Search Results (4,989)

Lutetium-177-PSMA-617 (Lu-PSMA) radioligand therapy (RLT) is established in metastatic castration-resistant prostate cancer (mCRPC), with regulatory approvals based on the VISION and TheraP trials. Subsequent trials have extended the evidence to taxane-naive mCRPC (PSMAfore) and demonstrated that combining Lu-PSMA with enzalutamide yields a significant overall survival benefit over enzalutamide alone (ENZA-p). However, higher and more homogeneous PSMA expression in treatment-naive disease, combined with lower tumor burden and preserved bone marrow reserve, provides a biological rationale for deploying RLT earlier in the disease course. In metastatic hormone-sensitive prostate cancer (mHSPC), the Phase III PSMAddition trial reported improved radiographic progression-free survival when Lu-PSMA was added to standard androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitor (ARPI), and the Phase II UpFrontPSMA trial demonstrated enhanced biochemical responses with Lu-PSMA induction before docetaxel. In oligometastatic and oligorecurrent disease, the BULLSEYE and LUNAR trials have shown progression-free survival benefits, raising the possibility of deferring androgen deprivation therapy and its associated morbidity. Meanwhile, next-generation radionuclides, including actinium-225 (WARMTH) and the dual beta-Auger emitter terbium-161 (VIOLET), are entering clinical development to address the radiobiological limitations of Lutetium-177. This review synthesizes the evidence for PSMA-targeted radioligand therapy across the prostate cancer disease continuum and discusses patient selection, treatment sequencing, and the access and cost-effectiveness considerations that will shape adoption in earlier disease settings. Full article

Pediatric Monteggia fracture-dislocations may be overlooked when ulnar injury is incomplete or plastically deformed and radiocapitellar malalignment is subtle. Radiographic interpretation is further complicated by incomplete ossification, non-standard projection, and the limitations of applying a single alignment line across all ages and imaging scenarios. This narrative review synthesizes clinically relevant evidence on radiocapitellar alignment assessment in suspected pediatric Monteggia lesions and proposes an imaging interpretation framework for radiographs and problem-solving imaging. The review integrates developmental anatomy, radiographic adequacy, radiocapitellar line behavior, forearm-based P-line assessment, lateral humeral line assessment, ulnar bow sign, and targeted second-line imaging with ultrasound, MRI, and arthrography. The framework emphasizes three practical steps: first determining whether the available images are adequate for line-based assessment; then selecting the line or sign according to age, ossification stage, projection, and available landmarks; and finally reporting discordant or limited studies as equivocal rather than forcing a binary normal/abnormal interpretation. We also summarize diagnostic error considerations, structured reporting elements, and future directions for AI-assisted measurement and uncertainty-aware interpretation. The proposed framework is intended to support consistent radiologic reasoning and communication among emergency physicians, radiologists, and pediatric orthopedic surgeons. It is not a validated diagnostic rule, and prospective observer-performance studies are needed before implementation as a clinical pathway. Full article

Background: Bone tissue is a dynamic structure capable of continuous remodeling; however, its regenerative capacity is limited in critical-size defects, often requiring the use of bone grafting procedures. Available grafting materials present inherent limitations, highlighting the need for strategies that can enhance regenerative outcomes. Hyaluronic acid (HA) has been proposed as a promising adjunctive agent because of its biological properties, including anti-inflammatory and pro-angiogenic effects. Objective: To systematically evaluate the available clinical evidence regarding the effects of HA as an adjunct in bone regeneration procedures, including alveolar ridge preservation, ridge augmentation, and maxillary sinus elevation. Materials and Methods: A systematic search was conducted in the PubMed, ScienceDirect, Google Scholar, and Wiley Online Library databases for studies published within the last 10 years. Clinical studies involving adult patients were included if they evaluated the local application of HA, regardless of formulation, and reported quantitative clinical, radiographic, histological, or histomorphometric outcomes related to bone regeneration. Results: Of the 728 records initially identified, 10 studies met the eligibility criteria and were included in the qualitative synthesis. Discussion: Overall, the available evidence suggests that HA may positively influence bone regeneration outcomes. The most consistent benefits were observed in alveolar ridge preservation and ridge augmentation procedures, including increased new bone formation, improved bone density, enhanced bone maturation, and reduced dimensional bone loss. In contrast, findings regarding maxillary sinus augmentation were less consistent. Conclusions: HA appears to be a promising adjunct in bone regeneration procedures. However, the current evidence remains limited and is primarily based on clinical outcomes, providing insufficient mechanistic data to fully elucidate its biological effects. Further well-designed randomized controlled trials with standardized protocols are required before definitive clinical recommendations can be established. Full article

