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Enamelin Directs Crystallite Organization at the Enamel-Dentine Junction

Enamel is an acellular material formed by the intricate process of amelogenesis. Disruption caused at the initial stages of development, by means of mutations in the ENAM gene encoding the enamelin protein, results in enamel hypoplasia. Little is known about the consequence of ENAM mutation on the enamel structure at a crystallographic level. The aim of this study was to characterize the structure of ENAM-mutated enamel to develop a deeper understanding of the role of enamelin protein during formation with regard to crystal organization. Synchrotron X-ray microdiffraction (SXRD) and scanning electron microscopy (SEM) have been used to measure and correlate enamel crystallography and microstructure in hypoplastic and healthy enamel. Rietveld refinement carried out on 2-dimensional diffraction patterns, collected from the Advanced Photon Source, were used to quantify changes in the preferred orientation (crystallographic texture) within the labial regions of each tooth slice and then correlated with the local microstructure. In general, healthy deciduous incisors displayed a higher degree of crystal organization across the labial surface in comparison with the hypoplastic enamel. ENAM plays the greatest functional role at the enamel-dentine junction (EDJ), as it was the region that exhibited lowest texture relative to unaffected controls. Other areas within the tooth, however, such as the cusp tip, displayed greater organization in line with healthy enamel, suggesting its effects are restricted to the early stages of enamel secretion. Observed clinically, the surface of ENAM-mutated hypoplastic enamel can appear to be normal, yet severe sub-nano and microstructural defects appear beneath the subsurface layer. Quantitative characterization of the crystallographic properties from enamel with known genotype expands the understanding of enamel formation processes and can aid better clinical diagnosis and tailor-made treatment.