The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.
Abscess ; Bicuspid ; Dental Pulp Calcification ; Dental Pulp Cavity ; Dental Pulp Necrosis ; Female ; Gutta-Percha ; Humans ; Incisor ; Tooth ; Tooth Bleaching ; Ultrasonics ; Young Adult

PURPOSE: The aim of this study was to compare cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) for the detection of pulp stones. MATERIALS AND METHODS: DPR and CBCT images of 202 patients were randomly selected from the database of our department. All teeth were evaluated in sagittal, axial, and coronal sections in CBCT images. The systemic condition of patients, the presence of pulp stones, the location of the tooth, the group of teeth, and the presence and depth of caries and restorations were recorded. The presence of pulp stones in molar teeth was compared between DPR and CBCT images. RESULTS: Pulp stones were identified in 105 (52.0%) of the 202 subjects and in 434 (7.7%) of the 5,656 teeth examined. The prevalence of pulp stones was similar between the sexes and across various tooth locations and groups of teeth (P>.05). A positive correlation was observed between age and the number of pulp stones (ρ=0.277, P < .01). Pulp stones were found significantly more often in restored or carious teeth (P < .001). CBCT and DPR showed a significant difference in the detection of pulp stones (P < .001), which were seen more often on DPR than on CBCT. CONCLUSION: DPR, as a 2D imaging system, has inherent limitations leading to the misinterpretation of pulp stones. Restored and carious teeth should be carefully examined for the presence of pulp stones. CBCT imaging is recommended for a definitive assessment in cases where there is a suspicion of a pulp stone on DPR.
Cone-Beam Computed Tomography ; Dental Pulp Calcification ; Humans ; Molar ; Prevalence ; Radiography ; Radiography, Panoramic ; Tooth

PURPOSE: This study was performed to investigate the relationship between sleep bruxism (SB) and pulpal calcifications in young women. MATERIALS AND METHODS: A total of 100 female participants between 20 and 31 years of age who were referred to our radiology clinic for a dental check-up, including 59 SB and 41 non-SB patients, were sampled for the analysis. SB was diagnosed based on the American Academy of Sleep Medicine criteria. All teeth were evaluated on digital panoramic radiographs to detect pulpal calcifications, except third molars, teeth with root canal treatment, and teeth with root resorption. Binary logistic regression analysis was used to determine the risk factors for pulpal calcifications. The Spearman correlation coefficient was applied and the Pearson chi-square test was used for categorical variables. To test intra-examiner reproducibility, Cohen kappa analysis was applied. P values < .05 were considered to indicate statistical significance. RESULTS: A total of 2800 teeth were evaluated (1652 teeth from SB patients and 1148 from non-SB patients), and 61% of patients had at least 1 dental pulpal calcification. No statistically significant relationship was found between SB and pulpal calcifications (P>0.05). In SB patients, the total number of pulpal calcifications was 129, while in non-SB patients, it was 84. Binary logistic analysis showed that SB was not a risk factor for the presence of pulpal calcifications (odds ratio, 1.19; 95% CI, 0.52–2.69, P>.05). CONCLUSION: No relationship was found between SB and pulpal calcifications.
Dental Pulp ; Dental Pulp Calcification ; Dental Pulp Cavity ; Female ; Humans ; Logistic Models ; Molar, Third ; Radiography, Panoramic ; Risk Factors ; Root Resorption ; Sleep Bruxism ; Sleep Medicine Specialty ; Tooth

OBJECTIVETo investigate the expression patterns of osterix in the early stage of cranio-maxillofacial developmental in zebrafish and to prepare for a further research of osterix gene in bone and tooth development.

METHODSThe osterix templates were amplified by PCR to generate DIG labeled antisense and sense probes. Whole mount in situ hybridization was used to analyze the expression patterns of osterix in the early stage cranio-maxillofacial development of zebrafish. The expression patterns of osterix gene in mineralization progresses of cranial and maxillofacial bones were compared. The osterix gene expression in tooth development and mineralization was highlighted by alizarin red staining.

