Investigating the etiology of multiple tooth agenesis in three sisters with severe oligodontia

Research algorithm for the detection of genetic patterns and phenotypic variety of non-syndromic dental agenesis

Introduction: Dental agenesis (DA), brings together the anodontia, oligodontia, hypodontia, characterized by a deficit in the development of a variable number of teeth. The objectives of the study were to illustrate the phenotypic variability of non-syndromic DA, to identify cases of DA with hereditary genetic transmission, and establish the mode of DA genetic pattern in these cases, together with the determination of DA prevalence in the population group study. Patients, Materials and Methods: The cross-sectional observational study was performed on a mixed population group, consisting of 861 Caucasian patients, between January 2018–December 2019. The clinical evaluation protocol of patients with DA, used to illustrate their phenotype, included the following stages: oral examination, photographic examination, and radiological examination. The evaluation protocol specific to the family genetic study of patients with DA, involved the following three stages: family survey, construction of the family tree and analysis of the pedigree structure. Results: The prevalence of DA in the population group was 2.78%. Regarding the phenotype, DA mainly affected the upper arch (50% of cases); bilateral DA had a significantly increased incidence (83.33% of cases) compared to unilateral form; in most cases (75%), a patient lacked one to two teeth, the lack of two teeth being the most common form (83.33% of cases); the upper lateral incisors were the teeth most frequently involved in DA (31.11% of the total missing teeth). Regarding the family genetic study, hereditary DA with autosomal dominant inheritance was present in 37.50% of cases. In the other cases (62.50%), isolated, sporadic forms of DA were registered, suggesting a spontaneous de novo mutation or a disorder of odontogenesis of a non-genetic nature. Conclusions: We consider that this study is of interest for current scientific research with applicability in dental medicine, by bringing actual information on the prevalence of non-syndromic DA in South-East Romania, the variety of phenotypic spectrum of DA for this geographic area, and the role of heredity in the DA genetic determinism in the studied population.

The prevalence and distribution of hypodontia in a sample of Qatari patients

OBJECTIVE

The aims of this study were to determine the prevalence of hypodontia in the permanent dentition in a sample of Qatari patients attending a dental center and to compare the results with the reported findings of other populations.

MATERIALS AND METHODS

Orthodontic files including orthopantomographs of 1000 patients (655 females and 345 males, 11-36-year-old) were examined and inspected for evidence of hypodontia.

RESULTS

The prevalence of hypodontia in the present Qatari sample was 7.8%; 6.9% was in males and 8.2% in females. Hypodontia was found more frequently in the maxilla than in the mandible. The distribution of missing teeth was noticed in the left side more than the right side. The most frequently missing teeth were the maxillary lateral incisors followed by the mandibular second premolars, maxillary second premolars, and mandibular left lateral incisor. The majority of patients with hypodontia had one or two teeth missing, but rarely more than four teeth were missing in the same patient. Bilateral missing teeth in the current study was commonly seen in the maxillary lateral incisor (14.1%) followed by mandibular second premolar (12.8%) and maxillary second premolar (6.4%).

CONCLUSIONS

The prevalence of hypodontia in a sample of Qatari individuals was within the range reported in the literature for other populations. The incidence of hypodontia in the anterior segment requires multidisciplinary team approach (orthodontic and prosthodontic) to restore the esthetic and function and improve patient self-esteem.

Non-syndromic oligodontia in permanent dentition: a case report

Tooth agenesis is one of the most common congenital anomalies seen in humans. Although absence of one or more teeth is common but absence of multiple teeth is rare. Oligodontia is a rare developmental anomaly, involving agenesis of six or more permanent teeth, excluding the third molars. The reported prevalence of oligodontia in permanent dentition is 0.14%. Oligodontia can present as an isolated condition or as a part of a syndrome. The present case report highlights a unique case of non syndromic oligodontia, with agenesis of four permanent incisors, left permanent canine and right second premolar in the mandibular arch and its management with a novel fixed functional prosthetic appliance. Prosthetic rehabilitation is an urgent need for these kind of patients so that they do not suffer from masticatory and esthetic problems which can eventually lower the self esteem of individuals.

Mutations in the MSX1 gene in Turkish children with non-syndromic tooth agenesis and other dental anomalies

Aim:

To search for mutations on the MSX1 gene and to present a genetic basis for non-syndromic tooth agenesis in conjunction with dental anomalies in a Turkish population.

