• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.2
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• pp.73-81
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• 2013

Purpose: Smad4 is a central mediator for transforming growth factor-${\beta}$/bone morphogenetic protein ($TGF-{\beta}/BMP$) signals, which are involved in regulating cranial neural crest cell formation, migration, proliferation, and fate determination. Accumulated evidences indicate that $TGF-{\beta}/BMP$ signaling plays key roles in the early tooth morphogenesis. However, their roles in the late tooth formation, such as cellular differentiation and matrix formation are not clearly understood. The objective of this study is to understand the roles of Smad4 in vivo during enamel and dentin formation through tissue-specific inactivation of Smad4. Methods: We generated and analyzed mice with dental epithelium-specific inactivation of the Smad4 gene (K14-Cre:$Smad4^{fl/fl}$) and dental mesenchyme-specific inactivation of Smad4 gene (Osr2Ires-Cre:$Smad4^{fl/fl}$). Results: In the tooth germs of K14-Cre:$Smad4^{fl/fl}$, ameloblast differentiation was not detectable in inner enamel epithelial cells, however, dentin-like structure was formed in dental mesenchymal cells. In the tooth germs of Osr2Ires-Cre:$Smad4^{fl/fl}$ mice, ameloblasts were normally differentiated from inner enamel epithelial cells. Interestingly, we found that bone-like structures, with cellular inclusion, were formed in the dentin region of Osr2Ires-Cre:$Smad4^{fl/fl}$ mice. Conclusion: Taken together, our study demonstrates that Smad4 plays a crucial role in regulating ameloblast and odontoblast differentiation, as well as in regulating epithelial-mesenchymal interactions during tooth development.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.2
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• pp.333-338
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• 2008

Supernumerary teeth are characterized by an excess number of teeth, which can be responsible for a variety of irregularities in the primary and transitional dentition. Supernumerary teeth, especially in the maxillary anterior region, may prevent the eruption of adjacent permanent teeth and cause their ectopic eruption, diastema, root resorption, or formation of dentigerous cyst. Therefore, early diagnosis of supernumerary teeth is important for prevention of such complications, and adequate treatment should be given according to their location, number, and morphologic features. In this case, four supernumerary teeth in the maxillary anterior region were disturbing the eruption of adjacent permanent incisors. Two of them were located in proximity to the central incisor tooth germs that their immediate removal may injure the permanent tooth germs. In order to minimize such complications, surgical extraction of the four supernumerary teeth was performed in two stages. At first, only two inverted conical supernumerary teeth were extracted. The other two tuberculous supernumerary teeth, close to the permanent tooth germs, were extracted later after their natural dislocation. In that way, we could minimize affects on the neighboring permanent tooth germs and also the amount of alveolar bone removed during surgery.

• The korean journal of orthodontics
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• v.47 no.6
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• pp.384-393
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• 2017

Fusion of teeth is a developmental anomaly. It occurs at the stage of tooth formation, which determines the shape and size of the tooth crown, when one or more teeth fuse at the dentin level during the morphodifferentiation of the dental germs. Such teeth show macrodontia and may cause crowding, as well as esthetic and endodontic problems. In this article, we report a rare case of a maxillary central incisor fused to a supernumerary tooth showing labial and palatal talon cusps, which was orthodontically moved across the midpalatal suture. A 13-year-old Caucasian boy sought treatment for the unesthetic appearance of his maxillary central incisor and anterior crowding. He was rehabilitated successfully via a multidisciplinary approach involving orthodontic, nonsurgical endodontic, periodontal, and prosthodontic treatments. After a 26-month treatment period, the patient's macroesthetics and microesthetics were improved. The overall improvement of this macrodontic tooth and its surrounding tissues through multidisciplinary treatment was documented using cone-beam computed tomography.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.4
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• pp.722-727
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• 2006

Most of impacted teeth reported are permanent teeth. Impaction of primary tooth caused by primary failure of eruption is rare and the most of impacted primary tooth are second primary molars. The etiology of a primary molar impaction would appear to be a physical barrier, early ankylosis of the tooth, abnormal development of the primary molar germ or malposition of the successor bud. Transposition has been described as an interchange in the position of two teeth within the same quadrant of the dental arch. It is most commonly seen with canine and lateral incisor teeth, but is rarely associated with the primary dentition. The two cases show the transposition of impacted primary molar and the tooth germ of second premolar in their clinical and radiographic examinations. In case 1, lower second primary molar was deeply impacted inferiorly to the tooth germ suspected to be a second premolar. In case 2, impacted all second primary molars were positioned inferiorly to the tooth germs suspected to be the successors. We extracted all second primary molars under general anesthesia and the extracted tooth germs appeared to be second premolars.

