Dental anomalies associated with amelogenesis imperfecta: a radiographic assessment

Metabolic Bone Diseases Affecting Tooth Eruption: A Narrative Review

Tooth eruption is an essential process for the development of the oral and maxillofacial system. Several inherited and acquired diseases might affect this tightly regulated process, resulting in premature, delayed, or even failed tooth eruption. The purpose of this article is to review the literature and the clinical parameters of metabolic bone diseases that affect tooth eruption. It examines the physiological aspects of tooth eruption and the pathophysiological changes induced by metabolic bone diseases, including changes in bone metabolism, density, and structure. The search strategy for this review included an electronic search in PubMed, Google Scholar, Medline, Scopus, and the Cochrane Library using the following keywords: "metabolic bone diseases", "tooth eruption", "delayed tooth eruption", and each reported disease in combination with "tooth eruption disorders", covering publications up to March 2024 and limited to English-language sources. Understanding the influence of metabolic bone diseases on tooth eruption is crucial for managing both dental and skeletal manifestations associated with these disorders. This review suggests that a multidisciplinary approach to treatment may significantly improve oral outcomes for patients suffering from such conditions. Clinicians should be aware of the specific dental abnormalities that may arise and consider comprehensive evaluations and individualized treatment plans. These findings underscore the need for further research into targeted therapies that address these abnormalities.

Dental treatment approaches of amelogenesis imperfecta in children and young adults: A systematic review of the literature

OBJECTIVE

The aim of this review was to compare various types of restorations used in children and young adults affected with amelogenesis imperfecta (AI) to determine the most effective restorative treatment.

METHODS

This systematic review included randomized controlled trials, retrospective and prospective cohorts conducted on children and young adults diagnosed with amelogenesis imperfecta and written in French or English. A systematic search was conducted using four databases, namely Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Science Direct and Scopus, using a selection of MeSH terms: "Amelogenesis Imperfecta," "Therapeutics," "Treatment Outcome," "Adult, young," "Child," "Dental Restoration, Permanent," "Dental Restoration, Temporary," and "Esthetics, Dental."

RESULTS

Out of 138 articles identified in the initial search, four articles met all the inclusion criteria. The results showed that ceramic restorations had better quality scores and longevity compared to other restorations.

CONCLUSION

Ceramic restorations could be considered the restorative treatment modality of choice for AI-affected children and young adults. However, more high-quality clinical trials involving young patients affected with AI are required to evaluate and compare the outcomes of different restorative approaches.

CLINICAL SIGNIFICANCE

Young patients affected with amelogenesis imperfecta usually suffer from low self-esteem, psychological problems and social avoidance, caused by the alteration of teeth such as discoloration, sensitivity, fractures and reduced size. For the dentist, selecting the appropriate restorative treatment for AI in young patients could be a veritable challenge. Therefore, it is important to have an evidence-based modality. For this reason, in this review, the different restorative approaches used in AI-affected young patients were compared to recommend the most effective treatment.

Dental and jawbone abnormalities linked to amelogenesis imperfecta: A retrospective and analytic study comparing panoramic radiographs

BACKGROUND

Amelogenesis Imperfecta (AI) is a disorder of tooth development characterized by abnormal enamel formation. In order to detect other dental and jawbone abnormalities that could be associated with AI, a retrospective and analytic study was conducted comparing panoramic radiographs of AI and non-AI patients.

MATERIAL AND METHODS

Digital panoramic radiographs of 60 AI and 60 non-AI patients were examined. Abnormalities in dental number, size, shape, eruption, and in the shape of the dental arches were checked and blindly recorded by two experimented observers. Descriptive statistics using percentages and chi-square test with .05 level of significance value was used.

RESULTS

Prevalence of supernumerary teeth, dental agenesis, microdontia, taurodontism, radicular dilacerations, dental inclusions, temporary teeth persistence, and pulp calcifications was significantly higher in AI patients compared to control patients. Prevalence of periapical images, cysts, and hypercementosis was lower in AI patients compared to control patients, with no statistically significant difference. A significant prevalence of mandibular hypoplasia was also noted in AI patients.

CONCLUSION

In addition to enamel defect, panoramic radiography was useful in detecting other dental abnormalities and mandibular hypoplasia associated with AI and should therefore be systematically indicated for AI patients' care.

Fluctuating asymmetry in third molar agenesis as an aid to estimate socioeconomic status

Traditionally, dental identification techniques are used to establish identity or assist in reconstructing an individual's biological profile. However, other aspects of identity, namely socioeconomic status (SES), can be estimated through teeth. This work aims to evaluate the influence of SES on third molar agenesis in a Portuguese population. X-rays from 448 subjects (223 belonging to a high and 225 to a low socioeconomic status) were assessed and demographic data (age, sex) and dental history were registered. Frequencies and associations between the variables were analyzed using the chi-square test. For each group, differences between third molar agenesis were studied using the Wilcoxon test. The significance level was 5%. X-rays displaying at least one agenesis were more common in females (in both SES groups). Differences between socioeconomic status were found in female subjects' upper right and lower left third molars, with a higher frequency of agenesis in the lower SES group. Agenesis of lower third molars displayed fluctuant asymmetry in both groups, whereas agenesis of upper third molars was also present in the lower SES group. These results suggest that socioeconomic status can affect third molar agenesis prevalence, and fluctuant asymmetry seems more prevalent in the lower SES, as it affects all third molars.

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations.

METHODS

Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics.

