Scrna-Seq And Treatment Of A Patient With Multifocal Itr

This case report described a rare case of multiple anterior teeth with multifocal internal tooth resorption (ITR) accompanied with amelogenesis imperfecta. The underlying pathological mechanisms was explored through single-cell sequencing (scRNA-seq) of the affected pulps. A 12-year-old boy presented with pinkish discoloration of the teeth without dental trauma or orthodontic treatment history, but underwent cholesteatoma surgery. Clinical examination revealed generalised yellowish-brown tooth crown discoloration with partial enamel defects and a grade-three debris index. The upper anterior teeth exhibited pinkish discoloration. Radiographic examination revealed oval radiolucent areas within multiple anterior teeth pulp chambers. The preliminary diagnosis of “multiple ITR with amelogenesis imperfecta” was made. The affected teeth were conducted root canal therapy with no further resorption during the 6-month follow-up. Diseased pulp scRNA-seq revealed increased stromal cell proportions compared to healthy controls, with upregulation of inflammatory and endoplasmic reticulum stress (ERS) pathway. Cell communication analysis revealed enhanced interactions between stromal and immune cells. ITR typically involves a single tooth. However, this patient presented with multifocal ITR. The underlying aetiology might involve defective enamel formation, leading to dentinal tubule exposure. Coupled with poor oral hygiene, bacteria likely infiltrated the pulp, resulting in pulpal infection and multifocal ITR. scRNA-seq revealed that immune cells might induce stromal cell-related ERS, exacerbating the inflammatory cascade and promoting ITR progression. Complicated multifocal ITR might be associated with anomalies of tooth structure, and immune cell-mediated ERS in stromal cells was a potential mechanism underlying ITR progression.