• Imaging Science in Dentistry
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• v.46 no.1
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• pp.57-62
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• 2016

Fusion is an abnormality of tooth development defined as the union of two developing dental germs, resulting in a single large dental structure. This irregular tooth morphology is associated with a high predisposition to dental caries and periodontal diseases. As a result of recurring inflammatory periodontal processes, disorders such as periodontal pocket, pericoronitis, and paradental cysts may develop. A rare mandibular anatomic variation is the retromolar canal, which is very significant for surgical procedures. The fusion of a paramolar and mandibular third molar associated with a paradental cyst co-occurring with the presence of a retromolar canal is rare, and the aim of the present study is to describe the evaluation of this anatomical configuration using cone-beam computed tomography.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.10 no.1
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• pp.22-25
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• 2014

Fibrous dysplasia(FD) is a benign fibro-ossifying disease in which fibrous tissue replaces normal bone and marrow. Craniofacial bones, including the maxilla and mandible, are commonly involved. A 7 year-old girl visited the clinic with a chief complaint of gingival swelling around the lower left primary molar. Mild bulging of the lower left periodontal tissue was observed. Not only the mandible, but also the maxilla, zygoma, sphenoid, and temporal bones were affected by FD. Permanent tooth germs were involved in the lesions and facial asymmetry was caused by lower left bone expansion. She was scheduled for a follow-up visit at the department of pediatric dentistry and oromaxillofacial surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.25 no.4
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• pp.311-323
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• 1999

The osteonectin is a sort of glycoprotein which is secreted in human tissues. The osteonectin is generally detected in number of normal or neoplastic human tissues in vivo, but hasn't been studied the role of osteonectin in developing human teeth and odontogenic tumors. We evaluated degree of the expression of osteonectin immunohistochemically in 20 cases of developing tooth germ which growth from fetus 5 to 38 weeks, and total 51 odontogenic tumors whitch has taken from routine biopsy, such as 10 ameloblastomas, 5 cases of adenomatoid odontogenic tumors and odontomas and odontogenic fibromas, 4 cases of cementomas and calcifying epithelial odontogenic cyst and odontogenic keratocyst and dentigerous cysts and periapical cysts, and 3 cases of ameloblastic fibromas and myxomas. The results were as follows: 1. The osteonectin on the bud stage of tooth germ was strongly expressed in the epithelial dental lamina and in the outer dental epithelium on the early bell stage, and also strongly expressed in the inner dental epithelium on the late bell stage of tooth germs. 2. In ameloblastoma, the osteonectin was strongly expressed in the epithelial tumor component and especially in the acanthomatous types. 3. In both of calcifying epithelial odontogenic tumor and adenomatoid odontogenic tumors, the osteonectin was moderately expressed on the duct like spindle cells and epithelial tumor cells around calcification areas. 4. In odontogenic tumors originated from epithelial-mesenchymal tissues, the osteonectin was moderately expressed on the epithelial tumor components and in odontogenic cysts, it was expressed in ghost cells and calcification areas only. These were summaried the osteonectin may be strongly related to the developing tooth germ and odontogenic tumors and could be regulated hard tissue of human tooth in morphogenesis and involved with calcification mechanism in development odontogenic tumors.

• Imaging Science in Dentistry
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• v.30 no.3
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• pp.169-181
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• 2000

Purpose: To investigate the expression of bone morphogenetic protein (BMP)-2/4 during eary tooth development after irradiation and calcium-deficient diet. Materials and Methods: The pregnant three-week-old Sprague-Dawley rats were used for the study. The control group was non-irradiation/normal diet group (Group 1), and the experimental groups were irradiation/normal diet group (Group 2) and irradiation/calcium-deficient diet group (Group 3). The abdomen of the rats at the 9th day of pregnancy were irradiated with single dose of 350 cGy. The rat pups were sacrificed at embryonic 18 days, 3 days and 14 days after delivery and the maxillae tooth germs were taken. The tissue sections of specimen were stained immunohisto-chemically with anti-BMP-2/4 antibody. Results: At embryo-18 days, immunoreacivity for BMP-2/4 of the Group 1 was modetate in stratum intermedium of dental organ and weak in dental papilla and dental follicle, but that of Group 2 was weak in cell layer of dental organ, and no immunoreacivity was shown in dental papilla and dental follice of Group 2 and in all tissue components of the Group 3. At postnatal-3 days, immunoreacivity for BMP-2/4 of the Group 1 was strong in cell layer of dental organ, odontoblasts and developing alveolar bone, but that of Group of 2 and Group 3 was weak in odontoblasts and developing alveolar bone. At postnatal-14 days, immunoreacivity for BMP-2/4 of the Group 1 was strong in newly formed cementum, alveolar bone and odontoblasts, but that of Group 2 was weaker than that of Group 1. In the Group 3, tooth forming cell layer showed weak immunoreactivity, but other cell layers showed no immunoreactivity. Couclusion : The expression of bone morphogenetic protein (BMP)-2/4 during early tooth development was disturbed after irradiation and calcium-deficient diet.

