Introduction and Enamel 24092014 Oral Histology and Physiology

Oral anatomy, physiology
and embryology
1
DR Jamal Naim, Oral Anatomy, Physiology & Embryology I
Introduction
The current-day clinical practice of the dentistry
involves:
 the prevention of demineralization of tooth
hard tissues,
 the promotion of enamel remineralization,
 the restoration of cavitated Teeth where
demineralization has become irreversible,
2
Introduction
 the diagnosis and treatment of developmental
hard tissue malformations, which can be caused
by environmental or genetic factors.
3
Introduction
On a daily basis, dental health providers make
diagnostic and treatment decisions that are
influenced by their understanding of tooth formation.
For example; a systemic condition during tooth
development, such as high fever, can produce a
pattern of enamel defects in the dentition. Knowing
the timing of tooth development permits estimates
about the timing of the disturbance.
4
Hard Tissues of the Teeth
5
Dental hard Tissues
 Enamel
 Dentin
 Cementum
6
Enamel
 Enamel is a nonvital insensitive hard tissue of the
teeth of an ectodermal origin.
 Protective covering of the anatomical Crown.
 It is the hardest tissue of the body.
 Ameloblasts are responsible for its formation
Amelogenesis)
 By the emergence of the teeth the ameloblasts are lost
and enamel can not be repaired or regenerated.
7
Enamel compositions
 Enamel consists of more than 96% inorganic
substances and traces of organic substances and
water (4%)
 Tooth enamel is unique among mineralized tissues
because of its high mineral content.
 The inorganic Material is closely related to calcium
hydroxyapatite [Ca10(PO4)6(OH)2].
8
Enamel compositions
by tissue by volume
weight
Minerals 95 - 97 % 88 – 90 %
(inorganic
materials)
Organic ≤1% ~2%
materials
water 2-3% 5 – 10 %
9
Enamel compositions
 The hydroxyapatite crystallites are highly
organized, tightly packed comprising 87% percent of
its volume and 95-96% of its weight.
10
Enamel compositions
 The organic materials are enamel proteins such
as amelogenin (90%), ameloblastin and enamelin,
(both 10%).
 The organic materials forms an organic network that
transport minerals during the Enamel formation
(amelogenesis) and determine the nature and direction
of crystal growth.
11
Enamel Properties
12
COLOUR THICKNESS
Physical
properties
of Enamel
PERMEABILITY HARDNESS
BRITTLNESS
13
COLOUR
Yellowish white to grayish white; it depends on:
1. Translucency, high crystal content accounts for the
translucency of enamel
2. Degree of calcification
3. Homogeneity
• Yellowish enamel is more translucent, better calcified and
homogenous.
• Grayish enamel is opaque, less calcified and less
homogenous. 14
THICKNESS
It is thick at the incisal edge and cusp tip of molars and
premolars (2-2.5 mm) and ends cervically as knife
edge.
15
Hardness and Brittleness
 It is the hardest calcified tissue in
human body because of its high
calcification and crystal orientation.
 Although of its hardness, enamel is
brittle (low shear strength, no
flexibility) especially when looses the
underlying elastic healthy dentin.
16
Thermal properties
 Low thermal conductivity & low thermal
expansion
 protects the dental pulp from insult due to
heat
17
Permeability
Enamel acts as a semi-permeable membrane for certain
ions from:
• the saliva to the outer layer of enamel
• the pulp to the inner layer of enamel across dentin.
18
Dentin
• Dentin and pulp are related embryologically,
histologically and functionally, have an
ectomesenchymal origin
• Odontoblasts are responsible for dentin formation
(Ododontogenesis)
• Dentin is a hard connective tissue and the Pulp is a
soft one.
19
Dentin
• Dentin forms the bulk of the tooth and provides
general form and shape to the tooth.
• It is covered by cementum at the root portion and by
enamel at the crown portion.
20
Compositions of dentin
by tissue by volume
weight
mineral 70 % 47 %
organic 20 % 33 %
material
water 10 % 20 %
21
1. mineralised organic matrix
 similar to bone, but higher proportion of inorganic

components & harder than bone
2. inorganic components:
 small hexagonal hydroxyapatite crystals,
 Ca10(PO4)6(OH)2,
 higher carbonate & magnesium levels than enamel

