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Enamel

- Enamel is the most highly mineralized ectodermal tissue in the body that covers the
anatomical crown.
-It forms a protective covering to resist the masticatory forces.
-It is an acellular, non-vital and insensitive tissue that cannot be replaced or
regenerated when injured.

*Physical properties:
Color:
- Ranges from yellowish white to greyish white depending on the degree of
translucency, calcification and homogeneity and thickness of the enamel.
-Yellowish teeth have thin translucent enamel through which the yellow color of
dentin is visible, while grayish teeth have more opaque enamel.
Thickness:
-On the cusps of human molars and premolars, the enamel shows a maximum
thickness of about 2 - 2.5mm thinning down to a knife-edge at the cervical line.
Hardness: - It is the hardest tissue in the body
-It is greatest at the surface and decreases gradually towards the amelodentinal junction
(ADJ).
-It is greater at the cusp and incisal ridge and decreases cervically.
-Enamel of permanent teeth is harder than that of the deciduous.
Brittleness:
-It is highly brittle especially when it loses its underlying dentin.
Permeability:
-It acts as a semi-permeable membrane that permits complete or partial passage of
certain ions and dyestuff from saliva to the outer layer of enamel.
-However it has a lesser degree of permeability from the pulp to the inner enamel layer
across the dentin.

*Chemical properties:
By weight: By volume :1

96% inorganic material.


4% organic and water (1-2% organic and 2% water).
88-90% inorganic material.
10-12% organic and water.

Inorganic material
Organic material:
- Crystalline calcium phosphate known as -It is present mainly in the prism
hydroxy apatite crystals,
sheath.
3Ca3 (P04)2. Ca (OH)2
-It forms a fine framework
- Fluoride ions can replace the hydroxyl group surrounding the crystals.
thus the hydroxy apatite are transformed to - It consists mainly of proteins in
fluoroapatite which are more caries resistant.
addition, traces of carbohydrates
( So addition of fluorine to the drinking water and lipids are found.
or the topical application of fluorides on the
surfaces of the teeth minimize the caries)
- The inorganic material is represented by the
rods and inter-rod regions.
- Minerals content increase from DEJ to the
surface.

Histological structure of enamel


-The unit structure of enamel is the enamel rod or prism which has an enveloping
sheath called prism sheath and surrounded in some regions by interprismatic
substance.

*Enamel prisms (rods)


-It is the unit structure of enamel
-By the light microscope, the rods appear clear and structurless as they are formed of
tightly packed crystals that allows light to pass through.
1-Number:
- Five million in the lower central incisor and twelve million in the upper first molars.
2-Direction :
- Perpendicular to the dentin surface in both deciduous and permanent teeth.
-In the cusp tip or incisal ridge regions, they are directed vertically.
-In the middle third, of the crown they become oblique (towards the occlusal surface).
-In the cervical region, they become horizontal in deciduous teeth, where the enamel
ends suddenly (abruptly). While in permanent teeth they are directed obliquely
rootwise because the enamel ends in a knife edge at the cervix (i.e. gradually).
3-Course:
- The enamel rods start straight from the DEJ (30 microns), then follow a wavy course
outwards. But just before they reach the outer surface of the enamel they become
straight again.

-Under the cusp tips and incisal ridges, the course of the enamel rods is more
complicated where they become twisted over each other to give maximum strength at
these areas, which are more, subjected to the masticatory forces (Gnarled enamel).
4-Diameter:
-The diameter of the enamel rod increases from the dentino-enamel junction (DEJ) to
the outer enamel surface by a ratio of 1:2.
-Its diameter is about 4 microns (at the DEJ) and its length is about 2.5 mm.
5-In transverse section:
-Enamel rods appear hexagonal, round, oval and fish scales.
6-By the electron microscope:
-The cross section in the enamel rod and interrod regions is similar to a keyhole.
-The heads of the key hole are directed occlusally while tails points cervically.
-The enamel prism (head) is made up of crystals with their long axes parallel to the
long axis of the prism at its central part.
-Crystals away from the central axis flare laterally to an increasing degree as they
approach the prism boundary.
-The crystals continue their lateral tilting until they become nearly perpendicular to the
prism in the interprismatic region (tail).