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the sacroiliac joints and spine and is associated with an increased risk of fractures due to persistent inflammation, reduced mobility and treatment-related factors. In radiographic axSpA (r-axSpA), assessment of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) may be limited by structural spinal changes. This cross-sectional study, conducted between March 2024 and June 2025, evaluated skeletal fragility in patients with r-axSpA using Radiofrequency Echographic Multi-Spectrometry (REMS)-derived Fragility Score (FS). Ninety patients with r-axSpA and sex-matched healthy controls underwent clinical assessment and REMS evaluation of lumbar spine and hip BMD, T-scores and spinal FS. Patients with r-axSpA had lower body mass index and higher rates of smoking, prior fractures and inflammatory markers compared with controls, while disease activity reflected a moderate burden. No significant differences in BMD or T-scores were observed between groups. However, FS was significantly higher in patients with r-axSpA (46.6 ± 15.4 vs. 31.2 ± 13.3, p = 0.004), corresponding to a higher fracture risk category, whereas correlations between FS and clinical parameters were not statistically significant. These findings suggest that REMS-derived FS may identify increased skeletal fragility in r-axSpA beyond conventional BMD measurements. Full article

Background: The styloid process exhibits considerable anatomical variability, and its elongation is frequently identified as an incidental finding on panoramic radiographs. However, limited evidence exists regarding its prevalence and possible association with craniofacial skeletal characteristics in adult orthodontic patients. Therefore, the aim of this study was to evaluate the prevalence, morphological characteristics, mineralisation patterns, and possible association of styloid process elongation with skeletal class and facial pattern in an adult orthodontic population. Methods: A retrospective cross-sectional study was conducted on 340 adult orthodontic patients (130 males and 210 females; mean age: 51.55 ± 6.62 years). Panoramic radiographs were used to assess styloid process elongation, defined as ≥30 mm, as well as its morphology and mineralisation patterns according to the Langlais classification. Lateral cephalograms were analysed to determine skeletal class and facial pattern. Statistical analysis included descriptive and inferential methods, with significance set at p < 0.05. Results: Styloid process elongation was identified in 47.65% of patients. Elongated processes showed significantly greater length and side asymmetry (p = 0.001). The most frequent morphology was normal (Type IV), while complete mineralisation (Type D) predominated. No significant associations were found between elongation and age or sex. Furthermore, no statistically significant relationship was observed between elongation and skeletal class (p = 0.479) or facial pattern (p = 0.531). Only a small proportion of patients reported symptoms according to the available clinical records, with no clear association with styloid process elongation. Conclusions: Styloid process elongation is a common incidental finding in adult orthodontic patients and does not appear to be associated with skeletal class or facial pattern. Its recognition on panoramic radiographs may improve the differential diagnosis of orofacial and cervical symptoms. Full article

Background: Chest X-ray imaging is a widely used diagnostic modality for identifying various lung diseases. Accurate multiclass classification of lung diseases enables timely treatment and improves patient survival. However, disease detection using chest X-ray images remains challenging due to heterogeneous data, overlapping radiographic features, and data privacy concerns. Furthermore, distinguishing among different lung diseases is difficult because of their similar clinical manifestations and imaging characteristics. Method: To address these challenges, a novel chaotic evolution optimization-enabled deep channel-attention broad convolutional neural network (CCEO-DCABNet) is proposed for multiclass lung disease classification within a federated learning (FL) framework. The proposed model ensures enhanced data privacy by allowing multiple client nodes and a central server to collaboratively train the model without sharing raw data. Prior to classification, image preprocessing is performed using Gaussian filter-based denoising followed by multiscale unsharp masking-based image sharpening. Subsequently, multiclass disease classification is carried out using DCABNet, whose parameters are optimized through the proposed CCEO algorithm. In addition, the federated learning process employs an averaging strategy for local model updates and global aggregation. Results: The proposed CCEO-DCABNet achieves an accuracy, true positive rate (TPR), and true negative rate (TNR) of $96.98\%$, $96.41\%$, and $97.45\%$. Conclusions: Experimental results demonstrate that the proposed CCEO-DCABNet framework effectively classifies multiple lung diseases from chest X-ray images while preserving data privacy through federated learning. The model achieves superior classification performance and can support reliable computer-aided diagnosis in clinical settings. Full article