22
 90% of organic content is collagen
 Type I collagen dominates
 Type III collagen
 Type V collagen
 10% of organic content is non-collagenous proteins and

the lipids, peptides, glycoproteins and proteoglycans of
the ground substance.
23
Dentin Properties
24
Properties of dentin
• Bonelike yellowish in color
• Elastic, less hard than enamel, but more than
cementum
• Less radio-opaque than enamel, but more than
cementum
• 3-10 mm thick
25
 vital
 avascular
 cellular
 contains odontoblast processes
 not replaced if damaged, but some capacity for

repair by deposition on its pulpal surface,
26
 sensitive
 dentin sensitivity
 dynamic
 ion exchange with surrounding environment
 dentin composition changes over lifetime
 dentin composition also changes as a result of external

damage: demineralisation  remineralisation
27
 Its elasticity provides flexibility & prevents fracture of
enamel.
 Its color varies from light yellow to pale yellow,

becoming darker with age.
 It is permeable, small molecules as therapeutic

substances & topical agents, due to presence of
Dentinal tubules.
 permeability decreases with age.

28
 less resistant to attrition,
occlusal and incisal attrition
 less resistant to abrasion
toothbrush & other abrasion
 less resistant to acid attack
caries & erosions
29
Cementum
 It is part of the tooth supporting tissues,
Periodontium
 It is a specialized hard connective tissue that

shares some physical, chemical, and structural
characteristics with compact bone.
 Unlike bone, however, human cementum is

avascular and not innervated
30
Cementum
 Cementum covers the anatomic roots of human
teeth.
 varies in thickness, the thickest part is at the root

apex and in the inter-radicular areas of multirooted
teeth (50-200um), thinnest at the CEJ (10-50um).
 Cementum furnishes a medium for the attachment

of collagen fibers that bind the tooth to surrounding
structures.
31
Cementum
 Cementum is pale yellow tissue with a dull
(cloudy) surface.
 Softer than dentin and bone.
 more permeable than dentin
 permeability gecreases with age
 Cementoblasts are responsible for its

formation (Cementogenesis) 32
Chemical composition
• 50-55% of weight organic material and water.
− Collagen fibrils
− Protein polysaccharides (proteoglycans)
• 45-50% inorganic material.
− Hydroxylapatite (calcium & phosphate)
− Various trace elements, (Fluor, copper, zinc etc.)
− the highest fluoride concentration of all tooth
tissue
33
Cementum
 Collagens: Types I (predominant), III,XII
 Matrix: Cells, Fibers, Ground substance
 Water
34
Amelogenesis
It is a two step process:
1. Enamel formation
2. Enamel maturation
Maturation (Mineralization) does not wait the complete

formation of Enamel.
Amelogenesis
Enamel formation:
 Induction after dentin formation (first layer is called
mantel dentin)
 Enamel proteins formed in RER and transported to
the distal end with secrete granules and released
extracellulary
 This is the aprismatic Enamel (Dentino-enamel
membrane)
36
Enamel formation
Histological Structure
Dentin Enamel
Dentino-enamel-Junction
Amelogenesis
Enamel formation:
 After formation of the DEM, the ameloblasts will
move away from dentin and develop the Tomes
process.
 TP will secrete the granules perpendicular to the
membrane of the TP
 This direction is responsible for the appearance of
the enamel prismatic and inter-prismatic substance.
39
Amelogenesis
Enamel maturation:
1. Initial or partial mineralization (immediate) during
matrix formation, 25-30% of the total
mineralization.
2. In a second stage the mineralization will be
completed, about 96% inorganic substance.
40
Amelogenesis
Enamel maturation:
 From cusp tip or incisal edge and progress
cervically
 The maturation of the crystals begins at its dentinal
end and progress to the outer surface.
 At first parallel to D.E.J and later to the outer
surface of enamel
 Maturation occurs by the growth of the primary
crystals till they fuse together
 The fibrils between the crystals will become
thinner.
41
Crystals at the formation stage Crystals at the maturation stage After the maturation stage
Maturation occurs by the growth of the primary

crystals till they fuse together
Amelogenesis
 After eruption, the maturation continues by
deposition of ions from saliva to reach 96 % of its
weight inorganic substance
43
HISTOLOGICAL STRUCTURE
OF ENAMEL
44
Ground section Decalcified section
the organic substance is the inorganic substance is

