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Concept: Permanent teeth


BACKGROUND: Cleidocranial dysplasia (CCD) is a rare congenital autosomal dominant skeletal disorder. The disorder is caused by heterozygosity of mutations in human RUNX2, which is present on the short arm of chromosome 6p21. The incidence of CCD is one per million births. CCD appears spontaneously with no apparent genetic cause in approximately 40% of affected patients, and one in three patients has unaffected parents. The most prevalent features associated with CCD are aplastic or hypoplastic clavicles, supernumerary teeth, failed eruption of permanent teeth, and a hypoplastic maxilla. CASE PRESENTATION: A 13-year-old Caucasian boy presented with a chief complaint of delayed eruption of the permanent anterior teeth. The patient was subsequently diagnosed with CCD based on the clinical examination, panoramic X-ray, anterior-posterior and lateral cephalogram, and chest radiograph findings. The details of this case are herein reported because of the extremely low incidence of this disorder. CONCLUSIONS: CCD is of clinical importance in dentistry and medicine because it affects the bones and teeth and is characterized by many changes in skeletal patterning and growth. Particularly in dentistry, CCD is of great clinical significance because is associated with delayed ossification of the skull sutures, delayed exfoliation of the primary teeth, lack of permanent teeth eruption, multiple supernumerary teeth, and morphological abnormalities of the maxilla and mandible. Patients with CCD seek treatment mainly for dental problems. Knowledge of the pathogenesis, clinical characteristics, and diagnostic tools of CCD will enable clinicians to render the appropriate treatment to improve function and aesthetics. Early diagnosis of CCD is crucial for timely initiation of an appropriate treatment approach.

Concepts: Medical terms, Medical statistics, Chromosome, Teeth, Hyperdontia, Dental anatomy, Cleidocranial dysostosis, Permanent teeth


- Primary tooth impaction is a rare phenomenon when compared to permanent teeth impaction. The purpose of this report is to present a 5-year-old Chinese girl who exhibited impaction of tooth 51, its unusual consequence on the permanent successor tooth and its comprehensive management. Her parents revealed that at 6 months of age, the patient had fallen from her bed and struck her face on the floor; however, there were no teeth present in the oral cavity. The intraoral examinations identified a bony-like projection on the buccal aspect of the alveolus in the 51 region. Radiographic examination revealed that tooth 51 exhibited an unfavourable orientation, with the crown directed towards the palate. Therefore, the impacted tooth 51 was surgically removed, and two years later tooth 11 erupted into the oral cavity with an indentation on its incisal aspect, which resembled the crown of the primary teeth, thus giving the appearance of a tooth within a tooth or ‘dens in dente’. Subsequently, enameloplasty and composite resin build-up was performed on tooth 11 for aesthetic reasons. It is very unusual to have the clinical crowns of both primary and permanent teeth in such close proximity within the alveolar bone, and the present case is a good example to emphasize that trauma to the primary teeth is of considerable importance due to the close proximity of the primary teeth to permanent tooth germs.

Concepts: Teeth, Incisor, Maxillary central incisor, Canine tooth, Maxillary lateral incisor, Deciduous teeth, Permanent teeth


The trace elements distribution embedded in tooth enamel offers a means to study exposure of toxic metals and allows the reconstruction of dietary behaviors. The quantification of most of the elements with a spatial high resolution (~50μm) is routinely achieved using laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS). However, the lack of a comprehensive framework of trace elements distribution in enamel jeopardizes any endorsed sampling strategy using LA-ICPMS. The present work is an effort to improve our knowledge on this issue. We studied a suite of 22 sectioned teeth with known dietary history, including 12 3rd molars from 12 living individuals and 10 primary teeth from 3 living individuals. Using LA-ICPMS, we measured Ca, Cu, Zn, Ni, Sr, Ba and Pb variations along 2 or 3 rasters from cervical to occlusal enamel. Calcium concentrations are lower in primary than in permanent teeth and do not vary spatially within a tooth suggesting that enamel matures homogeneously before eruption. The Pb/Ca ratio does not vary within tooth enamel and between primary and permanent tooth enamel. The Cu/Ca and Ni/Ca ratios do not vary within tooth enamel but discriminate primary from permanent tooth enamel. The Zn/Ca ratios are higher in permanent than in primary tooth enamel, and increase up to an order of magnitude in the last hundred of microns at the enamel surface. The Sr/Ca and Ba/Ca ratios are higher in permanent than in primary tooth enamel, and decrease from the enamel-dentine junction towards outer enamel in permanent but not in primary tooth enamel. Considering the Ca-normalized intra-tooth variations of Zn, Sr and Ba, we recommend to perform laser ablation rasters along the enamel-dentine junction because this area is likely to retain most of the original and complete chemical information related to individual’s life.

