ORAL HISTOLOGY - MIDTERMS

ENAMEL
● hard prosthetic substance covering the anatomic crown of teeth
● Hardest biologic tissue and most mineralized tissue of the body
● Able to resist fracture during stress of mastication
● Provides the shape and contour of the crowns of teeth
● Covers the part of the tooth exposed to the oral environment
● Poor conductor of both heat and electricity
● Thickest at the crest of cusps or incisal edges (2.5 mm)
● Becomes thinner within the pits and fissure and over the facial, lingual and interproximal
surfaces
● Thinnest at the cervical margin (100micrometers)
● Non-vital tissue
Physical characteristics
● Extremely hard
● Brittle
● Texture: smooth and glossy
● External surface of the tooth (incisal/occlusal) is more harder/ mineralized - because of
the proximity in oral fluids where Calcium phosphate fluoride can be found
● Enamel near DEJ, is less harder
● Thickness
○ Thickness varies from different parts of tooth and from tooth to tooth
○ posterior cusp tips are the thickest - 2.5 mm
○ While 2mm Incisal edge
○ And featheredge at cementoenamel junction (100 micron)
○ So it gets thinner as it goes to the cervical of the tooth Thick at maxillary lingual
surfaces of molar and mandibular buccal surfaces
● Color
○ translucent appears grayish white or yellowish white
○ Color - determined by differences in translucency and thickness of enamel -
yellowish on area with thin enamel and grayish on area with thick enamel
○ Bluish on incisal area - pure enamel
● Hardness
○ Enamel is the Hardest tissue in our body - 343 KHN (knoop hardness number)
because it is composed of 95 to 98% of inorganic materials which include
calcium and phosphate ions that make up strong hydroxyapatite crystals. (300x
harder than dentin)
○ However due to having not enough organic content the enamel is Brittle
○ With its hardness, it can resist masticatory impact of about 10-20kg per tooth
 ○ (Knoop hardness, a measure of the hardness of a material, calculated by
measuring the indentation produced by a diamond tip that is pressed onto the
surface of a sample.)
● Solubility
○ Dissolves in acidic media.
○ Also, if the enamel dissolves the teeth are more susceptible to cavities and
decay.
○ It can be dissolved with chemicals used in decalcified section of tooth
● Permeability
○ Enamel is selectively permeable
○ More Permeable at 0-12 yrs old
○ It Allows diffusion of molecules
○ And it is an important factor because it allows fluoride to get incorporated and
make the enamel harder
○ Route of passage occurs via rod sheath, enamel lamellae and enamel tufts which
are rich in organic content
● Specific gravity (density)
○ 2.8
○ After eating or while eating teeth is being demineralized
○ Lower the pH of saliva - glucose
○ Demineralized state brush right away - can cause damage
Composition
● Inorganic material 96-98%
○ Hydroxyapatite crystals
■ Made up of calcium(Ca10), phosphate(PO4)6, and hydroxyl atoms (OH2)
○ Fluorine
○ Carbonates & trace elements
● Organic substance - 2-4%
○ Protein - amelogenin/enamelin water
○ TRAP - tyrosine-rich amelogenin protein
■ Bulk of organic material of enamel
■ Peptide sequence tightly bound to hydroxyapatite crystals and
non-amelogenin proteins
● Amelogenins
○ Enamel protein found in fetal enamel
○ Glutamic acid, proline and histidine (aa EPH)
● Enamelins
○ Enamel proteins found in mature enamel (formed after birth)
○ Aspartic acid, serine and glycine (aa DSG)
● * enamel matrix
○ Amelogenin 90%
○ Non amelogenin 10%
■ Enamelin
■ Tuftelin
 ■ Ameloblastin
Structure of enamel
● Enamel rods/ enamel prism
○ Basic structural unit of enamel
○ Highly organized pattern of tightly packed mass of hydroxyapatite crystal
orientation
○ Hexagonal and primsimlike shape (looks like a tennis racket/ fish tail
appearance)
○ Originate at the DEJ and through the thickness of the enamel to the surface
○ Somewhat cylinder in shape
○ Made up of crystals whose axes run for the most part parallel to the longitudinal
axis of the rod
○ Transverse striations
■ Daily apposition of enamel
■ Dark lines crossing the rods making the rod appear segmented when
sections cut along the longitudinal axis of the enamel rods
○ Cross-section: appear oval or round or fish scale like
○ x -section under electron microscope: shape of a keyhole
○ A cylindrical rod that has a spatial relation to the interior region directly cervical to
it
○ Horse-shoe or paddle-shaped or racquet-shaped with a head and tail
○ Head of the rod is - broadest part 5-microns wide
○ Tail of the rod - elongated thinner portion, 1 micron wide
○ Length 9 - microns long
○ Coronal Cervical direction
■ smaller dimension near DEJ
■ Larger near the outer enamel surface
○ Runs in a direction generally perpendicular to the surface of the dentin (at right
angle to the DEJ), with a slight inclination toward the cusps
○ Tent-like manner under the pits and fissures - converging toward the bottom of
the pit or fissure
○ Thin more vertically near the cusp tip
○ Proximal sides
■ Runs horizontally
○ cusp/incisor
■ Vertical direction
○ Cervical enamel
■ Permanent teeth- runs horizontally or obliquely inclined apically
(diagonally but incline apically)
■ Deciduous teeth- runs horizontally or obliquely inclined coronally
(oblique but runs coronally )
○ Gnarled enamel/ gnarled enamel rod
■ Occurs near the cervical, incisal, and occlusal regions
■ Intertwining of groups of enamel rods following a curving irregular path
towards the tooth surface
■ Purpose: makes the enamel stronger, more release resistance to forceps
■ Not straight
■ Tortuous interwinning pathways of enamel rods irregularly from the DEJ
■ Offers the greatest resistance to the cusps and incisal areas where most
forces are applied
■ Strengthens enamel rods
■ Woven during formation into a mass that resists an average masticatory
impact of 20-30 pounds per tooth
■ Contain more enamel protein and recrystallized hydroxyapatite crystals-
more acid resistance
 ● Enamel rod sheath
○ Cover enamel rod
● Interrod enamel
○ Substance that cements the rods together
○ An area surrounding each rodd in which crystals are oriented in a different
direction from those making up the rod

Structural characteristics of enamel

● Incremental lines of Retzius
○ Mark the primary calcification
○ Named after Andres Retzius (1756-1860), anatomist in stockholm
○ Identified using the ground section of calcified teeth but can also been seen in
forming enamel
○ AKA growth lines or striae of retzius Horse-shoe shaped structure *cus coming
from the incisal
○ Found in repeating pattern throughout the entire enamel
○ Ground section
■ Appears brownish
■ Runs from the DEJ in an oblique direction toward the occlusal surface
○ Cross section
■ Appears as concentric rings
○ Longitudinal section:
■ Series of dark bands reflecting successive enamel-forming fronts
○ Horse-shoe shaped structure over the dental core near the incisal edges or cusp
tip
○ Quasi Rhythmical order
■ Near the axial surfaces and neck of the tooth
○ 4-150 micrometers
■ Distances between lines
■ Become progressively less in an occlusal to cervical direction
■ *Thinner as it goes to the cervical region
○ Prominent in most human permanent teeth
○ Less prominent in postnatal deciduous enamel
○ Rare in prenatal enamel
○ Incremental lines of retzius recognized on microdiographs as zones that are
mostly hypomineralized
○ Formed as a result of a temporary constriction of Tomes’ processes associated
with a corresponding increase in the secretory phase forming interrod enamel
○ Represent the physical record of a period of rest between two active secretory
phase during amelogenesis
○ Perikymata- imbrication lines of Pickerill grooves represent the lines of retzius as
they meet the surface of the enamel
■ Closely spaced in the cervical margin
■ Further apart in the mid-coronal region
■ Absent at the cusp tips and incisal edge
● Transverse striations
○ Periodic band or cross striations
○ Occurring at a rate of 4 um per day
○ Mark daily apposition growth of the enamel
○ Alternating constrictions and expansion of the rods
○ Found on individual enamel rods
○ Cross striations seen to indicate a daily variation in the secretory activity of the
ameloblasts while the striae of Retzius represents a weekly rhythm
● Bands of hunter- schreger
○ An optical phenomenon produced solely by changes in rod direction
○ Seen most clearly in longitudinal ground section
○ More apparent near the DEJ
○ They appear because group of rods were cut transversely or parallel to the long
axis
○ Appear as dark and light alternating zones
○ Reflects the weave-shaped course of enamel rods in three-dimensional space
○ Through to be functionally adapted structures for the prevention of enamel
cracking during chewing/ mastication
○ Diazones
■ Dark bands
■ Rods cut transversely perpendicular to their long axes
○ Parazones
■ light bands
■ Rods cut parallel to their long axes
● Enamel tuft
○ Originate at the DEJ
○ Distributed somewhat regular around the junction about ⅕ to ⅓ of the thickness of
the entire enamel
○ Resemble the tuft of grass growing out of the root in an occlusal cervical direction
○ Composed of hypomineralized enamel rods, interrod enamel and organic
material-enamelin
○ When carries spread from the tooth’s surface to near the DEJ, these
hypocalcified (more organic) tufts cause a lateral spread
○ Usually arise from the scalloped peak

● Enamel lamellae
○ Visible cracks on the surface of enamel
○ Extend from varying depths from the enamel surface toward the DEJ
○ Serves as possible avenue for dental caries
○ Originate at the surface of the tooth
○ Some develop during enamel formation
■ Spaces formed between rods during mineralization
○ Some created during tooth function
■ Stress from breathing cold air or drinking cold beverage
 ■ Small cracks occur where enamel is weakened by underlying caries

● Enamel spindle
○ Found at the DEJ, short straight, think dark structure extending from short
distance
○ Arises from the extensions of the dentinal tubules that penetrate the DEJ into the
enamel
○ One of the factors that causes the hypersensitivity of the DEJ
○ Usually seen everywhere unlike yung isa na sa peak ng tuft
○ Seen as black or dark irregular or spiral-shaped or club-shaped structures
○ Dark appearance is due to the presence of air and debris resulting from the
preparation of the section
○ Normally filled with dentinal fluid
○ Most often occur along the DEJ under the cusp tip or incisal edge where the
junction is sharply bent
○ Mostly, they are not aligned along the same path as the enamel rod

