A curriculum vitae of teeth: evolution, generation, regeneration

Impaired oral health: a required companion of bacterial aspiration pneumonia

Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.

Unraveling the structure, chemical composition, and conserved signaling in leech teeth

Unlike vertebrates, the number of toothed taxa in invertebrates is very few, with leeches being the only tooth-bearing organisms in the phylum Annelida. Copious studies have been conducted regarding vertebrate teeth; however, studies regarding the structure and function of invertebrate teeth are limited. In this study, the tooth structure of leeches, specifically Hirudo nipponia and Haemadipsa rjukjuana, was revealed, which showed sharp and pointed teeth along the apex of three jaws. Understanding conserved signaling regulations among analogous organs is crucial for uncovering the underlying mechanisms during organogenesis. Therefore, to shed light on the evolutionary perspective of odontogenesis to some extent, we conducted de novo transcriptome analyses using embryonic mouse tooth germs, Hirudo teeth, and Helobdella proboscises to identify conserved signaling molecules involved in tooth development. The selection criteria were particularly based on the presence of tooth-related genes in mice, Hirudo teeth, and Helobdella proboscis, wherein 4113 genes were commonly expressed in all three specimens. Furthermore, the chemical nature of leech teeth was also examined via TEM-EDS to compare the chemical composition with vertebrate teeth. The examination of tissue-specific genetic information and chemical nature between leeches and mice revealed chemical similarities between leech and mice teeth, as well as conserved signaling molecules involved in tooth formation, including Ptpro, Prickle2, and Wnt16. Based on our findings, we propose that leech teeth express signaling molecules conserved in mice and these conserved tooth-specific signaling for dental hard tissue formation in mice would corresponds to the structural formation of the toothed jaw in leeches.

Hyaluronan degradation by HYAL2 is essential for odontoblastic differentiation and migration of mouse dental papilla cells

The coordination between odontoblastic differentiation and directed cell migration of mesenchymal progenitors is necessary for regular dentin formation. The synthesis and degradation of hyaluronan (HA) in the extracellular matrix create a permissive niche that directly regulates cell behaviors. However, the role and mechanisms of HA degradation in dentin formation remain unknown. In this work, we present that HA digestion promotes odontoblastic differentiation and cell migration of mouse dental papilla cells (mDPCs). Hyaluronidase 2 (HYAL2) is responsible for promoting odontoblastic differentiation through degrading HA, while hyaluronidase 1 (HYAL1) exhibits negligible effect. Silencing Hyal2 generates an extracellular environment rich in HA, which attenuates F-actin and filopodium formation and in turn inhibits cell migration of mDPCs. In addition, activating PI3K/Akt signaling significantly rescues the effects of HA accumulation on cytodifferentiation. Taken together, the results confirm the contribution of HYAL2 to HA degradation in dentinogenesis and uncover the mechanism of the HYAL2-mediated HA degradation in regulating the odontoblastic differentiation and migration of mDPCs.

Novel PAX9 Mutations Causing Isolated Oligodontia

Hypodontia, i.e., missing one or more teeth, is a relatively common human disease; however, oligodontia, i.e., missing six or more teeth, excluding the third molars, is a rare congenital disorder. Many genes have been shown to cause oligodontia in non-syndromic or syndromic conditions. In this study, we identified two novel PAX9 mutations in two non-syndromic oligodontia families. A mutational analysis identified a silent mutation (NM_006194.4: c.771G>A, p.(Gln257=)) in family 1 and a frameshift mutation caused by a single nucleotide duplication (c.637dup, p.(Asp213Glyfs*104)) in family 2. A minigene splicing assay revealed that the silent mutation resulted in aberrant pre-mRNA splicing instead of normal splicing. The altered splicing products are ones with an exon 4 deletion or using a cryptic 5' splicing site in exon 4. Mutational effects were further investigated using protein expression, luciferase activity assay and immunolocalization. We believe this study will not only expand the mutational spectrum of PAX9 mutations in oligodontia but also strengthen the diagnostic power related to the identified silent mutation.

Maternal Diet Associates with Offspring Bone Mineralization, Fracture Risk and Enamel Defects in Childhood and Influences the Prenatal Effect of High-Dose Vitamin D Supplementation

We previously demonstrated a beneficial effect of high-dose vitamin D in pregnancy on offspring bone and dental health. Here, we investigated the effect of maternal dietary patterns during pregnancy on the risk of bone fractures, bone mineralization and enamel defects until age 6 years in the offspring. Further, the influence of diet on the effect of high-dose vitamin D was analyzed in the COPSAC2010 mother-child cohort including 623 mother-child pairs. A weighted network analysis on FFQs revealed three specific maternal dietary patterns that associated (Bonferroni p < 0.05) with both offspring bone and dental health. The effect of prenatal high-dose (2800 IU/day) vs. standard-dose (400 IU/day) vitamin D on offspring bone mineral content (adjusted mean difference (aMD): 33.29 g, 95% CI: 14.48-52.09, p < 0.001), bone mineral density (aMD: 0.02 g/cm2 (0.01-0.04), p < 0.001), fracture risk (adjusted incidence rate ratio: 0.36 (0.16-0.84), p = 0.02), and enamel defects in primary (adjusted odds ratio (aOR): 0.13 (0.03-0.58), p < 0.01) and permanent molars (aOR: 0.25; (0.10-0.63), p < 0.01) was most pronounced when mothers had lower intake of fruit, vegetables, meat, eggs, sweets, whole grain, offal and fish. This study suggests that prenatal dietary patterns influence offspring bone and dental development, and should be considered in order to obtain the full benefits of vitamin D to enhance personalized supplementation strategy.

Spatiotemporal expression of fibroblast growth factor 4 and 10 during the morphogenesis of deciduous molars in miniature pigs

OBJECTIVE

Fibroblast growth factors (FGFs) play pivotal roles in mediating interactions between dental epithelium and mesenchyme throughout tooth initiation and morphogenesis. This study aimed to elucidate the roles of FGF4 and FGF10 in the regulation of tooth development.

DESIGN

In this study, we investigated spatiotemporal expression patterns of FGF4 and FGF10 in the third deciduous molars (DM3) of miniature pigs at the cap, early bell, and late bell stages. Pregnant miniature pigs were obtained, and the samples were processed for histological staining. Non-radioactive in situ hybridization, immunohistochemistry, and real-time PCR were used to detect mRNA and protein expression levels of FGF4 and FGF10.

RESULTS

FGF4 was expressed in the dental epithelium and mesenchyme at the cap stage. At the early bell stage, epithelial expression of FGF4 was reduced while mesenchymal expression got stronger. At the late bell stage, the FGF4 expression was restricted to the inner enamel epithelium (IEE) and differentiating odontoblasts. FGF10 was expressed intensely in both epithelium and mesenchyme at the cap stage. The expression of FGF10 was concentrated in the secondary enamel knots and surrounding mesenchyme at the early bell stage. FGF10 was weakly detected in the IEE by the late bell stage.

