Notes:

This is the 1st part of 29/2 lecture, the 2nd part will be done by my friend ahmad assla7y. The doctor was reading from the slides a lot, so I'll include all the slides in the script, so you don't have to go back to the slides unless u want to see the pictures or to read it as outline. The last part from the 2nd lecture slides (22/2 lecture) will be in the 2nd part of this script. The words in Arabic are just translation and it doesn't contain any new information. Because I think it's important to look at the pictures to understand this lecture completely (specially the one in the 4th slide) I modified that pictures and put it in this script, if it's not clear for u in the hard copy u can download the soft copy of the script from the group in Facebook. The DR wasn't separating between the different topics of the lecture so I tried my best to make good headlines.

Let's go:

AMELOGENESIS Introduction
AMELOGENESIS: is the process by which the tooth secretes enamel (the process of enamel formation, amelo means enamel, genesis means formation). Last time we talked about some kind of interaction between enamel organ and the ectomesenchymal tissue, and this interaction leads to development or the secretion of the dental hard tissues. Internal Enamel Epithelium (IEE) deposits and later on modifies Enamel, so the cells that are responsible for enamel formation are the Internal Enamel Epithelial cells, if u remember we said we have 4 different cells in enamel organ, and these cells were: The Internal Enamel Epithelial cells, External Enamel Epithelial EEE, Stellate Reticulum SR cells, Stratum Intermedium cells. *Let us discus them in details: 1- The Internal Enamel Epithelial cells (which line the concavity of enamel
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organ) these cells are very important because these cells are the one responsible for the development or the secretion of enamel. 2-External Enamel Epithelial EEE (that are located at the periphery of the enamel organ) and they secret the structures inside the enamel organ from the outside surrounding , that's why enamel organ is avascular, this means that no blood vessel are allowed to inter or get inside the enamel organ and this means that the hydrostatic pressure inside enamel organ should be equal to the area below the enamel organ which is the dental papilla area, and this equilibrium between hydrostatic pressure between the two sides of the enamel epithelial cells is very important to maintain the three dimensional shape of tooth. If u remember we said that if the hydrostatic pressure of the dental papilla more than the hydrostatic pressure of inside of enamel organ, the tooth will swell and the crown of the tooth will look like hemispherical (.) So what keeps the shape (the very detailed shape) of the tooth is the equilibrium between hydrostatic pressure inside enamel organ and outside enamel organ. So an important function of the external enamel epithelium is to prevent the blood vesselsfrom getting inside and this is important to establish this equilibrium. 3- Stellate Reticulum SR cells: these cells are Specialized cells within enamel organand they are star like cells, they are important because they are located in amorphous (( environment, this amorphous environment also protects the hydrostatic pressure inside enamel organ. So why do we have the stellate reticulum in the form of star or stellate like cells? Because it's important that these cells pass the nutrients and oxygen to the other cells (to the whole area of enamel organ). We said enamel organ is derived from ectoderm, that's why enamel is ectodermal in its origin, however the rest of the tooth structure (dentin, dental pulp, cementum, periodontal ligament and alveolar bone) isn't from ectoderm but it's from the ectomesenchyme, and remember we said ectomesenchyme is from neural crest cells, so that's why they are called ecto-mesenchyme cause
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they are originally from the ectoderm at the periphery of the neural plate but they migrate and become distributed within the mesoderm (mesenchyme is the mesoderm). 4- Stratum Intermedium cells. Very important note: this introduction at least there will be 5 questions from it in the exam, so be careful when u answer the questions. So the Internal Enamel Epithelial cells deposits and later on it modifies enamel, the rest of enamel organ components play incompletely understood but important function or role in AMELOGENESIS. So the rest of the cells (including Stratum Intermedium, Stellate Reticulum and External Enamel Epithelium) we still don't know a lot of things about these cells but remember again about the other 3 types: - External Enamel Epithelium: are located at the periphery of the enamel organ and so that's why they are important in passing the nutrients and oxygen to the other cells, and function in maintaining the shape of the tooth (however what actually passes the nutrient to the other cells is the Stellate Reticulum). - Stellate Reticulum: looks like network of cells so it's easy to pass the nutrient to other cells, and are important in maintaining the hydrostatic pressure inside enamel organ. (The DR said in example that (EEE) is the one that allow the nutrient to pass and the SR cells are the one that distribute it). - Stratum Intermedium these cells are located just in contact with External Enamel Epithelium so they have very important role supporting the protein synthesis in IEE in order to deposit enamel, so Stratum Intermedium is very important in Amelogensis, but it's not like other cells.