CONCLUSION

This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Case Report: Crown Resorption in a Patient With Junctional Epidermolysis Bullosa and Amelogenesis Imperfecta With LAMB3 Gene Mutations

Background: Epidermolysis bullosa (EB) corresponds to a series of conditions characterized by extreme fragility of the skin and/or mucous membranes. Of the four main types of EB, junctional EB (JEB) is the most associated with alterations in the teeth. The purposes of this study were to determine the clinical, histopathological, and ultrastructural characteristics of teeth with amelogenesis imperfecta (AI) in a patient with JEB, and compare them with control teeth, and correlate the findings with the mutations present in the patient.

Case Report: The study was conducted on a 10-year-old patient with JEB carrier of two recessive mutations in the LAMB3 gene and absence of the laminin-332 protein (LM-332), determined by immunofluorescence on a skin biopsy. The patient presents hypoplastic AI with very thin and yellow-brown colored enamel. Extraction of two permanent molars was performed due to pain and soft tissue covering the crown, resembling pulp polyp or hyperplastic gingiva. Light and scanning electron microscopy (SEM) revealed very thin enamel varying from complete absence to 60 μm, absence of normal prismatic structure, and presence of a cross-banding with a laminated appearance. The histopathological study revealed granulation tissue causing external crown resorption.

Conclusion: Although coronary resorption has been reported in patients with syndromic and non-syndromic AI, this is the first clinicopathological report of coronary resorption in partially erupted teeth in patients with JEB with mutations in the LAMB3 gene and hypoplastic AI. In patients with this condition, the presence of partially erupted teeth with soft tissue covering part of the crown, without a periodontal pocket, and with a radiographic image of partial coronal radiolucency should lead to suspicion of external coronary resorption.

Radiographic Diagnosis of Systemic Diseases Manifested in Jaws

Radiographic changes of the oral and maxillofacial hard tissues can be an indication of an underlying systemic disease. In this article, the range of individual disease entities that have both systemic and dental manifestations are reviewed. Images for many conditions are provided to illustrate the radiographic changes. A summary of the most common jaw affected, radiographic and pathognomonic findings, and management aspects is listed in a table format within this article for quick reference.

A novel hypothesis based on clinical, radiological, and histological data to explain the dentinogenesis imperfecta type II phenotype

Purpose/Aim: The aim of this study was to explore whether dentinogenesis imperfecta (DGI)-related aberrations are detectable in odontogenic tissues. Materials and Methods: Morphological and histological analyses were carried out on 3 teeth (two maxillary 1^st molars, one maxillary central incisor) extracted from a patient with DGI Type II. A maxillary 2^nd molar teeth extracted from a healthy patient was used as control. A micro-computed tomographic (μCT) data-acquisition system was used to scan and reconstruct samples. Pentachrome and picrosirius red histologic stains were used to analyze odontogenic tissues and their collagenous matrices. Results: Our findings corroborate DGI effects on molar and incisor root elongation, and the hypo-mineralized state of DGI dentin. In addition to these findings, we discovered changes to the DGI pulp cavity: Reactionary dentin formation, which we theorize is exacerbated by the early loss of enamel, nearly obliterated an acellular but still-vascularized DGI pulp cavity. We also discovered an accumulation of lamellated cellular cementum at the root apices, which we hypothesize compensates for the severe and rapid attrition of the DGI tooth. Conclusions: Based on imaging and histological data, we propose a novel hypothesis to explain the complex dental phenotypes observed in patients with DGI Type II.

Molar incisor hypomineralisation and dental anomalies: A random or real association?

BACKGROUND

Clinical observations suggest molar incisor hypomineralisation (MIH) may present with other dental conditions.

AIMS

The study aimed to determine the prevalence and variety of dental anomalies in children presenting with MIH.

DESIGN

A convenience sample of children referred to a UK dental hospital was recruited. Orthopantogram radiographs, taken as part of routine care, were assessed for dental anomalies. Two calibrated examiners reviewed the films separately and determined the presence and character of anomalies.

RESULTS

Radiographs were obtained from 101 patients, with an age range of 6-15 years. Co-existing hypodontia was identified in 12%, with lower second premolars being the most commonly missing teeth. Concurrent ectopic first permanent molars were identified in 8%, and infraocclusion of one or more primary molars was identified in 9%. Abnormal morphology was found in 9%, including macrodont and microdont teeth. In total, 29% of patients had an associated dental anomaly. Examiners had perfect agreement using Cohen's kappa coefficient.

CONCLUSION

This high prevalence of dental anomalies, particularly hypodontia, in children with MIH is a novel and clinically important finding. Further research is warranted considering the potential implications for assessment and treatment planning.

Association of enamel-renal syndrome with sialolith: A rare entity

Amelogenesis imperfecta (AI) is a disease primarily affecting amelogenesis, but other various aberrations have been reported in association with this entity. Enamel-renal syndrome (ERS) is a very rare disorder associating AI with nephrocalcinosis. It is known by various synonyms such as AI nephrocalcinosis syndrome, MacGibbon syndrome, Lubinsky syndrome and Lubinsky–MacGibbon syndrome. The purposes of this article are to describe other dental anomalies which are rarely associated with AI making the diagnosis of AI a complex disorder and also to report a rare case of MacGibbon syndrome presented with sialolith of submandibular gland duct which is the first reported case in the literature.

How the Prevalence of Pulp Stone in a Population Predicts the Risk for Kidney Stone

Introduction:

Conflicting researches exist on relationship between pulp stones and systemic disorders. Nephrolithiasis is a common disease with severe pain and discomfort with increasing prevalence worldwide. The purpose of this study is to evaluate the correlation between pulp and kidney stones to help find a method for early detection of kidney stones.

Methods and Materials:

the sample of this case-control study comprised of 154 subjects (77 patients with and 77 patients without kidney stone approved by sonographic examination). Two oral and maxillofacial radiologists evaluated their panoramic images for the presence of pulpal stones.