*Rod (Prizm) sheath


- It is an incomplete envelope around the prism.
- It is less calcified than the rod itself, i.e. it has a higher organic content, thus it resists
decalcification more than the prism.
- They are formed along the interface between crystals in the rods (heads) of one row
and interprismatic regions (tail) of the above row that has different crystal direction.
-The crystals in the prism sheath are not so tightly packed, allowing more spaces
between them for more organic material to be present.
-In the enamel prism and interprismatic region, the crystals are tightly packed so that
organic material becomes minute and compressed between the crystals forming just an
envelope around them.

*Inter rod (Interprizmatic) substance


-Enamel rods are separated from each other by highly calcified inter rod substance.
- It has the same composition as the rod but with different crystals orientation.
-In human teeth it appears to be minimum or even absent in certain areas.

Hunter Schreger's bands:


-They represent an optical phenomenon seen by examining L.S. ground section of
enamel under oblique reflected light

-They are alternating dark bands (diazones) and light bands (parazones) that start at the
A.D.J. and end shortly before reaching the outer surface of enamel.
-They are present at the middle and cervical thirds of the crown and absent in the
region of gnarled enamel (at the cusp tip).
- They are the result of the wavy course of the enamel rods which disappear at the
outer surface and at the region of gnarled enamel.

*Incremental lines of enamel


I- Cross striations or short increments:
-Each enamel rod is built up of segments of uniform length 2.5-6 microns (average 4
microns) separated by dark lines that gives it a striated appearance.
-They represent the rhythmic formation of the enamel matrix by the ameloblasts (daily
rate of secretion).
2-Incremental lines of Retzius "Brown striae of Retzius"
- These are lines that denotes the rhythmic formation of enamel
- They denote periods of activity alternating with periods of rest.
-In L.S ground sections, they appear as brown bands starting from the ADJ to the
outer surface.
- Under the incisal ridges and cusp tips they surround the tip of dentin and not reach
the outer surface (semicircles).
- At the middle and cervical parts of the crown they reach the outer surface
(Represented as perikymata)
-In cross sections, they appear as concentric rings parallel to the DEJ resembling the
growth rings in a cross section of a tree.
- These lines denote the formation of the enamel matrix in 4 days (distance between
every 2 bands is 16 microns).
-When the incremental lines are broad or closer to each others, they indicate metabolic
upsets or systemic disturbance
-Electron microscopic reveals a decrease in the number of hydroxy apatite crystals in
the incremental lines.
3- Neonatal line:
-This is one of the brown striae of Retzius that gets accentuated.
-It is present in all the deciduous teeth and first permanent molars.
-It separates enamel formed before birth (prenatal) from that formed after birth
(postnatal).
-It is due to the abrupt change in nutrition and environment at birth.
-The prenatal enamel is better than that of the postnatal due to the more protected
conditions and constant nutrition.
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*The amelodentinal junction ( ADJ )Or Dentinoenamel junction(DEJ)


-In ground sections the ADJ appears scalloped (The convexities directed towards
dentin).
-It was thought that these scalloping cause the firm attachment between enamel and
dentin, however sometimes the ADJ appears smooth (no scalloping) and still enamel
and dentin are firmly attached.
-In addition, if a small slice of the tooth is made at the ADJ the enamel remains
attached to the dentin.
-The firm attachment between enamel and dentin at the ADJ is due to the
interdigitation between the fibrils and the hydroxy apatite crystals of the first formed
layers of enamel and dentin.