CONCLUSIONS

Our results indicated that FGF4 and FGF10 might have partially redundant functions in regulating epithelium morphogenesis. FGF4 may be involved in regulatory signaling cascades mediating interactions between the epithelium and mesenchyme. In addition, the downregulation of FGF10 expression may be associated with the cessation of mesenchymal cell proliferation and initiation of preodontoblast polarization.

Three-Dimensional Assessment and Comparison of the Maxillary Tuberosity Between Skeletal and Dental Class I and Class II Adults in Maxillary Third Molar Agenesis Using Cone Beam Computed Tomography: A Descriptive Cross-Sectional Human Study

AIM AND OBJECTIVE

The objective of this study was to assess and compare the dimensions (width (W), height (H), and length (L)) of the tuberosity distal to maxillary permanent second molar in individuals with skeletal and dental Class I and Class II malocclusions who had maxillary third molar agenesis.

METHODOLOGY

Cone beam computed tomography (CBCT) was used to measure the left (L) and right (R) anatomical tuberosity dimensions in three dimensions using the WillMaster software (HDX WILL Corporation, Korea). The measurements were compared between Class I (n = 35) and Class II (n = 35) normo-hypodivergent adult subjects. The dimensions were measured at regular 2 mm intervals from the cementoenamel junction (CEJ) and distovestibular root of the maxillary second molar in terms of the width (e.g., W1, W2, and W3), height (e.g., H1, H2, and H3), length (e.g., L1, L2, and L3) to the posterior limit of the tuberosity. Statistical analysis included descriptive statistics, Mann-Whitney U tests, and intraclass correlation coefficient tests.

RESULTS

The width of the tuberosity at LW0, LW1, and LW2 was significantly higher in Class I compared to that in Class II. The right tuberosity in Class II showed significantly higher values in height at all reference points. The right tuberosity at RL0 and RL1 exhibited significantly higher values in the length of the Class II group compared to the Class I group.

CONCLUSIONS

The dimensions of the maxillary tuberosity (width, height, and length) varied between the Class I and Class II groups. Wider maxillary tuberosities were observed in the Class I group, while the Class II group had greater height and length dimensions of the tuberosity.

Sexual Dimorphism in Third Molar Agenesis in Humans with and without Agenesis of Other Teeth

Sexual dimorphism in the human dentition is of interest from a developmental, evolutionary, and clinical point of view. Here, we investigated sexual dimorphism in third molar agenesis patterns and severity in non-syndromic white European individuals with (group A: 303 individuals) and without agenesis (group B: 303 individuals) of teeth other than the third molars. There was no sexual dimorphism in the patterns or the severity of third molar agenesis within groups. Both sexes showed a higher number of third molar agenesis per individual in group A than in group B. The most common third molar agenesis pattern was that of no third molars. For both females and males, bilateral third molar agenesis was approximately three times more frequent in group A than in group B (p < 0.001), whereas no difference was detected for unilateral agenesis. These findings indicate a strong genetic control of the developmental process of tooth formation, with any disruptions affecting both sexes in a similar manner. Overall, the higher vulnerability of third molar formation could be associated with the evolutionary trend in humans towards a reduced number of molar teeth, which seems to show no sex-related differences.

Circadian clock—A promising scientific target in oral science

The oral and maxillofacial organs play vital roles in chewing, maintaining facial beauty, and speaking. Almost all physiological processes display circadian rhythms that are driven by the circadian clock, allowing organisms to adapt to the changing environment. In recent years, increasing evidence has shown that the circadian clock system participates in oral and maxillofacial physiological and pathological processes, such as jaw and tooth development, salivary gland function, craniofacial malformations, oral carcinoma and other diseases. However, the roles of the circadian clock in oral science have not yet been comprehensively reviewed. Therefore, This paper provides a systematic and integrated perspective on the function of the circadian clock in the fields of oral science, reviews recent advances in terms of the circadian clock in oral and maxillofacial development and disease, dialectically analyzes the importance of the circadian clock system and circadian rhythm to the activities of oral and maxillofacial tissues, and focuses on analyzing the mechanism of the circadian clock in the maintenance of oral health, affecting the common diseases of the oral and maxillofacial region and the process of oral-related systemic diseases, sums up the chronotherapy and preventive measures for oral-related diseases based on changes in tissue activity circadian rhythms, meanwhile, comes up with a new viewpoint to promote oral health and human health.

Plumping up a Cushion of Human Biowaste in Regenerative Medicine: Novel Insights into a State-of-the-Art Reserve Arsenal

Major breakthroughs and disruptive methods in disease treatment today owe their thanks to our inch by inch developing conception of the infinitive aspects of medicine since the very beginning, among which, the role of the regenerative medicine can on no account be denied, a branch of medicine dedicated to either repairing or replacing the injured or diseased cells, organs, and tissues. A novel means to accomplish such a quest is what is being called “medical biowaste”, a large assortment of biological samples produced during a surgery session or as a result of physiological conditions and biological activities. The current paper accentuating several of a number of promising sources of biowaste together with their plausible applications in routine clinical practices and the confronting challenges aims at inspiring research on the existing gap between clinical and basic science to further extend our knowledge and understanding concerning the potential applications of medical biowaste.

Eruption Timing and Sequence of Primary Teeth in a Sample of Romanian Children

Teething is considered a significant event in the growth and development of the child by parents and especially by paediatric dentists and forensic scientists. They constantly need an “up-to-date mirror” of its variability for different geographic regions. The aims of the current study were to determine the timing and sequence of primary tooth emergence, and to establish a correlation between tooth eruption and general growth and external parameters in a sample of Romanian children. This study included 70 healthy children (53% girls and 47% boys), and the analysed data resulted from the questionnaires completed by parents during the whole process. General and specific data on primary teeth eruption were obtained. The differences between sexes were insignificant, except for the maxillary and mandibular canines (p = 0.047 and p = 0.018) and lower temporary second molars (p < 0.001), which were significantly increased in boys. The differences found between the two hemiarches were insignificant (p = 0.197). The mean age of eruption of the first tooth erupted was 7.07 ± 1.990 months. The unpaired t-test was used for comparison of the timings of eruption of the first primary teeth, according to the number of previous births and type of diet, and it was insignificant (p = 0.665 and p = 0.983 respectively).