Enamel Formation
Different regions of IEE will be at different stages of enamel-forming process, this means if we find a group of cells at the cusp tip or the incisal edge of the tooth active in producing enamel, this doesn't mean that all the cells will be
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active in producing enamel at different regions of the crown (that means that it's there may be cells that produce enamel in some region and in another region the cells may haven't even differentiated, and this is normal because enamel and dentine development do not occur at the same time at different regions of the tooth). The 1st areas that where enamel formation and also dentine formation is the cusp tip and the incisal edge and the last region is the cervical of the tooth (so the most recent enamel is enamel located near the cervical line and the oldest one is underneath the cusps). (Internal enamel epithelial cells will become ameloblast so one's it's fully differentiated it's now called ameloblast and it will start depositing enamel). So I if I asked in the exam: Internal enamel epithelial cells directly deposits enamel true or false? False, coz ameloblast is the one that directly deposits enamel, so be careful. When we say enamel is completed that means the crown is completed, so: Crown completion is defined as: when the total amount of enamel is deposited. By the time enamel is completed each ameloblast have completed the same life cycle, so each ameloblast have a life cycle and it passes through different stages and we'll discuss these stages (so all of them will pass through these stages but it's not necessary that we'll have simultaneous growth between two different ameloblast). In animals that have continuous teeth growth (Rodents )their teeth is in continuous growth or formation, not like many mammals coz in our teeth once the root is completed there will be no tooth development , amelogensis is present throughout the animals life, so why do it need continuous amelogensis? Coz their teeth is always subjected to erosion or friction and this lead to tooth material lose, so if there is no continuous amelogensis it will lose its teeth quickly, so in many mammals if we lose enamel it's will not be replaced.

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Life cycle of ameloblast

Note :(pay attention that this stages is form ameloblast development Not enamel development). ameloblast development takes place in 5 stages, and these are: 1-Presecretory stage: which is the stage before the secretion of enamel. 2-Secretory stage: the stage in which enamel is deposited. 3-Transition stage: between secretory and maturation. 4-Maturation stage: in this stage enamel will be mature (and this means when enamel is secreted it will not be mature) maturity here means the maturity of the structure of enamel, coz the mature enamel must be 96% Mineralized but by the end of the secretory stage enamel is only 30% Mineralized, so to get to 96% it's must undergo maturation stage, so there will be addition of extra minerals. 5- Post-maturation stage.

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(Very Important note: the numbers in the picture doesn't represent the number of the stages in the previous page, for example 2 in the picture is not secretory stage, so pay attention). (Note: there is mistake in 4b in the previous picture, the nucleus should be proximal). This is the life cycle of ameloblast(see the picture), so (1) is preameloblast and (2) is the ameloblast at the presecretory stage coz we don't see any enamel here, the black line is the basement membrane (or the basal lamina) that separate ameloblasts form odontoblasts (that will from dentine) and these is the enamel at the beginning of secretion. so this is the beginning of the secretory stage (3), we can see some enamel form, and here the continuation of the process of enamel secretion(4a), notice that at the secretory stage ameloblast will start to form a process (Tomes' processes TP). After enamel secretion we'll have transition stage (4b) then we'll have the stage of maturation (5a) (in this stage we'll have addition of extra minerals on the enamel). Let's now discus them one by one:

1- The Presecretory stage:

Includes all ameloblastic activities before secretion of enamel matrix. What is enamel matrix? Enamel is composed of two components: -1st enamel matrix (organic proteins): act as a framework, so it's similar to building a wall, if u want to build a wall u need metal bars and wood and then between them u add the cement and the blocks. -2nd the enamel minerals (inorganic) which resemble the blocks. So the Presecretory stage has two main sub-stages: A- Differentiation of IEE cells (so they are not differentiated yet):
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Differentiation means: all the changes that happen in the cell to make the cell able to secrete the enamel (the cells get into different shape and different arrangement in order to be able to secrete enamel). This process (differentiation)Begins at future cusp tips &incisal edges (for the anterior teeth)and this happen in the cusp and incisal edges before it happen in the cervical which is the last area where IEE differentiate (and the last area for the tooth to form). Cells of IEE change from cuboidal (preameloblast) to polarized columnar (ameloblast at Presecretory stage),(so from 1 to 2 in the picture). (Polarized cell: is the cell whose nucleus is not in the center of the cell (so it's near one pole of the cell)). So here we have polarized columnar cell, the nucleus should be located near the Stratum Intermedium cell (the DR talked about the structures in the picture, I mentioned them in it). So the end where the enamel will be secreted is the end that the nucleus will go away from it to have big space for the storage and secretion. Always remember the end which doesn't have the nucleus is the active end of the cell. Also Adjacent cells are linked by gap junctions in this stage, and u already know the types of junctions between the cells like desmosomes and tight junction and gap junction, so gap junction allows the exchange of material between the cells, it's not like desmosomes, so we can see some exchange between these cells in this stage. Q:Why do we need junctions between the cells? Because I don't want the interior of enamel organ to mix with the dental papilla, notice that after the presecretory stage (in the secretory stage) the basement membrane or the basal lamina disappears, this basement membrane separate the enamel organ from the dental papilla, so if we don't provide a junction between the cells fluid will pass from inside the enamel organ to dental papilla, so I need the cells to be in contact to prevent this, and this is the function (the other function) of this gap junction to make cells close to each other to prevent this fluid from passing. Basal lamina marks future enamel-dentine junction EDJ, so we still have the basal lamina (the basement membrane) and it will represent the EDJ coz the
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enamel will be formed and each layer of enamel formed will push the cells away, and the dentin will be formed and it's will push the cells away, so this lead to cell separation and the junction will be in the area where the basal lamina was. B-Subsequent resorption: The other sub-stage is Subsequent resorption) (of basal lamina, because we want to deposit enamel. Once odontoblasts (the cells that going to form dentine) have differentiated the basal lamina disappears. Future ameloblast & odontoblasts are in intimate) ( contact allowing inductive signaling to occur, this happens after the basal lamina disappears, and this signals are important in interacting the cells to development of the dentine and enamel (important in activating the odontoblasts and the IEE). So we have the enamel and the dentine (see them in the picture) and here is the enamel-dentine junction which is the area where the basement membrane was, these means that if we came to this tissue before one weak we'll find that the odontoblasts and the IEE is in contact, but now they are separated by the enamel and the dentine. The enamel and dentin form between the enamel organ and dental papilla, which one comes 1st? The 1stlayer that forms is dentine followed by enamel followed by dentine followed by enamel and so on.