Background: Wrist-hand radiographic skeletal maturation methods are widely used for forensic age estimation of living individuals, remaining among the most widely accepted imaging modalities in forensic practice despite limited evidence supporting their use at the legally relevant 18-year threshold. This systematic review aims to provide a quantitative synthesis of the widely recognized but previously unsynthesized body of evidence regarding their diagnostic accuracy (sensitivity, specificity, AUC-curve, mean absolute error-MAE) for forensic adult age estimation. Methods: Six databases (Scopus, PubMed, Google Scholar, Embase, Cochrane, Clarivate) between 1980 and 2026 were searched. Studies evaluating wrist-hand skeletal maturation for forensic age estimation in individuals ≥16 years with verified chronological age were included. Two reviewers independently screened studies and extracted data. Quality was assessed using QUADAS-2. DerSimonian-Laird random-effects model estimated the sensitivity and specificity of the wrist-hand bones maturation at the age of 18 years, and pooled MAE. GRADE assessed the certainty of evidence. Results: From 747 records, 23 studies (11,425 participants, 15 countries, 2003–2025) were included. Pooled MAE was 0. 537 years (95% CI: 0.387–0.686; 95% PI: 0.33–0.79 years), but obtained from 3 Italian studies conducted on clinical populations, and all characterized by high risk of bias. At the 18-year threshold, pooled sensitivity was 69.5% (95% CI: 61.6–77.3%; 95% PI: 35.3–100%) and specificity 85.56% (95% CI: 83.53–87.60%; 95% PI: 77.2–93.9%). Nevertheless, the heterogeneity was extreme (I² > 98%) for all diagnostic measures, and calculated prediction intervals confirm that individual study results are expected to vary widely. QUADAS-2 assessment revealed 82.6% of studies with high/unclear patient selection bias. GRADE-certainty was VERY LOW for both outcomes due to serious risk of bias, very serious inconsistency, and serious indirectness. Conclusions: Wrist-hand skeletal maturation shows low accuracy and high rates of misclassification for age estimation at the 18-year threshold. The wide prediction intervals (sensitivity 35–100%, specificity 77–94%, MAE 0.33–0.79 years) indicate that performance in a new study population may differ substantially from the pooled estimates. Very low certainty evidence, extreme heterogeneity, and substantial methodological limitations preclude confident application. Results should be interpreted with caution in forensic contexts, preferably combining multiple age indicators, in particular dental evidence. Full article

Background/Objectives: Osteoporosis is a major public health concern associated with increased fracture risk and reduced quality of life if not detected at an early stage. Automated analysis of knee X-ray images using artificial intelligence has shown promising potential for opportunistic osteoporosis screening. This study aims to develop and evaluate a multi-stage deep learning and machine learning framework for osteoporosis classification, with particular emphasis on external validation, calibration drift, and cross-domain generalization performance. Methods: Knee X-ray images were categorized into three classes: Normal, Osteopenia, and Osteoporosis. Deep features were extracted using pretrained convolutional neural networks, including ResNet18, EfficientNetB0, and DenseNet121. The extracted features were subsequently classified using multiple machine learning models, including Neural Network, Efficient Linear, Support Vector Machine, and Naive Bayes classifiers. Two data augmentation strategies were investigated: targeted minority-class augmentation and full 3× dataset expansion with class balancing. Model performance was evaluated using accuracy, precision, recall, F1-score, and AUC on internal validation, independent test sets, and external validation datasets. Additional analyses included reliability calibration assessment, isotonic recalibration, and class-prior boosting with cross-validated threshold optimization to address external domain shift. Results: EfficientNetB0 and DenseNet121 consistently outperformed ResNet18 across most evaluation metrics. Under the balanced augmentation strategy, EfficientNetB0 combined with Efficient Linear demonstrated strong and stable performance, while DenseNet121 paired with a Neural Network achieved the highest overall classification performance. External validation revealed a substantial discrepancy between AUC and threshold-based metrics, indicating the presence of calibration drift and class-prior mismatch across imaging domains. Reliability analysis showed severe probability collapse in the Osteopenia class during external testing. Post-hoc recalibration improved probability reliability, while class-prior boosting substantially increased Osteopenia sensitivity and improved balanced accuracy and macro F1-score under external validation conditions. Conclusions: The proposed framework demonstrates the feasibility of combining pretrained CNN-based deep feature extraction with machine learning classifiers for osteoporosis classification from knee X-ray images. The findings further highlight that maintaining model performance under external testing conditions may require not only strong feature extraction capability but also adaptive recalibration and deployment-aware threshold optimization to address calibration drift and cross-domain variability. While the results are encouraging, the present study should be considered a proof-of-concept investigation. Although the framework was evaluated using an independent public external dataset, further validation using larger and more diverse multi-center clinical cohorts is necessary to establish generalizability and clinical utility before routine clinical implementation can be considered. Full article