burnt and the inorganic dissolved and the organic
substance remain substance remain
45
Enamel is formed of:
• Enamel crystallites
• Enamel Rod
• Rod Sheath (packaging of rods) and
• Interrod Substance
46
25-30 nm
Enamel crystallites
 crystallites are the smallest units of

enamel
 They are hexagonal in form
 About 60-70 nm in length and 25-30 nm
in width 60-70 nm
47
Rod and interrod enamel:
 The Tomes’ process organizes enamel crystallites
into rod enamel (rod= about 100 crystallites) and
interrod enamel.
 Enamel crystallites that elongate near the tip of the
Tomes’ process form the rod enamel.
 Crystallites that lengthen near the intercellular
junctions form the interrod enamel.
 The rod enamel and interrod enamel differ in the
orientation of their crystallites
48
The rod and interrod enamel differ in the orientation of their crystallites
Tomes process
Rod enamel
Tomes process
Interrod enamel
Rod sheath
50
 The border between rod and
interrod enamel is distinct because
part of the ameloblast membrane
is “nonsecretory,” which creates
gaps in the mineralization front.
 The apatite crystals are oriented
parallel to the long axes of the rod
in its body and deviate about 65
as they fan out into the margin
and the tail.
51
The enamel rods are
arranged in rows with
alternating orientation.
The interrod enamel

By electron microscopy a common key-hole or
paddle-shape rod is seen in cross section.
interrod enamel
rod enamel
coronal
cervical
54
The head of the rod is toward the occlusal or incisal
surface where the tail is cervically.
coronal
cervical
55
• The number of the enamel rods varies
from 5 millions in lower lateral incisor to 12
millions in the upper first permanent molar.
• The number of the rods equals the number
of the ameloblasts.
• At the tooth surface there are about 20000-
30000 enamel rods in 1 mm2
• The density of the rods is at the DEJ about
10% higher than at the enamel surface.
56
• The diameter of the enamel rod is about 5
µm. In key-hole type the height is about 9
µm.
• It increases from the dentino-enamel
junction to the outer enamel surface by a
ratio of 1:2.
57
The enamel rod is perpendicular to the dentin
surface.
• In deciduous teeth ; the enamel rod is
vertical at the cusp tip or incisal edge
then become oblique toward the occlusal
surface at the middle part and become
horizontal at the cervical area (so
enamel ends cervically abruptly).
58
• In permanent teeth; the direction of the enamel
rods are similar to that of the deciduous teeth at
the occlusal 2/3 but at the cervical region are
directed root wise (so the enamel ends
cervically as a knife edge).
permanent teeth deciduous teeth
59
Course: the enamel rod starts straight at dentino-
enamel junction (D.E.J.) for about 30 µ then has a
wavy course till near the outer surface of enamel
where it become straight once more.
Wavy
course of
enamel rods
60
Wavy course of enamel rods
61
Enamel Histology
At the incisal edge or cusp tip the enamel rod has a
twisted course and is called gnarled enamel
Twisted
Gnarled course of
enamel enamel rods
62
 In ground section D.E.J. appears as scalloped line.
 The presence of this irregular surface assures the
union between enamel and dentine.
63
Dentin Enamel
Electron micrographs
of the Dentino-
enamel-Junction
The surface of
Dentin after
removing of
Enamel
Enamel spindle:
It is an odontoblastic process which extends in between
the cells of inner dental epithelium before the
formation of enamel.
Enamel Tufts:
 They arise from D.E.J. to about
1/5 to 1/3 of the enamel
thickness as tufts of grass.
 It always appears in transverse
ground section.
 They are hypo-calcified prisms
and inter-prismatic substance.
 It takes this shape because of
the wavy course of the enamel
rod for several layers leading to
this tuft form.
Enamel Tufts
 If a tuft runs till the outer enamel
layers (more than 1/3 of enamel Enamel lamella
thickness), then we speak about
Enamel lamella (true lamella, Type A
lamella).
 They are also hypo-calcified prisms
and inter-prismatic substance.
 True lamella should be distinguished
from other types of lamellae (cracks,
type B and type C lamella)
Enamel lamella
Enamel lamella Enamel lamella
type A,
type B type C
True lamella
hypo-calcified prisms Enamel cracks pre- Enamel cracks post-
and inter-prismatic eruptive, eruptive, can reach
substance can reach dentine dentine
Filled with epithelial Filled with organic

