A Case of Multiple Idiopathic Root Resorption

Tooth root resorption is multifactorial, and its etiology and pathogenesis are poorly understood. Tooth root resorption is often incidentally revealed on radiographic examination. Here, we report a case of root resorption in multiple teeth of unknown etiology. Radiographic examination revealed root resorption in the cervical region of the left lateral incisor, canine, first and second premolars, and first and second molars of the mandible. Panoramic radiographs revealed no mandibular lesions that could cause tooth resorption. The patient did not wish to undergo any treatment and is currently under observation. Tooth root resorption with unknown etiology is rare, and further case collection is needed to determine the cause and treatment.

An Overview of the Use of Medicinal Plants in Regenerative Dentistry

Aim: The oral cavity has the particularity to host multiple hard and soft tissues, in this paper, we will discuss the current therapies that lead to cell differentiation by regenerative therapies and the future alternatives proposed by medicinal plants and all the regenerative potential of these different tissues. Material and Methods: A detailed review of the literature through the various search engines: Scopus, PubMed, google scholar, Cochrane, etc., uses the selected keywords to explore the effect of the regenerative potential of several medicinal plants. Results: Through our research, we have proceeded to sort different medicinal plants, according to their repairing and regenerative potential on the different tissues of the oral cavity. Conclusion: Future studies are conceivable to explore the opportunities and potential provided by medicinal plants in the field of regenerative dentistry.

Junctional epidermolysis bullosa in children:an overview

Epidermolysis bullosa consist of a pattern of diseases which is mainly associated with genetic defects in the integrity of structures that cause the adhesion of the epidermis with the dermis,primarily called as the Basement Membrane Zone.If the defect is associated with the lamina lucida of the basement membrane zone,it is called junctional epidermolysis bullosa(JEB).JEB is mainly inherited in an autosomal recessive manner.The characteristic feature of all the JEB subtypes is enamel hypoplasia.This article is aimed at identifying the main features of JEB in children.Fifty articles which were published between 2000 and 2022 were reviewed and the types,investigations and management of JEB are explained based on the existing literature.

哺乳动物骨骼组织中羟磷灰石晶体生长过程的原子力显微镜研究(英文)

本文以哺乳动物牙齿中enamel晶体为例 ,简要地报道了用原子力显微镜现场跟踪用高氯酸处理过的enamel晶体在模拟其生长环境中的生长过程。结果表明 :enamel晶体经高氯酸处理后 ,碳酸根离子可能取代晶体中的磷酸根离子从而增加了生长位点。

Effects of 45S5 bioglass on surface properties of dental enamel subjected to 35% hydrogen peroxide

Tooth bleaching agents may weaken the tooth structure. Therefore, it is important to minimize any risks of tooth hard tissue damage caused by bleaching agents. The aim of this study was to evaluate the effects of applying 45S5 bioglass （BG） before, after, and during 35% hydrogen peroxide （HP） bleaching on whitening efficacy, physicochemical properties and microstructures of bovine enamel. Seventy-two bovine enamel blocks were prepared and randomly divided into six groups： distilled deionized water （DDW）, BG, HP, BG before HP, BG after HP and BG during HP. Colorimetric and microhardness tests were performed before and after the treatment procedure. Representative specimens from each group were selected for morphology investigation after the final tests. A significant color change was observed in group HP, BG before HP, BG after HP and BG during HP. The microhardness loss was in the following order： group HP〉 BG before HP, BG after HP〉 BG during HP〉DDW, BG. The most obvious morphological alteration of was observed on enamel surfaces in group HP, and a slight morphological alteration was also detected in group BG before HP and BG after HP. Our findings suggest that the combination use of BG and HP could not impede the tooth whitening efficacy. Using BG during HP brought better protective effect than pre/post-bleaching use of BG, as it could more effectively reduce the mineral loss as well as retain the surface integrity of enamel. BG may serve as a promising biomimetic adjunct for bleaching therapy to prevent/restore the enamel damage induced by bleaching agents.