Hypes and Hopes of Stem Cell Therapies in Dentistry: a Review

One of the most exciting advances in life science research is the development of 3D cell culture systems to obtain complex structures called organoids and spheroids. These 3D cultures closely mimic in vivo conditions, where cells can grow and interact with their surroundings. This allows us to better study the spatio-temporal dynamics of organogenesis and organ function. Furthermore, physiologically relevant organoids cultures can be used for basic research, medical research, and drug discovery. Although most of the research thus far focuses on the development of heart, liver, kidney, and brain organoids, to name a few, most recently, these structures were obtained using dental stem cells to study in vitro tooth regeneration. This review aims to present the most up-to-date research showing how dental stem cells can be grown on specific biomaterials to induce their differentiation in 3D. The possibility of combining engineering and biology principles to replicate and/or increase tissue function has been an emerging and exciting field in medicine. The use of this methodology in dentistry has already yielded many interesting results paving the way for the improvement of dental care and successful therapies.

Spatiotemporal Expression Patterns of Critical Genes Involved in FGF Signaling During Morphogenesis and Odontogenesis of Deciduous Molars in Miniature Pigs

The fibroblast growth factor (FGF) pathway plays an important role in epithelial-mesenchymal interactions during tooth development. Nevertheless, how the ligands, receptors, and antagonists of the FGF pathway are involved in epithelial-mesenchymal interactions remains largely unknown. Miniature pigs exhibit tooth anatomy and replacement patterns like those in humans and hence can serve as large animal models. The present study investigated the spatiotemporal expression patterns of critical genes encoding FGF ligands (FGF3, FGF4, FGF7, and FGF9), antagonists (SPRY2 and SPRY4) and receptors (FGFR1, FGFR2, and FGFR3) in the third deciduous molars of miniature pigs at the cap (embryonic day 40, E40), early bell (E50), and late bell (E60) stages. The results of in situ hybridization (ISH) with tyramide signal amplification and of qRT-PCR analysis revealed increased expression of FGF7, FGFR1, FGFR2, and SPRY4 in dental epithelium and of FGF7 and FGFR1 in mesenchyme from E40 to E50. In contrast, the results revealed decreased expression of FGF3, FGF4, FGF9, and FGFR3 in dental epithelium and of FGF4, FGF9, FGFR2, and FGFR3 in the mesenchyme from E40 to E60. Mesenchyme signals of FGF3, FGF4, FGF7, SPRY2, FGFR2, and FGFR3 were concentrated in the odontoblast layer from E50 to E60. The distinct expression patterns of these molecules indicated elaborate regulation during dental morphogenesis. Our results provide a foundation for further investigation into fine-tuning dental morphogenesis and odontogenesis by controlling interactions between dental epithelium and mesenchyme, thus promoting tooth regeneration in large mammals.

Neonatal stunting and early childhood caries: A mini-review

The nutritional status of pregnant women greatly determines their newborn outcome. Deficiencies of several micronutrients are associated with stunting in early childhood, affecting health into adulthood. However, apart from the systemic disease that has been a concern so far, fetal undernutrition can also be associated with dental caries in a child's early life, especially since the primary teeth begin to form during the mother's gestation period. The important thing to underline regarding the intrauterine formation of primary teeth is especially in terms of enamel formation. One of the causes of developmental enamel defects that will contribute to the emergence of early childhood caries is the malnutrition of the pregnant mother. This mini-review aims to understand the linkage mechanism behind neonatal stunting to early childhood caries. This concept is expected to generate further research to help prevent both growth stunting and early childhood caries. In addition, with some evidence-based research, the importance of the first dental visit can be further promoted.

Dental Pulp Stem Cells Derived From Adult Human Third Molar Tooth: A Brief Review

The fields of regenerative medicine and stem cell-based tissue engineering have the potential of treating numerous tissue and organ defects. The use of adult stem cells is of particular interest when it comes to dynamic applications in translational medicine. Recently, dental pulp stem cells (DPSCs) have been traced in third molars of adult humans. DPSCs have been isolated and characterized by several groups. DPSCs have promising characteristics including self-renewal capacity, rapid proliferation, colony formation, multi-lineage differentiation, and pluripotent gene expression profile. Nevertheless, genotypic, and phenotypic heterogeneities have been reported for DPSCs subpopulations which may influence their therapeutic potentials. The underlying causes of DPSCs’ heterogeneity remain poorly understood; however, their heterogeneity emerges as a consequence of an interplay between intrinsic and extrinsic cellular factors. The main objective of the manuscript is to review the current literature related to the human DPSCs derived from the third molar, with a focus on their physiological properties, isolation procedures, culture conditions, self-renewal, proliferation, lineage differentiation capacities and their prospective advances use in pre-clinical and clinical applications.

Tooth structure, mechanical properties, and diet specialization of Piranha and Pacu (Serrasalmidae): A comparative study

The relationship between diet, bite performance, and tooth structure is a topic of common interest for ecologists, biologists, materials scientists, and engineers. The highly specialized group of biters found in Serrasalmidae offers a unique opportunity to explore their functional diversity. Surprisingly, the piranha, whose teeth have a predominantly cutting function and whose main diet is soft flesh, is capable of exerting a greater bite force than a similarly sized pacu, who feeds on a hard durophagous diet. Herein, we expand our understanding of diet specialization in the Serrasalmidae family by investigating the influence of elemental composition and hierarchical structure on the local mechanical properties, stress distribution, and deformation mechanics of teeth from piranha (Pygocentrus nattereri) and pacu (Colossoma macropomum). Microscopic and spectroscopic analyses combined with nanoindentation and finite element simulations are used to probe the hierarchical features to uncover the structure-property relationships in piranha and pacu teeth. We show that the pacu teeth support a durophagous diet through its broad cusped-shaped teeth, thicker-irregular enameloid, interlocking interface of the dentin-enameloid junction, and increased hardness of the cuticle layer due to the larger concentrations of iron present. Comparatively, the piranha teeth are well suited for piercing due to their conical-shape which we report as having the greatest stiffness at the tip and evenly distributed enameloid. STATEMENT OF SIGNIFICANCE: The hierarchical structure and local mechanical properties of the piranha and pacu teeth are characterized and related to their feeding habits. Finite element models of the anterior teeth are generated to map local stress distribution under compressive loading. Bioinspired designs from the DEJ interface are developed and 3D printed. The pacu teeth are hierarchically structured and have local mechanical properties more suitable to a durophagous diet than the piranha. The findings here can provide insight into the design and fabrication of layered materials with suture interfaces for applications that require compressive loading conditions.