Results:

A total of 42.9% of subjects showed pulp stones. Most of the teeth with pulp stone in case and control groups were molars (86.30% and 72.97%, respectively). In the group with kidney stones, pulp stones were detected in 38 patients (49.4%), while in the control group, they were detected in 28 subjects (36.4%). Although there was not a significant relationship between the presence/absence of pulp stone and kidney stone (P=0.143), there was statistically significant association between number of teeth with pulp stone in a patient and the presence of kidney stone (P<0.013). The chance of having kidney stone is 5.78 times higher in the subjects having pulp stone in three teeth or more (≥ 3 teeth).

Conclusion:

Although there is not a correlation between the presence of pulp and kidney stone, the chance of having kidney stone is 5.78 times higher in the subjects with ≥ 3 teeth having pulp stone. Thus, the number of teeth with pulp stone can serve as a predictor for possibility of having kidney stone.

The Effect of MMP-13, MMP-12, and AMBN on Gingival Enlargement and Root Deformation In a New Type of Gingival Fibromatosis

This case compared gene-expression between a new type of idiopathic gingival fibromatosis (IGF) and normal gingiva, to clarify the nature of the gingival overgrowth and dental anomaly. A 6-year-old girl with generalized gingival overgrowth and root deformations was diagnosed with IGF. Gene expression profiles were compared between normal gingiva (N=9) and one IGF gingiva using cDNA microarray. Genes related to regulation of cell proliferation and proteolytic degradation were expressed strongly in IGF. MMP-13 and MMP-12 expression were 120 times and 96 times lower in IGF, respectively, whereas AMBN expression was 79 times higher. RT-PCR and immunohistochemical staining supported the microarray results. Reduced proteolytic activity due to low MMP-13 and MMP-12 expression appears to be a potential mechanism for gingival overgrowth. Genetic investigations, such as expression levels of MMP-13, MMP-12, and AMBN, may enable classification of a new syndrome characterized by gingival enlargement with abnormal root development.

Amelogenesis Imperfecta: Case Study

Amelogenesis imperfecta (AI) refers to a group of rare genetic disorders that involve tooth development and that are passed down through families as a dominant trait. This condition is characterized by abnormal enamel formation caused by gene mutations that alter the quality and/or quantity of enamel. This dental problem can impact both primary and permanent dentition, varies among affected individuals, and results in esthetic and functional problems. This condition caused the patient in the current case report to have a lack of confidence when speaking. The treatment for amelogenesis imperfecta depends on the severity of the problem and age of the patient. It is crucial to plan a proper remedy, which requires collaboration among dental specialties to execute comprehensive dental treatment in order to provide a long-term solution with adequate esthetics. The current clinical study presents a patient affected by AI that was diagnosed when the patient was a child. The interdisciplinary treatment continued throughout his childhood and into adult life. The initial treatment consisted of resin composite veneers and stainless-steel crowns to restore the defective tooth structure. The malocclusion of the patient was corrected using a fixed orthodontic appliance that was placed when he had an entire permanent dentition. The treatment plan was eventually intended to include all ceramic crowns and veneers.

Management of Amelogenesis Imperfecta: A 15-Year Case History of Two Siblings

OBJECTIVE

Amelogenesis imperfecta (AI) is a heterogenous genetic disorder that interferes with normal enamel formation in the absence of systemic disorders. The patients' main concerns are caries susceptibility, poor esthetics, and generalized sensitivity. There is a broad clinical spectrum, from discolorations to consequent enamel alterations. This case report describes the 15-year case study and the full-mouth rehabilitation of two siblings affected by a hypocalcified AI. Clinical Considerations: In these two patients, conservative care with stainless steel crowns and direct composite restorations was undertaken to restore function and esthetics and to reduce sensitivities in primary and mixed dentitions. The difficulties in monitoring resulted in severe infectious complications (dental abscess with cutaneous fistula), important dental defects, and loss of spaces with subsequent malocclusion. In the young adult dentition, they were treated by extractions, root canal therapies, and new restorations: stainless steel crowns for permanent molars, direct composite restorations (with strip crowns) for incisors and maxillary canines (to improve the crown morphology as well as to mask the discolorations and the malpositions), and adjusted composite crown molds using a thermoforming procedure for premolars and the mandibular canines. The main difficulties were rapid tooth surface loss, bonding to atypical enamel, developing dentition, long-term follow-up.

CONCLUSION

Restoring function and esthetics in AI-affected patients is a challenge from primary to adult dentition. Early corrections are essential to avoid dental damage and for psychological benefits. This clinical report highlights the adhesive rehabilitation for anterior and premolar areas and the difficulty of patient follow-up.

Amelogenesis Imperfecta with Coronal Resorption: Report of Three Cases

Intracoronal resorption of the permanent dentition in cases of amelogenesis imperfecta (AI) is a rare finding which poses an added complication to the already complex management of this condition. This paper presents three cases of AI associated with delayed eruption of permanent teeth in which asymptomatic intracoronal resorption occurred. CPD/Clinical Relevance: This paper highlights the fact that teeth affected with amelogenesis imperfecta may undergo asymptomatic intracoronal resorption which is only identifiable radiographically.