RESULTSSpecific DIG labeled probes of osterixwere synthesized successfully. The whole mount in situ hybridization showed that the osterix expression was in the intramembranous ossification at 3 days post fertilization(dpf) and 4 dpf. The specific osterix expression in tooth at 5 dpf and 6 dpf were also observed. The sense probe served as a negative control. Osterix expressed in the unmineralized early bone matrix, the tooth matrix of the primary tooth(3V(1), 5V(1)) and the first replacement tooth(4V(2)).

CONCLUSIONSOur findings showed that osterix might play roles in the process of the early mineralized bone matrix changing into the late mature mineralized bone matrix and the process of development and mineralization of tooth crown matrix.

Animals ; Calcification, Physiologic ; genetics ; Gene Expression ; Gene Expression Regulation, Developmental ; In Situ Hybridization ; Maxillofacial Development ; genetics ; Osteogenesis ; genetics ; Sp7 Transcription Factor ; Tooth ; metabolism ; Transcription Factors ; genetics ; metabolism ; Zebrafish ; Zebrafish Proteins ; genetics ; metabolism

PURPOSE: In this study, we aimed to develop dental charts for Turkish children and young adults of both genders within the age group of 4.5-22.5 years according to tooth mineralization and eruption in a format similar to that proposed by AlQahtani et al. MATERIALS AND METHODS: In total, 753 digital panoramic radiographs from 350 males and 403 females were assessed. The permanent teeth were evaluated according to the classification system described by Demirjian et al. The eruption stage was assessed with Bengston's system, which was modified by AlQahtani et al at four points. RESULTS: Teeth generally developed earlier in females than in males. This was particularly notable in the age group of 5-14 years. However, this difference was usually visible in only one stage, not in all teeth. It has been determined that the mixed dentition period ended with the shedding of the second deciduous molars in both genders. CONCLUSION: The dental charts presented here included information that could be beneficial to dental clinicians in making appropriate diagnosis and planning orthodontic and surgical procedures. These charts also provided datasets for preliminary dental age estimation in Turkish children and young adults.
Age Determination by Teeth ; Child* ; Classification ; Dataset ; Dentition, Mixed ; Diagnosis ; Female ; Humans ; Male ; Molar ; Radiography, Panoramic ; Tooth Calcification ; Tooth Eruption ; Tooth* ; Young Adult*

We present the binding ability of a new peptide (CMPQVMPMC-) with dental enamel after being evaluated in the present study. Under a standard procedure, the recovery of M13 filamentous phage was greatly enhanced by displaying the peptide in phage coat protein p III. Then the cyclic peptide was synthesized using a solid method. The effect of the cyclic peptide in vitro biomineralization was tested in a single-diffusion microtiter plate gel system. Absorbance at 405 nm of each sample was recorded for 24 h at every 6 h intervals. The relatively increased values of each sample were expressed as percentages relative to the blank group (100%). The cyclic peptide resulted in a concentration-dependent delayed nucleation. In addition, the overall values of peptide groups at the end of 24 h were lower than those in the control group but much higher than those in the BSA control group.
Dental Enamel ; chemistry ; Peptides ; chemical synthesis ; chemistry ; Protein Binding ; Tooth Calcification

PURPOSE: This study investigated the possible correlation between the mineralization of the second molars and the chronological age of a sample population of the state of Paraiba, Brazil. MATERIALS AND METHODS: One thousand eight hundred fifty-four digitized panoramic images using a scanner of a private dental radiology service were obtained in six months. Of these, 457 were selected from patients aged 4.6 to 16 years who met certain criteria. The images were assessed twice by a radiologist with 5 years experience. A minimum interval of 30 days between the evaluations of the same patient was established. To analyze the relationship between chronological age, calcification level proposed by Demirjian et al in 1973, gender, and tooth, a multiple linear regression model was adjusted, taking age as the response variable (p<0.05). RESULTS: The gender and calcification level were significantly correlated with the age of the patients (p<0.05). There was a significant difference between the average age of the patients' upper teeth compared to the lower ones in both genders (p<0.05). The dental development occurred earlier in female individuals than in male ones, and there was no significant difference between the right and left second permanent molars. CONCLUSION: It was observed that ethnic variables are related to certain parameters of age and sex identification in the Brazilian population, providing important information for forensic evaluations.
Age Determination by Teeth ; Aged ; Female ; Humans ; Linear Models ; Male ; Molar ; Radiography, Panoramic ; Tooth ; Tooth Calcification