Dentino-enamel junction
● Junction between enamel and dentin
● Seen as scalloped profile in cross-section
○ Concavity towards the enamel
○ Convexity towards the dentin
● Microlinkage strengthens the attachment of the enamel to dentin

Age changes
● Attrition
○ Physiologic wearing away of tooth tissue
 ● Loss of perikymata
○ On the surface of enamel
● Discoloration
○ Teeth darken with age
○ Due to addition of organic material to enamel from environment
○ Due to deepening of dentin color seen through the thinning layer of translucent
enamel
○ Due to carries, non-vital pulp
● Reduced permeability
○ Fluoridization- topical application of fluoride
○ Fluoridation- addition of fluoride by drinking water; systemic
● Modification of surface layer
○ Due to ionic exchange with the oral environment
○ Progrssive increase in fluoride content of surface enamel achieved by
Fluoridization or fluoridation of drinking water
● Apparent reduction in the incidence of caries

Clinical implication
● Dental caries
○ A disease of the hard tissue of the teeth
■ Demineralization
● Acids of bacteria
● Attack Inorganic
■ Proteolysis
● enzymes
● Attack protein part
○ Predisposed areas (prone areas)
■ Deep pits and fissures
■ Enamel lamellae
○ Its progression follows the course of the enamel rods
○ In cavity preparation, overhanging or unsupported enamel must be removed to
prevent fracture and causes leakage around the filling and secondary caries
● Fluoridation
○ If fluoride ion is incorporated into and absorbed on the hydroxyapatite crystals,
the crystals becomes more resistant to acid dissolution
● Acid etching
○ Enamel conditioning
○ Pits and fissures sealant
○ Cementing brackets to the tooth surfaces
○ Etched areas can be remineralized by sodium or stannous fluoride

AMELOGENESIS

1. Morphogenetic stage
 ○ Late bell stage
○ Inner enamel epithelium (IEE) separated from the membrana preformativa
○ Low columnar cells increase from 12 to 40 um
○ Large oval nucleus
○ Golgi apparatus and mitochondria are located at the proximal end
○ Pre-ameloblast

2. Organization and differentiation/ Organizing stage

○ Pre-ameloblasts stimulate the differentiation of the fibroblasts from the dental
papilla into odontoblasts
○ Odontoblast move away from the pre-ameloblasts toward the center of the dental
papilla and secrete the dentin matrix
○ Cells become longer
○ Reversal of polarity occurs by migration of golgi apparatus and centrioles to distal
parts of the cell
○ Nuclei shifts to the proximal part of the cell
○ Amount of rough ER increases
○ Basal lamina supporting ameloblasts disintegrates after dentin formation
3. Secretory stage/ Formative stage
○ Ameloblasts lay down a matrix of mucopolysaccharides and organic fibers on top
of membrana performativa = dentino-enamel membrane
○ Union of the 2 structures become the DEJ
○ Tome's processes
○ Conical projections from both ameloblasts and odontoblasts are formed after the
first increment of enamel is beginning to form
○ Junctional complexes
■ Attachment between ameloblasts
○ Terminal Bar apparatus
■ Junctional complexes appearing at the junction of the cell bodies and
tome’s process
○ Pre-enamel rod arises from the daily formation of junctional complexes and
tome’s processes
○ 4 um in height
○ This stage starts after the first layer of dentin is laid down
○ Development of a blunt process occurs on ameloblast surface
○ It penetrates basal lamina too enter predentin
4. Mineralizing stage/ maturation stage
○ After the secretion of the full thickness of the immature enamel is completed
 ■ Ameloblasts pass through a brief transitional phase
■ Ameloblasts become shorter and lose its tome’s processes and become
involved in enamel maturation
○ As soon as amelogenesis is deposited, matrix began to mineralize
○ Primary calcification
■ Every 16 mineral layer (lines of retzius)
■ 25 - 30% mineral salts deposited
○ Secondary calcification
■ Enamelin- protein of mature enamel
○ Enamel maturation occurs after most of enamel matrix in occlusal or incisal areas
is laid down
○ Ameloblasts are slightly reduced in length with appearance of microvilli at their
distal surface
○ Most of the organelles associated with formation of enamel are enclosed in
phagocytic vacuoles and are digested by lysosomal enzymes
5. Protective stage
○ Primary enamel cuticle - nasmyth's membrane
○ Secondary enamel cuticle - REE (reduced enamel epithelium)
○ After mineralization of Enamel is complete, ameloblasts lose their striated border
and also the shape.
○ These cells form the reduced enamel epithelium over the newly formed enamel.
It prevents connective tissue from coming in contact of enamel till eruption occurs
6. Proteolytic stage/ Desmolytic stage
○ Ameloblasts went back to become the inner enamel epithelium
○ Unite with the rest of the enamel organ and become the reduced enamel
epithelium
○ Junctional epithelium
○ The reduced enamel epithelium induces atrophy of connective tissue separating
it from Oral epithelium and helps in eruption of tooth.
○ Premature degeneration of REE can result in soft tissue impaction of tooth due to
failure of desmolysis of connective tissue between tooth and oral epithelium
Clinical considerations
● Amelogenesis imperfecta
○ Enamel hypoplasia
■ defect of the enamel that only occurs while teeth are still developing.
○ Enamel hypocalcification
■ presence of white, brown or yellow stains on teeth and opaqueness on the
tooth enamel
 DENTIN
○Hydrophilic
○Hard biological tissue that makes up the bulk of the tooth covered coronally by
enamel and in the root region by cementum
○ Encloses and protects the pulp tissue
○ Covers the entire pulp cavity
● PHYSICAL PROPERTIES
○ Hard calcified tissue, less hard than enamel but harder than cementum and bone
○ Has yellowish intrinsic color (clinical); pinkish (decalcified); white (ground)
○ Firm, resilient or elastic and deformable
○ Radiopaque: white images on the radiograph; Radioluscent: dark images on the
radiograph
○ Porous and permeable
○ Positively birefringent
■ Like having 2 images
■ optical quality
■ Describe how light pass through dentin
■ Because of net effect of super imposing optically positive collagen fibers
and optically negative crystals
● CHEMICAL PROPERTIES

WEIGHT VOLUME

Inorganic 70% 45%

Hydroxyapatite

Organic 20% 33%

Collagen (type I)
Ground substance

Water 10% 22%

● *Organic because of odontoblasts

TYPES OF DENTIN
● Primary Dentin (Regular dentin/orthodentin)
○ Develop before eruption of the tooth
○ Has regularly arranged dentinal tubules
○ Mantle Dentin
■ peripheral/ Outer thin layer of dentin
■ Run parallel to the DEJ
■ Consists of thick collagen alpha-fibrils
■ More organic because Branchings of odontoblastic processes
■ Less Densely mineralized
■ About 150μm (0.15mm)
■ First layer of dentin to be deposited
■ Located adjacent to the enamel in the crowns of teeth and adjacent to the
cementum in the roots
■ Part of primary dentin near the DEJ
 ○ Circumpulpal Dentin
■ Main Bulk of dentin mass
■ Consists of collagen (beta) β-fibrils and a mucopolysaccharide ground
substance
■ Forms walls of pulp cavity

○ *Mucopolysaccharide
■ Long unbranched polysaccharides
■ Highly polar and attract water (hydrophilic)
■ Useful as a lubricant or as a shock absorber
● Secondary Dentin
○ Formed continuously throughout life (as long as tooth and pulp is vital)
○ Develops after root formation has been completed
○ Also found in unerupted tooth
○ Represents the continuing but much slower deposition of dentin by the
odontoblasts after the root formation has been completed
○ Greater deposition on the root and floor of the pulp chamber than on the sides
■ Results to asymmetric reduction in size and shape of the pulp chamber
and its number of pulp horns [pulp recession]
■ Importance: to know where the pulp is
○ Characterized by a slower rate of deposition and an abrupt change in the
direction of the dentinal tubules
○ Closer to the pulp
● Tertiary Dentin (Irritation, Reparative, or Reactive, irregular secondary)
○ Made in areas where it needed
○ Formed in response to outside or noxious stimuli (stimuli such as attrition,
erosion, caries, cavity, preparation or therapeutic)
■ Noxious: harmful, irritative, undesirable;only areas that have irritations
○ Result of defensive activities of the pulp-dentin complex
○ May have variable, atypical structure:
■ Reduced number of dentinal tubules
■ Irregularly arranged dentinal tubules, wavy in their course
■ Absence of dentinal tubules
○ Found only on localized areas along the dentin-pulp interface
○ Whenever dentin is violated by caries, abrasion or attrition,one should expect an
increase in the amounts of hard tissues in the underlying pulp
○ Irregularly arranged and few dentinal tubules
○ With aging or severe damage, tertiary dentin can totally obliterate the pulp cavity
○ Types:
○ Vasodentin
■ Dentin with vascular inclusion
○ Osteodentin
■ Similar to bone
○ Atubular fibrodentin
■ With fibers but lacking tubes, Due to atypical dentin formed of tertiary
dentin

● Schreger’s line
○ Marks the demarcation/division/change of primary and secondary dentin or
tertiary dentin
○ Slower rate of deposition
 ○ Abrupt change in the direction of dentinal tubules
○ Aka calciotraumatic line

● Predentin (Dentinoid)
○ Unmineralized or Uncalcified dentin matrix 10-47μm/microns in thickness
○ Lines the innermost portion of dentin, nearest to the pulp
○ Consists of mainly of collagen, glycoproteins and proteoglycans
○ Not yet mature but Calcifies within 24hrs as another band of predentin is forming
pulpward
○ Thickest where active dentinogenesis is occurring
○ Its presence is important in maintaining the integrity of dentin
■ Mineralized dentin is vulnerable to resorption by odontoclasts