Amelogenesis Imperfecta: Rehabilitation and Brainstorming on the Treatment Outcome after the First Year

Amelogenesis imperfecta (AI) affects enamel on primary and permanent dentition. This hereditary disorder is characterized by loss of enamel, poor esthetics, and hypersensitivity. Functional and cosmetic rehabilitation is challenging with variety of treatment options. This report presents the treatment of an AI patient using conventional fixed dentures and discusses issues related to posttreatment complications and prosthetic treatment outcome after 1 year of follow-up. A 19-year-old male AI patient with impaired self-esteem presented with hypersensitive, discolored, and mutilated teeth. Clinical examination revealed compromised occlusion and anterior open-bite. After hygiene maintenance full-coverage porcelain-fused-to-metal fixed restorations were indicated and applied. At the end of the treatment acceptable functional and esthetic results could be achieved. However, nearly a year after treatment a gingival inflammation in the esthetic zone complicated the outcome. Insufficient oral hygiene was to be blamed. Tooth sensitivity present from early childhood in these patients may prevent oral hygiene from becoming a habit. The relaxation due to relieve of hypersensitivity after treatment makes oral hygiene learning difficult. Continuous oral hygiene maintenance motivation may be crucial for the success of the treatment of AI patients. Treatment of AI patients should be carefully planned and an acceptable risk-benefit balance should be established.

Crown lengthening procedure in the management of amelogenesis imperfecta

Full mouth rehabilitation includes a promising treatment planning and execution thus fulfilling esthetic, occlusal, and functional parameters maintaining the harmony of the stomatognathic system. Crown lengthening procedures have become an integral component of the esthetic armamentarium and are utilized with increasing frequency to enhance the appearance of restorations placed in the esthetic zone. Crown lengthening plays a role to create healthy relationship of the gingiva and bone levels so as to gain access to more of the tooth which can be restored, if it is badly worn, decayed or fractured, below the gum line. This paper highlights the full mouth crown lengthening procedure performed on a patient with amelogenesis imperfecta.

Clinical findings and long-term managements of patients with amelogenesis imperfecta

The aim of this clinical case series is to present a diagnosis and different treatment methods of patients in different ages with amelogenesis imperfecta (AI) as well as further treatments during a 3-6 years follow-up period. A number of 31 patients (16 female, 15 male with a mean age of 10.77 ± 2.65 years) with AI have been examined for the study group between 2007 and 2010 years. A detailed anamnesis was recorded, followed by a clinical and radiological assessment of oral health. The types of AI classified for each patient according to clinical and radiographic evaluation. The main complaints of patients, presence of dental caries and dental anomalies were noted. Necessary treatments had been planned for the individual cases of AI. A number of 19 patients had hypoplastic (HP) form, and 10 patients showed hypomaturation (HM) form of AI, while one patient showed hypocalcified form of AI and one patient had HM-HP form with taurodontism. Main complaints were chiefly related to dissatisfactory esthetics and dental sensitivity. Caries prevalence index was 93.5%. Mean decayed, missing, filling permanent teeth (DMF) and DMF surface (DMFS) were found as 2.74 ± 1.71 and 6.23 ± 3.99; df (decayed, filling primary teeth) and dfs (decayed, filling primary teeth surface) were found as 3.12 ± 2.85 and 5.24 ± 4.97, respectively. All patients received individual clinical care, including preventive, restorative, and prosthetic treatments. Patients have scheduled for regular follow-up in every 3 months. Composite restorations were used as the most common treatment (25 patients, 80.6%). The treatment plan should be based on patient's age, type of defects and individual needs of the patients. Necessary treatment plan is essential, not only due to functional and aesthetic reasons, but also for the positive psychological impact on young patients.

Outcome of restorative treatment in young patients with amelogenesis imperfecta. a cross-sectional, retrospective study

OBJECTIVES

The longevity of dental restorations in patients with amelogenesis imperfecta (AI) is limited. The aim of this paper is to compare oral health and longevity of dental restorations in a group of young patients with AI compared to a control group.

METHODS

Patients included were 82 patients with AI, 40 boys and 42 girls, 6 to 25 years old (mean age 14.5±4.3 years) and a control group matched in age, gender and residential area. All patients received an examination recording dental caries, gingivitis, previous therapy, replaced restorations, tooth sensitivity, and number of dental visits. Patient dental records, extending from 6 to 10 years before the study, provided data on previous care.

RESULTS

Annual mean number of dental visits in the AI group was 2.9±1.7 compared to 1.9±1.2 in the control group (p<0.001). DMFS was 8.1±15.6 in the AI group compared to 1.0±2.0 in the control group (p<0.001). The longevity of dental restorations was significantly lower in the patients with AI, with 24.7±35.1% of the AI group requiring replacement of fillings during the observation period compared to 9.23±23.7% in the control group (p=0.001). Patients with hypomineralized/hypomaturized AI have restorations of shorter longevity than those with hypoplastic AI (p<0.01). Porcelain crowns had significantly longer survival than composite resin materials in the AI group (p<0.001). Clinical Significance This study shows the need for long-lasting restorative solutions for patients with AI. It also shows the importance of establishing an early permanent therapy plan for these patients to avoid frequent dental visits.

A Rare Co-occurrence of Amelogenesis Imperfecta (AI) and Various Non-Enamel Manifestations In Siblings-Report of Two Cases

Amelogenesis Imperfecta (AI) is a hereditary enamel defect which is characterized by developmental abnormalities in the quantity and/ or quality of enamel. This condition has been associated with dental anomalies, including taurodontism, congenitally missing teeth, delayed eruption, crown resorption, pulpal calcifications and odontogenic fibromas. This paper presents two cases of AI which were associated with multiple impacted permanent teeth in both the cases; and pulpal calcifications and pericoronal odontogenic fibromas of W.H.O type additionally, in one of the cases.