Review of research on the mechanical properties of the human tooth

‘Bronze teeth＇ reflect the mechanical properties of natural teeth to a certain extent. Their mechanical properties resemble those of a tough metal, and the gradient of these properties lies in the direction from outside to inside. These attributes confer human teeth with effective mastication ability. Understanding the various mechanical properties of human teeth and dental materials is the basis for the development of restorative materials. In this study, the elastic properties, dynamic mechanical properties （visco-elasticity） and fracture mechanical properties of enamel and dentin were reviewed to provide a more thorough understanding of the mechanical properties of human teeth.

The effect of cold-light-activated bleaching treatment on enamel surfaces in vitro

This in vitrostudy aims to evaluate the crystal and surface microstructure of dental enamel after cold-light bleaching treatment. Twelve sound human premolars were cross-split into four specimens, namely, mesio-buccal （Group LP）, disto-buccal （Group P）, mesio-lingual （Group NP） and disto-lingual （Group L） specimens. These four groups were treated using the standard cold-light bleaching procedure, a bleaching agent, a peroxide-free bleaching agent and cold-light, respectively. Before and after treatment, all specimens were analyzed by high-resolution, micro-area X-ray diffraction and scanning electron microscopy. Using a spectrometer, tooth color of all specimens was measured before and after treatment. The phase of the enamel crystals was identified as hydroxyapatite and carbonated hydroxyapatite. After treatment, specimens in Groups LP and P showed significantly weaker X-ray diffraction peaks, significant reduction in crystal size and crystallinity, significant increase in L~ but decrease in a＊ and b＊, and obvious alterations in the surface morphology. However, specimens in Groups NP and L did not show any significant changes. The cold-light bleaching treatment leads to demineralization in the enamel surface. The acidic peroxide-containing bleaching agent was the major cause of demineralization, whereas cold-light did not exhibit significant increase or decrease effect on this demineralization.

Characteristics of newly-formed cementum following emdogain application

Periodontal regenerative techniques have been proposed; however, the outcomes remain debatable. The present investigation assessed the regenerated cementum following enamel matrix derivative application in dehiscence-type defects. Buccal osseous dehiscences were surgically created on the maxillary cuspid, and the second and fourth premolars in five female beagle dogs. The treatment group （n=15 sites） received the enamel matrix derived application, whereas the control groups （n=15） did not. The dogs were sacrificed 4 months following treatment and the specimens were histologically and histometrically examined. The newly formed cementum was uneven in thickness and mineralization, overlapped the old cementum and exhibited functional orientation, cementocyte lacunae and collagen fibril bundles. Most of the histological specimens showed the presence of a gap between the newly formed cementum and the underlying dentin. Control sites did not exhibit any cementum formation. The present study concluded that newly formed cementum is of cellular type and exhibits multiple characteristics.

Effect of Galla chinensis on the In Vitro Remineralization of Advanced Enamel Lesions

Aim The effect of Galla chinensis on de-/re-mineralization of advanced enamel lesions was investigated by using micro-CT in a prolonged in vitro experiment. Methodology Baseline mineral contents of sound enamels were first analyzed. Then lesions were produced in an acidic buffer solution （2.2 mmol.L-1 Ca（NO3）2, 2.2 mmol-L1 KH2PO4, and pH=4.5） for 21 days, with thrice daily three-minute treatments, divided into four groups： Group A, 4 000 ppm crude aqueous extract of Galla chinensis （GCE）; Group B, 4 000 ppm gallic acid; Group C, 1 000 ppm F aq. （as NaF, positive control）; Group D, deionized water （negative control）. Next, the blocks were immersed in a remineralization solution （1.5 mmol.Lz CaC12, 0.9 mmol.L1 KH2PO4, 0.1 ppm F, and pH=7,0） for 200 days. Mineral loss （ML） in each region of interest （ROI） and integrated mineral loss （IML） of the lesions were calculated （comparing with baseline mineral content of sound enamel） at different time points. Results After 21 days demineralization, fluoride treatment showed a statistically significant demineralization-inhibiting effect among the four groups, and after 200 days of remineralization, mineral content recovery was ordered （lowest to highest） as A=C〈B〈D. Conclusion GCE could slow down the remineralization of enamel in the surface layer and thereby facilitate ion transport into the lesion body. The mechanism of Galla chinensis in enhancing the remineralization of dental caries is different from fluoride.