• Imaging Science in Dentistry
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• v.30 no.3
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• pp.159-168
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• 2000

Purpose: To elucidate the effects of the irradiation and calcium-deficient diet on expression of interleukin (IL)-1 during tooth formation of rat molar. Materials and Methods: The pregnant three-week-old Spague-Dawley rats were used for the study. The control group was non-irradiation/normal diet group, and the experimental groups were irradiation/normal diet group and irradiation/calcium-deficient diet group. The abdomen of the rats on the 9th day of pregnancy were irradiated with single dose of 350 cGy, The rat pups were sacrificed on the 14th day after delivery and the maxillae tooth germs were taken. The specimen were prepared to make sections for light microscopy, and some of tissue sections were stained immunohistochemically with anti-IL-l antibody. Results: In the irradiation/normal diet group, dental follicle showed fewer blood vessels, mononuclear cells, and fusions of mononuclear cells than in non-irradiation/normal diet group. Alveolar bone showed a few osteoblasts and osteoclasts. Periodontal ligament showed collagen fibers and fibroblasts with irregularity. Weak immunoreactivity for IL-l was shown in dental follicle, alveolar bone, and periodontal ligament. In the irradiation/calcium-deficient diet group, dental follicle showed sparse cellularity. Alveolar bone showed diminished number of osteoblasts. Periodontal ligament showed irregular collagen fibers and atrophy of cementoblasts and fibroblasts. No immunoreactivity for IL-1 was shown in dental follicle, alveolar bone, and periodontal ligament. Conclusion: Irradiation and calcium-deficient diet seems to cause disturbance of the expression of interleukin-l during tooth formation of rat molar.

• Proceedings of the KACD Conference
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• 2001.05a
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• pp.247-251
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• 2001

;A dental developmental anomaly is defined as an isolated aberration in tooth form, caused by a disturbance or abnormality which occurred during tooth development. There are numerous types of dental anomalies, and a considerable variation in the extent of the defects occurs with each type. Teeth with these anomalies pose unique challenges. Since the defects are not always apparent clinically, they can confuse diagnosticians investigating the etiology of pulpal pathosis. When endodontic treatment is required, the defects often hinder access cavity preparation and canal instrumentation. Treatment planning also becomes more challenging, since the defects can create complicated periodontal problems, and the malformed teeth can be difficult to restore, particularly those weakened by endodontic therapy. Fusion is defined as the joining of two developing tooth germs resulting in a single large tooth structure. The incidence of fusion is < 1% in the Caucasian population, and it is believed that physical force or pressure produces contact of the developing teeth. Clinically and radiographically, a fused tooth usually appears as one large crown with at least partially separated roots and root canals. There may be a vertical groove in the tooth crown delineating the originally separate crowns. Dens invaginatus is a deep surface invagination of the crown or root that is lined by enamel. Teeth in both maxillary and mandibular arches may be affected, but the permanent maxillary lateral incisor is the tooth most commonly involved. Studies have revealed an incidence ranging from 0.25% to as high as 10%. The invagination ranges from a slight pitting to an anomaly occupying most of the crown and root. The invagination frequently communicates with the oral cavity, allowing the entry of irritants and microorganism either directly into pulpal tissues or into an area that is deparated from pulpal tissues by only a thin layer of enamel and dentin. This continuous ingress of irritants and the subsequent inflammation usually lead to necrosis of the adjacent pulp tissue and then to periapical or periodontal abscesses. If the invagination extends from the crown to the periradicular tissue and has no communication with the root canal system, the pulp may remain vital. Recommended treatment of fused tooth and dens invaginatus has been reported in the endodontic literature. This case report describes the endodontic treatment of a maxillary laterl incisors having fused crown and dens invaginatus.natus.