It is limited to enamel cell or connective contents of saliva
tissue
70
To differentiate between true lamella and crack we do
careful decalcification:
the true lamella will remain where cracks will
disappear.
Enamel lamella could act as caries spread way.
71
 During the secretory stage, enamel crystals do not
grow continuously, but rather extend in
increments.
 The enamel rod is formed in a rhythmic manner,
every segment of 4 µm in length and formed in a
day. It is manifested structurally as prism cross-
striations
4 µ/day
72
 More prominent cross-striations occur in a regular
period of about every 4 days and are known as
striae of Retzius or incremental lines.
 In longitudinal ground section they appear as dark
bands reflecting the rhythmic enamel formation.
striae of Retzius
73
 At the incisal edge and cusp tip they arise from the
D.E.J. then go upward and outward surrounding
the tip of dentine and come to D.E.J. again so, they
do not reach the outer surface of enamel.
striae of Retzius
74
The external manifestation of the incremental lines of
Retzius represented as transverse wave like
grooves on the surface of the enamel are known as
perikymata.
perikymata
75
perikymata
76
striae of Retzius
77
striae of Retzius
78
Neonatal line:
It is an enlarged stria of Retzius which present in all
deciduous teeth and 1st permanent molar.
This line separates between enamel formed before
birth and enamel formed after birth.
This line is due to the sudden change of nutrition and
environment due to birth.
The quality of enamel formed before birth is better than
that formed after birth, because of the more
protected conditions and constant nutrition of the
fetus.
Prenatal enamel
Neonatal line
Postnatal enamel
80
Structure less enamel:
 This layer is highly mineralized than the rest of enamel
and its thickness is 30 microns.
 This surface layer of enamel is aprismatic.
 It is lost rapidly after eruption due to abrasion, attrition
and erosions.
81
Hunter and Schreger bands :
It is an optical phenomenon caused by changes of rod
direction (the wavy course).
They are seen clearly by longitudinal ground section
viewed by reflected light at inner 2/3 of enamel.
The phenomenon appears as dark and light alternating
bands, starting from the D.E.J. and ends shortly from
the outer surface of enamel where the enamel rods
run straight to the surface.
82
Hunter - shreger bands
83
 The dark bands (Diazones) absorb the light where
the light bands (Parazones) reflect the light.
 If the light passes from the opposite side, the light
and dark bands will be reversed.
Hunter - shreger bands
84
A fibrilar cementum:
A type of cementum formed on
the cervical part of the
enamel for a short
distance.
It is formed due to the
degeneration of the
reduced dental epithelium
covering the cervical area
of the enamel before
eruption.
85
Enamel
Dentin
A fibrilar cementum
cementum
86
Age changes of enamel
• It is a non-vital tissue and can not be
regenerated.
• Increase in fluoride apatite
• Discoloration and darkening
• Reduced permeability>>>> less caries
87

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Introduction and Enamel 24092014 Oral Histology and Physiology

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Oral anatomy, physiology

 similar to bone, but higher proportion of inorganic

 small hexagonal hydroxyapatite crystals,

 higher carbonate & magnesium levels than enamel

 Type I collagen dominates

 Type III collagen

 10% of organic content is non-collagenous proteins and

 contains odontoblast processes

 not replaced if damaged, but some capacity for

 ion exchange with surrounding environment

 dentin composition changes over lifetime

 dentin composition also changes as a result of external

 Its color varies from light yellow to pale yellow,

 It is permeable, small molecules as therapeutic

 permeability decreases with age.

occlusal and incisal attrition

 less resistant to abrasion

toothbrush & other abrasion

 less resistant to acid attack

caries & erosions

 It is a specialized hard connective tissue that

 Unlike bone, however, human cementum is

 varies in thickness, the thickest part is at the root

 Cementum furnishes a medium for the attachment

 Softer than dentin and bone.

 more permeable than dentin

 permeability gecreases with age

 Cementoblasts are responsible for its

Maturation (Mineralization) does not wait the complete

Maturation occurs by the growth of the primary

the organic substance is the inorganic substance is

 crystallites are the smallest units of

The interrod enamel

permanent teeth deciduous teeth

Filled with epithelial Filled with organic

Enamel lamella could act as caries spread way.

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