FAM20A mutations can cause enamel-renal syndrome (ERS)

Enamel-renal syndrome (ERS) is an autosomal recessive disorder characterized by severe enamel hypoplasia, failed tooth eruption, intrapulpal calcifications, enlarged gingiva, and nephrocalcinosis. Recently, mutations in FAM20A were reported to cause amelogenesis imperfecta and gingival fibromatosis syndrome (AIGFS), which closely resembles ERS except for the renal calcifications. We characterized three families with AIGFS and identified, in each case, recessive FAM20A mutations: family 1 (c.992G>A; g.63853G>A; p.Gly331Asp), family 2 (c.720-2A>G; g.62232A>G; p.Gln241_Arg271del), and family 3 (c.406C>T; g.50213C>T; p.Arg136* and c.1432C>T; g.68284C>T; p.Arg478*). Significantly, a kidney ultrasound of the family 2 proband revealed nephrocalcinosis, revising the diagnosis from AIGFS to ERS. By characterizing teeth extracted from the family 3 proband, we demonstrated that FAM20A(-/-) molars lacked true enamel, showed extensive crown and root resorption, hypercementosis, and partial replacement of resorbed mineral with bone or coalesced mineral spheres. Supported by the observation of severe ectopic calcifications in the kidneys of Fam20a null mice, we conclude that FAM20A, which has a kinase homology domain and localizes to the Golgi, is a putative Golgi kinase that plays a significant role in the regulation of biomineralization processes, and that mutations in FAM20A cause both AIGFS and ERS.

Treatment considerations for patient with Amelogenesis Imperfecta: a review

Amelogenesis imperfecta (AI) is a group of inherited disorders primary affecting the structural of enamel. Patients with AI experience poor esthetic, excessive tooth sensitivity and compromised chewing function that dental treatments are frequently required at early age. This review describes the non-enamel implications, stage-specific management strategies and outcomes of selected restorative materials based on literature evidence.

Amelogenesis imperfecta and generalized gingival overgrowth resembling hereditary gingival fibromatosis in siblings: a case report

Amelogenesis imperfecta (AI) is a group of hereditary disorders primarily characterized by developmental abnormalities in the quantity and/or quality of enamel. There are some reports suggesting an association between AI and generalized gingival enlargement. This paper describes the clinical findings and oral management of two siblings presenting both AI and hereditary gingival fibromatosis (HGF) like generalized gingival enlargements. The treatment of gingival enlargements by periodontal flap surgery was successful in the management of the physiologic gingival form for both patients in the 3-year follow-up period. Prosthetic treatment was also satisfactory for the older patient both aesthetically and functionally.

Multiple unerupted teeth with amelogenesis imperfecta in siblings

Amelogenesis imperfecta encompasses a group of inherited abnormalities that are generally considered to primarily affect the formation and/or calcification of enamel. This case report describes the unusual presentation of amelogenesis imperfecta in siblings as multiple unerupted teeth, multiple pulpal calcifications, and multiple dilacerations of roots along with the defect in the enamel. The intent of our report is to highlight a rare co-occurrence of amelogenesis imperfecta with multiple morphologic alterations in siblings.

An interdisciplinary approach for rehabilitating a patient with amelogenesis imperfecta: a case report

Amelogenesis imperfecta (AI) has been defined as a group of hereditary enamel defects. It can be characterized by enamel hypoplasia, hypomaturation, or hypocalcification of the teeth. AI may be associated with some other dental and skeletal developmental defects. Restoration for patients with this condition should be oriented toward the functional and esthetic rehabilitation. This clinical report describes the oral rehabilitation of a young patient diagnosed with the hypoplastic type of AI in posterior teeth and hypomatured type of AI in anterior teeth.

Prevalence and distribution of selected developmental dental anomalies in an Indian population

The purpose of this study was to determine the prevalence of developmental dental anomalies in an Indian population and to statistically analyze the distribution of these anomalies. The study was based on clinical examination, evaluation of dental casts, and panoramic radiographs of 1123 Indian subjects (572 males, 551 females), who visited the outpatient clinic at Government Dental College, Indore between November 2009 and September 2010, after obtaining their informed consent. These patients were examined for the following developmental dental anomalies: shape anomalies (microdontia, talon cusp, dens evaginatus, fusion, taurodontism), number anomalies (hypodontia, oligodontia, anodontia), structural anomalies (amelogenesis imperfecta, dentinogenesis imperfecta) and positional anomalies (ectopic eruption, rotation, impaction). The percentages of these anomalies were assessed for the whole group and compared using statistical analysis. Among the 1123 subjects, a total of 385 individuals (34.28%) presented with the selected developmental dental anomalies. The distribution by sex was 197 males (34.44%), and 188 females (34.06%). Out of the total 1123 individuals, 351 (31.26%) exhibited at least one anomaly, 28 (2.49 %) showed two anomalies and 6 (0.53%) displayed more than two anomalies. P values indicated that the dental anomalies were statistically independent of sex. On intergroup comparison, positional anomalies were significantly most prevalent (P < 0.05) in the Indian population. The most common developmental dental anomaly was rotation (10.24%), followed by ectopic eruption (7.93%). The next common group was number anomalies. The most common number anomaly was hypodontia (4.19%), which had a higher frequency than hyperdontia (2.40%). Analyzing the next prevalent group of shape anomalies, microdontia (2.58%) was found to be the most common, followed by taurodontism (2.49%), dens evaginatus (2.40%) and talon cusp (0.97%). Dentinogenesis imperfecta (0.09%) was the rarest, followed by amelogenesis imperfecta (0.27%) and fusion (0.27%).

Amelogenesis Imperfecta with Anterior Open Bite: A Rare Case Report

This clinical report describes the treatment plan for a young patient affected by amelogenesis imperfecta with anterior open bite. The objectives of the treatment were to eliminate tooth sensitivity while enhancing esthetics and restoring masticatory function. Treatment included resin composite laminate veneers on maxillary anterior teeth and stainless steel crowns for posterior teeth.

Imaging evalution of the gingival fibromatosis and dental abnormalities syndrome

OBJECTIVE

The purpose of this study was to evaluate the dentomaxillofacial imaging features of one family affected by the gingival fibromatosis (GF) and dental abnormalities (DA) syndrome.