STRUCTURAL ELEMENTS
● summary:
○ Dentinal matrix
■ Peritubular dentin or intratubular dentin
■ Intertubular dentin
○ Dentinal tubules
■ Odontoblastic process/ tomes’ fiber/ dentinal fiber periodontoblastic space
 ■ Intratubular nerve
■ S shaped

● DENTINAL MATRIX
○ Calcified part
○ Intercellular material of dentin consist of 2 fundamental units
○ Formed elements
■ Collagenic - alpha or koff’s fibers
■ Fibrous - beta fibrils
○ Unformed elements
■ Mucopolysaccharides/ ground substance

DENTAL MATRIX
○ Ground substance - mucopolysaccharides
○ a. Intratubular Dentin/ peritubular dentin
■ “Intra” means within
■ Surrounds the odontoblastic process
■ Uniformly mineralized
■ Covers the wall of dentinal tubules
■ Very dense, more calcified (has more hydroxyapatite crystals per unit
volume)
■ Found in vital teeth (as long as the pulp is alive) seen all throughout life
■ When you get older, tubules will be completely occluded filled with
intratubular dentin
○ b. Intertubular Dentin
■ “Inter” means in between
■ Found between the dentinal tubule
■ Makes up the main bulk of dentinal material/ dentin matrix
■ Primary secretory product of odontoblast
■ Less densely mineralized (in comparison to peritubular dentin)
■ Contain canaliculi - branches of odontoblastic process are housed;
intercommunication of odontoblasts
■ Consists of type I collagen fibers in which hydroxyapatite crystals are
deposited
■ Gives hardness to dentin
■ Represents the primary secretory product of odontoblasts
■ consist of:
● Large amount of collagen fibers where apatite crystals are
deposited
● Ground substance of phosphoproteins, proteoglycans, etc.
 Transverse/ cross section:

Longitudinal section:
*White part: peritubular dentin (seen around the odontoblastic process)
*Dark part: intertubular dentin (usually more in number)

○ C. DENTINAL TUBULES
■ Regularly arranged canals from the pulp to the DEJ and CEJ
■ Tapered structures [0.947μm/microns (DEJ) and 1.2-2.547μm/microns
(pulp)]
● Larger near/on the pulp
■ More tubules per unit area near the pulp
■ The nearer the pulp (deep dentin), the softer the dentin
● Intertubular dentin will be less
■ Exhibits a S-shaped curvature, because it follows the course the
movement of odontoblast from the DEJ going towards the pulp
■ Least pronounced in the incisal and cuspal areas
■ Results from the crowding of the odontoblasts as they move toward the
corner of the pulp
● a. Odontoblastic process/Tome’s process/Dentinal fiber
○ Ends of odontoblast
○ Cytoplasmic extension of the odontoblast
○ Found inside the dentinal tubule
○ Higher number of predentin
● b. Periodontoblastic space
○ Located between the odontoblastic process and the walls of the tubule
○ Contains the dentinal fluid
● c. Intratubular nerve
○ The tubules near the DEJ: smaller and more sparsely distributed than near the
pulp
○ Tubules in root dentin: smaller and less numerous than in comparable depths
of coronal dentin, farther apart
○ Canaliculi: small canals connecting are tubule to another

● THEORIES OF DENTIN SENSITIVITY

○ One of the most unusual feature of the dentin-pulp complex
○ Overwhelming sensation perceived by this complex is Pain
○ Stimuli
■ Air-water spray
■ Contact with a bur or probe
■ Dehydration
○ Dentin is more sensitive along the DEJ and near the pulp
■ 1. Direct conduction theory
● Dentin is directly innervated
● Where you find a nerve in a tubule
● Dentin is innervated through dentinal tubules
● Direct conduction happens there, but not all tubules have
nerve.That’s why this theory isn’t enough
■ 2. Transduction theory
● Odontoblasts act as receptors
● “trans” means across
● Nerves/receptors will be inside the pulp
■ 3. Hydrodynamic theory
● Fluid movement through the tubules stimulates receptors
● Most popular and widely accepted
 ● Surface tension
● Disturbance (by temperature, physical, osmotic changes) will
send to receptors

*DT- dentinal tubules

*NF - predentin?
*OD - dontoblast
STRUCTURAL CHARACTERISTICS OF DENTIN
● INTERGLOBULAR DENTIN
○ Areas of structural defect where unmineralized or hypomineralized
○ hypomineralized dentin where calcospherites have failed to fuse into a
homogenous mass, resulting to an area which is uncalcified
■ Calcospherites: globular zones of mineralization that are supposed to
grow
■ Not good -> weaker
○ Prevalent in vitamin D-deficiency and exposure to high levels of fluoride
○ Result from failure of globules of calcospherites to fuse into a homogenous mass
within mature dentin
○ Unmineralized spots
○ Irregular in shape
○ Most frequent see in circumpulpal dentin just below the mantle dentin inside the
DEJ
○ Found in coronal dentin
○ Tubules run uninterrupted through interglobular dentin

● GRANULAR LAYERS OF TOME’S

○ Structural defect that comprise uncalcified parts of ground substance
 ○ Numerous and closely packed, tiny areas of hypomineralized dentin appear as
dark (black) granules in ground section found at the dentino-cemental junction of
the root dentin
○ Probably due to the coalescing and looping of the terminal portion of the tubules
○ Looping is related to the lower rate of dentin formation in root dentin; looping
cause hypomineralization
○ Clinical importance:
■ If cementum is exposed due to gingival recession, patients will experience
sensitivity during oral prophylaxis or cavity preparation in case of caries
removal
■ This sensitivity will stimulate dentin sclerosis or formation of tertiary dentin
○ Layer of block granular structure
○ Located in the root dentin adjacent to the cementum
○ Seen only in ground sections
○ Due to the arrangement of collagen and matrix protein at the interference
between dentin and cementum
■ Looping of the tubule

● INCREMENTAL OF VON EBNERS/TRANSVERSE STRIATIONS

○ Marks the 5-day increment where changes in collagen fiber orientation are
demonstrated
○ Growth lines/ daily apposition lines of dentin
○ Organic matrix of dentin is deposited rhythmically at a rate of 4μm/microns per
day and is mineralized in 12th cycle
● CONTOUR LINE OF OWEN
○ Corresponds to the incremental line of Retzius of enamel growth lines of dentin
occur at irregular intervals
○ Its width measure the duration of the disturbance that caused them
○ Changes in the coloration of the dentin
○ Intercept the DEJ and meet an accompanying striae of Retzius that was formed
at the same time
○ Alternate calcification of dentin

● GLOBULAR MINERALIZATION
○ Deposition of crystals in several distinct area of matrix – calcospherites
○ Calcospherites
■ Globular masses that enlarge to form a calcified mass
■ Faster dentin deposition, larger globules
■ Slower deposition, smaller globules
■ Very slow, it appears linear
■ 1 layer of odontoblast
● AGE CHANGES
○ SCLEROTIC DENTIN/ transparent dentin
■ Thickening of the peritubular dentin
■ Complete obliteration of the dentinal tubules
■ Physiological aging process defense reaction
■ Tubules that have become occluded with calcified material so that
bacteria could not enter
■ Dentin assumes a glossy appearance
■ Increases as we age
■ Filled with intratubular dentin,
■ Most common in the apical 1/3 of the root and midway between DEJ and
pulp
■ Have a transparent appearance
■ Respond to the carious lesion
■ Pulp is protected
 ○ *****TERMINAL BRANCHING
■ Branching towards the DEJ
● a. Dichotomus branching
● b. Greater branching of dentinal tubules
○ DEAD TRACTS
■ Dentinal tubules are emptied by:
● Complete retraction of the odontoblastic process from the tubule
● Death of the odontoblasts
● May result from attrition, erosion, abrasion, caries and
odontoblastic crowding
■ Dentinal tubules which are filled with air that appear black in ground
sections
■ Found on areas where there’s irritation
■ Responds to moderate or severe levels of stimuli
● Caries, attrition, abrasion
● When teeth cure mechanically prepared to within 1.5mm of the
pulp
■ In about 15 days,
● → New odontoblasts are differentiated from mesenchymal cells of
the pulp and these replacement of odontoblast lay down the
reparative dentin to protect the pulp
● → Reparative dentin: no odontoblastic process inside

● DENTIN SENSITIVITY
○ Hypersensitivity
■ Occurs when dentin becomes exposed and tubules are open at the dentin
surface
■ When there’s recession in gingiva
○ 2 treatment approaches
■ 1. Interrupt the neural response to pain stimuli
■ 2. Occlude the tubules to block the hydrodynamic mechanism
● DENTINOGENESIS
○ Process of dentin formation
○ Begins at the late bell stage
○ Dentin
■ Formative cell: Odontoblast
■ Formative organ: Dental papilla
■ Embryonic origin: Ectomesenchyme
■ DENTAL PAPILLA → PREODONTOBLAST → ODONTOBLAST
○ Terminal Bar Apparatus
■ Formal at the distal pole of pre-ameloblast
■ Keep them in contact with each other
○ Enamel organ: signals the cells of dental papilla to form odontoblast
○ Von Korff’s Fibers: large diameter collagen fibers which is the first sign of dentin
formation
○ Odontoblasts elaborate a finer β-fibril
○ Synthesis of non-collagen elements to form ground substance → PREDENTIN
○ Aprismatic enamel
■ No rods
■ Difficult to etch as well as the higher mineral
■ More mineralized in the subsurface
○ If we remove 0.5mm from the surface of the tooth, the substance is enamel
ALYSSA’S NOTES - DENTINOGENESIS
DENTINOGENESIS
● process of dentin formation
● different stages of dentin formation after differentiation of the cell result in different types
of dentin: mantle dentin, primary dentin, secondary, and tertiary
● is performed by odontoblasts, which are a special type of ectomesenchymal cells on the
outer wall of dental pulps, and it begins at the late bell stage of a tooth development.
● Will continue throughout life

● LIFE CYCLE OF ODONTOBLASTS:

1. Odontoblast Differentiation (Pre- odontoblasts).
2. Formative (secretory) stage:
a. Mantle dentin formation.
b. Odontoblastic process appearance.
3. Quiescent (resting) stage.