*Enamel lamellae
-Thin leaf like structures that extend from the enamel surface toward A.D.J. and may
extend into the dentin.
-There are three types of enamel lamellae.
1- Developmental lamellae type A (True enamel lamellae)
-They represent poorly calcified enamel prisms and interprismatic substance as a
result of mild stimulus.
-Lamellae type A are limited to the enamel.
2- Non developmental Enamel lamellae
a-Enamel lamellae type B
- A crack that occurs in teeth before eruption due to sever stimulus.
- It may extend into the dentin.
- It is filled with either:1- Cells of the enamel organ (REE),
or
2-Cells of the adjacent connective tissue (dental sac).
b-Enamel lamellae type C
-Crack that occurs in teeth after eruption due to sever stimulus.
-Filled with organic material from the saliva.
-It may extend into the dentin.
-Enamel lamellae could act as an important means of spread of dental caries.

*Enamel tufts
-They are hypocalcified enamel rods and inter rod substance.
-Resemble tufts of grass when examined in T.S. thick ground sections under low
magnification
-As the hypocalcified segments, lying in different planes and curving in different
directions so they appear as if they are projecting from a single point of the scalloped
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ADJ.
-They start from the ADJ to about 1/5-1/3 the thickness of enamel.
-They are more numerous than enamel lamellae.

*Enamel spindles
-They originate from the processes of odontoblasts that extended between the inner
enamel epithelium before dentin and enamel formation.
-In ground sections the organic content of the spindles disintegrates and replaced by
air, so they appear dark in transmitted light.
-Best demonstrated in longitudinal ground sections.
-Numerous under the cusp tip and incisal ridge.
- It is an uncalcified structure.

Surface structures of enamel


1- Outer structureless enamel rodless enamel"
-Prismless enamel occurs in the outermost 30 microns of the enamel.
-It is found in all deciduous teeth and in 70% of the permanent teeth.
-It is present at the cervical area more than cusp tips and incisal ridges.
-No prism outlines are visible and the hydroxy apatite crystals are aligned parallel to
each other and perpendicular to the surface.
-Tomes' processes are absent during the formation of this enamel.
-This surface layer is highly mineralized than the rest of the enamel.
-Rodless enamel occurs as a result of the absence of Tomes , processes on the
ameloblasts in the final stage of enamel formation.
-This layer may be lost rapidly by abrasion, attrition and erosion in erupted teeth.
NB: Inner structureless enamel
-It is the first formed layer of enamel (at the ADJ) which is formed before the
ameloblasts develop their Tomes' processes
-It lacks prismatic structures and all the crystals are uniformly aligned parallel to
each other and perpendicular to the dentin surface.
2- Perikymata
- It is the external manifestations of the brown striae of Retzius that appear as
transverse wave like grooves on the enamel surface.
-They are continuous around the tooth and parallel to each other.
- Their concentration gradually decreases from the cervical to the occlusal surface or
incisal edges.
3- Rod ends
-They are concave depressions that vary in depth and shape.

-They are shallowest at the cervical region and deepen near the occlusal surface and
incisal edges.
4- Cracks:
- They are fissure like structures seen on all enamel surfaces.
- They are the outer edges of enamel lamellae.
-They extend for varying distance.
5- Afibrillar cementum:
- It is type of cementum that covers the cervical area of enamel in about 60% of the
teeth
- It is secreted when the reduced enamel epithelium retracts from the cervical region
during tooth development.
-It happens due to separation of the reduced enamel epithelium from the crown surface
before eruption exposing the newly formed enamel to the dental sac cells resulting in
their differentiation into cementoblasts and lay cementum layer over enamel.
-This afibrillar cementum is sparsely distributed and consists of a well mineralized
ground substance that contains neither collagen fibers nor embedded cells.
6- Pellicle and dental plaque:
- As the tooth erupts, it is covered by a pellicle consisting of debris from the enamel
organ that is lost rapidly.
- Salivary pellicle is an organic deposit on the surface of teeth, always reappears
shortly after teeth have been polished.
- Dental plaque forms on the pellicle especially in more protected areas of dentition.