Concepts: Ratio, Teeth, Tooth development, Tooth enamel, Deciduous teeth, The Elements, Permanent teeth, Dentistry subjects


The results in human sex chromosome aneuploidies had shown that the extra Y chromosome increases permanent and deciduous tooth crown sizes in the mesiodistal and labiolingual directions. The hypothesis of the study was that the additional Y chromosome increases the permanent tooth crown growth in a vertical dimension. We also aimed to observe possible sex difference in the permanent tooth crown height.

Concepts: Human, Male, Chromosome, Sex, Teeth, Sex-determination system, Deciduous teeth, Permanent teeth


The origin and dispersion of the first Americans have been extensively investigated from morphological and genetic perspectives, but few studies have focused on their health and lifestyle. The archaeological site of Lapa do Santo, central-eastern Brazil, has exceptionally preserved Early Holocene human skeletons, providing 19 individuals with 327 permanent and 122 deciduous teeth dated to 9,250 to 7,500 years BP. In this study, we test whether the inhabitants of Lapa do Santo had high prevalence of dental caries as previous studies of Lagoa Santa collection have indicated, using individual and tooth as units of analyses. The results show a high prevalence of dental caries in the permanent dentition (5.50%, n=327 teeth; 69.23%, n=13 individuals) compared to other samples of hunter-gatherers worldwide. In addition, dental caries in deciduous teeth start occurring as early as 3 to 4 years old, suggesting an early start to caries. Compared with other samples from Lagoa Santa, Lapa do Santo shows statistically similar prevalence of overall caries but different caries location pattern. We believe that a subsistence adaptation to a tropical environment rich in sources of carbohydrates, such as fruits, is the best explanation for the overall caries prevalence.

Concepts: Lactic acid, Teeth, Tooth development, Dental caries, Minas Gerais, Tooth fairy, Deciduous teeth, Permanent teeth


The delivery-related neonatal line (NNL) appears into the enamel of primary teeth and first permanent molars at birth and is a marker of live birth process. It varies in width and its location, is different in each deciduous tooth type, and is indicative of gestation time. It is unclear which triggers determine NNL at birth. Our objective was to investigate the effect of the duration and mode of delivery on NNL width. NNL of 129 teeth, a collection derived from a long-term, prospectively followed population cohort, was measured under light microscope. Altogether, 54 sections with most optimal plane of sectioning were analysed for the duration and mode of delivery. NNL was detected in 98% of the deciduous teeth with the median width of 9.63μm (min 3.16μm, max 27.58μm). A prolonged duration of vaginal delivery was highly significantly associated with a narrower NNL (r=-0.41, p=0.0097). No significant association was found between the width of NNL and mode of delivery (p=0.36). NNL is demonstrable in virtually all deciduous teeth. The width seems to be inversely proportional to the duration of delivery. Causes of the inverse proportion are speculated to result from altered amelogenesis induced by prolonged and intensified delivery-associated stress. Further research is needed to clarify the underlying mechanisms.

Concepts: Childbirth, Head and neck anatomy, Teeth, Tooth development, Canine tooth, Tooth fairy, Deciduous teeth, Permanent teeth


Gingivitis commonly progresses to periodontitis in permanent dentition but rarely in deciduous teeth. Little is known about the biochemical differences between gingiva of deciduous and permanent teeth. Here we compared the protein profiles of gingival crevicular fluids (GCF) from the gingiva of deciduous and permanent teeth.