METHODS

Conventional radiographs (periapical and panoramic) and cone beam CT (CBCT) were performed in nine members of this family: four were affected by the syndrome and five were not.

RESULTS

The four affected members demonstrated mild generalized GF in association with DA, including hypoplastic amelogenesis imperfecta, intrapulpal calcifications, delay on tooth eruption and pericoronal radiolucencies in unerupted teeth. None of these oral changes were identified in the five unaffected members. All nine members presented alterations in the paranasal sinuses and mucosal thickening of the maxillary sinus was the most common finding.

CONCLUSION

Family members not affected by the syndrome showed similar alterations in the paranasal sinuses and CBCT was useful to characterize the dentomaxillofacial features of this new syndrome associating GF and DA.

Case series: clinical findings and oral rehabilitation of patients with amelogenesis imperfecta

BACKGROUND

Children with amelogenesis imperfecta (AI) experience many oral difficulties including sensitivity and aesthetics. The methods of treating AI children are limited and therefore a program of care was evaluated in order to assess the clinical efficacy of providing preventive and restorative treatments.

CASE REPORTS

A non-randomised convenience sample of 12 patients with AI was evaluated. A comprehensive patient history was recorded, followed by a clinical and radiographic assessment of oral health. In 8/12 patients a hypoplastic form of AI was diagnosed, in 2/12 cases hypomaturation and in 2/12 cases hypocalcified form were noted. Chief complaints were mainly related to unsatisfactory aesthetics and dental sensitivity. In 8 patients there was active dental caries. Most of the patients had gingivitis and showed fair oral hygiene. The presence of non-enamel dental anomalies was recorded in 9 patients.

TREATMENT

All patients received meticulous preventive care. Initial treatment depended on AI type and oral health of the patient. During the transition period, both conventional and resin modified glassionomer cements, as well as composite resin materials, were used to restore posterior teeth. Direct composite resin restorations were used to improve the appearance of anterior teeth. In 4 patients a long-lasting interdisciplinary approach including orthodontics, metal-ceramic crowns and fixed partial dentures, and direct composite restorations was required.

FOLLOW-UP

Follow-up periods varied between 2-11 years. All children have been regularly recalled at 3 monthly intervals. Caries prevalence has remained low during the follow-up postoperative period and patients have reported satisfaction with the treatment they have received.

CONCLUSION

AI is associated with multiple non-enamel anomalies and requires a complex treatment. Treatment planning is related to the age of the patient, the type and severity of the disorder, and the oral health of the patient. Early diagnosis, preventive care and timely treatment are of foremost importance to improve oral health in children with AI.

Case report: Unclassified syndrome involving dental enamel, dentine and lack of tooth eruption

BACKGROUND

Regional odontodysplasia, also described as ghost teeth, has been described on a number of occasions, in some cases generalized odontodysplasia affecting both the primary and the permanent dentition. However, generalised odontodysplasia is a very rare finding, involving large pulps and short roots of the whole dentition and in the cases previously reported the teeth finally erupt. In the case reported on herein this has not happened.

CASE REPORT

A female patient, now aged 22-years-old, cared for in the TAKO-centre (Oslo) since she was 5 years old, presented with a continuing problem of absence of permanent teeth due to total lack of eruption. All her permanent teeth were either retained intra-alveolar or had been extracted following previous periods of pain and infections. There was no enamel on any of the permanent teeth and the dentine was softer than normal. In addition, there appeared to be very little potential for eruption. Hence, tooth development was affected in all aspects. Her skeletal height was much shorter than expected taking her tall parents into consideration. After all possible assessments, no specific diagnosis for the condition of this young woman has been determined.

TREATMENT

Before the present series of dental care the patient was wearing full dentures in both jaws. In the autumn of 2007, implants were placed in her maxilla and an implant supported fixed prosthesis in porcelain was installed the following spring. Similarly, implants were placed in her mandible, partly in retained teeth, in the autumn of 2008, and an implant supported fixed prosthesis was inserted during the spring of 2009.

FOLLOW-UP

after prosthetic treatment a dental hygienist has seen the patient regularly. No problems or signs of infections have occurred to date.

CONCLUSION

This case report concerns a rare and apparently un-named syndrome affecting both primary and permanent teeth. This paper has been written with an aim of gathering the views as to the aetiology of her problem, hopefully finally to provide a definitive diagnosis.

Hypocalcified type of amelogenesis imperfecta in a large family: clinical, radiographic, and histological findings, associated dento-facial anomalies, and resulting treatment load

OBJECTIVE

The purpose of this study was to report on the clinical, radiographic, and histological dental findings and the resulting treatment load in a five-generation family with amelogenesis imperfecta (AI).

MATERIAL AND METHODS

Thirteen affected and 15 unaffected individuals were examined clinically and radiographically. In addition, four exfoliated deciduous teeth were examined by scanning electron microscopy and microradiography.

RESULTS

The mode of inheritance of AI was autosomal-dominant. At eruption, most of the tooth enamel was yellow, lacking translucency, and prone to gradual loss in subjects with AI. Post-eruptive breakdown of enamel was extensive in accordance with the histological observations of hypomineralized and porous enamel. Extensive enamel loss and discoloration were observed in older affected individuals. The treatment need had been extensive: 76.2% of the total number of teeth present in affected individuals had been treated with partial or full coverage compared to 1.7% of the teeth in unaffected relatives. Unaffected individuals had more endodontically treated teeth than AI-affected relatives. Adjunctive findings, e.g. tooth agenesis, tooth impaction, pulp stones, enlarged follicular space, and taurodontism, were rare in both groups.