Accurate automated interpretation of upper-extremity musculoskeletal radiographs remains challenging because fracture appearance varies across anatomical regions and can be subtle under class imbalance. This study proposes a two-stage deep learning framework for MURA-based X-ray analysis, aiming to improve body-part recognition and body-part-wise abnormality detection. Multiple architectures were first compared for seven-class body-part classification, after which the selected hybrid Xception-Swin model was fine-tuned for abnormality detection within each anatomical subset. The framework combines Xception-derived local structural features with Swin Transformer contextual features using attention-based fusion, and performance was evaluated using accuracy, F1-score, AUC-ROC, Cohen’s kappa, calibration, component-level ablation, post hoc explainability, and zero-shot FracAtlas validation. For body-part classification, the model achieved accuracy = 0.9643, macro F1 = 0.9574, AUC-ROC = 0.9963, and kappa = 0.9579. For abnormality detection, accuracy ranged from 0.7289 to 0.8538, F1 from 0.7191 to 0.8508, AUC from 0.7693 to 0.9080, and kappa from 0.4449 to 0.7071. Ablation on hand and humerus radiographs showed the highest macro F1 with Hybrid Attention, while FracAtlas validation yielded AUC = 0.8247 and kappa = 0.5812. The results support complementary CNN-Transformer fusion and indicate preliminary cross-dataset generalizability. Implementation resources are available at Zenodo. Full article

Background/Objectives: Peri-implantitis is a major complication in implant dentistry, and its radiographic diagnosis remains challenging because conventional assessment is operator-dependent and bone loss is often detected only after measurable changes occur. Artificial intelligence (AI) may support the detection, quantification, and prognostic assessment of peri-implant bone conditions. This review aimed to synthesize evidence on AI-based radiographic approaches for peri-implantitis detection, marginal bone loss measurement, and risk stratification. Methods: PubMed and Scopus were searched for original studies published between 2013 and 2025 that applied artificial intelligence (AI), including machine learning and deep learning, to peri-implantitis. Eligible studies focused on peri-implant bone assessment and reported quantitative performance metrics. Extracted data included imaging modality, AI model, task, dataset, reference standard, validation strategy, performance, and clinical relevance. A qualitative synthesis was performed. Results: Eleven studies met the eligibility criteria; however, one full text could not be retrieved, and ten studies were included. In most of the studies, peri-implant marginal bone loss detection or measurement was performed using periapical/intraoral radiographs, while only few studies used panoramic or combined imaging. Common architectures included YOLO variants, Faster R-CNN, Mask R-CNN, U-Net, ResNet, and AlexNet. Performance was generally encouraging for implant localization, bone loss detection, keypoint identification, and severity classification. Only one study addressed outcome prediction. All studies were retrospective and internally validated. Conclusions: AI may support radiographic detection and quantification of peri-implant bone loss as an adjunctive diagnostic tool. However, evidence is limited by retrospective designs, heterogeneous reference standards, lack of external validation, and limited clinical-data integration. Future studies should prioritize prospective multicenter validation, longitudinal imaging, and multimodal models. Full article