Concepts: Gingiva, Teeth, Periodontitis, Periodontal disease, Gingivitis, Deciduous teeth, Permanent teeth, Dentistry subjects


This study aimed to provide, for a Jordanian population, the first norms of the faciolingual diameters of the permanent dentition and the mesiodistal diameters of the second molars and to provide and review previously published data on the mesiodistal diameters of the permanent teeth up to the first molars in order to investigate any secular trends.

Concepts: Teeth, Permanent teeth


The differences in genetic backgrounds between deciduous and permanent teeth might contribute to the differences in developmental processes, histological characteristics, and tooth life cycles. Here, we attempted to identify significantly different modules between permanent and deciduous teeth via network and pathway analyses. We identified 291 differentially expressed genes (DEGs) between permanent and deciduous teeth using significance analysis of microarray methods. Co-expression networks of DEGs were constructed by weighted gene co-expression network analysis (WGCNA). Three pathways with a significant number of DEGs and P value <0.01 were identified. Integrated co-expression network and pathway (pathway and adjacent gene) analyses were used to extract three pathway-related modules: the calcium signaling pathway-related, ECM-receptor interaction pathway-related, and neuroactive ligand-receptor interaction pathway-related modules. We also attempted to analyze the topological centralities (degree, closeness, stress, and betweenness) of co-expression networks and modules. Four genes (TMEM229A, PPAPDC1A, LEPREL1, and GAD1) and three pathway-related modules that were significantly different in the deciduous and permanent teeth showed similar properties and good centralities. The relative expression levels of key genes were validated, and the differential expression of TMEM229A, LEPREL1, and GAD1 was confirmed by reverse transcription-polymerase chain reaction (P < 0.05). In conclusion, the results of this study may provide a greater understanding of the molecular pathogenesis and potential biomarkers of the progression from deciduous to permanent teeth.

Concepts: DNA, Gene, Genetics, Gene expression, Teeth, Tooth fairy, Deciduous teeth, Permanent teeth


Bisphosphonates have established their role as medical therapy for pediatric osteogenesis imperfecta (OI) patients. Since bisphosphonates have also been shown to delay tooth development in animal models, we aimed to assess whether the medication has a similar effect on children with OI. In this cross-sectional study, bisphosphonate-treated OI patients of whom dental panoramic tomograph was taken between 3 and 16years of age formed the study group. The patients, 22 in total, had been treated with pamidronate, zoledronic acid or risedronate for at least one year before the radiography. Developmental stage of the permanent teeth, resorption of the deciduous teeth, and number of the erupted permanent teeth were radiographically assessed in the left mandibular quadrant. Dental panoramic tomographs of 50 OI patients, naïve to bisphosphonates, and of 50 healthy individuals of the same age were used as controls. The dental development was statistically significantly accelerated in the OI group naïve to bisphosphonates showing median advancement of dental age by 0.63years from chronological age and median increase in the number of erupted teeth by 0.31 as compared to Finnish norms. Bisphosphonate-treated OI patients displayed, however, age-appropriate dental development. The OI patients not treated with bisphosphonates also showed statistically significantly faster resorption of the deciduous teeth than the treated ones, and displayed an altered interrelationship between the resorption stage of an individual primary tooth and the developmental stage of the succedaneous permanent tooth, unlike the OI patients treated with bisphosphonate. No correlation between either cumulative bisphosphonate dose or between treatment length and any measured component of the dental development was found. To conclude, OI itself was found to lead to advanced dental development. Bisphosphonate treatment had a delaying effect in all the three aspects studied, resulting in a rate of dental development indistinguishable from normal.

Concepts: Osteoporosis, Bisphosphonates, Multiple myeloma, Teeth, Tooth development, Osteogenesis imperfecta, Deciduous teeth, Permanent teeth