Resin infiltration of deproteinised natural occlusal subsurface lesions improves initial quality of fissure sealing

The aim of this ex vivo study was to evaluate the infiltration capability and rate of microleakage of a low-viscous resin infiltrant combined with a flowable composite resin(RI/CR) when used with deproteinised and etched occlusal subsurface lesions(International Caries Detection and Assessment System code 2). This combined treatment procedure was compared with the exclusive use of flowable composite resin(CR) for fissure sealing. Twenty premolars and 20 molars revealing non-cavitated occlusal carious lesions were randomly divided into two groups and were meticulously cleaned and deproteinised using Na OCl(2%). After etching with HCl(15%), 10 premolar and 10 molar lesions were infiltrated(Icon/DMG; rhodamine B isothiocyanate(RITC)-labelled) followed by fissure sealing(G-?nial Flo/GC; experimental group, RI/CR). In the control group(CR), the carious fissures were only sealed. Specimens were cut perpendicular to the occlusal surface and through the area of the highest demineralisation(DIAGNOdent pen, Ka Vo). Using confocal laser-scanning microscopy, the specimens were assessed with regard to the percentage of caries infiltration, marginal adaption and internal integrity. Within the CR group, the carious lesions were not infiltrated. Both premolar(57.9% ± 23.1%) and molar lesions(35.3% ± 22.1%) of the RI/CR group were uniformly infiltrated to a substantial extent, albeit with significant differences(P = 0.034). Moreover, microleakage(n = 1) and the occurrence of voids(n = 2) were reduced in the RI/CR group compared with the CR group(5 and 17 specimens,respectively). The RI/CR approach increases the initial quality of fissure sealing and is recommended for the clinical control of occlusal caries.

Meeting report:a hard look at the state of enamel research

The Encouraging Novel Amelogenesis Models and Ex vivo cell Lines （ENAMEL） Development workshop was held on 23 June 2017 at the Bethesda headquarters of the National institute of Dental and Craniofacial Research （NIDCR）. Discussion topics included model organisms, stem cells/cell lines, and tissues/3D cell culture/organoids. Scientists from a number of disciplines, representing institutions from across the United States, gathered to discuss advances in our understanding of enamel, as well as future directions for the field.

Loss of epithelial FAM20A in mice causes amelogenesis imperfecta, tooth eruption delay and gingival overgrowth

FAM20A has been studied to a very limited extent. Mutations in human FAM20A cause amelogenesis imperfecta, gingival fibromatosis and kidney problems. It would be desirable to systemically analyse the expression of FAM20A in dental tissues and to assess the pathological changes when this molecule is specifically nullified in individual tissues. Recently, we generated mice with a Fam2OA-floxed allele containing the beta-galactosidase reporter gene. We analysed FAM20A expression in dental tissues using X-Gal staining, immunohistochemistry and in situ hybridization, which showed that the ameloblasts in the mouse mandibular first molar began to express FAM20A at 1 day after birth, and the reduced enamel epithelium in erupting molars expressed a significant level of FAM2OA. By breeding K14-Cre mice with Fam20An^x/fl^x mice, we created K14-Cre;Fam20Af/flox/flox （conditional knock out, cKO） mice, in which Fam20A was inactivated in the epithelium. We analysed the dental tissues of cKO mice using X-ray radiography： histology and immunohistochemistry. The molar enamel matrix in cKO mice was much thinner than normal and was often separated from the dentinoenamel junction. The Fam2OA-deficient ameloblasts were non-polarized and disorganized and were detached from the enamel matrix. The enamel abnormality in cKO mice was consistent with the diagnosis of amelogenesis imperfecta. The levels of enamelin and matrix metalloproteinase 20 were lower in the ameloblasts and enamel of cKO mice than the normal mice, The cKO mice had remarkable delays in the eruption of molars and hyperplasia of the gingival epithelium. The findings emphasize the essential roles of FAM20A in the development of dental and oral tissues.

