Development and growth of teeth

Dr. MADHUSUDHAN REDDY

 Tooth development

• Primitive oral cavity: stratified squamous epithelium (Oral

Ectoderm)
• Oral ectoderm contacts with endoderm of foregut –
buccopharyngeal membrane
• At about 27th day of gestation – buccopharyngeal
membrane ruptures
• Connection between primitive oral cavity and foregut
• Connective tissue below oral ectoderm – neural crest cells
or ectomesenchyme
• These cells instruct or induce oral ectoderm to start tooth
development in future maxilla and mandible
• 3 weeks after rupture of buccopharyngeal
membrane, basal cell of ectoderm proliferate more
rapidly – primary epithelial band

Vestibular lamina Dental lamina

 Fate of dental lamina

• Dental lamina is active for shorter duration

• Soon after tooth development starts the dental lamina
starts degenerate
• In third molar region will be active till the age of 5 years
• As the tooth develops the connection breaks and islands of
epithelial cell remain within the jaws and gingiva – “cell
rests of serres”
 Tooth development

• Certain points in future developing maxilla and mandible

ectoderm bulges and grow into the underlying
mesenchyme
• 10 in maxilla and 10 in mandible arranged in the form of
horse shoe shape
• Each growth of dental lamina represent enamel organ of
tooth bud of deciduous tooth
• Not all enamel organs starts developing at the same time
• Dental papilla : ectomesenchymal condensation below the
enamel organ
• Dental sac or dental follicle: ectomesenchyme surrounding
enamel organ and dental papilla
 Developmental stages
• Tooth development is continuous process
• Based on developmental history of tooth
– Morphology of the enamel organ –Morphological stages of tooth
development
– Physiologic activity of the tooth bud – Physiological stages of tooth
development
 Bud stage/ proliferation

• This is the initial stage of tooth formation where enamel

organ resembles a small bud
• During the bud stage the enamel organ consists of
peripherally located low columnar cells and centrally
located polygonal cells
• The surrounding mesenchymal cells proliferate results in
condensation of cells in 2 areas
– Dental papilla
– Dental sac
 Cap stage/ proliferation
• As the tooth bud continues to proliferate it does not expand
uniformly into a large sphere
• Instead unequal growth in different parts of the tooth bud
leads to the cap stage
• Shallow invagination on the deep surface of bud
• Peripheral cells of the cap stage are cuboidal, cover the
convexity of the cap and are called the outer enamel
epithelium
• The cells in the concavity of the cap becomes tall columnar
cells and represent the inner enamel epithelium
• The outer enamel epithelium is separated from the dental
sac and the inner enamel epithelium from the dental
papilla by a delicate basement membrane
• The ectomesenchymal condensation i.e the dental papilla
& the dental sac are pronounced during this stage of tooth
development
• Polygonal cells located between the outer and inner enamel
epithelium, begin to separate due to water being drawn
into the enamel organ from the surrounding dental papilla
• As a result the polygonal cells become star shaped but
maintain contact with each other by their cytoplasmic
process
• As the star shaped cells from a cellular network, they are
called the stellate reticulum
• The cell in the center of the enamel organ are densely
packed and form the enamel knot
• This knot projects towards the underlying dental papilla
• At the same time a verticle extension of the enamel knot
called the enamel cord occurs
• They act as a reservoir of the dividing cell from the
growing enamel organ
• Enamel knot acts as a signaling centers as any important
growth factors are expressed by the cells of the enamel
knot and thus play an important role in determining the
shape of the tooth
 Bell stage/ histodifferentiation

• Bell stage consists of following layers in enamel organ

• Outer enamel epithelium
• Inner enamel epithelium
• Stratum intermedium
• Stellate reticulum
 Bell stage/ histodifferentiation
• Due to continued uneven growth of the enamel organ it
acquires a bell shape
• Shape of the crown is decided in this stage
• Shape of the crown is due to pressure exerted by dental
papilla on the inner enamel epithelium
 Bell stage/ histodifferentiation
• Inner enamel epithelium

• Single layer of cells that differentiates prior to

amelogenesis into tall columnar cells called ameloblasts

• These cells attached to one another by junctional

complexes laterally and to cells in stratum intermedium by
desmosomes

• The cells of the inner enamel epithelium exert a strong

influence on the underlying mesenchymeal cells of dental
papilla which later differentiates into odontoblasts
 Bell stage/ histodifferentiation
• Stratum intermedium