Changes of dental papilla in the Presecretory stage

Changes of outer mesenchymal cells of dental papilla: in Presecretory stage we don't only have changes in enamel organ or IEE, also we have changes that take place in the dental papilla (this means there is changes in both of them in this stage). The outer mesenchymal cells Differentiation into odontoblasts notice that the cells in the dental papilla at the periphery started to become odontoblasts so they are different from the remaining of the cells, so differentiation in the odontoblasts always precedes that of IEE cells which follows deposition of first pre-dentine (as we said the 1st hard tissue is dentine). Additional notes on The Presecretory stage
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Terminally differentiated pre-ameloblast are joined at SR end by desmosomes forming proximal terminal web, so as I said the ameloblasts are connected by gap junctions, but near the end (the stratum intermediume end) they are connected by desmosomes. (some cleaver student said that the in slide number 7 it's written SR instead of SI , the DR said plz correct it, so it's SI not SR). As the cells form these desmosomes they will be like a network, it's called the proximal terminal network, it's called proximal coz it's in the proximal end of the cell (proximal means close to the center of enamel organ, distal means away from it) so enamel formation takes place in the distal end of the cell (that have tome's process). Why do we need desmosomes again? To separate the inside of enamel organ from the outside of it to keep the shape of the tooth, coz this makes the hydrostatic pressure in balance(this was explained in the paragraph before the last one in page number 7).

2-Secrtory stage:
This is the stage at which enamel starts to form. Fully differentiated ameloblasts have proximally-placed nucleus(already explained in page number 7). Basic enamel matrix is assembled in the endoplasmic reticulum & carried to Golgi apparatus before packaging into secretory granules, which is similar to any protein formation. Secretory phase begins with the formation of a thin layer of enamel matrix as ameloblasts retreat ( ) from EDJ (also already explained in the last paragraph in page number 7). (Notice the 1st layer of enamel is different from subsequent layers, it's different in its structure). Subsequently ameloblasts develop Tomes processes at the secretory end (so the 1st layer comes 1st then the cell develop tome's process).
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So if I asked in the exam: tome's process development take place before any enamel formation take place, true or false? False, coz we have a thin layer of enamel forms before the process. Another Question: tomes' process in the distal or proximal end of the cell? The Answer is Distal end (the secretory end). Ameloblasts are joined by a proximal terminal bar apparatus (web) consisting of junctional complexes &desmosomes, so after tomes' process develop, in addition to desmosomes we have also junctional complexes that provide more connection between cells, it also separate enamel from enamel organ coz we don't won't any exchange between them (if there was exchange there may be extra minerals or anything that affect enamel). Secretion process

Shape of Tomes processes TP determines the prismatic( )structure of enamel, because we have a role that says: "any crystals of mineral should be at right angle ( )to the surface" these are crystals or crystallites (see the picture), because we have 2 surfaceses of tomes process in different orientations the crystallites will be at different orientations, so tomes process make them in that orientations, and this gives the enamel strength (so tome's process is responsible for the prismatic structure).

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notice the first layer of enamel (which deposited before the formation of tome's process) has one orientation, so all of them will be parallel to each other. Interpit prongs (the space between tow toms processes)develop to deposit first the enamel matrix of the prisms peripheries, so these prongs represent the periphery of the prisms of prismatic structure. Then, TP infills the residual pits as they retreat from the prisms core, so enamel take the shape of prisms, and the core of the prism is related to the area of tomes process (tomes process will be at the center of the prism). So these are tomes process (see the pictures below), I might ask u this image shows enamel formation at which stage? Because we see tomes process it's at the secretory stage (not any other stage).

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Here we have stratum Intermedium (see the below) and this is stellate reticulum and this is enamel and tomes process, is this enamel mature? No, coz it have not undergone maturation yet.

The doctor jumped over some info in slide number 11, so plz go to it. The happy endfor me :P As I said the 2nd part will be done by my friend I would like to say thnx to Mr. Jehad al-ammari coz he is an amazing friend And of course my friend Ahmad Al Sala7y, thnx man and I'm sry for involving u in this disaster xD I hope u enjoyed my work, and forgive me for all the mistakes in it If u find any mistake, plz write it the facebook group in oral histo doc Good luck in this semester, and in dentistry. Best wishesYour colleague: Ammar Al-dawoodyeh

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The 2nd part of the lecture

Secretion process (continued)
The orientation of the crystallites in within the prisms

here this illustration shows three ameloblasts at the active stage of secretion of enamel matrix, because each tomes process has two surfaces, we said each crystallite should be perpendicular to the surface of ameloblast, because of that any secretion from this area (the DR pointed at on surface of tomes process) should be perpendicular to the surface, and the other surface also the same thing, so I'll end up with crystallite of deferent orientations for each other.