Human enamel thickness and ENAM polymorphism

The tooth enamel development gene, enamelin （ENAM）, showed evidence of positive selection during a genome-wide scan of human and primate DNA for signs of adaptive evolution. The current study examined the hypothesis that a single-nucleotide polymorphism （SNP） C14625T （rs7671281） in the ENAM gene identified in the genome-wide scan is associated with a change in enamel phenotype. African Americans were selected as the target population, as they have been reported to have a target SNP frequency of approximately 50%, whereas non-Africans are predicted to have a 96% SNP frequency. Digital radiographs and DNA samples from 244 teeth in 133 subjects were analysed, and enamel thickness was assessed in relation to SNP status, controlling for age, sex, tooth number and crown length. Crown length was found to increase with molar number, and females were found to have thicker enamel. Teeth with larger crowns also had thicker enamel, and older subjects had thinner enamel. Linear regression and generalized estimating equations were used to investigate the relationship between enamel thickness of the mandibular molars and ENAM SNP status; enamel in subjects with the derived allele was significantly thinner （P= 0.040） when the results were controlled for sex, age, tooth number and crown length. The derived allele demonstrated a recessive effect on the phenotype. The data indicate that thinner dental enamel is associated with the derived ENAM genotype. This is the first direct evidence of a dental gene implicated in human adaptive evolution as having a phenotypic effect on an oral structure.

Deformation prediction of porcelain-enameled steels with strain history by press forming and high-temperature behavior of coating layer

Porcelain enamel coatings were widely applied for the protection of steel products because they offered high corrosion protection,resistance to heat and abrasion,high hardness,hygiene and ease of cleaning.The typical process to produce enameled steels is roughly divided into two stages:the first stage consists of a forming process to give the desired shape to a steel substrate,and the second stage consists of a firing process to bond enamel frits on the substrate.This firing process requires a high temperature above 800 °C,which may lead to austenitic transformation and severe thermal deformation of the steel substrate.The aim of this study is to develop a finite element analysis (FE analysis) technique to predict the mechanical and thermal deformations of the enameled steels during forming and any further enameling process,including firing.The FE analysis involves analyzing the strain history of the steel substrate,which comprises the stress and thickness distributions of the substrate and its deformed shape,and the high-temperature behavior of the enamel coating layer.The validity of the FE analysis is verified through the U-bending test and firing test with various numbers and positions of enamel coating layers on the substrate.The results reveal that the FE analysis results agree well with the experimental results with 8% error.

Globoside accelerates the differentiation of dental epithelial cells into ameloblasts

Tooth crown morphogenesis is tightly regulated by the proliferation and differentiation of dental epithelial cells. Globoside （Gb4）, a globo-series glycosphingolipid, is highly expressed during embryogenesis as well as organogenesis, including tooth development. We previously reported that Gb4 is dominantly expressed in the neutral lipid fraction of dental epithelial cells. However, because its functional role in tooth development remains unknown, we investigated the involvement of Gb4 in dental epithelial cell differentiation. The expression of Gb4 was detected in ameloblasts of postnatal mouse molars and incisors. A cell culture analysis using HAT-7 cells, a rat-derived dental epithelial cell line, revealed that Gb4 did not promote dental epithelial cell proliferation. Interestingly, exogenous administration of Gb4 enhanced the gene expression of enamel extracellular matrix proteins such as ameloblastin, amelogenin, and enamelin in dental epithelial cells as well as in developing tooth germs. Gb4 also induced the expression of TrkB, one of the key receptors required for ameloblast induction in dental epithelial cells. In contrast, Gb4 downregulated the expression of p75, a receptor for neurotrophins （including neurotrophin-4） and a marker of undifferentiated dental epithelial cells. In addition, we found that exogenous administration of Gb4 to dental epithelial cells stimulated the extracellular signal-regulated kinase and p38 mitogen-activated protein kinase signalling pathways. Furthermore, Gb4 induced the expression of epiprofin and Runx2, the positive regulators for ameloblastin gene transcription. Thus, our results suggest that Gb4 contributes to promoting the differentiation of dental epithelial cells into ameloblasts.