• A few layers of squamous cells form the stratum

intemedium, between the inner enamel epithelium and the
stellate reticulum

• These cells are closely attached by desmosomes & gap

junctions

• This layer seems to be essential to enamel formation

 Bell stage/ histodifferentiation

• Stellate reticulum

• The stellate reticulum expands further due to continued

accumulation of intra cellular fluid

• These star shaped cells, have a large processes anastomose

with those of adjacent cells

• As the enamel formation starts, the stellate reticulum

collapses to a narrow zone thereby reducing the distance
between the outer and inner enamel epithelium
 Bell stage/ histodifferentiation
• Outer enamel epithelium

• Low cuboidal cells

• Thrown into folds which are rich in capillary network, this

provides a source of nutrition for the enamel organ

• Before the inner enamel epithelium begins to produce

enamel. Peripheral cells of the dental papilla differentiate
into odontoblasts

• These cuboidal cells later assumes a columnar form and

produce dentin
 Dental lamina
• Dental lamina is seem to extend lingually and is termed
successional dental lamina as it give rise to enamel organs of
permanent successors of deciduous teeth
• The enamel organ of decicuous teeth in the bell stage show
successional lamina and their permanent successor teeth in
the bud stage
 Dental sac
• Circular arrangement of fibers and resembles a capsule
around the enamel organ

• The fibers of the dental sac form the periodontal ligament

fibers that span between the root and the bone

• The junction between the inner enamel epithelium and

odontoblasts outlines the future dentino-enamel junction
 Advanced bell stage/ morphodifferentiation

• Commencement of mineralization and root formation

• The junction between the inner enamel epithelium and

odontoblasts outline the future dentinoenamel junction

• Formation of dentin occurs first along the future

dentinoenamel junction in the region of future cusps and
proceed pulpally and apically

• After the first layer of dentin is formed, the ameloblasts lay

down enamel over the dentin in the future incisal and
cuspal areas
• The enamel formation then proceeds
coronally & cervically in all the
regions from the dentinoenamel
junction towards the surface
• The cervical portion of enamel
organ gives rise to hertwig epithelial
root sheath (HERS)
• This HERS outlines the future root
& thus responsible for the size shape
and length & number of roots
• Apposition is the deposition of the matrix of the hard
enamel structure
• Appositional growth of the enamel and dentin is a layer
like deposition of an extracellular matrix. This type of
growth is therefore additive
• Appositional growth is characterised by regular and
rhythematic deposition of extracellular matrix, which is of
itseklf incapable of furtehr growth
 Root formation

• The development of roots begin after enamel & dentin

formation has reached the future cementoenamel junction
• The enamel organ plays an important role in root
development by forming HERS, which models the shape of
the root
• HERS consists of outer & inner enamel epithelium only
• As the first layer of the dentin has been laid down, the
epithelial root sheath loses its structural continuity and is
close relation to the surface of the root
• Its remnants persists as an
epithelial network of
strands or clumps near the
external surface of the
root
• These epithelial remnants
are found in the
periodontal ligament of
erupted teeth and are
called as rests of mallasez
• Prior to the beginning of root formation, the root sheath
forms the epithelial diaphragm
• The outer & the inner enamel epithelium bend at the
future cementoenamel junction into a horizontal plane,
narrowing the wide cervical opening
• The proliferation of the cells of the epithelial diaphragm is
accompanied by the proliferation of the cells of the
connective tissues of the pulp, adjacent to the diaphragm
• The free end of diaphragm does not grow into the
connective tissue but the epithelium proliferates coronal to
the epithelial diaphragm
• Connective tissue of the dental sac surrounding the root
sheath proliferates & invades the continuous double
epithelial layer dividing it into network of epithelial
strands
• The rapid sequence of proliferation & destruction of
Hertwig’s root sheath explains the fact that it cannot be
seen as a continuous layer on the surface of developing root
• In the last stages of the root development, the proliferation
of the epithelium in the diaphragm lags behind that of the
pulpal connective tissue
• The wide apical foramen is reduced first to the width of the
diaphragmatic opening itself & later is further narrowed
by opposition of dentin & cementum to the apex of the root
• Differential growth of the epithelial diaphragm in the
multi-rooted teeth causes the division of root trunk into 2
or 3 roots
• During the general growth of enamel organ, expansion of
its cervical opening occurs in such a way that long tongue
like extensions of the horizontal diaphragm develop Before
division of the root trunk occurs, free ends of the
horizontal epithelial flaps grow towards each other & fuse
• The single cervical opening is divided into 2 or 3 openings