Materials and Methods:

The patients included in this study were otherwise healthy, with ages ranging from seven to eighteen years. Eighty-two of them had one to six teeth missing (Group I) and 26 had more than six teeth missing (Group II), except for the third molars,. The missing teeth and dental anomalies were examined clinically and radiographically. The MSX1 gene was sequenced from the blood samples of patients who consented to the study.

Results:

Mutations or polymorphisms on the MSX1 gene were identified in six patients. Taurodontism was seen in patients from both groups I and II. The nucleotide changes were identified by mutation screening.

Conclusions:

Performing family studies, screening other candidate genes, and investigation of interactions between genes will provide a basis for better analysis of tooth agenesis models and their association with other dental anomalies.

Axis inhibition protein 2 polymorphisms may be a risk factor for families with isolated oligodontia

The objective of the present study was to search for Msh homeobox 1 (MSX1), paired box gene 9 (PAX9), ectodysplasin‑A (EDA) and axis inhibition protein 2 (AXIN2) variants in a family with isolated oligodontia and analyse the pathogenesis of mutations that result in oligodontia phenotypes. Members of a single family (but of different descent) with oligodontia and unrelated healthy controls were enrolled in our study. Genomic DNA was isolated from blood samples. Mutation analysis was performed by amplifying MSX1, PAX9, EDA and AXIN2 exons as well as their exon‑intron boundaries and sequencing the products. DNA sequencing of the AXIN2 gene revealed three mutations in the two patients with oligodontia: a homozygotic silent mutation c.1365A>G (p.Pro455=) in exon 3, two c.956+16A>G mutations (II‑1: homozygosis; III‑1: heterozygosis) and c.1200+71A>G (homozygosis) in the intron, which possibly contributed to structural and functional changes in proteins. The heterozygotic mutations c.1365A>G and c.1200+71A>G were identified in the proband's mother (II‑2). No mutations were detected in the MSX1, PAX9 and EDA genes of oligodontia patients. The findings suggest that the c.956+16A>G, c.1365A>G and c.1200+71A>G mutations of AXIN2 may be responsible for the oligodontia phenotype in this family, but these findings require further study.

Genetic background of nonsyndromic oligodontia: a systematic review and meta-analysis

OBJECTIVES

The goal of this work was to identify all known gene mutations that have been associated with the development of nonsyndromic oligodontia.

METHODS

A systematic literature search was performed electronically in two databases (PubMed, Medpilot) supplemented by a hand search. Articles published up to March 2012 were considered. Search terms were combined as follows: oligodontia and genes, oligodontia and mutations, tooth agenesis and genes, and tooth agenesis and mutations. A meta-analysis of the data was conducted based on the Tooth Agenesis Code (TAC).

RESULTS

Seven genes are currently known to have a potential for causing nonsyndromic oligodontia. All these genes vary both in terms of number of identified mutations and in terms of number of documented patients: 33 mutations and 93 patients are on record for PAX9, 10 mutations and 51 patients for EDA, 12 mutations and 33 patients for MSX1, 6 mutations and 17 patients for AXIN2, and 1 mutation in 1 patient for EDARADD, NEMO, and KRT17 each. A total TAC score of 250 was found to have cutoff properties, as 100% of MSX1 and 80% of EDA patients exhibited TAC ≤ 250, whereas 96.9% of PAX9 and 90% of AXIN2 patients exhibited TAC >250. Furthermore, 94.3% of EDA patients but only 28.6% of MSX1 patients exhibited odd-numbered TAC scores in at least one quadrant, and 72.7% of PAX9 but none of the AXIN2 patients were found to show TAC scores of 112 in at least one quadrant.

CONCLUSION

In order of decreasing frequency, PAX9, EDA, MSX1, AXIN2, EDARADD, NEMO, and KRT17 are the seven genes currently known to have a potential for causing nonsyndromic oligodontia. TAC scores enabled us to identify an association between oligodontia phenotypes and genotypes in the patients covered by this meta-analysis.

Clinical and genetic evaluation of a Chinese family with isolated oligodontia

OBJECTIVES

Oligodontia is defined as the congenital absence of 6 or more permanent teeth excluding the third molar. Tooth agenesis may be classified as syndromic/non-syndromic and as familial/sporadic. To date, more than 300 genes have been found to be involved in tooth development, but only a few of these genes, such as MSX1, PAX9 and AXIN2, are related to the condition of non-syndromic oligodontia. The objective of the present work was to investigate the disease-causing gene of non-syndromic oligodontia in a Han Chinese family and analyse the pathogenesis of mutations that result in oligodontia.