Background and Clinical Significance: Odontogenic myxoma (OM) is a rare benign neoplasm of the jawbones characterized by spindle-shaped cells embedded in a myxoid stroma. Despite its benign histological nature, it demonstrates locally aggressive behavior, significant invasiveness, and a high risk of recurrence. OM ranks as the third most common odontogenic tumor after odontoma and ameloblastoma. It affects both sexes and occurs more frequently in the mandible than in the maxilla, typically during the second to fourth decades of life. Macroscopically, OM is non-encapsulated, whitish-gray, and gelatinous. Radiographically, it usually presents as a radiolucent lesion with fine bony trabeculae, producing a characteristic “tennis racket” appearance. Case Presentation: We report a case of a 27-year-old male diagnosed with maxillary odontogenic myxoma measuring 2.3 × 1.7 cm. Clinical, radiographic, and histopathological findings were evaluated, and the lesion was treated conservatively by surgical enucleation and curettage. Results: The surgical procedure was completed without complications. Histopathological analysis confirmed the diagnosis of odontogenic myxoma. The patient showed satisfactory postoperative healing, and no evidence of recurrence was observed during a 10-month follow-up period. Conclusions: Although odontogenic myxoma is benign, its locally aggressive nature and recurrence potential require accurate diagnosis and appropriate management. Conservative treatment by enucleation and curettage may be effective for small, well-defined lesions, provided that careful long-term follow-up is maintained to monitor for recurrence. Full article

Background: Congenital fibular deficiency is a rare longitudinal deficiency of the lower extremity associated with limb-length discrepancy, ankle and foot deformity, soft-tissue imbalance, and functional impairment. Reconstruction may be challenging because bone healing, regenerate maturation, and mechanical stability can be less predictable in selected patients. Case Presentation: A man with congenital fibular deficiency developed chronic distal tibial nonunion after corrective osteotomy at another institution. The nonunion persisted for four years, and the patient presented to our hospital with inability to bear weight and wheelchair dependence. A comprehensive salvage strategy was performed, including Achilles tendon lengthening using the Vulpius technique, removal of retained fixation material, debridement and refreshment of the nonunion site, negative bacteriological cultures, autologous cancellous iliac bone grafting, acute shortening and compression of the docking site, circular external fixation, proximal tibial osteotomy, and gradual lengthening. Low-intensity pulsed ultrasound was applied postoperatively as an adjunctive biological stimulus. Results: Bone union was achieved, and the external fixator was removed approximately one year after surgery. A total lengthening of 78 mm was achieved. At 12-year follow-up, the AOFAS ankle-hindfoot score was 90, ankle range of motion was 5° dorsiflexion and 40° plantarflexion, and the JOA knee score was 95. The patient walked independently without assistive devices and continued to work. Mild residual varus deformity of the proximal tibia was present, but the patient reported no knee pain, ankle pain, or ankle instability, and radiographs showed no progressive osteoarthritic changes. Conclusions: In selected patients with congenital fibular deficiency and chronic nonunion after previous treatment, durable limb salvage may be achieved using an individualized strategy that addresses both biological and mechanical factors. Full article

Background/Objectives: Focal fibrocartilaginous dysplasia (FFCD) is a rare, benign developmental disorder of the growing skeleton first described 40 years ago. It is characterised by a fibrocartilaginous tether adjacent to the physis, which disrupts symmetrical growth and leads to progressive angular deformity. The aim of this review was to define site-specific clinical patterns and management principles for FFCD to optimise patient outcomes. Methods: We conducted a narrative review of more than four decades of published literature on FFCD. All identified English-language case reports, case series, and review articles were analysed to synthesise evidence on clinical presentation, anatomical location, natural history and treatment strategies. Results: To date, 169 cases have been reported, with approximately two-thirds involving the proximal tibia. Tibial lesions typically present in toddlers as unilateral genu varum and, in most cases, demonstrate spontaneous remodelling and complete resolution. In contrast, femoral and upper-limb lesions rarely resolve spontaneously and often progress, thereby warranting earlier and more invasive management. Radiographic findings are highly characteristic, most commonly showing a cortically based metaphyseal lucency with a sclerotic rim. These features are generally considered sufficient for diagnosis, usually eliminating the need for biopsy. Management has evolved towards a tailored approach, consisting of observation for tibial lesions with potential for spontaneous resolution and timely surgical intervention for femoral or upper-limb lesions at risk of progression or joint compromise. Conclusions: Despite the advances made in recent decades, FFCD remains a distinctive yet heterogeneous condition in paediatric orthopaedics. This narrative review summarises more than four decades of published literature, including case reports, case series, and review articles, with particular attention to site-specific clinical patterns and their implications for optimising management. Full article