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, Dmp1-null (Dmp1(-/-)), Klotho-deficient (kl/kl), Dmp1/Klotho-double-deficient (Dmp1(-/-)/kl/kl) and wild-type (WT) mice were killed at the age of 6 weeks. Combinations of X-ray, microcomputed tomography (μCT), 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 Dmp1(-/-) (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).
Ameloblasts ; pathology ; Amelogenesis ; physiology ; Animals ; Apoptosis ; physiology ; Cell Differentiation ; physiology ; Dental Enamel ; pathology ; Dental Pulp ; pathology ; physiology ; Dental Pulp Cavity ; pathology ; Dentin ; abnormalities ; pathology ; Dentinogenesis ; physiology ; Extracellular Matrix Proteins ; genetics ; physiology ; Glucuronidase ; genetics ; Homeostasis ; physiology ; Hyperphosphatemia ; physiopathology ; Immunohistochemistry ; Mice ; Mice, Knockout ; Microscopy, Electron, Scanning ; Odontoblasts ; pathology ; Odontogenesis ; physiology ; Ossification, Heterotopic ; genetics ; pathology ; Phosphates ; physiology ; Tooth Calcification ; physiology ; X-Ray Microtomography

Enamel crystals are unique in shape, orientation and organization. They are hundreds of thousands times longer than they are wide, run parallel to each other, are oriented with respect to the ameloblast membrane at the mineralization front and are organized into rod or interrod enamel. The classical theory of amelogenesis postulates that extracellular matrix proteins shape crystallites by specifically inhibiting ion deposition on the crystal sides, orient them by binding multiple crystallites and establish higher levels of crystal organization. Elements of the classical theory are supported in principle by in vitro studies; however, the classical theory does not explain how enamel forms in vivo. In this review, we describe how amelogenesis is highly integrated with ameloblast cell activities and how the shape, orientation and organization of enamel mineral ribbons are established by a mineralization front apparatus along the secretory surface of the ameloblast cell membrane.
Ameloblasts ; chemistry ; cytology ; Amelogenesis ; physiology ; Basement Membrane ; chemistry ; Crystallization ; Dental Enamel ; chemistry ; Dental Enamel Proteins ; secretion ; Humans ; Tooth Calcification

Cementum is the outer-, mineralized-tissue covering the tooth root and an essential part of the system of periodontal tissue that anchors the tooth to the bone. Periodontal disease results from the destructive behavior of the host elicited by an infectious biofilm adhering to the tooth root and left untreated, may lead to tooth loss. We describe a novel protocol for identifying peptide sequences from native proteins with the potential to repair damaged dental tissues by controlling hydroxyapatite biomineralization. Using amelogenin as a case study and a bioinformatics scoring matrix, we identified regions within amelogenin that are shared with a set of hydroxyapatite-binding peptides (HABPs) previously selected by phage display. One 22-amino acid long peptide regions referred to as amelogenin-derived peptide 5 (ADP5) was shown to facilitate cell-free formation of a cementum-like hydroxyapatite mineral layer on demineralized human root dentin that, in turn, supported attachment of periodontal ligament cells in vitro. Our findings have several implications in peptide-assisted mineral formation that mimic biomineralization. By further elaborating the mechanism for protein control over the biomineral formed, we afford new insights into the evolution of protein-mineral interactions. By exploiting small peptide domains of native proteins, our understanding of structure-function relationships of biomineralizing proteins can be extended and these peptides can be utilized to engineer mineral formation. Finally, the cementomimetic layer formed by ADP5 has the potential clinical application to repair diseased root surfaces so as to promote the regeneration of periodontal tissues and thereby reduce the morbidity associated with tooth loss.
Amelogenin ; chemistry ; physiology ; Biomimetic Materials ; chemistry ; Calcium-Binding Proteins ; Carrier Proteins ; physiology ; Cementogenesis ; physiology ; Dental Cementum ; chemistry ; Humans ; Peptide Fragments ; Peptide Mapping ; methods ; Peptides ; physiology ; Protein Engineering ; methods ; Sequence Homology, Amino Acid ; Tissue Engineering ; methods ; Tooth Calcification ; physiology