Revisiting the human dental follicle: From tooth development to its association with unerupted or impacted teeth and pathological changes

Dental follicles are involved in odontogenesis, periodontogenesis, and tooth eruption. Dental follicles are unique structures, considering that their remnants can persist within the jawbones after odontogenesis throughout life if the tooth does not erupt. Pathological changes may occur in these tissues as individuals age. The changes range from benign to life threatening. Thus, the assessment of age-related changes in dental follicles associated with unerupted teeth is of paramount importance. In this review, we summarize the physiological roles and changes in dental follicles in odontogenesis, tooth eruption, and aging, in addition to the pathological changes associated with these structures. We encourage investigators to consider this peculiar tissue as a unique model and explore its potential to clarify its importance from the viewpoints of developmental biology, tissue physiology, and pathology.

Molecular Evolution of Tooth-Related Genes Provides New Insights into Dietary Adaptations of Mammals

Mammals have evolved different tooth phenotypes that are hypothesized to be associated with feeding habits. However, the genetic basis for the linkage has not been well explored. In this study, we investigated 13 tooth-related genes, including seven enamel-related genes (AMELX, AMBN, ENAM, AMTN, ODAM, KLK4 and MMP20) and six dentin-related genes (DSPP, COL1A1, DMP1, IBSP, MEPE and SPP1), from 63 mammals to determine their evolutionary history. Our results showed that different evolutionary histories have evolved among divergent feeding habits in mammals. There was stronger positive selection for eight genes (ENAM, AMTN, ODAM, KLK4, DSPP, DMP1, COL1A1, MEPE) in herbivore lineages. In addition, AMELX, AMBN, ENAM, AMTN, MMP20 and COL1A1 underwent accelerated evolution in herbivores. While relatively strong positive selection was detected in IBSP, SPP1, and DSPP, accelerated evolution was only detected for MEPE and SPP1 genes among the carnivorous lineages. We found positive selection on AMBN and ENAM genes for omnivorous primates in the catarrhini clade. Interestingly, a significantly positive association between the evolutionary rate of ENAM, ODAM, KLK4, MMP20 and the average enamel thickness was found in primates. Additionally, we found molecular convergence in some amino acid sites of tooth-related genes among the lineages whose feeding habit are similar. The positive selection of related genes might promote the formation and bio-mineralization of tooth enamel and dentin, which would make the tooth structure stronger. Our results revealed that mammalian tooth-related genes have experienced variable evolutionary histories, which provide some new insights into the molecular basis of dietary adaptation in mammals.

Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample

The diagnostic accuracy of the I_3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I_3ML and I_3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I_3ML and I_3MR, respectively. In addition, all these quantities were high when only the I_3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I_3ML and I_3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

Introduction: biopolymers and biocomposites

Biopolymers and biocomposites are an exciting class of ubiquitous materials. Interest in these materials has been driven in part by their biocompatibility/biodegradability, sustainability, potentially low-cost, renewability, being environmental benign, among other properties. These fascinating materials come in a range of forms from the DNA and RNA that is essential to life to the cellulose and collagen that mechanically reinforce tissues and as hybrid organic–inorganic composites like teeth. Herein, we summarize some aspects of the two classes of materials biopolymer and biocomposites, exploring specific examples while pointing to potential monomer sources, neoteric post-extraction modification and processing conditions. This lays the foundation to the following more specific chapters while illustrating the breadth of these material classes.

Exploring directional and fluctuating asymmetry in the human palate during growth

Objectives

Palate morphology is constantly changing throughout an individual's lifespan, yet its asymmetry during growth is still little understood. In this research, we focus on the study of palate morphology by using 3D geometric morphometric approaches to observe changes at different stages of life, and to quantify the impact of directional and fluctuating asymmetry on different areas at different growth stages.

Materials and Methods

The sample consists of 183 individuals (1–72 years) from two identified human skeletal collections of 19th and early 20th Century Italian contexts. A 3D‐template of 41 (semi)landmarks was applied on digital palate models to observe morphological variation during growth.

Results

Asymmetrical components of the morphological structure appears multidirectional on the entire palate surface in individuals <2 years old and become oriented (opposite bilateral direction) between 2 and 6 years of age. Specifically, directional asymmetry differentially impacts palate morphology at different stages of growth. Both the anterior and posterior palate are affected by mild alterations in the first year of life, while between 2 and 6 years asymmetry is segregated in the anterior area, and moderate asymmetry affects the entire palatal surface up to 12 years of age. Our results show that stability of the masticatory system seems to be reached around 13–35 years first by females and then males. From 36 years on both sexes show similar asymmetry on the anterior area. Regarding fluctuating asymmetry, inter‐individual variability is mostly visible up to 12 years of age, after which only directional trends can be clearly observed at a group level.

Discussion

Morphological structure appears instable during the first year of life and acquires an opposite asymmetric bilateral direction between 2 and 6 years of age. This condition has been also documented in adults; when paired with vertical alteration, anterior/posterior asymmetry seems to characterize palate morphology, which is probably due to mechanical factors during the lifespan. Fluctuating asymmetry is predominant in the first period of life due to a plausible relationship with the strength of morphological instability of the masticatory system. Directional asymmetry, on the other hand, shows that the patterning of group‐level morphological change might be explained as a functional response to differential inputs (physiological forces, nutritive and non‐nutritive habits, para‐masticatory activity as well as the development of speech) in different growth stages. This research has implications with respect to medical and evolutionary fields. In medicine, palate morphology should be considered when planning orthodontic and surgical procedures as it could affect the outcome. As far as an evolutionary perspective is concerned the dominance of directional asymmetries in the masticatory system could provide information on dietary and cultural habits as well as pathological conditions in our ancestors.

Third molar agenesis in modern humans with and without agenesis of other teeth

Background

The number of teeth in the human dentition is of interest both from developmental and evolutionary aspects. The present case-control study focused on the formation of third molars in modern humans aiming to shed more light on the most variable tooth class in the dentition.

Materials and Methods

For this reason, we investigated third molar formation in a sample of 303 individuals with agenesis of teeth other than third molars (agenesis group) and compared it to a sex and age matched control group of 303 individuals without agenesis of teeth other than third molars.

Results

The prevalence of third molar agenesis in the agenesis group was 50.8%, which is significantly higher than the 20.5% in the control group (p < 0.001). The chance of a missing third molar in the agenesis group was increased by 38.3% (p < 0.001), after controlling for the agenesis in other teeth factor. When considering the amount of missing third molars per individual, a clear tendency towards more missing third molars was evident in the agenesis group compared to the control group. The frequency of bilaterally missing third molars in the agenesis group was 29% in the maxilla, as well as in the mandible, which is about three times higher than the frequency of unilaterally missing third molars (p < 0.001). In the control group, bilaterally missing third molars occurred in 8.6% in the maxilla and 8.9% in the mandible.

Conclusion

The present results indicate that genetic factors involved in tooth agenesis affect also the dentition as a whole. Furthermore, the third molars are more vulnerable to factors involved in agenesis of other teeth and they are more often affected as a whole. These findings seem to be associated with the evolutionary trend in humans towards reduced molar number.

Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study

OBJECTIVES

Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT) MATERIALS AND METHODS: Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cell-homing concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05).

RESULTS

Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months follow-up. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%).

CONCLUSION

This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP.

CLINICAL RELEVANCE

The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning.

Tooth-shape adaptations in aglyphous colubrid snakes inferred from three-dimensional geometric morphometrics and finite element analysis

To date there are few quantitative studies investigating the evolution of tooth shape and function in aglyphous snakes in relation to diet. A considerable evolutionary decrease in body size is observed in whip snakes of the genus Dolichophis and their sister-group Eirenis. This was coupled with a considerable shift in diet from a regime consisting mainly of prey with endoskeleton to prey bearing a hard exoskeleton. Three-dimensional (3D) geometric morphometrics revealed that the maxillary and palatine teeth of E. persicus are blunt and conical in shape, while the same teeth are sharp and elongated in E. punctatolineatus and D. schmidti. Blunt and conically shaped teeth, as observed in E. persicus, seem to be more adapted for biting hard-bodied, arthropod prey. In contrast, the sharp and elongated teeth in Dolichophis and E. punctatolineatus, are likely specialized for puncturing prey with an endoskeleton. The results of a finite element analysis confirms that during the biting of a hard-bodied prey, the generated stresses in E. persicus teeth are well below the von Mises yield criterion, while in D. schmidti the value is roughly two to three times higher, indicating that E. persicus teeth are better suited for biting hard-bodied prey such as arthropods.

A metabolomic study on the association of exposure to heavy metals in the first trimester with primary tooth eruption

BACKGROUND

The influence of prenatal heavy metals exposure on primary tooth eruption in humans is rarely reported.

AIM

Based on the cohort study design, we investigated the association of exposure to 12 heavy metals in the first trimester with primary tooth eruption, and the maternal metabolisms in the first trimester which might be related to the above relationship.

METHODS

Maternal urine samples were collected in their first trimester, and 12 metals (Ti, V, Fe, Co, Cu, As, Se, Cd, Sn, Hg, Tl, U) were measured using the inductively coupled plasma mass spectrometry method. The maternal metabolome in the first trimester was analyzed by ultrahigh performance liquid chromatography coupled mass spectrometry based metabolomics using urine samples. The infant's first tooth eruption time and number of teeth at age one were recorded by oral examination and questionnaire.

RESULTS

No significant associations were observed between heavy metals exposure in the first trimester and primary tooth eruption, except for Co. The level of Co was positively associated with time of infant's first tooth eruption, and was negatively associated with the number of teeth at age one. Based on metabolomic profiling, glycine was revealed as the key mediating metabolite, which showed negative correlation with Co and opposite effect of Co in the primary tooth eruption.

CONCLUSIONS

Prenatal Co exposure in the first trimester might delay the primary tooth eruption in children through the decreased glycine-disrupted dentin formation, providing the first evidence and novel insights into the control of prenatal heavy metals exposure for ensuring normal (timely) primary tooth eruption.

The involvement of genes related to bile secretion pathway in rat tooth germ development

Tooth formation is accomplished under strict genetic control procedures. Therefore, exploring the gene network system of tooth development has a very positive practical significance for the study of tooth tissue regeneration and the prevention and treatment of tooth abnormalities. Early bell stage is the initial phase of odontoblast formation and dentin matrix deposition in the process of tooth development. Through RNA sequencing and differential gene analysis of the rat tooth germ samples at cap stage and early bell stage, we found that the bile secretion pathway was the most significant difference signal pathway during the development between cap stage and bell stage, which mainly included ABCC3, AQP4, SLC10A1, SLC2A1, SLC4A4, ADCY5, AQP9, CFTR, ATP1A2, ATP1B1 and ATP1A1, totally 11genes. Immunostaining revealed that SLC2A1, SLC4A4, ADCY5 and ATP1B1were mainly expressed in epithelium in bud stage and inner and outer enamel epithelium during the embryonic phase. In the postnatal 1 and postnatal 7, SLC2A1, SLC4A4 and ABCC3 were highly expressed in ameloblasts and odontoblasts while ADCY5, ATP1B1 and SLC10A1was expressed moderately only in odontoblasts. This finding illustrated that the bile secretion pathway related genes may participate in the development of tooth germ.

Genodermatoses with teeth abnormalities

Many genodermatoses exhibit abnormal teeth findings. Studies examining these entities are scarce and narrow in their scope. This paper reviews the evolution, development, and structure of the tooth and provides a summary of genodermatoses with aberrant dental findings. The latter are classified according to the abnormal dental findings: periodontal disease, anodontia/oligodontia/hypodontia, polydontia, enamel hypoplasia, natal teeth, dental pits, and others. Finally, we provide an algorithm that dermatologists and dentists can follow to better recognize genodermatoses with dental involvement.

An update on human periapical cyst-mesenchymal stem cells and their potential applications in regenerative medicine

The broad clinical applications of Mesenchymal Stem Cells (MSCs) in the regenerative medicine field is attributed to their ability to self-renew and differentiate into multiple cellular lineages. Nowadays, MSCs can be derived from a variety of adult and fetal tissues including bone marrow, adipose tissue, umbilical cord and placenta. The difficulties associated with the isolation of MSCs from certain tissues such as bone marrow promoted the search for alternative tissues which are easily accessible. Oral derived MSCs include dental pulp stem cells (DPSCs), dental follicle progenitor cells (DFPC), and periodontal ligament stem cells (PDLSC). Being abundant and easily accessible, oral derived MSCs represent an interesting alternative MSC type to be employed in regenerative medicine. Human periapical cyst-mesenchymal stem cells (hPCy-MSCs) correspond to a newly discovered and characterized MSC subtype. Interestingly, hPCy-MSCs are collected from periapical cysts, which are a biological waste, without any influence on the other healthy tissues in oral cavity. hPCy-MSCs exhibit cell surface marker profile similar to that of other oral derived MSCs, show high proliferative potency, and possess the potential to differentiate into different cell types such as osteoblasts, adipocytes and neurons-like cells. hPCy-MSCs, therefore, represent a novel promising MSCs type to be applied in regenerative medicine domain. In this review, we will compare the different types of dental derived MSCs, we will highlight the isolation technique, the characteristics, and the therapeutic potential of hPCy-MSCs.