1.) ODONTOBLAST DIFFERENTIATION

● Bell Stage
○ occurs at the late bell stage, by the differentiated cells of the dental papilla called
the odontoblasts.
○ The differentiation of the underlying cells of the dental papilla into
pre-odontoblasts occurs under the influence of the signaling molecules and
growth factors released from the undifferentiated cells of the inner enamel
epithelium.
● *Growth Factors
● *Signaling Molecules
● *Bone Morphogenetic Proteins (BMP)
● *help in differentiation of dental papilla cells to pre- odontoblasts
○ As soon as the cells of the inner enamel epithelium differentiates into pre-
ameloblasts the underlying cells of the dental papilla will stop dividing and will
form two daughter cells.
○ Out of these two daughter cells one of them will differentiate into
(1)pre-odontoblasts while the other one will (2)remain undifferentiated in the pulp
of a tooth which can be activated any time by an external stimulus.
○ Pre-odontoblasts, then gradually become bigger in size, elongate to become
odontoblasts and develop numerous organelles like rough endoplasmic reticulum
(RER), ribosomes and golgi complex necessary for protein secretion.
○ As differentiation progresses, the cells grow in length, the acellular zone
gradually disappeared and reaches about 40 μ in height and 7 μ in width.
● * Acellular zone – cell free zone; in between the IEE and Dental Papilla cells – ground
substance laid down by the subodontoblastic cells

2.) FORMATIVE STAGE

○ Mantle Dentin Formation
 ■ The secretory odontoblasts form extensive junction complexes and gap
junction to form distinct row of odontoblasts, the cell also exhibit alkaline
phosphatase activity which is necessary for Ca++ transport into the cell
■ Secretory odontoblasts are aligned along the periphery of the pulp.
■ Functionally, this cell is considered to consists of 2 distinct parts: cell
body in which synthesis and secretion of proteins occurs and cell
process whereby secretion occur.
■ The odontoblastic process consists of one main bulk with numerous
lateral branches along its length.
■ The first sign of dentin formation is the appearance of distinct,
large-diameter collagen fibrils called Von Kroff’s fibers
■ Odontoblasts once fully differentiated start to secrete collagen molecules
and non- collagenous proteins in the extracellular region towards the IEE
■ The initial mantle dentin matrix comprises of mainly type I collagen and
partly von Korff’s fibres comprising type III collagen.
* Type 1 Collagen – This type accounts for 90% of your body's collagen and is
made of densely packed fibers. It provides structure to skin, bones, tendons,
fibrous cartilage, connective tissue, and teeth.
* Von Korff’s fibres – thick collagenous fibers in the developing tooth; indicate
that start of dentin formation
● Odontoblastic Process Formation (tome’s fiber)
○ After the odontoblast secretes this initial mantle dentin matrix, it develops a
process called the odontoblastic process which extends into the extracellular
matrix.
○ This odontoblastic process otherwise called Tome’s fiber keeps elongating as
more organic matrix is deposited and odontoblast moves towards the pulp
*Tome’s process is the distal extension of an ameloblast that is responsible for
secretion of rod and inter rod enamel.
*Whereas, Tome’s fiber is the odontoblastic process of the odontoblast present within
dentinal tubules in the fully formed dentin.
○ Odontoblastic processes are finally embedded in dentinal tubules in the fully
formed dentin.
○ Hence the mantle dentin does not have dentinal tubules.

3.) QUIESCENT STAGE:

○ This stage occurs after completion of the circumpulpal dentin. The odontoblast
cell loses most of their protein forming organelles to accommodate the decrease
in their function.
○ The fully differentiated and actively secreting odontoblasts decrease slightly in
size and the cell process stop to elongate as dentin formation is reduced.
○ Meanwhile the odontoblasts had reached the quiescent stage, however, they
produce dentin in a very slow rate but may be reactivated after injury.

● FORMATION OF PREDENTIN (DENTIN MATRIX FORMATION)

 ○ The first indication of predentin formation is the development of bundles of fibrils
among the fully differentiated odontoblast.
○ These bundles were known as Von Kroff’s fibers, that form the major component
of the first formed thickness of dentin and are attached to the basement
membrane of the inner dental epithelium.
○ These fibers (Korff ’s fibers) , were thought to be secreted by the
subodontoblastic cells of the dental papilla. They have an argyrophilic reaction
(stain black with silver).
○ Under E/M(electron microscope), it was found that this black stain is of the
ground substances among the cells and not due to the thick collagen fibers.
○ So, the formation and secretion of these fibers is proved to be from
odontoblasts and not from other cells.
○ After odontoblasts differentiated, the collagen formation begins in ribosomes
sites of RER as procollagen, then pass to Golgi complex where they are
glycosylated to be transferred as secretory vesicles towards the secretory poles
of the cells.
○ Once the secretory vesicles secreted outside the cell, the procollagen molecules
aggregated as large fibers of type I collagen fibers in ground substance which
is the product of odontoblasts incorporated with some of pre-existing substance
of the cell free zone to form Mantle dentin.
○ The large collagen fibrils are 0.1-0.2 μm in diameter; these fibrils are aligned at
right angles to the basement membrane, while in the mantle dentin of the root,
they are parallel to it.
○ The first formed thickness of dentin is the mantle dentin. As dentin is further
deposited, the first formed fibers fade gradually and smaller fibrils constitute a
network in the dentin subsequent to the mantle dentin, i.e. circumpulpal dentin.
○ Odontoblasts function in the formation of both the collagen fibers and the acid
mucopolysaccharides of the dentin matrix
● FORMATION OF CIRCUMPULPAL DENTIN
○ Once the layer of mantle dentin is formed, dentinogenesis continue in a slightly
different manner to form circumpulpal dentin which is the basic structure of dentin
and forms its bulk.
○ The odontoblasts increase in size obliterating the intercellular spaces with
extensive junctional complexes develop to form distinct row of odontoblasts.
○ As the matrix is formed, the odontoblasts begin to move towards the pulp. The
plasma membrane of the odontoblasts adjacent to the inner dental epithelium
pushes out several short processes called Odontoblastic Process (Tome’s Fiber).
○ Occasionally, one of them may penetrate the basement membrane and interpose
itself between the cells of the inner dental epithelium to form Enamel Spindle.
Circumpulpal dentin is formed in a similar way to mantle but differ from mantle dentin in:
○ The collagen fibers are smaller in diameter 0.05 μm and more closely packed
and interwoven with each other.
○ The fibers are generally present at right or oblique angle to the tubules (parallel
to dentin surface).
 ○ The ground substance is exclusively a product of odontoblasts.
● MATURATION (MINERALIZATION) OF PREDENITN
○ It occurs at a rate that parallel to matrix formation, and both formation and
maturation of predentin begin at the tip of the crown and proceeding in a rhythmic
pattern to be gradually completed cervically.
○ It does not occur until a fairly wide band of matrix is formed. Thus until the matrix
is completed, the width of predentin remain constant (10-20 um).
○ After the odontoblasts form a wide band of predentin, they bud off matrix vesicles
which are small vesicle exit from their plasma membrane into the extra cellular
organic matrix.
○ These vesicles are rich in calcium and phosphate ions and contains alkaline
phosphatase enzyme, their function is to provide a special micro-environment to
form the first hydroxyapatite crystals.
○ Once the first crystal forms within such vesicle it grows rapidly and rupture
through the vesicle wall to spread as a cluster of crystallites and fuse with
adjacent clusters to form a fully mineralized matrix.
○ Apetite crystals will obscure the collagen fibrils of the dentin matrix. However,
when these globules do not fuse with each other, areas of uncalcified dentin are
left and known interglobular dentin.
○ The predentin is then calcified in a linear pattern or occasionally by globular
pattern.
○ The long axis of crystals are paralleling the fibril axis in rows. Occasionally, the
crystals appear to be deposited in the fibrils themselves.
The dentin mineralization follows two different patterns, linear and globular depending on the
rate of dentin formation:
● Globular calcification: deposition of crystals in several areas of the matrix at one time,
with continued calcification, globular masses develops, which enlarge and fuse to form a
single mass, usually present in mantel dentin where matrix vesicle give rise to
mineralization fossil that grow and coalesce. The size of globules depends on the rate of
dentin deposition with the largest globules occurs when dentin deposition is fast. When it
slow down the mineralization front appears uniform and mineralization is linear.
● In circumpulpal dentin , mineralization front can progress in a linear or globular pattern.

● CLINICAL CONSIDERATIONS
○ Dentinogenesis imperfecta
■ Metallic restorations as thermal conductors
■ Permeability - effective sealing
■ Rapid penetration of caries
■ Dentin vitality
■ Pulp capping
■ pain / sensitivity
■ Disturbance of matrix formation and dentin mineralization
■ Characterized by:
 ● Abnormally translucent enamel
● Bulbous crowns with short roots
● Obliteration of pulp chamber
● Need for a base under metallic restoration
■ Base cements: (GIC) blocks of thermal impulses
○ Permeability of dentin
■ Need for effective sealing of dentinal tubules as a requisite for restorative
dentistry
○ Indirect pulp capping
■ Placement of calcium hydroxide liner of deep cavities to protect the pulp
■ Rapid penetration and spread of caries

PULP
[See alyssa’s notes]
 CEMENTUM
● Calcified dental
● Mineralized non-homogenous connective tissue
● Not as hard as enamel and dentin
● Covers the entire dentin of the root from the CEJ to the apex
● Extends into the apical foramen to line the apical walls of the root canal
● The only tooth tissue that is considered as a component of both tooth and periodontium
● Covers root dentin
● About 0.05mm thick at the cervical part of the root
● Thicker on the apical part of the root of a functioning tooth
● Less radiopaque
● Formative organ: Dental follicle
● Formative cell: Cementoblast

PHYSICAL PROPERTIES
● Contains the least mineral compared to enamel, dentin and bone
● Light yellow in color
● Has no luster
● Permeable to varying degrees like enamel and dentin
CHEMICAL COMPOSITION
● Organic matrix (50-55%)
○ Collagen (mainly Type I)
○ Chondroitin Sulfate
○ Water
● Inorganic/Mineral Component (45-50%)
○ Hydroxyapatite crystals

