a bony wall was present. Histological examination showed small fragments of viable bone, some of which were covered by a thin fibrovascular lining. No epithelial lining was observed in the examined sections

Cherubism is a rare fibro-osseous disorder of the jaws that typically presents in early childhood and is recognised as genetically heterogeneous. While the condition is well described in non-African populations, African data and molecular confirmation remain limited. Background/Objectives: This structured narrative review aimed to synthesize published African cases of cherubism by describing patterns of presentation, diagnosis, management, and genetic investigation. Methods: A structured narrative literature review was conducted using PubMed, Scopus, Google Scholar, and African Journals Online. Peer-reviewed case reports and case series describing cherubism in African patients were included. Data extraction followed predefined criteria, capturing demographic features, age at onset and presentation, clinical, radiological and histological findings, management strategies, and the use of molecular genetic testing. Findings were synthesised descriptively. Results: Fourteen studies reporting 20 individual cases from eight African countries were identified, with the majority originating from North Africa. Although symptom onset most commonly occurred in early childhood, the median age at presentation for management was 13.75 years, suggesting delayed access to care. Molecular genetic testing was reported in only two cases, while most diagnoses relied on clinical, radiological, and histopathological features. Surgical intervention was commonly described, with fewer cases managed conservatively. Conclusions: Within the limitations of a structured narrative review based predominantly on published case reports and case series, and constrained by the scarcity of molecularly confirmed cases, the available African literature on cherubism remains limited in scope, geographically skewed, and characterised by incomplete genetic reporting. Recurring features include delayed presentation, reliance on clinical diagnosis, and limited use of molecular testing. These observations reflect gaps in reporting and genetic characterisation rather than population-level patterns, underscoring the need for improved molecular diagnostics, multidisciplinary care, and African registries.