Number of teeth is associated with facial size in humans

During human evolution there has been an increase in the size of the brain and the cranium, whereas the size of the face, as well as the size and number of teeth have decreased. In modern humans, the occurrence of missing permanent teeth, namely tooth agenesis, is common. It could be attributed to a biological mechanism of tooth number reduction that has evolved during time and might still be active. Although, if evident, it would add support to this theory, the relationship between this phenotype and craniofacial size remains largely unknown. The present case-control study shows that modern individuals with tooth agenesis have indeed smaller facial configurations. For example, a 15-year-old female with no, one, or ten missing teeth would have a facial centroid size of 511.83, 510.81, or 501.70 mm, respectively. No such effect was observable in the cranial base and the cranium. Our results suggest that common gene regulatory mechanisms that have evolved over time, continue to regulate the number of teeth and facial size of modern humans in a coordinated manner. We anticipate our findings to enrich our understanding of the evolution and development of the human head and kindle future developmental research on this field.

Pointing on the early stages of maxillary bone and tooth development - histological findings

Although the morphological stages of tooth development, in parallel with maxillary bone construction, are known for decades, the intimate mechanisms of early development of the oral cavity structures and tooth's proper and associated tissues are still incompletely elucidated. Nowadays, the research in embryology was shifted from the morphological to the molecular and genetic approach. This new approach is accomplished by using in vivo and in vitro experimental studies performed on animal models and cell lines. The interest in the knowledge of these events at gene and molecular level is still current, aiming to sustain the progress in the endorsement of novel regenerative and restorative therapies. However, the morphological standpoint maintains its interest, because the extrapolation of the results of experimental studies in humans requires a strong confirmation. Within this context, our work aims to analyze the histological characteristics of the maxillary bone and integrated tooth germs during the early stages of embryonic development. The study group consisted in mandible fragments obtained by dissection of the cephalic extremities collected from fetuses aged from 10 to 24 weeks, after medical or spontaneous abortions. The tissue specimens were processed for the histological exam. The histoarchitectonic traits of the initial stages of mandibular bone tissue and tooth development were assessed. The results revealed the dynamics of the ossification stages, from stages of early-dispersed intramembranous ossification to the organization of the dental alveoli, incorporated step-by-step in the maxillary body, and the simultaneous presence of tooth germs with different sizes and shapes, in accordance with the development stage. Our study complements the existing data regarding the embryonic period, bringing an important contribution for the enlargement of existing morphological, visual information for maxillary bone and tooth development.

Biomechanical stress regulates mammalian tooth replacement via the integrin β1-RUNX2-Wnt pathway

Renewal of integumentary organs occurs cyclically throughout an organism's lifetime, but the mechanism that initiates each cycle remains largely unknown. In a miniature pig model of tooth development that resembles tooth development in humans, the permanent tooth did not begin transitioning from the resting to the initiation stage until the deciduous tooth began to erupt. This eruption released the accumulated mechanical stress inside the mandible. Mechanical stress prevented permanent tooth development by regulating expression and activity of the integrin β1-ERK1-RUNX2 axis in the surrounding mesenchyme. We observed similar molecular expression patterns in human tooth germs. Importantly, the release of biomechanical stress induced downregulation of RUNX2-wingless/integrated (Wnt) signaling in the mesenchyme between the deciduous and permanent tooth and upregulation of Wnt signaling in the epithelium of the permanent tooth, triggering initiation of its development. Consequently, our findings identified biomechanical stress-associated Wnt modulation as a critical initiator of organ renewal, possibly shedding light on the mechanisms of integumentary organ regeneration.

An overlooked placode: Recharacterizing the papillae in the embryonic eye of reptilia

The papillae in the chicken embryonic eye, described as scleral papillae in the well-known Hamburger and Hamilton (1951) staging table, are one of the key anatomical features used to stage reptilian (including bird) embryos from HH30-36. These papillae are epithelial thickenings of the conjunctiva and are situated above the mesenchymal sclera. Here, we present evidence that the conjunctival papillae, which are required for the induction and patterning of the underlying scleral ossicles, require epithelial pre-patterning and have a placodal stage similar to other placode systems. We also suggest modifications to the Hamburger Hamilton staging criteria that incorporate this change in terminology (from "scleral" to "conjunctival" papillae) and provide a more detailed description of this anatomical feature that includes its placode stage. This enables a more complete and accurate description of chick embryo staging. The acknowledgment of a placode phase, which shares molecular and morphological features with other cutaneous placodes, will direct future research into the early inductive events leading to scleral ossicle formation.

Regrowing a tooth: in vitro and in vivo approaches

Biologically oriented regenerative dentistry in an attempt to regrow a functional tooth by harnessing the natural healing capabilities of dental tissues has become a recent trend challenging the current dental practice on repairing the damaged or missing tooth. In this review, we outline the conceptual development on the in situ revitalization of the tooth replacement capability lost during evolution, the updated progress in stem-cell-based in vivo repair of the damaged tooth, and the recent endeavors for in vitro generation of an implantable bioengineered tooth germ. Thereafter, we summarize the major challenges that need to be overcome in order to provide the rationale and directions for the success of fully functional tooth regeneration in the near future.

Prenatal developmental sequence of the skull of minke whales and its implications for the evolution of mysticetes and the teeth-to-baleen transition

Baleen whales (Mysticeti) have an extraordinary fossil record documenting the transition from toothed raptorial taxa to modern species that bear baleen plates, keratinous bristles employed in filter-feeding. Remnants of their toothed ancestry can be found in their ontogeny, as they still develop tooth germs in utero. Understanding the developmental transition from teeth to baleen and the associated skull modifications in prenatal specimens of extant species can enhance our understanding of the evolutionary history of this lineage by using ontogeny as a relative proxy of the evolutionary changes observed in the fossil record. Although at present very little information is available on prenatal development of baleen whales, especially regarding tooth resorption and baleen formation, due to a lack of specimens. Here I present the first detailed description of prenatal specimens of minke whales (Balaenoptera acutorostrata and Balaenoptera bonaerensis), focusing on the skull anatomy and tooth germ development, resorption, and baleen growth. The ontogenetic sequence described consists of 10 specimens of both minke whale species, from the earliest fetal stages to full term. The internal skull anatomy of the specimens was visualized using traditional and iodine-enhanced computed tomography scanning. These high-quality data allow detailed description of skull development both qualitatively and quantitatively using three-dimensional landmark analysis. I report distinctive external anatomical changes and the presence of a denser tissue medial to the tooth germs in specimens from the final portion of gestation, which can be interpreted as the first signs of baleen formation (baleen rudiments). Tooth germs are only completely resorbed just before the eruption of the baleen from the gums, and they are still present for a brief period with baleen rudiments. Skull shape development is characterized by progressive elongation of the rostrum relative to the braincase and by the relative anterior movement of the supraoccipital shield, contributing to a defining feature of cetaceans, telescoping. These data aid the interpretation of fossil morphologies, especially of those extinct taxa where there is no direct evidence of presence of baleen, even if caution is needed when comparing prenatal extant specimens with adult fossils. The ontogeny of other mysticete species needs to be analyzed before drawing definitive conclusions about the influence of development on the evolution of this group. Nonetheless, this work is the first step towards a deeper understanding of the most distinctive patterns in prenatal skull development of baleen whales, and of the anatomical changes that accompany the transition from tooth germs to baleen. It also presents comprehensive hypotheses to explain the influence of developmental processes on the evolution of skull morphology and feeding adaptations of mysticetes.