Age changes in enamel


1-

Attrition:

-Attrition is the physiological wearing away of the tooth hard substance.


-It usually occurs as a result of parafunctional movements, as found in bruxism, which can
cause irreversible damage to the enamel .
-Wear polished facets are pronounced in older.
-Other processes of enamel destruction include abrasion (involving foreign elements, such as
toothbrushes) and erosion (involving chemical processes, such as lemon juice)

2-

Colour:

-Tooth color gradually darkens with age as a result of exposure to tobacco, coffee, and tea.

-It may be a result of the underlying dentin becoming thicker as well as reducing
tranclucency of the tooth as enamel becomes thinner.

3-

Modification in the surface layer:

-With age there is a localized increase in certain elements such as nitrogen and fluorine. This
reduces the enamel porosity and susceptibility to caries.

4-

Permeability:

-With age, enamel becomes less permeable to fluids, less soluble to acid, and contains less
water.

Life history of ameloblasts


The development of ameloblasts is most described in five main stages:
1Differentiating stage (pre-secretory ameloblast).
2Secretory stage.
3Transitional stage.
4Maturative stage.
5Protective stage.
1-Differentiating stage:
-Occurs at the end of the bell stage.
-The inner dental epithelium will change from a cuboidal to columnar with the nucleus
sitting at the proximal end of the cell (facing the dental organ).
- Golgi complexes migrate distally and the amount of rough endoplasmic reticulum
increases
- Most of the mitochondria cluster in the proximal region.
-Junctional complexes develops at the distal extremity of the cell which play an
important role in amelogenesis ( they determine what may or may not pass between
the ameloblasts to enter or leave the enamel).
-At this stage, odontoblasts differentiation from the undifferentiated cells of the dental
papilla occurs.
-Then, the pre-ameloblasts release enzymes that degrade the basal lamina separating
them from the odontoblasts.
*At this stage the cells can secrete small isolated areas of unmineralized enamel
matrix (stippled material)
2- Secretory stage:
-Begins after the first layer of dentin has been formed which induce the
differentiation of the pre-ameloblasts into ameloblasts, (reciprocal induction).
-During this stage the cells increase their length (50-70u) and secrete a partially

mineralized enamel matrix (contains 20-30 % of the total mineral content of


enamel).
-The Golgi complex increase in volume, the rough endoplasmic reticulum increases
and the mitochondria cluster in the proximal region.
-These changes are related to the initiation of secretion of enamel matrix.
-The adjacent ameloblasts are attached together by junctional complexes (distal and
proximal terminal bars).
-In this stage, the ameloblasts develop their Tome's processes which determine the
direction of the enamel crystals.
*Secretory ameloblasts are responsible for the formation of: 1-Initial rodless
(aprismatic) enamel layer and 2-Rod (prismatic) enamel layer
3- Transitional stage:
During this period:
1-There is withdrawal of Tome's processes,
2- Reduction in the height of the ameloblast
3-Decrease in cells number (50%), volume and organelle content.
4-The outer structureless or prismless enamel is formed.
* Transitional stage: responsible for the formation of Final rodless (aprismatic)
enamel layer
4- Maturative stage:
- Begins after most of the thickness of the enamel matrix in the occlusal or incisal
regions has been formed.
-The ameloblasts show reduction in the height, volume and organelle content.
-The excess organelles are enclosed in autophagic vacuoles and digested by the
lysosomes.
-This is followed by a shift of many of the remaining organelles to the distal part of
the cell with complex folding of the distal plasma membrane forming a striated
border.
-The striated border greatly increases the surface area of the distal end of the
ameloblast which indicates a rapid transport of material across the plasma
membrane.
- Cytoplasmic vacuoles containing material resembling enamel matrix are present.
-This form of maturative ameloblast is called ruffled ended ameloblast ( 80%) to
be differentiated from another form characterized by having smooth distal plasma
membrane and is called smooth ended ameloblasts (20%).
-Both forms are engaged with maturation of enamel through reabsorption of
proteins and water from the enamel matrix and precipitation of hydroxy apatite
crystals.
-The ameloblasts modulate (change its morphology from smooth to ruffled ended)
every 8 hours so it does three complete modulations / day