FUNCTIONS
● Anchors the teeth to the alveolus (alveolar socket)
● Seals the surface of the root dentin and covers the ends of the open dentinal tubule
● Compensates for the lost tooth substance due to attrition
● Contributes to the continuous vertical eruption of teeth
● Regulates the periodontal space (between bone and cementum) as bone resorbs
● Has ability to resorb
● *For sensitive tooth, cementum seals dentinal tubules
● Repairs
○ Resorbed part of cementum surface (there’s still cementoblast)
○ Fractured roots
■ -> it provides new surface for the reattachment of torn periodontal
ligament fibers
RESORPTION OF CEMENTUM
● About 90% of permanent teeth show evidence of small regions of cementum resorption
● Resorbed surfaces are scalloped
● CEMENTUM RESORPTION < ALVEOLAR BONE RESORPTION
 ○ Why we can move teeth orthodontically
● Normal process of cementum and dentin resorption
○ During exfoliation of deciduous teeth
○ Force of eruption of secondary teeth
● Causes of resorption
○ Exfoliation of deciduous teeth
○ Tooth drift
○ Traumatic occlusion
○ Infection
○ Excessive orthodontic forces
● REPAIR OF CEMENTUM
○ Cementoblasts located immediately on the surface of the tooth that they will
produce. Because in case of injury the cementoblasts will immediately place a
layer of cementum on the injured part of the tooth
○ a. Functional repair
■ Restore function because periodontal ligament fibers are reattached
■ Resorption lacunae are only partially filled
■ Periodontal fibers are anchored in the surface of shallow depression
■ Alveolar bone becomes thickened through apposition to re-establish the
physiologic width of the periodontal space
■ *like a basic first aid; function: to reestablished the physiologic width of
periodontal space
○ b. Anatomical repair
■ Resorption lacunae are completely filled
■ Continuity of the root surface is re-established
■ Fiber apparatus of the periodontal ligament is re-attached
■ Reattachment of fibers, but on top of the root, it is smooth already
■ *basically good as new, di obvious it was broken

TYPES OF CEMENTUM
● a. Acellular Afibrillar Cementum
○ No cell
○ No fiber
○ Contains neither cementocytes nor collagen fibrils
○ May be the product of only the matrix-forming cementoblasts
○ Formerly called coronal cementum
○ Found on the CEJ
○ Cementum is above the enamel
○ *when cementoblasts is trapped within the matrix of cementum, then it becomes
a cementocytes
● b. Acellular Extrinsic Fiber Cementum
○ No cell
 ○ Collagen fibers found here are made from outside(fibroblast of periodontal
ligament)
○ Consists of Sharpey’s fiber (extensions of periodontal fibers); closely packed
bundles of extrinsic collagen fibrils
○ Formerly known as primary cementum or fibrous cementum
○ Formed predominantly on the cervical and middle portion of the root directly on
the external dentinal surface
○ May be mixed with the cellular type in the middle 1/3 of the root
● c. Cellular Mixed Fiber Cementum
○ Has cells
○ Fibers from mixed
○ Contains cementocytes
○ Has both extrinsic Sharpey’s fiber and intrinsic fibers (bundles of collagen
fibers in the cementum)
○ Referred to as secondary cementum
○ Formed during root formation on root surfaces facing furcations
○ Formed around the closing root apex, extends into the entrances of root canal
and may spread coronally over root surfaces
○ *Secondary cementum formation is a continuous process
○ *The thickness of cementum on the root surface increase with age (forensic
dentistry)
● d. Cellular Intrinsic Fiber Cementum
○ Has cells
○ Fibers from cementum
○ No extrinsic fibers or sharpey's fiber
○ Contains cementocytes and intrinsic bundles of collagen fibrils
○ Exclusive products of the cementoblasts
○ Formed only during reparative process such as:
■ Filling in of resorption lacunae
■ Repair of root fractures
■ During Anatomical/ functional repair
● E. Intermediate Cementum
○ Found right next to dentin
○ A thin, non-cellular, amorphous (no definite shape) layer of hard tissue (10μm
thick)
○ Deposited in the inner layer of epithelial root sheath (no collagen)
○ The first layer of hard tissue deposited
○ Seals the tubules of dentin
○ Composed of enamelin instead of collagen
○ Has harder consistency; it calcifies to a greater extent than dentin and cellular
cementum
○ Hyaline layer of Hopewell-Smith
■ Then clear zone between Tome’s granular layer and Primary Cementum
 AC- acellular cementum
D- dentin
Arrows- presence of cementocytes (housed in lacunae)

PRIMARY AND SECONDARY CEMENTUM

● Acellular cementum
○ Primary Cementum
○ Laid down during root formation
○ Mainly in the pericervical (upper) region of the root
● Cellular cementum
○ Secondary cementum
○ Laid down after eruption and throughout life
○ Perioapical (lower) and interradicular regions of the root
○ Cementocytes: cells in cementum
○ Apical cementum (cellular/secondary) can be 5x thicker than cervical cementum
(acellular/primary)
 ■
Cementum increase in thickness with age becoming about 3x thicker in
interval between 11-76 years of age
STRUCTURAL COMPONENTS
● Cementum Matrix
○ 1. Extrinsic fibers / Sharpey’s fibers
■ Collagen fibers formed by fibroblasts of periodontal ligament
■ Partly incorporated into the cementum
■ Always exist in the cementum in a straight line
■ Changes occur and affect the direction of the fibers
● (mesial migration, tipping, occlusal drift)
■ Fibrous collagen fibrils forming fibrous structure which belongs ot the
periodontal ligament and not intrinsic to the cementum
○ 2. Intrinsic fibers
■ From cementoblasts
■ The cementoblasts also lay down
■ Fine collagen fibers which lies parallel to the surface of the cementum
■ Incremental Lines of Salter
● Growth lines of cementum
● Parallel with the cementum surface
● Equivalent to:
○ enamel - transverse striations
○ Dentin - von ebner
○ 3. Ground substance
■ Non-collagenous, became collagen is found in fibers
■ Consists of the normal assembly of
● a. Proteoglycans
● b. Glycoproteins
● c. phosphoproteins
● Cells of Cementum
○ 1. Cementoblasts
■ Outside the cementum/on the surface of cementum
■ Form the Cementum
■ Found lining the root surface of
■ Interposed between bundles of periodontal ligament
■ Active Cementoblasts
● Round, plump cells with basophilic cytoplasm with an extensive
rough endoplasmic reticulum
● Phasic deposition of cementum continues through life
■ Resting cementoblasts
● Closed or Hemtaoxyphilic nucleus with little cytoplasm
○ 2.Cementocytes
■ Inside the cementum
■ Cells that can’t eat, die
■ Quick form of cementum, many cemetocytres
 ■ Cementoblasts that are trapped in the lacunae during its development
■ Sparse amount of cytoplasm and numerous process occupying the
canaliculi in the mineralized cementum matrix
■ Depends on the diffusion from the periodontal ligament for essential
nutrients o The canaliculi of cellular cementum have a tendency to be
polarized and extend towards the periodontal ligament side of root to get
nutrients
■ Depend on the diffusion of nutrients from periodontal ligament
■ Lacunae: space that houses the cell body of cementocytes
■ Canaliculi: elongated space that houses the processes

CEMENTO-ENAMEL JUNCTION
● Outside the tooth
● 1. Overlapping
○ Cementum Overlaps The Enamel
○ Most common
○ Occurs in 60% of teeth
● 2. Butt-joint
○ Cementum meets the enamel in a butt joint forming a distinct CEJ
○ Occurs in 30% of health
○ Meets in particular point
○ Second most common
● 3. Gapped CEJ
■ A gap occurs between cementum and enamel
■ Exposed Root Dentin
■ Occurs in 10% of teeth
○ All of these relationships may be found around the circumference of a single
tooth

CEMENTOGENESIS
● Hertwig’s Epithelial Root Sheath (HERS)
○ Extension of enamel organ that extends apically to the root
○ Extension of cervical loop (Outer Enamel Epithelium + Inner Enamel Epithelium)
 ○ Determines the size and shape of the roots
○ Induces dentin formation in the root
○ Ectodermal in origin
○ Induces the differentiation of odontoblast
● Process:
○ HERS break up —>
○ Cells of the dental follicle come in contact with dentin —>
○ Multipotential cells differentiate into cementoblasts —>
○ CEMENTUM —>
○ CEMENTOBLASTS —>
○ CEMENTOID/PRE-CEMENTOBLAST (Uncalcified) —>
○ CEMENTUM

EARLY STAGE OF CEMENTOGENESIS

● The periodontal fibroblast contribute the extrinsic fibers that become incorporated in the
cementum (Sharpey’s fiber)
● The cementoblasts provide the ground substance and intrinsic fibers that surround and
fill the space between the extrinsic fibers
● As new cementum is deposited on the surface, the cementoblasts are displaced toward
the periodontal ligament avoiding entrapment
● It gives rise to the acellular extrinsic fiber cementum
● This cementum is laid down comparatively slowly
● The collagen fibrils are densely and regularly packed
● Secondary cementum grows first, then primary cementum
● Primary cementum
○ Acellular
○ Formed slowly
○ Covers coronal 2/3 of the root
● Secondary cementum
○ Cellular
○ Formed more rapidly
○ Covers apical ⅔ of the root
○ * Primary and Secondary cementum overlaps
○ * In the middle portion, tooth can have both that’s why when you add them, they
are equal to 1 ⅓

CLINICAL SIGNIFICANCE
● Hypercementosis
○ Excessive Amount Of Cementum Formed
○ May be diffused, circumscribed or localized
○ Covering the apical half or the entire root surface
○ Can occur on a single tooth or groups of teeth
○ Caused by overproduction of the cellular cementum
○ [both mixed fiber cementum and intrinsic fiber cementum]
 ○ Types:
■ a. Cementum Hypertrophy
● Related to function
● Overgrowth of cementum found in functioning teeth
● Increase in physiologic function as in abutment teeth
● Abutment: supporting teeth when prosthesis is placed
■ b. Cementum Hyperplasia
● Overgrowth of cementum found in non-functioning teeth:
● Occurs with Retained deciduous/impacted teeth
● Natural/orthodontically induced tooth movements
● Teeth without opposing teeth causes supraeruption