CONCLUSIONS

Affected family members had the hypocalcified type of AI, which is characterized by severe hypomineralization, extensive post-eruptive loss, and discoloration of the enamel. Adjunctive findings were rare. Individuals with the hypocalcified type of AI have an extensive restorative treatment load compared to unaffected relatives.

Prevalence of carotid and pulp calcifications: a correlation using digital panoramic radiographs

OBJECTIVE

To compare the prevalence of pulp calcification with that of carotid calcification using digital panoramic dental radiographs.

STUDY DESIGN

Digital panoramic radiographs of patients at a dental oncology clinic were included if (1) the carotid artery bifurcation region was visible bilaterally and (2) the patient had non-restored or minimally restored molars and/or canines. An endodontist evaluated the images for pulpal calcifications in the selected teeth. An oral and maxillofacial radiologist independently evaluated the same images for calcifications in the carotid bifurcation region. Odds-ratio and Pearson chi(2) were used for data analysis. Presence of pulpal calcification was also evaluated as a screening test for the presence of carotid calcification.

RESULTS

A total of 247 panoramic radiographs were evaluated. 32% (n = 80) had pulpal calcifications and 25% (n = 61) had carotid calcifications with 12% (n = 29) having both carotid and pulp calcifications. A significantly higher prevalence of both pulp and carotid calcification was found in subjects older than age 60 years compared to younger age groups. Accuracy of pulpal calcification in screening for carotid calcification was 66.4%.

CONCLUSIONS

Both pulp and carotid calcifications were more prevalent in older individuals. The presence of pulp calcification was not a strong predictor for the presence of carotid calcification.

Case reports of a new syndrome associating gingival fibromatosis and dental abnormalities in a consanguineous family

BACKGROUND

Gingival fibromatosis (GF) is characterized by fibrotic enlargement of the gingiva that can be inherited as an isolated trait (named hereditary gingival fibromatosis) or as a component of a syndrome. This article reports one kindred affected by a syndrome characterized by GF associated with dental abnormalities (DA) including generalized thin hypoplastic amelogenesis imperfecta (AI).

METHODS

To characterize the pattern of inheritance and the clinical features, 70 family members were examined. Hematoxylin and eosin staining, immunohistochemistry, and scanning electronic microscopy (SEM) were performed to identify the alterations on gingiva, teeth, and dental follicles.

RESULTS

Examination of the family pedigree demonstrated multiple consanguineous first-cousin marriages and an autosomal recessive trait of inheritance. Four members demonstrated mild GF in association with DA, including generalized thin hypoplastic AI, intrapulpal calcifications, delay of tooth eruption, and pericoronal radiolucencies involving unerupted teeth. One of those four patients also had mental retardation (MR). MR as an isolated feature was observed in six members, whereas isolated GF was found in one individual. A combination of gingivectomy and gingivoplasty followed by regular dental procedures were performed in these patients. Histologic examination of the gingival enlargement revealed a dense connective tissue containing myofibroblasts, islands of odontogenic epithelium, and calcified psammomatous deposits, which resembled cementicle-like structures by SEM. Pericoronal lesions also showed calcified psammomatous deposits in association with islands of odontogenic epithelium. Enamel ultrastructure analysis revealed normal surface alternating with irregular and porous areas.

CONCLUSION

To the best of our knowledge, these cases represent a new syndrome within the spectrum of those including GF.

Fixed rehabilitation of an ACP PDI class III patient with amelogenesis imperfecta

This clinical report describes the oral rehabilitation of a 19-year-old woman diagnosed with hypoplastic-type amelogenesis imperfecta (AI). She presented with discolored and mutilated teeth, missing teeth, anterior open bite, and posterior short crowns. She was classified as an American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class III patient. The aim of treatment was to restore esthetics and improve masticatory function. The patient's esthetic and functional expectations were successfully attained with porcelain laminate veneers and all-ceramic and metal-ceramic restorations after extensive crown lengthening. The patient was regularly recalled during the postoperative period. Loss of retention of one all-ceramic crown and minimal recession of the gingiva of one laminate veneer were noted at 4-year recall.

A clinical and histological study of dental defects in a 10-year-old girl with pseudoxanthoma elasticum and amelogenesis imperfecta

BACKGROUND

The prominent dental feature of a 10-year-old girl was severely hypoplastic enamel in permanent teeth.

CASE REPORT

Severe dental defects were detected in a 10-year-old female patient affected by pseudoxanthoma elasticum and amelogenesis imperfecta. An orthopantomographic examination revealed a reduction of enamel thickness on the crown of all erupted and unerupted teeth, agenesis of the maxillary right second premolar, delayed eruption of mandibular first premolars, and the presence of large calcifications in all tooth pulp chambers. A detailed histological analysis of permanent mandibular first molars showed that pulp calcifications presented a concentric laminate organization and merged to almost completely obliterate the pulp chamber. Osteodentine was visible all along the pulpal surface of the radicular dentine. Broad resorption areas were present in the outermost dentine at both coronal and radicular levels. Radicular resorption areas presented a typical rectangular form and were filled with acellular cementum. Cementum thickness was highly increased on the root surface. Apposition of cellular cementum-like tissue was also observed on the coronal dentine surface.

CONCLUSION

Before treating patients affected by amelogenesis imperfecta and/or pseudoxanthoma elasticum, paediatric dentists should be aware of the presence of pulp calcifications that add to the complexity of endodontic procedures.

Amelogenesis imperfecta, rough hypoplastic type, dental follicular hamartomas and gingival hyperplasia: report of a case from Central America and review of the literature

We report on a black male patient from Central America with amelogenesis imperfecta, rough hypoplastic type, dental follicular hamartomas, and gingival hyperplasia. Although previous reports have described this association of amelogenesis imperfecta with hyperplastic follicular hamartomas or central odontogenic fibroma-like lesions in blacks from South Africa, we have noticed non-black patients in the literature with similar findings.