6- Protective stage:
-After complete formation and mineralization of enamel, cells of the enamel organ
cannot be differentiated from one another.
-They form 3-4 layers of stratified epithelium that cover the enamel and called reduced
enamel epithelium.
- It is separated from the enamel surface by the 1ry enamel cuticle (basal lamina like
structure) which is the last product of the ameloblast
-This reduced enamel epithelium protects the enamel by separating it from the
connective tissue until the tooth erupts.
-If the reduced enamel epithelium undergoes degeneration in a localized area, enamel
will be exposed to the surrounding connective tissue which may cause enamel
resorption or cementum deposition on the bare enamel area.

Amelogenesis
{ Amelo = Enamel & genesis = formation }
-In amelogenesis there is no clear cut band of organic matrix such as predentin in
dentin, but it seems that both organic and inorganic{apatite crystals} are secreted
together from the ameloblasts as enamel matrix.
Amelogenesis occurs in two stages:

I- Formation of enamel matrix

Synthesis of enamel proteins occurs in the rough endoplasmic reticulum, where it


passes to the Golgi complex in which it is condensed, a polysaccharide fraction is
added and packed into membrane bound secretory granules. These granules migrate to
the distal extremity of the cell and their contents are released against the newly formed
dentin (mantle dentin).
Little-if any-interval exists between the secretion of enamel proteins and the
appearance of inorganic crystals within it.
aStippled material secretion :
The pre-secretory ameloblasts (preameloblasts) release small isolated drops of
unmineralized enamel matrix called stippled material.
bInitial rodless (aprismatic) enamel layer:
- The ameloblasts secreats a new layer of enamel matrix against the dentin surface
which has no enamel rods ( inner rodless area).
Crystals of this first formed layer of enamel interdigitates with crystals of the mantle
dentin and provides the firm attachment between fully formed enamel and dentin at the
ADJ.
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cRod (prismatic) enamel layer:


As this first increment of enamel (inner rodless enamel) is formed the ameloblasts
migrate away from the dentin surface and each ameloblast develops a short conical
projection called Tomes' process which contains only secretory granules without any
organelles.
-The junction between the ameloblast and Tomes' process is marked by the distal
junctional complexes.
Secretion of further layers of enamel proteins occurs from the sides of the cone
shaped Tome's processes forming the enamel rod and the inter rod substances.
- The only difference between the two is the orientation of the calcium crystals
Crystallization the enamel matrix which occurs nearly at the same time of its
secretion accounts for 25-30% of the total mineral content of the fully mineralized
enamel.
dFinal rodless (aprismatic) enamel layer:
- At the end of secretory stage, the ameloblasts become shorter and Tomes' processes
are lost and accordingly the last formed layer of enamel do not contain any enamel
rods as the initial layer of enamel.

II - Maturation stage:
1Primary maturation:
- The first secreted enamel matrix contains20-30 % of the mineral content of mature
enamel.
2-

Secondary maturation :

- It is characterized by gradual completion of mineralization to reach the 96 % of the total


weight of enamel.
- After the entire thickness of enamel matrix is secreted the maturation begins. .
- In the same time the ameloblasts transport mineral ions into enamel matrix which cause
growth of the crystals
- The enamel crystals never fuse.

3-

Tertiary maturation:

- After tooth eruption, precipitation of certain ions on the outermost enamel layer occurs
from saliva.
- This process may increase the mineral content of enamel and so increasing its hardness.

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