Ectodermal and ectomesenchymal marker expression in primary cell lines of complex and compound odontomas: a pilot study

BACKGROUND

Odontomas are odontogenic tumors with hamartoma features that are classified as compound or complex. Our objective was to characterize the proliferation of ectodermal and ectomesenchymal profile markers of primary cell cultures of complex and compound odontomas.

METHODS

Four samples of compound odontomas (OdCm) and three of complex odontomas (OdCx) were obtained from patients attending the Oral Pathology and Medicine Clinic of the Graduate Dental School, National Autonomous University of Mexico for primary culture generation. MTT, immunocytochemistry and RT-PCR assays of CD34, Sox2, Amel, Ambn, p21, EDAR, Msx1, Msx2, Pax9, RUNX2, BSP, OPN, Barx1 and GAPDH (control) were performed. Additionally, six paraffin-embedded odontomas were obtained for immunocytochemistry and RT-PCR validation assays. The mean and standard deviation were determined, and ANOVA and Kruskall-Wallis tests were performed.

RESULTS

Cultured compound odontoma exhibited higher proliferation, and an ectomesenchymal immunocytochemistry profile with predominant expression of Amel, BSP, Pax9, EDAR, Barx and Msx2; in complex cultured odontoma Sox2, CD34, RUNX2 and OPN predominated. Our statistical analysis showed a significant difference in PCR analysis (P<0.05) for OPN and CD34. Paraffin-embedded odontomas showed similar pattern with difference for NGFR and Sox2 for immunohistochemistry and EDAR, BARX1 and PAX9 for RT-PCR assays.

CONCLUSIONS

The results suggested heterogeneous behavior for both odontoma cell lines, because in compound odontomas predominant biomarkers are related to the enamel knot, late-stage odontogenesis and ectomesenchymal interactions; and in complex odontoma the significant expression of CD34 and OPN could be responsible for the difference behavior and mineralized amorphous structure.

Associations of maternal, perinatal and postnatal factors with the eruption timing of the first primary tooth

We recruited 1296 mothers in their first trimester from the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University between May 2014 and September 2015 to investigate the associations of maternal, perinatal and postnatal factors with the eruption timing of the first primary tooth (ETFPT) in a Chinese population. We collected maternal demographic information and clinical data during the perinatal and postnatal period, and oral examinations of the infants were performed by a doctor at 6, 9 and 12 months of age. Multiple regression analysis was used to identify significant explanatory variables for ETFPT. The mean age at eruption of the first primary tooth for all the infants was 6.82 ± 1.90 months. After adjustment for confounders, higher maternal childbearing age (β = 0.57; 95%CI = 0.13–1.02), female sex (β = 0.26; 95%CI = 0.07–0.52), and low birth weight (β = 0.98; 95%CI = 0.20–1.76) were significantly associated with delayed eruption of the first primary tooth, while macrosomia (β = −0.79; 95%CI = −1.30–−0.28) was significantly associated with earlier eruption of the first primary tooth. Maternal childbearing age, infant sex and infant birth weight were significant determinants of ETFPT.

Exploiting the Oral Microbiome to Prevent Tooth Decay: Has Evolution Already Provided the Best Tools?

To compete in the relatively exposed oral cavity, resident microbes must avoid being replaced by newcomers. This selective constraint, coupled with pressure on the host to cultivate a beneficial microbiome, has rendered a commensal oral microbiota that displays colonization resistance, protecting the human host from invasive species, including pathogens. Rapid increases in carbohydrate consumption have disrupted the evolved homeostasis between the oral microbiota and dental health, reflected by the high prevalence of dental caries. Development of novel modalities to prevent caries has been the subject of a breadth of research. This mini review provides highlights of these endeavors and discusses the rationale and pitfalls behind the major avenues of approach. Despite efficacy, fluoride and other broad-spectrum interventions are unlikely to further reduce the incidence of dental caries. The most promising methodologies in development are those that exploit the exclusive nature of the healthy oral microbiome. Probiotics derived from the dental plaque of healthy individuals sharply antagonize cariogenic species, such as Streptococcus mutans. Meanwhile, targeted antimicrobials allow for the killing of specific pathogens, allowing reestablishment of a healthy microbiome, presumably with its protective effects. The oral microbiota manufactures a massive array of small molecules, some of which are correlated with health and are likely to antagonize pathogens. The prohibitive cost associated with sufficiently rigorous clinical trials, and the status of dental caries as a non-life-threatening condition will likely continue to impede the advancement of new therapeutics to market. Nevertheless, there is room for optimism, as it appears evolution may have already provided the best tools.

Mixed odontogenic tumors in four young dogs: ameloblastic fibroma and ameloblastic fibro-odontoma

Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO) are mixed odontogenic tumors (odontogenic tumors with induction) that are reported only rarely in dogs. These tumors are histologically complex and, to a degree, recapitulate the early stages of tooth development, comprising 2 types of tissue: neoplastic odontogenic epithelium, and induced ectomesenchyme (dental pulp). AFOs are distinguished from AFs by the additional presence of hard dental matrices such as dentin. Herein, we describe the key diagnostic features of AF and AFO in 4 young dogs.

Stem Cells from Dental Pulp: What Epigenetics Can Do with Your Tooth

Adult stem cells have attracted scientific attention because they are able to self-renew and differentiate into several specialized cell types. In this context, human dental tissue-derived mesenchymal stem cells (hDT-MSCs) have emerged as a possible solution for repairing or regenerating damaged tissues. These cells can be isolated from primary teeth that are naturally replaced, third molars, or other dental tissues and exhibit self-renewal, a high proliferative rate and a great multilineage potential. However, the cellular and molecular mechanisms that determine lineage specification are still largely unknown. It is known that a change in cell fate requires the deletion of existing transcriptional programs, followed by the establishment of a new developmental program to give rise to a new cell lineage. Increasing evidence indicates that chromatin structure conformation can influence cell fate. In this way, reversible chemical modifications at the DNA or histone level, and combinations thereof can activate or inactivate cell-type-specific gene sequences, giving rise to an alternative cell fates. On the other hand, miRNAs are starting to emerge as a possible player in establishing particular somatic lineages. In this review, we discuss two new and promising research fields in medicine and biology, epigenetics and stem cells, by summarizing the properties of hDT-MSCs and highlighting the recent findings on epigenetic contributions to the regulation of cellular differentiation.