Amelogenesis imperfecta - a systematic literature review of associated dental and oro-facial abnormalities and their impact on patients

OBJECTIVE

Amelogenesis imperfecta (AI) is a disease primarily affecting amelogenesis, but other aberrations have been reported. The purposes of this review were: (1) to identify other anomalies associated with AI, and (2) to describe the impact of the disease and its associated conditions on the oral health-related quality of life of patients, and the economic consequences.

MATERIAL AND METHODS

A literature search was conducted in the following databases: PubMed, EMBASE, Bibliotek.dk, The Cochrane Library, Web of Science, and OMIM, supplemented by a search for selected authors. Based on titles and abstracts, 137 papers were identified.

RESULTS

Most articles were case reports or case series with few cases. Aberrations were reported in the eruption process, in the morphology of the crown, in the pulp-dentine organ, and in the number of teeth. Gingival conditions and oral hygiene were usually reported to be poor, and calculus was a common finding. Open bite was the most commonly reported malocclusion. A negative impact on patients' oral health-related quality of life was described, but information was scarce. No information was found on the economic impact.

CONCLUSIONS

A number of aberrations associated with AI have been reported, but not sufficiently systematic to allow for a secondary analysis and synthesis of the findings. The impact on patients in terms of reduced quality of life and economic burden needs to be studied.

The frequency of occurrence of abnormal frenal attachment of lips and enamel defects in Turner syndrome

OBJECTIVE

The aim of the work was to register the frequency of occurrence of abnormal frenal attachment of lips and enamel defects and find the correlation between these anomalies and three types of Turner syndrome.

MATERIALS AND METHODS

Fifty patients (aged 20-40 years) were clinically and cytogenetically diagnosed and divided into three groups, according to karyotype: 45,X (17 cases), with structural aberrations of chromosome X (12 cases) and with mosaic karyotype (21 cases). The control group consisted of 51 healthy woman aged 21-40 years. Subjects were screened for developmental anomalies in the labial frenula and enamel defects in three groups of Turner syndrome.

RESULTS

Some significant anomalies of soft and hard tissues were found in studied patients: abnormal frenal attachments (42% of cases), enamel opacities (58% of cases) and enamel hypoplasia (38% of cases). Differences in the occurrence of these anomaly in all group with Turner syndrome in comparison with the control group were significantly different. Enamel defects were prevalent in the patients with karyotype 45,X and patients with structural aberrations of chromosome X in comparison with the mosaic karyotype.

CONCLUSION

The results of the present study have shown, that abnormal attachment of lips and enamel defects were more frequent in Turner syndrome patients than in the control group. Enamel defects were correlated with the karyotypes of Turner syndrome and abnormal attachment of lips was not correlated with the karyotypes of Turner syndrome.

The molecular control of and clinical variations in root formation

Roots of teeth perform critical functions to anchor the teeth in the jaws and transmit the masticatory forces in such a way as to minimize fracture and wear of the dentition. Tooth root development involves a variety of cell types, epithelial-mesenchymal interactions, the enumeration of specialized extracellular matrices, processing of these matrices and strict control over the microenvironment to allow the cementum and dentin to mineralize. While many of the specific molecular mechanisms involved in root formation remain poorly understood, our knowledge of these events and pathways has advanced markedly over the past decade. The molecular bases of many hereditary conditions having associated dental root anomalies are now known. Therapeutic approaches based on the molecular biology of root formation have and will continue to emerge and be translated into improved clinical care. The purpose of this study was to review our knowledge regarding developmental defects of root formation, the molecular mechanisms involved, and the impact of root variants on clinical dentistry.

Interdisciplinary approach to treating a patient with amelogenesis imperfecta: a clinical report

Treatment of a patient with amelogenesis imperfecta (AI) presents a real problem from both functional and esthetic points of view. An esthetic result also will result in an improvement in the patient's quality of life. This clinical report illustrates the oral rehabilitation of a 24-year-old man diagnosed with hypomature type of AI. The aim of treatment was to both restore esthetics and improve masticatory function. Esthetic expectations of the patient were successfully attained by placing all-porcelain crowns from canine to canine in each arch, 12 crowns total. Moreover, metal-ceramic three-unit fixed partial dentures for the missing mandibular right first molars were fabricated for the patient's masticatory function. Resin composite restorations were applied to the maxillary premolars, the maxillary right first molar, the mandibular left premolars, and the right first premolar to modify the occlusion. No deterioration in the restorations and no pathology associated with the rehabilitation were found at the 1-year recall, and the patient's esthetic and functional expectations were satisfied. CLINICAL SIGNIFICANCE This article provides an overview of an interdisciplinary approach to treating the difficult condition of AI using a combination of treatments to achieve optimal esthetics and function.

Prevalence and distribution of dental anomalies in orthodontic patients

INTRODUCTION

The purpose of this study was to determine the prevalence of developmental dental anomalies in the Turkish population.

METHODS

The study was based on the dental casts, intraoral photographs, and panoramic radiographs of 3043 Turkish children (1658 girls, 1385 boys) who had orthodontic treatment at the Department of Orthodontics at the University of Ankara between 1978 and 2003. These patients were examined for 8 developmental dental anomalies: fusion, gemination, microdontia, macrodontia, oligodontia, hypodontia, hyperdontia, and amelogenesis imperfecta. The percentages of these anomalies were assessed in the whole group, and the sexes were compared.

RESULTS

It was found that 5.46% of the total group had at least 1 developmental dental anomaly. The distribution by sex was 70 boys (5.05%) and 96 girls (5.79%).

CONCLUSIONS

Hypodontia is the most common developmental dental anomaly in the Turkish population, followed by microdontia.