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This is the prismatic structure of enamel, I want you to understand this illustration, each prism of enamel is actually is a key hole in cross-section ( ( ,) the DR means the blue area in the pic). now this key hole has two parts, head and tail, so rounded big structure is the head and the tail below is the structure below the head so that's why we have head and tail. When you organize all key holes adjacent to each other each tail should be located between four heads, so this is one tail, there is the head of the same key hole structure (pointed up) and there is another head (pointed down) here another head (pointed left) and another head (pointed right). These prisms are long, they start from one surface of enamel to other surface, but if we make a cross-section throw this structure it looks like a key hole. Now notice the orientation of crystallite, near the center of the head, crystallites tend to be parallel to the long axis of the prism but if we go away from center the crystallites starts to diverge or start to develop different orientations, Notice that within each prism the change in the orientation of crystallite is gradual ( )but when the edge of one prism meets the edge of other prism or when the periphery of one prism meets the periphery of another prism the change of crystallites orientation is sudden. Because we have gradual change in the orientation of crystallites within one prism the crystallites tend to be dense and very packed, so the organic material will be very limited in the area here, because we don't have spaces between the crystallite for it, while when one prism meet the other there will be good space because of the sudden change in the orientation of the crystallites, that's why in enamel organic material tends to be accumulated at the periphery of the prism. The importance of this structure in conservative dentistry In dentistry we use what we call composite filling, these should be attached to the tooth not like the amalgam filling, amalgam fillings are attached to the tooth by mechanical retention, but composite fillings are attached to the tooth by chemical retention , How can we do that?
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before attaching a composite filling to the tooth we have to etch the surface ( )by using phosphoric acid 50% concentrated, this acid degrade ) (the minerals but not the organic material, so the periphery of the prisms will not affected but the center of the prism become deep ) ( so we have elevations and depressions so the surface of the tooth that has been etched will be rough and it will fix the filling very well. The termination of the secretory stage once the full thickness of enamel matrix has been completed then this mean that this is the end of secretory stage, Let's assume that enamel in some area is 1mm in thickness, once ameloblasts have build 1mm of the thickness of enamel then the secretion stage terminates and because the tomes processes are associated with the secretory stage of enamel formation that's why we will not have any further function for tomes processes that's why it retract ) )and aprismatic enamel is form at the surface, so this mean that enamel has a thin layer of aprismatic at the beginning of its formation and a thin layer at the end of its formation, so we have two thin layers of enamel formation that are not prismatic and the rest of enamel is prismatic why? Because tomes processes are the once responsible for the prismatic structure, so tomes processes appear just after the beginning of the secretion and they disappear just before the termination. Why do we need maturation of enamel? After that we have transition for secretory stage to maturation stage, why do we need maturation in enamel? there is 70 % of organic material by weight and 30% minerals, the initial enamel formation that is laid down during the secretory stage is not fully mineralized, that's why the initial form of enamel is not very tough, it's slightly soft, now how can I made this enamel fully mineralized? for example we have a box thats has potatoes thats represent the organic material and we have sand filled the spaces between the potatoes which represent the minerals, in order to add extra sand which is the minerals we must remove some potatoes .

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So maturation involves removal or absorption of organic material and addition of extra minerals, finally the organic material instead of being 70 % it becomes4% and the in organic material instead of 30% it becomes 96%. Maturation involves converting the initially deposited enamel into the fully mineralized enamel, so that's why transition state is the stage where is the ameloblasts change from its secretory to maturation form.