● Epithelial Rests of Malassez

○ Remnants (something that is left) of the Hertwig’s Epithelial Root Sheath (HERS)
○ Discrete clusters or islands of epithelial cells separated by the surrounding
connective tissue by a basal lamina
○ Often appear as a network within the periodontal ligament close to the cementum
surface
○ May result in:
■ Enamel pearl/ Enameloma
● Localized flat/broadly knob-shaped cemental thickening on the
root surface
● Enamel drops at the center of bifurcation or trifurcation
● These protrusions develop when a patch of the epithelial root
sheath fails to break free from the dental surface
○ Epithelial cells differentiate into ameloblasts which proceed
to deposit enamel
● It often mimic subgingival calculus deposits and may lead to
similar patterns of periodontal tissue destruction
● Vary from 0.3-2.9mm in diameter
● May be composed of enamel only, enamel and dentin, or enamel,
dentin, and pulp
■ Cementicles
● Calcified, spherical bodies around 0.4mm in size
● Made up of concentric shells of acellular extrinsic fiber cementum
● located in the periodontal ligament after tooth eruption
● May be free in periodontal ligament, attached to the surface
cementum or embedded in cementum
● *usually no problem. Only causes problem when it impinged
nerves and vessels
■ denticles
■ Cyst/Tumor
● Reticular cysts
○ Cyst fluid filled cavities found at the periapical/ roots
 ● Dentigerous cysts
○ Cyst found associated with erupting teeth
● Enamel Projections
○ Bad, because you need periodontal ligament attachment
○ Enamel drops at the center of bifurcation/trifurcations
○ May lead to pockets in furcation to result infection
○ Neither enamel pearls nor enamel projections can be removed by stain
● Cementum is less susceptible to resorption than bone
○ Basis for orthodontic tooth movement
● Similar to bone in structure & not sensitive does not contain nerves
● Ankylosis
○ Difficulty of tooth to come out because it is well cemented
○ Union of cementum and dentin with alveolar bone
○ Problem when you do extraction
● Susceptible to caries
 PERIODONTAL LIGAMENT
● One of the supporting tissues of the periodontium
● Around the tooth
● Reddish because it is a bloody tissue
● Cell-rich, fiber-rich, non-calcified, dense/fibrous connective tissue structure that joins the
cementum to the alveolar bone
● Continuous with the connective tissue of the gingiva at crest of the alveolar bone
● Wider than cementum
● Forms a joint-like connection between both cementum and bone considered as
syndesmosis
○ Syndesmosis: an articulation in which the bones are joined by a ligament
● Made up of a lot of fibers
● Ranges in width from 0.10-0.38mm
● Thinnest around the mid-root
● Varies with age
○ The younger you are, the wider and thicker the PDL
○ 11-16 years: 0.21mm
○ 31-51 years: 0.18mm
○ 51-67 years: 0.15mm

FUNCTIONS
● 1. Supportive
○ Attaches the tooth to the alveolar bone proper
● Serves as a shock absorber by mechanisms that provide resistance by light as
well as heavy forces
● The viscoelastic properties of the PDL gives tooth a degree of mobility and the
ligament is able to respond to increase forces by remodelling processes
● 2. Sensory (pain and pressure)
○ Having receptors to know the amount of force during masticatory cycle
○ Necessary for the proper positioning of the jaw during normal function
○ To estimate the amount of pressure in mastication
○ To identify which tooth is to be percussed
 ■ Percussion: diagnostic procedure that involves testing for the presence of
the jaw during normal function
○ PDL can register two(2) sensations:
■ a. Pain: free nerve endings of sensory fibers
■ b. Pressure: mechanoreceptors [Ruffini-like endings]
○ Afferent nerve fibers: regulate local blood supply
● 3. Homeostatic
○ PDL responds to the changes
○ PDL undergoes continuous remodelling
○ Renewal of cell population through continuous cell divisions
○ Remodelling is subjected to functional, metabolic and aging effects
○ Homeostasis: the tendency to maintain internal equilibrium by adjusting the
physiological processes
○ Periodontitis: breakdown of PDL (periodontal ligament)
● 4. Nutritive
○ Blood supply maintains the variability of its various cells
○ Provides essential nutrients

CELLS OF PERIODONTAL LIGAMENT

● A. Fibroblasts
○ Principal cells of PDL
○ Densely packed
○ Shaped like spindle or flat disks
○ Long ovoid nuclei
○ Numerous cytoplasmic processes of various lengths
○ The cytoplasm contain abundance of organelles associated with protein
synthesis and secretions
■ Satisfy the functional demands, required to change in shape and
migration
○ With an ability to achieve an exceptionally high rate of turnover of proteins,
especially collagen
○ Large cell with an extensive cytoplasm with a lot of organelles associated with
synthesis of secretion
 ○ Responsible for formation and degradation of collagen
■ * Cells responsible for dentin degradation/resorption are odontoclasts
○ With a well-developed cytoskeleton
■ Prominent actin networks
● Actin: muscle contraction to maintain the shape
■ Functional demands on the cell [change shape in migration]
○ Involved in the synthesis and degradation of collagen
○ Show frequent cell to cell contacts
■ Adherens and gap junctions (desmosomes)
■ Adherens junction: provides mechanical attachment between adjacent
cells
○ Fibronexus
■ Specialized focal contacts with extracellular matrix
■ Fibronectin in matrix connects with actin in cell, connection called as
fibronexus
● B. Cementoprogenitor / Osteoprogenitor
○ Found exclusively in the sections of the periodontal ligament adjacent to
cementum and bone
○ Closely resemble inactive fibroblasts
○ Cementoblast: basophilic found inside the cementum
○ Cementoclast: multinucleated found in the Howship’s lacunae of cementum
○ Osteoblast: formation of bone; found in the peripheral part of periodontal
ligament adjacent to the bone; not found in PDL
○ Osteoclast: bone resorption; not found in PDL; multinucleated; found in
Howship’s lacunae of alveolar bone
○ Howship’s lacunae
■ Concavities/depression in bone or cementum where osteoclasts or
cementoclasts (clast cells) are located
■ Digging of bone
○ Bone spicule moves depending on resorption
● C. Epithelial cells
○ Epithelial rests of malassez
○ Found in periodontal ligament
○ Remnants of the hertwig’s epithelial root sheath (HERS)
○ Mostly arranged in strands
○ Found in the inner thirds of the periodontal ligament parallel with the cementum
○ It can form dental cysts through persistent proliferation stimulated by acute or
chronic inflammation
○ Near cementum
○ Strands (linear) or rounded
○ With a basal membrane
○ Can form dental cysts if stimulated
○ Continuously released for their maintenance and function on EGF molecule
■ Epithelial Growth Factor: regulation of PDL from Epithelial cells
 ○ Diffuse throughout the extracellular matrix among the fibroblasts
○ Upon reaching the bone surface it; it stimulates osteoclastic activity to maintain
the periodontal ligament
● D. Undifferentiated cells [Progenitor cells]
○ Progenitor cells
○ Located within 5 micrometer of blood vessel
○ Source of new cells for the periodontal ligament
■ Apoptosis - physiologic cell death
○ Perivascular location (around blood vessel)
○ Production of new cells must be balanced by migration of cells out of the PDL or
by apoptosis (a natural process of self-destruction in certain cells; programmed
cell death// necrosis: pathologic cell death)
● Macrophages
○ Defense cells
○ Phagocytic activity
■ Bacteria, dead cells and foreign bodies
● Leukocytes
○ Specially lymphocytes and plasma cells may appear in the periodontal ligament
when stressed by disease

CONNECTIVE TISSUE FIBER

COLLAGEN FIBERS
● a) Collagen fibers
○ Predominantly present in the fiber system/ in PDL
○ Basic component is the collagen fibrils
■ Mixture of type type I and III individual fibrils having an average diameter
of 55 mm
■ provides tensile strength to the PDL
○ Several such fibrils become arranged parallel with one another to form a fibril
bundle
○ Arranged into distinct and definite fiber bundles
○ Fibers within a bundle are interwoven
○ Makes it stronger
○ DENTOALVEOLAR GROUP OF FIBERS
● Principal fiber bundles from cementum to alveolar bone
● Types/ Classified according to their functional orientation into:
● 1) Alveolar crest fibers
○ Oblique in an apical direction
○ Attached to the cementum just below the cemento-enamel
junction
○ Running downwards and outward to insert into the rim of
the alveolus
○ *Keeps tooth in place
○ Functions:
 ■ Resist vertical and intrusive forces
■ Anchor the tooth to the alveolus

● 2) Horizontal fibers
○ Immediately apical to the alveolar crest at right angles to
the axis of the tooth
○ Runs horizontally from cementum towards the bone
○ Follows a wavy course
○ Functions:
■ Resist horizontal or lateral forces or pressure
applied to the tooth crown
■ (horizontal pressure: medial, distal, buccal ,
lingual movement)

● 3) Oblique fibers
○ Most numerous and largest group
○ From cementum to bone oriented obliquely to insert into
the bone in a coronal direction
○ Shock absorber
○ Functions:
 ■ Sustain occlusal or vertical forces
■ Resist intrusive masticatory forces
● 4) Apical fibers
○ All over the apical
○ All teeth have apical fiber group
○ Radiating from the cementum around the apex of the root
of the bone
○ Founds at the base of the socket
○ Functions:
■ Prevents vestibule-oral tipping (horizontal
movement )