Background: Pulmonary Alveolar Proteinosis (PAP) is a rare interstitial lung disease characterized by intra-alveolar accumulation of lipoproteinaceous material. Although its radiologic features are well documented, the disease’s impact on cardiovascular mechanics—specifically right ventricular (RV) adaptation—remains underexplored. This study aims to explore the correlation between radiologic severity of parenchymal involvement, quantified by high-resolution computed tomography (HRCT) scores, and right heart hemodynamics, with a focus on RV-pulmonary artery (RV-PA) coupling and interventricular interaction. Methods: This retrospective observational study analyzed 13 adult patients with confirmed PAP and 70 age- and sex-matched healthy controls. All participants underwent concurrent thoracic HRCT and transthoracic echocardiography. Structural lung damage and “crazy-paving” patterns were quantified using a total lobar HRCT score ranging from 0 to 30. Echocardiographic evaluation assessed right heart hemodynamics, using the tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio (TAPSE/sPAP) as an index of RV-PA coupling and the RV/LV ratio. Given the small sample size, p-values for correlations were adjusted for multiple comparisons using the Bonferroni method, and findings should be regarded as exploratory. Results: Left ventricular parameters were preserved across both groups. However, PAP patients had significantly impaired right heart indices compared with controls, including a larger RV basal diameter (37.2 ± 2.3 vs. 32.6 ± 1.6 mm, p < 0.001), higher sPAP (38.5 ± 3.5 vs. 23.6 ± 2.9 mmHg, p < 0.001), and a higher RV/LV ratio (0.98 ± 0.19 vs. 0.60 ± 0.06, p < 0.001). Furthermore, the RV-PA coupling marker, TAPSE/sPAP, was markedly reduced in the PAP cohort (0.43 ± 0.07 vs. 0.88 ± 0.13 mm/mmHg, p < 0.001). After Bonferroni correction, elevated HRCT scores remained strongly associated with a higher RV/LV ratio (r = 0.89, p < 0.001) and a lower TAPSE/sPAP ratio (r = −0.90, p < 0.001). Subgroup analysis indicated that patients with severe radiological scores had more pronounced RV enlargement and lower RV-PA coupling reserves. Conclusions: In this exploratory analysis, radiographic severity of alveolar lipoproteinaceous accumulation in PAP was strongly associated with isolated right ventricular dysfunction and impaired RV-PA coupling, despite preserved left heart function. These hypothesis-generating findings suggest that echocardiographic assessment of TAPSE/sPAP and RV/LV ratios may be useful for the clinical follow-up of PAP patients; however, causality cannot be inferred from this small, retrospective, single-center cohort, and larger prospective studies are warranted. Full article

Background: Vitamin D deficiency rickets is a metabolic bone disorder caused by impaired calcium and phosphate homeostasis resulting from insufficient vitamin D. In children, severe vitamin D deficiency can disturb the mineralization of growing bones and teeth. Although the skeletal manifestations are well recognized, reports describing generalized developmental enamel defects affecting nearly all permanent teeth remain limited. Methods: A 6-year-9-month-old Japanese boy with a history of vitamin D deficiency rickets diagnosed at 2 years 5 months of age was referred to our department for evaluation of generalized discoloration and morphological abnormalities affecting multiple permanent teeth. Clinical, radiographic, and medical findings were reviewed. Results: Laboratory examination at diagnosis revealed severe vitamin D deficiency with elevated intact parathyroid hormone levels. Possible contributing factors included exclusive breastfeeding, delayed weaning, avoidance of fish and dairy products, and limited outdoor activity. Following oral alfacalcidol supplementation, skeletal and biochemical findings gradually normalized. However, clinical examination revealed generalized enamel hypoplasia affecting the permanent incisors and first molars, characterized by yellow-brown discoloration, rough enamel surfaces, morphological irregularities, and attrition, whereas the primary dentition showed no obvious abnormalities. Panoramic radiography demonstrated generalized crown malformation involving both erupted and unerupted permanent teeth, particularly the permanent incisors, first molars, and canines, while premolars and second molars were relatively unaffected. Based on the developmental timing of the affected teeth and the patient’s medical history, the enamel defects were considered to be associated with systemic mineralization disturbance during early childhood. Restorative treatment, including composite resin restorations and stainless steel crowns, was performed to improve aesthetics and occlusal function. Preventive surgical exposure followed by composite resin restoration was also performed for the permanent canines at the onset of eruption. Conclusions: Severe vitamin D deficiency during critical stages of tooth development may be associated with irreversible developmental enamel defects in the permanent dentition, even after apparent systemic recovery from rickets. Early dental assessment, long-term dental follow-up, and multidisciplinary management should be considered in children with a history of nutritional rickets. Full article