3-Transition stage:
What happen in the transition stage? enamel secretion of course stop because the end up of the secretory phase, we want to remove the organic material which is the enamel proteins (amelogenin) , so these are removed to make space to add extra minerals. Changes on the ameloblast: ameloblasts become reduced in height & number, protein synthesis organelles are reduced because the syntheses of enamel stops, blood vessels invaginate enamel organ and reach the proximal end of ameloblasts. Notice that enamel after has been formed, we cannot change the shape of the tooth, that's why no problem if blood vessels invaginate enamel organ. Vascularization Ameloblasts itself Absorb the organic material, we said enamel organ is avascular so no blood vessels in it, why? Because we want maintain the shape of the tooth, but once enamel is formed the shape of the tooth won't be affected, that's why the blood vessels will wait out said enamel organ until full enamel formation and its formed they can get inside and they needed to get inside because now we want the blood directly to pass the nutrients and oxygen to the forming cells, that's why the role of Stellate Reticulum and Stratum Intermedium and external enamel Epithelium stop at this stage, so blood vessels invaginate enamel organ and reach the proximal end of ameloblasts, ameloblasts form a basal lamina over the immature enamel, the Basel lamina appears in short time before the maturation stage so it appears at the prePage 16 of 21

secretory stage, and present at the secretory stage, present at the transition stage absent at the maturation stage and at post-maturation stage . Enamel proteins are composed of amelogenin 90% and 10% are non amidogens like enamelin and tuftelin amelogenins are lighter than non amelogenins, these will be discussed when we will take the structure of enamel next lecture.

4-Maturation stage
Immature enamel is mineralized to 30% of that of erupted teeth, how can we convert these initially enamel only 30% mineralized into fully mineralized enamel? we need to remove amelogenins and also most of the water and organic matrix and in the space provided we need addition of calcium and phosphate ions, enamel crystallites increase in size with reduction in the intra-crystallite spaces so these spaces will be reduced because they were occupied by the organic material that started to be removed, small peptides and amino acids and non-amelogenins remain bound to the crystallites, mature enamel is 96 % mineralized because of that it's the hardest known biological material Note: enamel is hard but brittle ) (it can easily fractured. Changes on the ameloblast: In this stage tomes process of ameloblasts are lost because we don't need now secretion of enamel, organelle content reduced because the vesicles that contain protein is gone because we don't need secretion any more. We have two forms of ameloblasts: Ruffled-ended ameloblasts and smooth ended ameloblasts, we said these ameloblasts have to absorb the organic material and they have to add the inorganic material, so they have two surfaces, Ruffled ended they look like microvilli, plasma membrane at the distal end is folded to form striated borders this is secretory phase of the maturation stage in this phase the ameloblast secret the extra minerals which is the extra 70%
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minerals and then we have the smooth ended phase (resorptive phase) where the organic material should be absorbed so the ameloblast have two functions in this stage: 1- Absorb the organic material, that's why it looks smooth ended. 2- Add minerals so it looks Ruffled-ended.

5- Post-maturation stage
Ameloblasts now have no function in affecting enamel but they have to protect enamel, that's why they become generally flattened because they have completed the function of enamel secretion and maturation (ameloblasts remain columnar at some fissure sites). Finally they secret the primary enamel cuticle which is an amorphous layer that form and separate these cells from enamel, this primary enamel cuticle is formed at the surface of formed enamel to protect formed enamel. Basel lamina reappears again and enamel organ layers merge with enamel cuticle producing what we call reduced enamel epithelium which protects the enamel.

As blood vessels invaginate enamel organ we don't want other cells of enamel organ like external enamel epithelium cells, Stratum Intermedium and Stellate Reticulum because enamel has already been formed so all these cells merge together and they fuse with the primary enamel cuticle to form what we call reduced enamel epithelium, reduced enamel epthilum keeps attach to the surface of the enamel while the tooth is still inside the bone and its function in protecting enamel, later on once the emergence in the mouth the reduced enamel epithelium will contribute to part of the gingiva.