Dentin matrix protein 1 and phosphate homeostasis are critical for postnatal pulp, dentin and enamel formation

Deletion or mutation of dentin matrix protein 1 （DMP1） leads to hypophosphatemic rickets and defects within the dentin. However, it is largely unknown if this pathological change is a direct role of DMP1 or an indirect role of phosphate （Pi） or both. It has also been previously shown that Klotho-deficient mice, which displayed a high Pi level due to a failure of Pi excretion, causes mild defects in the dentinal structure. This study was to address the distinct roles of DMP1 and Pi homeostasis in cell differentiation, apoptosis and mineralization of dentin and enamel. Our working hypothesis was that a stable Pi homeostasis is critical for postnatal tooth formation, and that DMP1 has an antiapoptotic role in both amelogenesis and dentinogenesis. To test this hypothesis, Dmpl-null （Dmpl-/-）, Klotho-deficient （kl/kl）, Dmpl/Klotho-double-deficient （Dmpl-/-/kl/kl） and wild-type （WT） mice were killed at the age of 6 weeks. Combinations of X-ray, microcomputed tomography （I^CT）, scanning electron microscopy （SEM）, histology, apoptosis and immunohistochemical methods were used for characterization of dentin, enamel and pulp structures in these mutant mice. Our results showed that Dmpl-/- （a low Pi level） or kl/kl（a high Pi level） mice displayed mild dentin defects such as thin dentin and a reduction of dentin tubules. Neither deficient mouse line exhibited any apparent changes in enamel or pulp structure. However, the double-deficient mice （a high Pi level） displayed severe defects in dentin and enamel structures, including loss of dentinal tubules and enamel prisms, as well as unexpected ectopic ossification within the pulp root canal. TUNEL assay showed a sharp increase in apoptotic cells in ameloblasts and odontoblasts. Based on the above findings, we conclude that DMP1 has a protective role for odontoblasts and ameloblasts in a pro-apoptotic environment （a high Pi level）.

Effectiveness of some herbals on initial enamel caries lesion

Objective: To evaluate the effectiveness of herbal medicaments such as ginger, rosemary and honey on remineralization of initial enamel lesion.Methods: Demineralized human enamel specimens were measured for baseline surface microhardness and fluorescence methods. Ten specimens in each of four groups were used in this in vitro recycling study with the following treatments which applied three times a day: 1) sodium fluoride toothpaste(Ipana, Procter & Gamble, Turkey), 2) gingerhoney(Arifoglu Herbals, Anzer Honey, Turkey), 3) ginger-honey-chocolate(Bind Chocolate, Turkey), 4) rosemary oil(Arifoglu Herbals, Turkey). Treatment regimens of demineralization and remineralization cycle were applied for 21 days. The post-treatment data were obtained by measurements of surface microhardness and fluorescence methods.Data were statistically analyzed by ANOVA test with Tukey's honest significant difference test.Results: Enhanced remineralization was observed with several of the treatment systems including ginger + honey and rosemary. Significant differences between treatments were observed by microhardness and Fluore Cam fluorescence assesment, compared to the positive control group(Na F dentifrice). Significantly, greater remineralization was observed with the honey + ginger treatment regimen. No significant differences between groups were observed using the fluorescence assessment method, quantitative lightinduced fluorescence.Conclusions: Herbals(ginger, honey and rosemary) have enhanced remineralization of initial enamel lesion.

