Purpose: Physiological dentin sclerosis is a distinctive phenomenon observed in transverse sections of the tooth root as a tooth ages. Since this effect has only been visualized 2-dimensionally, this pilot proof-of-concept study aimed to propose a novel method to visualize and quantify physiological sclerotic dentin 3-dimensionally using density-based micro-computed tomography (CT)-generated gray values. Materials and Methods: Forty single-rooted premolars of known chronological age from the Malay male population were scanned with a micro-CT scanner. The X-ray source was operated at 160 kV, 100 μA, and a voxel size of 48.8 μm.Three-dimensional volume datasets for each tooth were reconstructed, and volumetric analysis was performed on the root dentin region using the open-source software FIJI (ImageJ) (ver. 1.54k, National Institutes of Health, Bethesda, USA). Results: Micro-CT imaging enabled the selection, isolation, and quantification of high-density areas in the tooth rootthat correspond to physiological sclerotic dentin. The generated gray value profile also reflected the characteristicbutterfly-shaped pattern seen in transverse root sections. A comparison of premolars from different age groups revealedthat individuals aged 31-60 years exhibited a larger butterfly-shaped area, reflecting the increase in high-density sclerotic dentin, compared with younger premolars. Conclusion In this pilot proof-of-concept study, visualization and measurement of physiological sclerotic dentin were shown to be feasible using micro-CT. However, the method is highly dependent on the capability of the micro-CT scanner and the performance of the image-processing software. Further research is needed to improve image quality using advanced micro-CT scanning techniques.

The association of paraneoplastic rheumatic disorder and acute lymphoblastic leukaemia is rarely reported in the adolescent male. The clinical manifestations develop within two years before the diagnosis of associated malignancy. We report a case of an 18-year-old male, who presented with pyrexia of unknown origin, bicytopenia and autoantibodies that was consistent with the diagnosis of systemic lupus erythematosus. The peripheral blood film was eventually consistent with pancytopenia, devoid of any dysplastic changes or abnormal cells. When his cytopenia persisted despite empirical steroid therapy, a trephine biopsy revealed a diagnosis of acute lymphoblastic leukaemia. He was started on chemotherapy with UKALL regime and was well in his recent follow-up early this year where he was on maintenance therapy.