Ekman-Westborg-Julin syndrome. A case report

The effect of Ekman-Westborg and Julin trait (generalized megadontia) and localized megadontia on tooth components size and ion content

AIMS

The objective of this study is to compare size, enamel thickness and ion relative concentration in generalized megadontia (Ekman- Westborg and Julin trait) and a localized megadont upper third molar to normal teeth.

MATERIALS AND METHODS

The MD dimensions of permanent teeth were compared to controls. Tooth components of molars were measured from X-rays and compared to controls. The enamel and dentin relative amounts of elements of mandibular first permanent molar and deciduous canines of E-WJ trait girl, and megadont upper third molar were determined using ESD program of SEM and compared to match-paired normal teeth.

RESULTS

The teeth of the girl diagnosed with E-WJ trait were true megadont (larger than mean ± 2SD). The ratio of enamel thickness to M-D dimension of molars of E-WJ trait and localized megadontia molars is reduced in comparison with normal similar teeth. In the enamel, carbon and silica concentrations were different in E-WJ trait teeth.

CONCLUSIONS

The enamel thickness was reduced in the E-WJ trait and megadont molars, but the relative amount of elements in enamel and dentin was similar to normal. The megadontia is due to a very large tooth germ, as determined by the DEJ, while the ratio of enamel apposition from the total M-D dimension is reduced.

CLINICAL RELEVANCE

Generalized megadontia, as observed in E-WJ trait, is due to large tooth germ, but the enamel thickness is similar to normal. Extractions of permanent teeth are necessary in order to allow normal eruption of teeth.

Oral characteristics of a patient with Ekman-Westborg-Julin trait: a case history

This article presents the case of a Japanese woman who had Ekman-Westborg-Julin trait. She had general macrodontia with multituberculism, evagination of the premolar, single conical roots, shovel-shaped incisors, enamel hypoplasia, impacted tooth, dental crowding, and an open bite. The oral and general characteristics of this patient are described and include the histological and radiographic findings of the mandibular third molars. We suggest that the distinctive oral features with macrodontia of the permanent teeth, multituberculism, evagination, single conical roots, and impaction of the tooth could be defined as the Ekman-Westborg-Julin trait.

A variant of the Ekman-Westborg and Julin trait

Ekman-Westborg and Julin is a trait that shows multiple macrodontia and multituberculism affecting only the teeth with no other anomalies (E-WJ). The aim of this report is to present a case which appears to manifest all the clinical signs of the E-WJ trait including odontoma formation. A 18-year-old girl with gingival inflammation particularly in the maxillary insicor area was referred to the authors' department. Panoramic, periapical and cephalometric radiographs were examined and complex odontoma associated with unerupted maxillary permanent lateral incisors was revealed. Intraoral examination revealed anterior crossbite, Angle Class III type malocclusion with mandibulary prominence and macrodontia of teeth 37, 12, 11 and 21. The patient was accepted as a new sporadic case of E-WJ. More case reports are needed to elucidate the causes and pathogenesis of this condition.

The prevalence of anterior teeth with dens invaginatus in the western Mediterranean region of Turkey

AIM

To assess the prevalence and type of dens invaginatus in anterior teeth of a selected population and to report associated dental complications.

METHODOLOGY

The records of patients examined in the Department of Paedodontics, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey between 1999 and 2006 were screened and a total of 2477 patients who had complete records with satisfactory radiographs were selected. The type of dens invaginatus and the presence of apical pathosis was determined from radiographs. Other dental abnormalities, syndromes and systemic diseases were noted. Variations in crown shape were also recorded.

RESULTS

Dens invaginatus was detected in 300 out of 2477 patients, with a prevalence of 12%; 82% of affected patients had dens invaginatus bilaterally. Maxillary lateral incisors were the most affected teeth. The majority of the teeth had normal crown morphology (95%). The most commonly seen type of dens invaginatus was type I (94%). Overall 33% of the patients with type III dens invaginatus and 4% of the patients with type II dens invaginatus had apical pathosis. No associations with other systemic diseases and syndromes and some limited association with hypodontia and dens evaginatus were detected.

CONCLUSION

A careful oral examination, radiographs, a suitable treatment plan and follow-up programme are crucial for early diagnosis and treatment for teeth with dens invaginatus.

A case of Ekman-Westborg-Julin trait: endodontic treatment of a macrodontic incisor

A case of Ekman-Westborg and Julin trait and endodontic treatment of a macrodontic lateral incisor with a necrotic pulp and periradicular pathosis presented in a 21-year-old woman. Clinical and radiological findings suggesting the Ekman-Westborg and Julin trait included multiple macrodontia, multituberculism, and single conical molar roots. Orthodontic problems such as mandibular prognatism and anterior and posterior cross-bite and other minor dental morphological changes were also found. Periradicular healing after endodontic treatment was followed by standardized periapical x-ray series, and signs of healing were observed at the 9 months postoperative control.

The Ekman-Westborg and Julin trait: report of a case

Macrodontia associated with multituberculism, central cusps, and pulpal invaginations is reported in a 7-year-old Hungarian girl. Over 5 years' follow-up the problems of the diagnosis, the similarity with and relationship to the Ekman-Westborg and Julin trait, and the difficulties of the treatment are discussed.

Multiple macrodontic multituberculism

Ekman-Westborg and Julin [1974: Oral Surg 38:217-222], described multiple macrodontia and multituberculism affecting the teeth without other anomalies (E-WJ). We describe a Chilean case in a 12-year-old with the typical dental alterations and with histopathologic findings that include absence of predentin layer and prominent reduced enamel epithelium. E-WJ is not a syndrome and we propose "multiple macrodontic multituberculism" as a better name for this anomaly of uncertain etiology affecting only the crowns of the teeth.