Biomimetic Precipitation of Uniaxially Grown Calcium Phosphate Crystals from Full-Length Human Amelogenin Sols

Human dental enamel forms over a period of 2 4 years by substituting the enamel matrix, a protein gel mostly composed of a single protein, amelogenin with fibrous apatite nanocrystals. Self-assembly of a dense amelogenin matrix is presumed to direct the growth of apatite fibers and their organization into bundles that eventually comprise the mature enamel, the hardest tissue in the mammalian body. This work aims to establish the physicochemical and biochemical conditions for the synthesis of fibrous apatite crystals under the control of a recombinant full-length human amelogenin rnatrix in combination with a pro- grammable titration system. The growth of apatite substrates was initiated from supersaturated calcium phosphate solutions in the presence of dispersed amelogenin assemblies. It was shown earlier and confirmed in this study that binding of amelogenin onto apatite surfaces presents the first step that leads to substrate-specific crystal growth. In this work, we report enhanced nucleation and growth under conditions at which amelogenin and apatite carry opposite charges and adsorption of the protein onto the apatite seeds is even more favored. Experiments at pH below the isoelectric point of amelogenin showed increased protein binding to apatite and at low Ca/P molar ratios resulted in a change in crystal morphology from plate-like to fibrous and rod-shaped. Concentrations of calcium and phosphate ions in the supernatant did not show drastic decreases throughout the titration period, indicating controlled precipitation from the protein suspension metastable with respect to calcium phosphate. It is argued that amelobtasts in the developing enamel may vary the density of the protein matrix at the nano scale by varying local pH, and thus control the interaction between the mineral and protein phases. The biomimetic experimental setting applied in this study has thus proven as convenient for gaining insight into the fundamental nature of the process ofamelogenesis.

Region-dependent micro damage of enamel under indentation

The objective of this investigation is to explore the region-dependent damage behavior of enamel, as well as to develop a good understanding of the deformation mech- anisms of enamel with numerical modeling. Nanoinden- tation experiments have been performed to investigate the load-penetration depth responses for outer and inner enamel. Results show that the unloading curve does not follow the loading curve, and degradation of stiffness in the unloading curve is observed. Based on the experimental data, a physi- cal quantity, the chain density in protein, has been introduced to the Drucker-Prager plastic model. Numerical simulations show that the simulated load-penetration depth curves agree with the experiments, and the stiffness degradation behav- iors of outer and inner enamel are captured by the numerical model. The region-dependent damage behavior of enamel could be revealed by the numerical model. The micro dam- age affected area at inner enamel is larger than that at outer enamel, indicating that the inner enamel experiences more micro damage than the outer one. Compared with its outer counterpart, the inner enamel which is rich in organic protein could break more internal protein chains to dissipate energy and to enhance its resistance to fracture accordingly.

The importance of a potential phosphorylation site in enamelin on enamel formation

Enamelin （ENAM） has three putative phosphoserines （pSers） phosphorylated by a Golgi-associated secretory pathway kinase （FAM20C） based on their distinctive Ser-x-Glu （S-x-E） motifs. Fam2OC-knockout mice show severe enamel defects similar to those in the Enam-knockout mice, implying an important role of the pSers in ENAM. To determine the role of pSer5s in ENAM, we characterized ENAMRgsc514 mice, in which Sers5 cannot be phosphorylated by FAM20C due to an E57〉Gs7 mutation in the S-x-E motif, The enamel microstructure of 4-week-old mice was examined by scanning electron microscopy. The teeth of 6-day-old mice were characterized by histology and immunohistochemistry. The protein lysates of the first lower molars of 4-day-old mice were analyzed by Western immunoblotting using antibodies against ENAM, ameloblastin and amelogenin. ENAMRgsc514 heterozygotes showed a disorganized enamel microstructure, while the homozygotes had no enamel on the dentin surface. The N-terminal fragments of ENAM in the heterozygotes were detained in the ameloblasts and localized in the mineralization front of enamel matrix, while those in the WT mice were secreted out of ameloblasts and distributed evenly in the outer 1/2 of enamel matrix. Surprisingly, the 15 kDa C-terminal fragments of ameloblastin were not detected in the molar lysates of the homozygotes. These results suggest that the phosphorylation of SerSS may be an essential posttranslational modification of ENAM and is required for the interaction with other enamel matrix molecules such as ameloblastin in mediating the structural organization of enamel matrix and protein-mineral interactions during enamel formation.