An overview of molecular and genetic alterations in selected benign odontogenic disorders

Developmental Defects of Enamel: A Bibliometric Analysis of the Top 100 Most-Cited Papers

BACKGROUND

Developmental defects of enamel (DDE) are a result of disturbances during formation and maturation of the enamel. Evaluating the most-cited DDE papers can provide important tools that point to the gaps and strengths of this important topic in dentistry.

SUMMARY

This bibliometric study analyzed the 100 most-cited papers on DDE. Using a combined keyword search strategy, the 100 most-cited papers were selected in the Web of Science Core Collection. Papers that addressed any type of DDE were included. The extracted data were title, number of citations, study theme, authorship, journal, type of DDE, type of dentition (primary or permanent), type of diagnosis, study design, year, and country of publication. The bibliometric networks were generated through VOSviewer software. The 100 papers had a range from 78 to 459 citations. The main themes of studies were etiopathogenesis (53%), prevalence and incidence (22%), and diagnosis (8%). The authors with the highest number of citations were Goodman AH and Rose JC (459 citations). Most articles were published in dental journals (47%). The most studied types of DDE were fluorosis and amelogenesis imperfecta in the permanent dentition (47%). Observational (24%) and non-systematic reviews (24%) were the most common study designs and ranged from 1977 to 2019. The country with the highest number of publications was the USA (41%).

KEY MESSAGES

Most of the top 100 DDE papers were about fluorosis and amelogenesis imperfecta, with top papers from three continents with English as the native language. This topic is of great importance in dentistry, and the need for further studies is highlighted, especially regarding the diagnosis and treatment of some DDEs.

A Review of Selected Dental Anomalies With Histologic Features in the Pediatric Patient

Unique dental conditions in children include odontogenic cysts and tumors, hereditary dental diseases, developmental anomalies, and lesions associated with the eruption of the primary or permanent teeth. Many of these conditions have long lasting effects on the adult dentition in terms of affecting esthetics, function, and overall quality of life. Inherited dental syndromes affect the dental hard tissues specifically the enamel, dentin, and/or cementum in a generalized manner, involving both primary and permanent teeth. These conditions manifest in altered quality or quantity of the hard tissues, leading to fragility, tooth loss and dental diseases such as caries, periapical pathology, and periodontal disease. This category includes amelogenesis imperfecta, dentinogenesis imperfecta, dentin dysplasia, hypophosphatasia, and hypophosphatemia. Developmental defects such as regional odontodysplasia are defined by involvement of the primary and permanent dentition in a localized manner, identified in early childhood. This review will elaborate on the histologic findings in these selected dental conditions with a discussion on clinical and radiographic findings, as well as molecular features wherever appropriate.

Clear Aligners in Patients with Amelogenesis and Dentinogenesis Imperfecta

Dentinogenesis imperfecta (DI) and amelogenesis imperfecta (AI) are hereditary abnormalities of dental hard tissues. Dental abnormalities may also be accompanied by symptoms of disorders such as osteogenesis imperfecta. AI and DI have a significant burden on socializing, function, and comfort; therefore, frequent screening and accurate diagnosis is the cornerstone of managing such conditions. Both AI and DI could be treated with many strategies, including restorative, prosthetic, periodontal, surgical, and orthodontics treatment. The interdisciplinary combination of orthodontic, prosthodontic, and periodontic treatment has been proven to improve the prognosis of AI and DI. Regarding orthodontic treatment, the most difficult element of orthodontic therapy may be maintaining a high level of motivation for what might be a prolonged form of treatment spanning several years. There are many forms of orthodontic management for AI and DI, including removable appliances, functional appliances, and fixed appliances. Clear aligner therapy (CAT) contains a broad range of equipment that works in different ways, has different construction processes, and is compatible with different malocclusion procedures. The application of CAT in patients with AI and DI is favorable over the fixed applicants. However, the available evidence regarding the application of CAT in AI is weak and heterogeneous. In this review, we discussed the current evidence regarding the application of clear CAT in patients with AI and DI.

Ameloblastic Fibro-Odontoma: At the Crossroad Between "Developing Odontoma" and True Odontogenic Tumour

Ameloblastic fibro-odontoma (AFO) is a controversial, rare benign mixed odontogenic tumour that was re-defined as "developing odontoma" in the 2017 WHO classification arguing that once dental hard tissues form, it is programmed to transform into odontoma. However, AFO still remains unclear in terms of its nature. We aimed to analyze a large series of AFOs and compare it to a large series of odontomas (ODs) in an attempt to set cut-off diagnostic parameters between these entities and discuss latest updates on AFO histopathologic, clinical and molecular features. A total of 23 well-documented AFOs were analyzed versus 310 ODs focusing on the age of the patients and size of the lesions. For AFO, mean age was 9.4 ± 3.9 years (range 3-16 years) and mean size (greatest diameter) was 2.9 ± 1.5 cm (range 0.8-5.5 cm). For OD-mean age was 26.5 ± 15.6 years (range 3-81 years), mean size 1.9 ± 0.9 cm (range 1-5 cm). Receiver operating curve (ROC) showed that a cut-off age of 13.5 years and below [area under the curve (AUC) 0.902, 95%CI 0.859-0.945; p < 001; sensitivity 80%, specificity 87%] and a cut-off size of 2.1 cm and above are likely to be associated with AFO (AUC 0.7, 95%CI 0.574-0.827; p = 0.001; sensitivity 57%, specificity 77%). Thus, the combination of age and lesion size may be used to distinguish between lesions of a true neoplastic nature (i.e., AFO) and hamartomatous formation (i.e., OD). Further molecular and genetic specifications are needed to provide a better understanding on the pathogenesis of AFO in support of our suggestion and aid in an accurate classification of AFO.