● 5) Interradicular fibers
○ Found only between roots of multinucleated teeth
○ Running from cementum (furcation) into the bone forming
the crest of the interradicular septum
○ Functions:
■ Resist tipping and torque
■ *Makes it difficult to remove posterior tooth
○ SHARPEY’S FIBERS
● Embedded portion in the cementum or bone
● Found only between roots of multinucleated teeth forming the crest of the
interradicular septum
● Fiber’s insertions are wider on the bone side than the cementum side
● Fibers within fiber bundle are not parallel with each other but are
interwoven
■ PDL permit the individual tooth a certain degree of mobility
■ PDL located in the periodontal space
■ Width 0.10 to 0.38 mm
● Narrower at the middle root
■ Diminishes with advancing age
■ Depends on functional demands
● Widened when increases functional load with thickened collagen
fiber bundles
● Lost of functional results to smaller PDL and its fiber bundles
become thinner and atrophic
○ PERIODONTAL SPACE
● Radiolucent in radiograph
 ● Narrow gap between cementum and bone
● Occupied by the PDL
● Response to increase functional load is widening of periodontal space
and thickening of the PDL
● Lost function -> thin or atrophic PDL bundles
○ INTERSTITIAL SPACE
● Space found between each group of fibers
● Contains blood vessels, nerves, lymphatics and loose connective tissue
cells
● interstitial indefinite tissue
● Maintain vitality of the PDL
● Also contain network of finer fibers interlace and support the dense
collagen bundles

● b) immature elastin fibers

○ Oxytalan
■ Bundles of microfibrils
■ Resemble elastic fibrils
■ Intertwined lengthwise to form fiber
■ Acid resistant
■ Insert into the cementum especially at the cervical region
■ Appears in larger number when the PDL is subjected to increase stress
■ Fibers run more or less vertically from the cementum surface apically
■ Thought to register tooth position and regulate blood flow
○ Elaunin fibers
■ Another form of elastic tissue
■ Embedded within a small quantity of elastin forming a network
■ Together with oxytalan fibers from a meshwork from cementum to bone
and sheathing the collagen fiber bundles
■ Argyrophil fibers *Can take up silver stain?
● c) Elastic fibers
○ Confined to the walls of blood vessels
● d) Reticular fibers
 ○ Aid in the support of blood vessels, lymphatic vessels and nerves
○ Ground substance
■ 70% water
● significant effect on the tooth’s ability to withstand stress loads
■ Glycosaminoglycans
● Ligament dermatan sulfate(principal)
○ Plays important role in ligament function
■ Glycoproteins
■ glycolipids
■ Amorphous background material that binds the tissues and fluids
■ and is thought to have a Increase in tissue fluids in areas of injury or
inflammation

BLOOD SUPPLY & INNERVATION

● Vascular Supply of the PDL
○ Superior (Maxillary ) and Inferior (Mandibular ) alveolar arteries and veins
(main supply)
○ 3 sources of periodontal blood vessel system
■ Dental artery
■ Interalveolar and Interradicular arteries
● Extends coronally inside bone septa and pass through Volkmann’s
canals into the PDL
■ Branches of Periosteal Arteries
● extends coronally through the facial and lingual mucous
membrane to the gingiva then communicates with the periodontal
blood vessel system
● Nerve supply / Innervation
○ Somatosensory system
■ Superior (NV2) dental plexus
■ Inferior (NV3) dental plexus
■ Free nerve endings
■ Ruffini corpuscles
■ Coiled endings
■ Encapsulated spindle type ending
■ From apical region or through CANALS OF ZUCKENKANDL &
HIRSCHFELD
■ Alveolar bone - Sieve(?) like/ cribriform plate
■ Nerve fibers run parallel to root axis along blood vessels
○ Autonomic system
■ Probably sympathetic affecting blood flow
TYPES OF NEURAL TERMINATION
● Different shapes of endings of nerve fibers
● a) Free Nerve Endings
○ Tree-like configuration
 ○ Most frequent
○ Found at regular intervals; all over
○ Thought to be both nociceptors (pain) and mechanoreceptors (pressure)
● b) Ruffini Corpuscles
○ Found around the root apex
○ Appear dendritic and end in terminal expansions
○ Found in close proximity to collagen fiber bundles
○ mechanoreceptors
● c) Coiled Ending
○ Found in the mid-region of the PDL
○ Function: not determined
● d) Encapsulated Spindle Type Ending
○ Lowest frequency
○ Associated with root apex
○ Covered with connective
FORMATIVE ORGAN: Dental follicle
FORMATIVE CELL: Fibroblast
EMBRYONIC ORIGIN: Ectomesenchyme

DEVELOPMENT OF Periodontal ligament

● Eruption process is not yet done, but PDL is already starting
● Most of the transformation of the dental follicle into the PDL begins at root formation
● Always occur after the disintegration of HERS
● With the simultaneous appearance of cementum
● Tooth germ still lies deep in the bony socket of the alveolar bone
○ a) Cemental fibers: attached to cementum
○ b) Alveolar fibers: attached to alveolar bone
○ c) Intermediate fibers: in between the cemental and alveolar fibers
● * CUSHION HAMMOCK LIGAMENT: continuous with intermediate fibers apical to
epithelial diaphragm; said to help in tooth eruption [Root Growth Theory]
● * Before eruption: PDL with loosely structured collagenous elements
● * Newly erupted teeth: wide PDL
● * Functional teeth: stimulation of bone formation; PDL narrows but becomes stronger
 Periodontal ligament formed by 2 fibers: cemental fibers and alveolar bone fibers (longer) =
intermediate plexus
Splicing is seen (knotting together) to form the plexus

INTERMEDIATE PLEXUS
● Zone of loose, not well-oriented collagen fibers
● In the center of the periodontal space
● Seem to intertwine into a lattice work
● Do not exist within the completely formed PDL
ORIENTATION OF PERIODONTAL FIBER BUNDLES:
● Depends on stage of tooth eruption

PHYSIOLOGIC CHANGES
● 1. Physiologic Mesial Drifting
○ Physiologic tooth migration in mesial direction
○ Compensates for interproximal tooth wear
○ Tooth remain in contact
○ Arch length is decreased
○ Contact points -> contact areas
○ Because of addition of cementum, you still manage to bite normally
○ Contact between teeth, wider when older
 ○ *Area pressure - bone resorption
■ Shortening PDL
■ rounded shape of interstitial tissue
○ *Area of tension - bone deposition
■ Lengthening PDL
■ Narrowed, elliptical of interstitial tissue
■ Bone formation
○ When exceed physiologic limit
● Periodontal space is wid in newly erupted teeth and becomes narrower over time
● Functional stresses will lead to thicker periodontal fiber bundles and less interstitial
tissue (loss of function)
● Periodontal ligament in the region of the permanent mandibular canine become thinner
with age
● 2. Decreased or loss of function
○ PDL becomes narrow and losses the organization of the fiber bundles
○ Interstitial spaces becomes wider
● 3. Increased functional stresses
○ Thicker fiber bundles
○ Less interstitial tissue
● EXCESSIVE FORCE: blood vessels (constrict) cannot sustain (usually happens when
you have braces) the blood supply of PDL that will lead to necrosis (cell death) and low
blood supply
CLINICAL CONSIDERATIONS
● Necrosis
● Health
● Renewal capability
● Adjustment period for prosthesis
● Hemorrhage due to acute trauma
● Pathologic lesions
○ Widening of PDL
○ presence of mobility clinically
● Integrity must be maintained
● Acute trauma
○ Fracture or resorption of cementum
○ Tears of fiber bundles
○ Haemorrhage
○ Necrosis
● Periodontal disease
○ No attachment of PDL
○ In cases of infection involving periodontium and bone
○ Periodontal probe: used for examination; lines are for measurement
○ Cause of loss of PDL
○ Calcular deposits -> treatment can be extraction
 ALVEOLAR BONE

● Specialized mineralized connective tissue composed of intercellular substances and

osteocytes with its processes in lacunae and canaliculi
● Formative organ: Dental follicle
● Formative cells: Osteoblast
● Embryonic origin: Ectomesenchyme
● Bone
○ 67% inorganic
■ Hydroxyapatite
○ 33% organic
■ 28% collagen
● Phosphoprotein
● Osteocalcin
● Osteonectin
● Bone Sialoprotein
● Bone specific protein
■ *5% non-collagen protein
● Osteopontin
● Proteoglycans

● Systematically controlled by hormonal factors

○ Growth factors
■ cytokines
● Locally controlled by mechanical forces
○ Piezoelectric conditions
■ Tooth movement

● Changes in the jaw as we age

● Can best resist
○ Compressive forces
■ Direction of force towards each other
■ Force that the bone is most common to
○ Forces directed along long axis of the tooth
● Can least resist
○ Tensile forces
○ Sliding stresses
● Functions:
○ Support and protection
○ Locomotion and attachment of muscles
○ Reservoir of minerals
○ Hemopoiesis [formation of blood cells]
STRUCTURAL ELEMENTS
● CELLULAR ELEMENTS
○ Osteoblast
■ Histologic appearance: round, smaller than osteoclast
■ Found on the surface of bone
■ uninucleated/ Mononucleated
■ Differentiate from a Precursor: Preosteoblast
■ Responsible for mineralization
■ Synthesize the following:
● Type I and Type IV collagen
● Cytokines are growth factor that regulate cell function and bone
formation (e.g., BMP = Bone Morphogenetic Protein)
■ Derived from mesenchymal stem cells:
● Adult bone marrow (BM-MSCs) and Liver
● Fetal tissues, amniotic fluid and umbilical cord blood (CB-MSCs)
■ Bone lining cells:
● Inactivate osteoblast when bone formation stops
● Retain gap junction in osteocytes
● Bone formation stops -> inactive
● osteoblasts – termed BONE LINING CELLS

○ Osteocytes
■ Entrapped osteoblasts in the lacunae
■ Number varies depending on the rapidity of the bone formation
■ More osteocytes when the bone formation is rapid
■ After bone formation
● -> it loses the ability to form matrix
● Reduce in size/ becomes smaller
■ Osteocytic lacuna
■ Canaliculi
■ Occupies osteolytic lacuna and canaliculi
● Maintains contact with adjacent osteocytes and osteoblasts/lining
cells
■ Responsible for osteolysis and osteoplasia – due to hormonal regulation
● Osteolysis: limited resorption of bone in lacunae and canal
● Osteoplasia: secondary rebuilding of perilacunar bone minerals
■ Prevent hypermineralization of bone by pumping calcium back into the
bloodstream