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Immature enamel and mature enamel and dentine in Histology Immature enamel is only 30 % mineralized so if we want to see this enamel under histological section we have process that we apply to all tissues , it's called decalcification because we need to cut this enamel by microtome, now when you put fully mature enamel which is 96% calcified then you loss enamel by the decalcification process that's why enamel appear in the picture above as white space, this mean it's mature enamel, but immature enamel has 70% organic material that won't be lost, so you will loss 30% of inorganic and the section of this enamel will accept staining with the purple stain, this explanation is important in histological stain sections and when you see space instead of enamel that's mean this space is of mature enamel, if you don't see space this is immature enamel. Dentin is different because it's not undergo maturation so dentin remain 70% mineralized 30% organic even if you put dentin in decallsiffecation agent it still have 30% of organic material that accept staining. Now this is the end of amelogensis lecture

The last part of the 2nd lecture

(I think slides with the doctor are different from the slides with me coz I don't see the pics that he is talking about, so I'm sry I have to do this part without pics) This is a tooth at building stage and you need to know the different part of that tooth we said at late bell stage we have the beginning of dentin formation and also enamel formation. we discussed the reciprocal interaction that leads to the development of hard tissues, we can see sometimes transient structures during the development of tooth (things that appear temporally and then disappear) like: enamel cored, enamel knot and enamel niche. Enamel knot is a localized mass of cells in the center of the internal enamel epithelial cells, sometimes in the cap stage for example see at the center of internal enamel epithelial cells we have a mass above these cells a this is
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transient temporary mass, this is called enamel knot, it's above dental papilla, so they r Non-proliferative cells produce signaling molecule, and they disappear and contribute to enamel cored, this enamel knot may proliferate and go upward to reach the external enamel epithelial cells here, it's become like a cord, so enamel cord is strand of cells deciding from the stratum Intermedium leads to Stellate reticulum, mainly involved in the mechanical transformation of cusps stage into bell stage these until this moment the function of these structures is not fully understood, these are called enamel septum when reaching external enamel epithelial cells because they separate enamel organ into two parts so that's why they call it enamel septum because it separates to sides. when it reaches the external enamel epithelium it makes an invagination call enamel navel, enamel navel is small invagination at the junction of the enamel core with the external enamel epithelial cells. Finally enamel niche it is an area enclosed by the double attachment of the enamel organ to dental lamina, these are temporary structures and the function of these structure is not fully understood.

Nerves and blood supply

Nerves supply start as plexus under dental papilla during cap, stage as we said we do not have blood vessels and nerves inside enamel organ, so the only way that blood vessels or nerves reach enamel organ is by reaching the periphery of the enamel organ and that's why the function of external enamel endothelial cells is to pass the nutrients to the remaining cells of the enamel organ. Nerves spread and penetrate dental papilla with the onset of dentinogenesis, Once dentiongenesis starts, nerves to become incorporated with the dental papilla, blood vessels invade dental papilla at early build stage but blood supply remains away from enamel organ until the full secretion of enamel. Blood vessels evident in dental follicle close association of the external enamel epithelial cells which they never penetrate, so As long as we have

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external enamel epithelial cells no blood vessels are allowed, once full enamel thickness has formed then no problem blood vessels are welcomed. This is a summary for the stages (there will be a lot of questions on it) The slide below represents the formation of enamel and dentin, At first, the first layer that formed is dentin then followed by enamel followed by dentin followed by enamel, you must know the last and first enamel and dentin in the picture. dentin formation is not like enamel formation, enamel formation has an end but dentin formation does not have an end so that's why as long as the tooth is a live the formation will of dentin will continue. This means that the dental pulp in an old man is smaller than the dental pulp in a young man why? Because an old man there has been the production of dentin for long period of time making dental pulp getting smaller and smaller, for this reason this has a clinical importance, root canal treatment in young people is much easier than root canal treatment in old people, because the pulp of the younger is big. so if I want to make a filling in a young person I have to be careful because the pulp is big so I can only go maybe 4 mm but in old man no problem you can go 5 to 6 mm without reaching the pulp so doing fillings in old people is much easier than doing fillings in young people. This is how the mandible looks like in radio graph. Done by: Ammar Aldawoodyeh Ahmad alssla7y

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