A case of multiple rootless teeth: A case report and review

Dentin dysplasia is a rare, hereditary disorder affecting the dental hard tissue. It is a congenital, autosomal dominant disease of unknown etiology that affects 1:100,000 populations. It may present as such affecting only the dental hard tissue or as one of the symptoms of underlying diseases such as calcinosis, Ehlers–Danlos syndrome, rhematoid arthitis, Vitaminosis D and Branchioskeletogenital syndrome. This was first described by Ballschmiede as rootless teeth in 1920 and termed as dentin dysplasia by Rushton in the year 1939. It is classified into Type I, II and III, in which Type III affects only the secondary dentition. This article reports a rare case of Type I dentin dysplasia in a 26-year-old male patient, and focus on clinical, radiological, ground section and histopathological aspects. It emphasizes the significance of early diagnosis and intervention for the psychological well-being of the individual.

Associations between tooth agenesis and displaced maxillary canines: a cross-sectional radiographic study

Background

The aim of present study was to test the association between hypodontia and displaced maxillary canine when compared with a control group.

Methods

The study group was composed of 336 subjects with a mean age of 10.7 ± 1.2 years, presenting with at least one missing tooth. Exclusion criteria included syndromes, craniofacial malformations, extractions and trauma history and previous orthodontic treatment. The control group consisted of 336 subjects with a mean age of 10.7 ± 1.2 years, without agenesis. Stepwise multiple logistic regression using the backwards elimination and the Wald test method was performed to identify the best combination of hypodontia and displaced maxillary canine (P < 0.05).

Results

The most represented category in study group consisted in mild agenesis (86.9%); moderate and severe agenesis groups respectively represented the 11.7 and 1.4% of study group. Agenesis was diagnosed in both arches in 46 subjects. Maxillary hypodontia and mandibular hypodontia was respectively detected in 156 and 134 subjects. The most frequent missing teeth were mandibular second premolars (45.8%), lateral incisors (41.7%) and maxillary second premolars (17.8%). A significant correlation between agenesis and displaced maxillary canine was observed in the study group (P < 0.05). Only the agenesis of maxillary lateral incisors remained in the final model during backward stepwise deletion. Significant association between the severity of dental agenesis and prevalence of displaced maxillary canine was not assessed.

Conclusions

The outcomes revealed no difference related to the severity of dental agenesis and prevalence of displaced maxillary canine. Only the agenesis of maxillary lateral incisors should be considered directly connected with displaced maxillary canine.

Electronic supplementary material

The online version of this article (10.1186/s40510-018-0226-0) contains supplementary material, which is available to authorized users.

Differences in E-Cadherin and Syndecan-1 Expression in Different Types of Ameloblastomas

Ameloblastomas are a group of benign, locally aggressive, recurrent tumors characterized by their slow and infiltrative growth. E-Cadherin and syndecan-1 are cell adhesion molecules related to the behavior of various tumors, including ameloblastomas. Ninety-nine ameloblastoma samples were studied; the expression of E-cadherin and syndecan-1 were evaluated by immunohistochemistry. E-Cadherin and epithelial syndecan-1 were more highly expressed in intraluminal/luminal unicystic ameloblastoma than in mural unicystic ameloblastoma and solid/multicystic ameloblastoma, whereas the stromal expression of syndecan-1 was higher in mural unicystic ameloblastoma and solid/multicystic ameloblastoma. Synchronicity was observed between E-cadherin and epithelial syndecan-1; the expression was correlated with intensity in all cases. There was a strong association between expression and tumor size and recurrence. The evaluation of the expression of E-cadherin and syndecan-1 are important for determining the potential aggressiveness of ameloblastoma variants. Future studies are required to understand how the expression of these markers is related to tumor aggressiveness.