DESIGN

We examined all individuals of the oligodontia family by clinical and radiographic examinations. Based on the clinical manifestations, the candidate genes MSX, PAX9 and AXIN2 were selected to analyse and screen for mutations.

RESULTS

The clinical evaluation suggested that the family might show non-syndromic oligodontia. DNA sequencing of the MSX1 gene revealed two mutations in the two patients with oligodontia: a heterozygotic silent mutation, c.348C>T (P.Gly116=), in exon 1 and a homozygotic deletion of 11 nucleotides (c.469+56delins GCCGGGTGGGG) in the intron. However, the silent mutation and the deletion mutation were thought to be known polymorphisms (rs34165410 and rs34341187) by bioinformatics analysis. We did not detect any mutations in the PAX9 and AXIN2 genes of oligodontia patients.

CONCLUSION

Our finding suggests that identified polymorphisms (c.348C>T and c.469+56delins GCCGGGTGGGG) may be responsible for the oligodontia phenotype in this Chinese family, but the association requires further study.

Tooth agenesis patterns and phenotype variation in a cohort of Belgian patients with hypodontia and oligodontia clustered in 79 families with their pedigrees

BACKGROUND

Even though tooth agenesis is the most common developmental anomaly of the human dentition, its genetic background and pathogenic mechanism(s) still remain poorly understood. Syndromic and isolated forms of hypodontia have been described and can occur sporadically or in families.

OBJECTIVES

We describe and analyse the hypo-/oligodontia phenotype variations in families. The index patient suffers from severe or mild hypodontia; case-parents/sib records are available. Furthermore, we aim to evaluate whether the different agenesis patterns in the pedigrees are predictive of mutations in specific genes based on reported genotype-phenotype associations.

MATERIALS AND METHODS

Dental records and pedigrees were collected from 79 families. In 67 families, the index patient presented with oligodontia while in 12 families with hypodontia. The phenotype data of 66 oligodontia index patients were analysed with the Tooth Agenesis Code software.

RESULTS

Nine families counted two members; one family counted three members affected with oligodontia. Twenty-four oligodontia families respectively had one (n = 17), two (n = 4), three (n = 2) or four (n = 1) additional family members presenting with hypodontia. Of the 77 oligodontia cases, two showed the same tooth agenesis pattern, while 75 patients showed unique tooth agenesis patterns.

CONCLUSIONS

Despite familial aggregation and expected Mendelian segregation, the number of missing teeth in the familial hypo-/oligodontia phenotypes and the tooth agenesis patterns are highly variable between the affected family members. Therefore, we hypothesize that tooth agenesis is not (always) a simple monogenic condition, but additional genetic or environmental factors can modify the expression of the phenotype.

Dentistry and molecular biology: a promising field for tooth agenesis management

Tooth agenesis is the failure of tooth bud development, causing definitive absence of the tooth. It is the most common dental anomaly, affecting up to one-quarter of the general population. The main cause is related to abnormal function of specific genes which play key roles during odontogenesis, particularly MSX1 and PAX9. MSX1 is a transcription factor highly expressed in the mesenchyme of developing tooth germs, whereas PAX9 is a transcription factor that shows a direct relationship with craniofacial development, particularly the formation of the palate and teeth. Despite the high frequency of tooth agenesis, there are as yet only a restricted number of mutations in MSX1 and PAX9 that have been associated with non-syndromic tooth agenesis. Thus, a deeper analysis of the gene networks underlying this anomaly is imperative. By means of a literature review based on Medline, PubMed, Lilacs, NCBI, and STRING, performed between 1991 and 2010 and focused on etiologically associated mutations, this work aimed to assess the latest advances in the genetic etiology of tooth agenesis and to offer an insight into how they can assist dental practice in the near future. A better knowledge of the genetic networks underlying tooth agenesis will lead to better treatment options and, perhaps, a tool for early diagnosis possibly related to DNA examination based on polymorphic variants. Such a test based on DNA analysis may be available to and accessible by clinicians, resulting in a more accurate diagnosis and allowing for a better approach to this anomaly.

Case report: identical twins revealing discordant hypodontia. The rationale of dental arch differences in monozygotic twins

BACKGROUND

While it is generally accepted that monozygotic (MZ) twins are identical with respect to inherited traits, because they share 100% of their genetic material, clinical findings and scientific evidence does not support this belief. In addition to environmental factors and stochastic developmental events, a number of genetic mechanisms, detectable by new techniques in molecular genetics, explain the differences frequently observed in MZ twins.