○ Osteoclasts
■ Large mononucleated cells
■ Seen in clusters
■ Occupied shallowed, hollowed-out depressions called Howship’s
Lacunae
 ■ Ruffled Border:
● Organelle-poor, brush-like cytoplasmic border which demarcates
the zone of resorption
● Releases acids and proteolytic enzymes (degrade organic portion
of bone)
● Bone matrix
○ Intercellular substances of bone
○ Consists of collagenous fibrils and calcified cementing substance (polymerized
glycoprotein bound with mineral salts)
● Sharpey’s fibers
○ Lateral fibrous elements extended into the bone matrix
● Blood vessels, nerves lymphatic tissues
○ Haversian canals

SEQUENCE OF RESORPTIVE EVENTS

1. Attachment of osteoclasts to mineralized surface of the bone
• Infection will result to resorption
• PDL is compressed
2. Creates sealed environment
3. Releases acids to demineralize the hard tissue
4. Organic matrix is degraded by secretion of proteolytic enzymes
• Acid: responsible to destruction of organic form

*Sealing Zone: function: para ‘di umabot ‘yung dangerous

chemicals sa bone na nirerelease ng osteoclasts

Histologic Arrangement of Mature Bone

A. Compact bone
● dense outer sheet of bone with closely packed layers
● 3 distinct types of layering
○ circumferential lamellae
■ Enclose the entire adult bone, forming its outer perimeter
■ nasa periphery
○ Concentric lamellae
■ Bulk of compact bone
■ Basic metabolic unit of bone = OSTEON
■ Haversian canal- houses a capillary
■ Volkmann’s canals - channels contain blood vessels
■ similar centers; cylinders
○ Interstitial lamellae
■ found in between/ interspersed between adjacent concentric lamellae and
fill the spaces between them
● Periosteum
○ Osteogenic connective tissue membrane
○ Surrounds every compact bone
○ connective membrane surrounding the compact bone
○ 2 layers:
○ 1. Inner layer
■ next to the bone surface; consists of bone cells, their precursors & rich
microvascular supply
○ 2. Outer layer
■ more fibrous; gives rise to sharpey's fibers
■ Penetrate the cellular layer of the periosteum & extend the circumferential
lamellae
● Endosteum
○ covers the internal surface of compact bone and entire surface of the cancellous
bone/ spongy bone
○ not well demarcated
○ loose connective with osteogenic cells
○ physically separates the bone surface from the marrow within
B. Spongy bone/ cancellous bone
● Trabecular bone
 ● Bone lamellae are arranged in from of flattened spicule surrounding the marrow spaces
● may spicules
● may spaces between bony plates
● Contain bone marrow

HISTOLOGIC STRUCTURE OF BONE

● Dense outer sheet of bone with closely packed layers
○ Compact bone
● Fundamental functional unit of compact bone
○ Haversian system
● Another term for haversian system
○ osteon
● Situated within lamellae are spaces called ____, which contains osteocytes
○ lacunae
● Connective tissue membrane surrounding compact bone
○ periosteum
● Terminal end of the periodontal ligament that insert into cementum and into the
periosteum of the alveolar bone
○ Sharpey’s fiber
● Run within the osteon perpendicular to the haversian canals, interconnecting the latter
with each other and the periosteum
 ○ Volkman’s canal
● Type of bone which is composed of heavy trabeculae
○ Spongy bone

ALVEOLAR PROCESS
● Processus alveolaris - maxilla
● Pars alveolaris- mandible
● Bony extension of the maxilla and mandible in which the roots of the teeth are
embedded
● Tooth dependent structures
● Develop along with the formation and eruption of teeth
● resorbed after the teeth are lost
● Morphology depends on size, shape and position of teeth
● Functions:
○ Anchors tooth/ teeth
○ Absorption and distribution of occlusal pressure
● Supports the teeth
● Contains the socket
● No teeth, no alveolar process
● Part of maxillary and mandibular with teeth and alveolar sockets
● Rests on basal bone
● Its proper development depends on tooth eruption and its maintenance on tooth
retention
● Morphology of alveolar process depends on size, shape and position of teeth
● Composed of an outer and inner cortical plate of compact bone that enclose the
spongiosa
○ Compartment of spongy bone (trabeculae and cancellous bone)
■ Anchors the teeth
■ Absorbs and distribute occlusal pressure
○ Spaces/perforations for blood vessels and nerves
○ Residual bridge: no alveolar process
○ 2 parts:
■ Interradicular septum
■ Interdental septum

ALVEOLAR CREST
 ● Rim
● 1-2mm into CEJ

STRUCTURE OF ALVEOLAR BONE

● Alveolar bone proper or lamina cribriformis
● inner , heavily perforated bony lamellae, forming the alveolar wall
● Attached to the trabeculae of the spongiosa
● Lamia dura - radiograph
● Bundle bone
○ multiple/ several layers of bone parallel to the surface of the alveolar bone
○ penetrated by Sharpey's Fibers
○ found in areas of recent bone apposition
○ with lines of rest

● Spongiosa
○ Consists of network of delicate trabeculae, marrow spaces
■ Maxillary tuberosity and angle of the mandible
● Erythropoietic red marrow
○ More in the maxilla than in mandible
○ Facial and lingual portions - horizontal
○ Interdental septa - vertical
○ Trajectories represents planes or lines of stress

Development of the maxilla

● Membranous bone deposition
● Center of ossification
○ Angle between the division where the anterior superior dental nerve is given off
from the inferior orbital nerve

Development of the mandible

● Condylar cartilage
● Coronoid cartilage
● Symphyseal cartilage
● Meckel's Cartilage
○ cartilage of the 1st branchial arch
○ supports the developing mandible but does not contribute to it
 ○ 2 bilateral cartilages from the otic capsule
○ ossification begins at the mental foramen,
○ cranially directed growth leads to formation of compartments for the developing
tooth germ
○ By 10th week, the rudimentary mandible is formed
○ Fate of Meckel’s Cartilage
■ incus of inner ear
■ malleus
■ sphenomalleolar ligament
■ sphenomandibular ligament
● Mental foramen

● Different Lines in Bone

○ 1. Cementing line - incremental lines
○ 2. Reversal line - new bone layer and resorption (scalloped)
○ 3. Aplastic Line - basophilic substance on surface of inactive bone
○ 4. Resting Line - new bone layer from inactive old bone

Age changes in bone

1. increased function - thicker trabeculae, smaller marrow spaces
2. Decreased function - thin trabeculae with wider marrow spaces
3.Teeth Movement:
• Pressure side - resorption
• Tension side - bone remodelling
• depends on functional and nutritional demands of bone
• Lamellae - haversian system
• Compact bone - spongy bone
• Bundle bone - haversian bone
• Bundle bone - lamellar bone - residual ridge
• after tooth extraction, embryonic bone forms within the socket
4. internal remodelling
5. Residual ridge

Clinical consideration
● LAMINA DURA
○ Hard layer
○ Corresponds to alveolar bone proper
○ Thin white line that parallels the outline of the roots of the teeth
○ Radiographic term for alveolar bone proper
○ Radiopaque /white
○ Only used for radiograph
○ Importance: periapical view, to follow the integrity
○ Possible cause of break in alveolar bone proper is glaucoma and the like.
● Orthodontic movement
 ● Trauma
● Hyperfunction of hypophysis
● Chronic infection
● Fractures and extraction sockets

EXTRA NOTES
1. Cortical plate
• Outer bone plate of varying thickness
• Outside wall of maxillary and mandibular
• Covered with periosteum
• Consists of Haversian system and interstitial lamellae
2. Alveolar bone proper
• Directly connected to PDL
• Made of spongy bone
• Lines the alveolus contained within the alveolar process
• Thin plate of cortical bone with numerous perforation (cribriform plate)
• Allows the passage of blood vessels between the bone’s narrow spaces and PDL
• The coronal rim of the alveolar bone forms the alveolar crest
• Surrounds each tooth as a continuous plate of compact bone
• Generally parallel to the CEJ at a distance of 1-2mm apical to it
• Becomes fused with and indistinguishable from the cortical plate (CP) of the alveolar
process in some area
• Meet at alveolar crest
• Radiopaque in a radiograph

Circumferential Lamellae
• encloses the entire bone forming its outer and inner perimeters

Concentric Lamellae
• makes up the bulk of compact bone
• form the basic metabolic unit of bone, osteon
• osteon
• cylinder of bone

Volkmann's Canal
Osteon
• osteons (hs1) with wide haversian canals are relatively young, while osteon (hs2) with
small haversian canals are more mature
Interstitial Lamellae
• found in between the concentric lamellae
 • fragments of pre-existing concentric lamellae from osteons created
during remodelling
Spongy Bone
• trabeculae, cancellous bone
• lamellae of bone are arranged in flattened spicules
• surround marrow spaces containing bone marrow
Structure of the Alveolar Bone
A. Cortical plate
B. Alveolar bone proper
C. Spongiosa
Cortical Plate
• found outside wall of maxilla and mandible
• continuous with the alveolar bone proper at the alveolar crest
• more pronounced and thicker in areas in the mandible than the Maxilla

Alveolar Bone Proper (Lamina Cribriformis, Lamina Dura)

• contains osteons and interstitial lamellae
• with bundle bone

Bone formation
3 mechanisms:
A. Endochondral Bone
• cartilage formation bone occurs by substitution rather than transformation (resorption of
cartilage then bone deposition)
• found condyle
B. Intramembranous ossification
• bone develops directly from fibrous tissue
• mesenchymal cells differentiate into osteoblast
• maxillary, body of mandibular and cranial vault
C. Structural Bone Growth
• function of sutures: accommodates growth of organs such as brain
and eyes
• development of maxilla
● Intramembranous bone deposition
● center of ossification:
• where the antero-superior dental nerve branches from the inferior
orbital nerve

Clinical Considerations:
- Lamina dura
- important diagnostic landmark
Fenestration
- hole in bone
- bone will resorbs locally, creating a window through which the root can be
Seen
Dehiscence
- the rim of bone between the fenestration and the alveolar crest disappears altogether

Disturbance in Condylar Growth

Acromegaly - hyperfunction of the pituitary gland