Mutation in SSUH2 Causes Autosomal-Dominant Dentin Dysplasia Type I

Dentin dysplasia type I (DDI) is an autosomal-dominant genetic disorder resulting from dentin defects. The molecular basis of DDI remains unclear. DDI exhibits unique characteristics with phenotypes featuring obliteration of pulp chambers and diminutive root, thus providing a useful model for understanding the genetics of tooth formation. Using a large Chinese family with 14 DDI patients, we mapped the gene locus responsible for DDI to 3p26.1-3p24.3 and further identified a missense mutation, c.353C>A (p.P118Q) in the SSUH2 gene on 3p26.1, which co-segregated with DDI. We showed that SSUH2 (p.P118Q) perturbed the structure and significantly reduced levels of mutant (MT) protein and mRNA compared with wild-type SSUH2. Furthermore, MT P141Q knock-in mice (+/- and -/-) had a unique partial obliteration of the pulp cavity and upregulation or downregulation of six major genes involved in odontogenesis: Dspp, Dmp1, Runx2, Pax9, Bmp2, and Dlx2. The phenotype of missing teeth was determined in zebrafish with morpholino gene knockdowns and rescued by injection of normal human mRNA. Taken together, our observations demonstrate that SSUH2 disrupts dental formation and that this novel gene, together with other odontogenesis genes, is involved in tooth development.

Molecular Classification of Oral Squamous Cell Carcinoma

Oral Squamous Cell Carcinoma (OSCC) is the commonest tumour in the oro-facial region with increasing incidence in the recent years. The disease is challenging as it still depicts a high morbidity and mortality rate. Clinico-pathological data, tumour site, pathologic site tumor, lymphnode, metastasis (TNM) staging, histological grade, invasion, perineural invasion and metastasis have been evaluated to a great depth in relation to OSCC. Co-morbidity factors like use of tobacco, alcohol consumption and various other factors including genetic predisposition have been looked at for finding a suitable treatment protocol. The crux of the matter in understanding the complexity of oral cancer lies in the biological heterogeneity of the tumour. Similar heterogeneity is seen in clinical presentation, histopathology and molecular changes at the cellular level. In spite of the disease being diagnosed, a prediction of the same related to behaviour has remained elusive. Hence, it is time to look beyond at the genetic and epigenetic events leading to molecular and cytogenetic changes that elucidate the pathogenesis and help in design and implementation of targeted drug therapy. A molecular classification of OSCC needs to be put in place much before a clinician can design the treatment protocol of the same and predict the prognosis.

Prevalence of pathologies related to impacted mandibular third molars

OBJECTIVE

Prevalence of cysts and tumors related to impacted third molars has been considered important because the risk justifies prophylactic extraction. This retrospective study aimed to evaluate the prevalence of cysts or tumors associated with impacted mandibular third molars (IMTMs) according to patients' age and gender.

METHODS

Over the period from August 2006 to August 2011, 20,802 third molars from 17,535 patients were removed. Among these, IMTMs without cysts nor tumors were classified as non-pathology group, and IMTMs with cysts and tumors were classified into pathology group. The prevalence of IMTMs and associated cysts or tumors was analyzed in patient groups stratified by age and gender. The pathology group patients were also classified according to histopathological findings and the corresponding age groups.

RESULTS

Radiographic signs of disease were detected for 176 lesions (0.846 %) in 165 patients. Of these, 135 (76.4 %) lesions were diagnosed as dentigerous cysts, 31 (17.6 %) as keratocysticodontogenic tumors, and 10 (5.7 %) as ameloblastomas. The prevalence of cysts or tumors tended to increase after 50 years of age, such as 7.27 % in 6th decades, 18.60 % in 7th decades, and 11.53 % in 8th decades, with a male predominance in older patients.

CONCLUSIONS

IMTMs in old age patients more than 50 years old has high possibilities of developing cyst or tumors especially in male patients. However, these results should not be used as the only evidence for justifying prophylactic extraction, and further studies should investigate the survival rate of IMTMs without any pathologic in older populations.

Site-specific function and regulation of Osterix in tooth root formation

Congenital diseases of tooth roots, in terms of developmental abnormalities of short and thin root phenotypes, can lead to loss of teeth. A more complete understanding of the genetic molecular pathways and biological processes controlling tooth root formation is required. Recent studies have revealed that Osterix (Osx), a key mesenchymal transcriptional factor participating in both the processes of osteogenesis and odontogenesis, plays a vital role underlying the mechanisms of developmental differences between root and crown. During tooth development, Osx expression has been identified from late embryonic to postnatal stages when the tooth root develops, particularly in odontoblasts and cementoblasts to promote their differentiation and mineralization. Furthermore, the site-specific function of Osx in tooth root formation has been confirmed, because odontoblastic Osx-conditional knockout mice demonstrate primarily short and thin root phenotypes with no apparent abnormalities in the crown (Journal of Bone and Mineral Research 30, 2014 and 742, Journal of Dental Research 94, 2015 and 430). These findings suggest that Osx functions to promote odontoblast and cementoblast differentiation and root elongation only in root, but not in crown formation. Mechanistic research shows regulatory networks of Osx expression, which can be controlled through manipulating the epithelial BMP signalling, mesenchymal Runx2 expression and cellular phosphorylation levels, indicating feasible routes of promoting Osx expression postnatally (Journal of Cellular Biochemistry 114, 2013 and 975). In this regard, a promising approach might be available to regenerate the congenitally diseased root and that regenerative therapy would be the best choice for patients with developmental tooth diseases.