CASE REPORT

Nine-year-old twin girls requested treatment for a dental malocclusion. Their facial and occlusal features were very similar. Panoramic radiographs revealed hypodontia of two permanent teeth in one twin (35 and 45) and of only one tooth in the other (45). An incorrect diagnosis of dizygosity (DZ) had been made at birth based on the presence of two amniotic sacs. Despite discordance in the dental complement of both girls their orthodontist suspected that the twins might be identical. A genetic study performed by quantitative fluorescence-polymerase chain reaction (QFPCR) analysis of chromosomes 13, 15, 16, 18, 21, 22, and X confirmed that the twins were MZ.

CONCLUSION

Discordances in dental complement between MZ twins are not uncommon and do not exclude monozygosity.

Isolated oligodontia associated with mutations in EDARADD, AXIN2, MSX1, and PAX9 genes

Oligodontia is defined as the congenital lack of six or more permanent teeth, excluding third molars. Oligodontia as well as hypodontia (lack of one or more permanent teeth) are highly heritable conditions associated with mutations in the AXIN2, MSX1, PAX9, EDA, and EDAR genes. Here we define the prevalence of mutations in the AXIN2, MSX1, PAX9, EDA, and EDAR genes, and the novel candidate gene EDARADD in a cohort of 93 Swedish probands with non-syndromic, isolated oligodontia. Mutation screening was performed using denaturing gradient gel electrophoresis and DNA sequence analysis. Analyses of the coding sequences of the six genes showed sequence alterations predicted to be damaging or potentially damaging in ten of 93 probands (10.8%). Mutations were identified in the EDARADD (n = 1), AXIN2 (n = 3), MSX1 (n = 2), and PAX9 (n = 4) genes, respectively. None of the 10 probands with mutations had other self-reported symptoms from ectodermal tissues. The oral parameters were similar when comparing individuals with and without mutations but a family history of oligodontia was three times more frequent for probands with mutations. EDARADD mutations have previously been reported in a few families segregating hypohidrotic ectodermal dysplasia and this is, to our knowledge, the first report of an EDARADD mutation associated with isolated oligodontia.

Sequence analysis of PAX9, MSX1 and AXIN2 genes in a Chinese oligodontia family

OBJECTIVES

The goal of our research was to look into the clinical traits and genetic mutations in nonsyndromic oligodontia in a Chinese family and to gain insight into the role of mutations of PAX9, MSX1 and AXIN2 in oligodontia phenotypes.

MATERIALS AND METHODS

6 subjects from a family underwent complete oral examination, including panoramic radiographs. Retrospective data were reviewed and blood samples were collected. PCR primers for PAX9, MSX1, and AXIN2 were designed through the Oligo Primer Analysis Software. PCR products were purified and sequenced using the BigDye Terminator Kit and analysed by the 3730 DNA Analyzer.

RESULTS

The proband missed 4 permanent canines, 2 permanent maxillary lateral incisors, 2 permanent mandibular lateral incisors, and 2 permanent mandibular central incisors, whilst his maternal grandfather lacked only 2 permanent mandibular central incisors. Moreover, the size of some permanent teeth appeared smaller than normal values of crown width of Chinese people. Oligodontia and abnormalities of teeth were not present in other family members. Radiographic examination showed that the proband and the rest of family members retained all germs of the third molars. There was one known mutation A240P (rs4904210) of PAX9 in the coding region in the proband and the maternal family members (II-2, II-3, and II-4), which possibly contributed to structural and functional changes of proteins. No mutations were identified in MSX1 and AXIN2.

CONCLUSIONS

Our findings may imply that the PAX9 A240P mutation is a risk factor for oligodontia in the Chinese population. A240P is likely to be a genetic cause of oligodontia though previous literature suggested it as a polymorphism only.

Congenital oligodontia of the deciduous teeth and anodontia of the permanent teeth in a cat

This report describes a rare case of congenital oligodontia of the deciduous teeth and anodontia of the permanent teeth in a cat. According to cat's veterinarian, the patient had only two deciduous upper canines and no permanent teeth had ever erupted. Post-mortem evaluation showed a complete absence of teeth in the oral cavity and inflammatory lesions were not found on the gums. Histopathological analysis of serial sections of maxilla and mandible revealed absence of odontogenic epithelium, inflammatory cells and odontoclastic resorptive lesions. Diagnosis was confirmed after both the establishment that there were no remaining dental structures and the exclusion of other relevant diseases that lead to tooth loss, such as periodontal disease, renal fibrous osteodystrophy, odontoclastic resorptive lesions, ectodermal dysplasia and trauma.