Potential Use of Human Periapical Cyst-Mesenchymal Stem Cells (hPCy-MSCs) as a Novel Stem Cell Source for Regenerative Medicine Applications

Mesenchymal stem cells (MSCs) are attracting growing interest by the scientific community due to their huge regenerative potential. Thus, the plasticity of MSCs strongly suggests the utilization of these cells for regenerative medicine applications. The main issue about the clinical use of MSCs is related to the complex way to obtain them from healthy tissues; this topic has encouraged scientists to search for novel and more advantageous sources of these cells in easily accessible tissues. The oral cavity hosts several cell populations expressing mesenchymal stem cell like-features, furthermore, the access to oral and dental tissues is simple and isolation of cells is very efficient. Thus, oral-derived stem cells are highly attractive for clinical purposes. In this context, human periapical cyst mesenchymal stem cells (hPCy-MSCs) exhibit characteristics similar to other dental-derived MSCs, including their extensive proliferative potential, cell surface marker profile and the ability to differentiate into various cell types such as osteoblasts, adipocytes and neurons. Importantly, hPCy-MSCs are easily collected from the surgically removed periapical cysts; this reusing of biological waste guarantees a smart source of stem cells without any impact on the surrounding healthy tissues. In this review, we report the most interesting research topics related to hPCy-MSCs with a newsworthy discussion about the future insights. This newly discovered cell population exhibits interesting and valuable potentialities that could be of high impact in the future regenerative medicine applications.

Homeobox genes and tooth development: Understanding the biological pathways and applications in regenerative dental science

OBJECTIVES

Homeobox genes are a group of conserved class of transcription factors that function as key regulators during the embryonic developmental processes. They act as master regulator for developmental genes, which involves coordinated actions of various auto and cross-regulatory mechanisms. In this review, we summarize the expression pattern of homeobox genes in relation to the tooth development and various signaling pathways or molecules contributing to the specific actions of these genes in the regulation of odontogenesis.

MATERIALS AND METHODS

An electronic search was undertaken using combination of keywords e.g. Homeobox genes, tooth development, dental diseases, stem cells, induced pluripotent stem cells, gene control region was used as search terms in PubMed and Web of Science and relevant full text articles and abstract were retrieved that were written in English. A manual hand search in text books were also carried out. Articles related to homeobox genes in dentistry and tissue engineering and regenerative medicine of odontogenesis were selected.

RESULTS

The possible perspective of stem cells technology in odontogenesis and subsequent analysis of gene correction pertaining to dental disorders through the possibility of induced pluripotent stem cells technology is also inferred.

CONCLUSIONS

We demonstrate the promising role of tissue engineering and regenerative medicine on odontogenesis, which can generate a new ray of hope in the field of dental science.

Teneurin-2 presence in rat and human odontoblasts

Teneurins are transmembrane proteins consisting of four paralogues (Ten-1-4), notably expressed in the central nervous system during development. All teneurins contain a bioactive peptide in their carboxyl terminal named teneurin C-terminal associated peptide (TCAP). The present study analyzed the detailed distribution of teneurin-2-like immunoreactive (Ten-2-LI) cells in developing and mature rat molar teeth, as well as in mature human dental pulps. Ten-2 and TCAP-2 genic expressions were also evaluated in rat and human dental pulps. Finally, Ten-2-LI cells were analyzed during the repair process after dentin-pulp complex injury in rat lower molar teeth. For this, histological sections of rat molar teeth and human dental pulps were submitted to immunohistochemical techniques, while total RNA from developing rat teeth and mature human dental pulps were submitted to conventional RT-PCR. Ten-2-LI cells were evident in the initial bell stage of rat molar teeth development, especially in ectomesenchymal cells of the dental papilla. Ten-2-LI odontoblasts showed strong immunoreactivity in rat and human mature teeth. Ten-2 and TCAP-2 genic expressions were confirmed in rat and human dental pulps. Dentin-pulp complex injury resulted in a decrease of Ten-2-LI odontoblasts after traumatic injury. Interestingly, Ten-2-LI cells were also evident in the pulp cell-rich zone in all postoperative days. In conclusion, Ten-2-LI presence in rat and human odontoblasts was demonstrated for the first time and Ten-2/TCAP-2 genic expressions were confirmed in rat and human dental pulps. Furthermore, it was revealed that Ten-2-LI rat odontoblasts can be modulated during the regenerative process.

Spatiotemporal Expression of Wnt/β-catenin Signaling during Morphogenesis and Odontogenesis of Deciduous Molar in Miniature Pig

The canonical Wnt/β-catenin signaling pathway has been shown to play essential roles in tooth initiation and early tooth development. However, the role of Wnt/β-catenin signaling in cusp patterning and crown calcification in large mammals are largely unknown. In our previous study, miniature pigs were used as the animal model due to the similarity of tooth anatomy and replacement pattern between miniature pig and human. Dynamic gene expression of third deciduous molar (DM3) in miniature pig at early stages was profiled using microarray method and expression of Wnt genes was significantly correlate with odontogenesis. In the present study, dynamic expression patterns of Wnt/β-catenin signaling genes of DM3 at cap, early bell and late bell (secretory) stage were identified. We found that Lef1 and Axin2 were expressed in the enamel knot and underlying mesenchyme regions. Meanwhile, Dkk1 was expressed in the peripheral and lower parts of dental papilla, thus forming the potential Wnt signaling gradient. We also found that β-Catenin, Axin2 and Lef1 were expressed strongly in undifferentiated cells of the inner enamel epithelium (IEE), but weakly in differentiated ameloblasts. Furthermore, we found that both Wnt signaling read-out gene Lef1 and the inhibitor Dkk1 were co-expressed in the pre-odontoblasts. In conclusion, the spatiotemporal distribution and potential gradient of Wnt signaling may contribute to cusp patterning and crown calcification. These data may yield insight into future study of precise control of crown morphogenesis and regeneration in large mammals.

Multiple talon cusps on maxillary central incisor: A case report

Dental anomalies affecting the teeth are relatively common. Simultaneous occurrence of multiple dental abnormalities in a single tooth is uncommon and relatively rare. One such abnormality routinely encountered in dental clinics is the talon cusp. It is also referred to as dens evaginatus, characterized by the presence of an accessory cusp-like structure projecting from the cingulum of anterior teeth. It has an increased predilection for maxillary teeth and permanent dentition. Although numerous cases of talon cusp have been reported in the literature, occurrence of multiple talon cusps in maxillary central incisors has not been found in the literature. This case report highlights the presence of talon cusps in maxillary anterior teeth with multiple impacted supernumerary teeth.