Abstract

ObjectivesTo understand the pathology of the ultrastructure of enamel affected by systemic disorders which disrupt enamel tissue formation in order to give insight into the precise mechanisms of matrix-mediated biomineralization in dental enamel in health and disease. MethodsTwo-dimensional synchrotron X-ray diffraction has been utilized as a sophisticated and useful technique to spatially quantify preferred orientation in mineralized healthy deciduous dental enamel, and the disrupted crystallite organization in enamel affected by a systemic disease affecting bone and dental mineralization (mucopolysaccharidosis Type IVA and Type II are used as examples). The lattice spacing of the hydroxyapatite phase, the crystallite size and aspect ratio, and the quantified preferred orientation of crystallites across whole intact tooth sections, have been determined using synchrotron microdiffraction. ResultsSignificant differences in mineral crystallite orientation distribution of affected enamel have been observed compared to healthy mineralized tissue. The gradation of enamel crystal orientation seen in healthy tissue is absent in the affected enamel, indicating a continual disruption in the crystallite alignment during mineral formation. ConclusionsThis state of the art technique has the potential to provide a unique insight into the mechanisms leading to deranged enamel formation in a wide range of disease states. Clinical relevanceCharacterising crystal orientation patterns and geometry in health and following disruption can be a powerful tool in advancing our overall understanding of mechanisms leading to the tissue phenotypes seen clinically. Findings can be used to inform the appropriate dental management of these tissues and/or to investigate the influence of therapeutic interventions or external stressors which may impact on amelogenesis.

Highlights

  • Diseases associated with mineralization defects are frequently investigated using structural characterisation of affected hard tissues to complement an existing understanding of disease pathogenesis informed by cellular and molecular studies

  • Characterising crystal orientation patterns and geometry in health and following disruption can become a powerful tool advancing our overall understanding of mechanisms leading to phenotypic expression

  • We have reported a similar trend in the past in the permanent dentition, where we observed that HA crystallites are most aligned in the cuspal regions, whilst along sides of the tooth away from the cusps and deeper into the enamel, crystallites are less ordered, likely due to the convolution of prism directions which occurs towards the amelodentinal junction (ADJ).[9,26]

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Summary

Introduction

Diseases associated with mineralization defects are frequently investigated using structural characterisation of affected hard tissues to complement an existing understanding of disease pathogenesis informed by cellular and molecular studies. Characterising crystal orientation patterns and geometry in health and following disruption can become a powerful tool advancing our overall understanding of mechanisms leading to phenotypic expression. More importantly dental enamel is highly mineralized and it’s unique hierarchical structure forms incrementally over extended time periods with individual teeth mineralizing in 4–5 years. Disruption in crystallographic features of dental enamel due to disease progression or therapeutic intervention can be closely correlated with event time points

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