CHAPTER 10: Early Tooth Development, Root
Development (Including Cementogenesis) and Tooth
Eruption
 The teeth develop by the mutual cooperation
and interaction of an ectodermal tissue (the
enamel organ) and mesenchymal tissue (the
dental papilla).
 As tooth development proceeds, there is an
increased complexity apparent in terms of
histogenesis and morphogenesis (both of
these being under the ‘control’ of the
mesenchymal dental papilla).
 Tooth eruption begins as the root forms
 The development of the root initially involves
the mapping out of the shape of the future
root by down growths of the cervical loop
regions of the enamel organ of the tooth
germ to form epithelial root sheaths. This
sheath then induces the differentiation of
odontoblasts and the secretion of root
dentine.
 Cementogenesis commences, with the
eventual incorporation of follicle collagen
fibres to form the initial periodontal ligament.
Early tooth development
The first histological sign of tooth development is the
appearance of a condensation of mesenchymal tissue
beneath the presumptive dental epithelium of the
primitive oral cavity.
The primary epithelial band then divides into two
processes:
 The vestibular lamina contributes to the
development of the vestibule of the mouth,
delineating the lips and cheeks from the
tooth-bearing regions.
 The dental lamina contributes to the
development of the teeth and a series of
swellings (the tooth germs) develops on the
deep surface of the dental lamina.
The tooth germs are classified into bud, cap and bell
stages according to the degree of
morphodifferentiation and histodifferentiation of
their epithelial components (enamel organs)
Bud stage
The enamel organ in the bud stage appears as a
simple, spherical, epithelial condensation that is
poorly morphodifferentiated and histodifferentiated.
It is surrounded by mesenchyme. The epithelial
component is separated from the adjacent
mesenchyme by a basement membrane.
Cap stage
 At the cap stage, and with progressive
morphodifferentiation, the deeper surface of
the enamel organ invaginates to form a cap-
shaped structure.
 In the late cap stage of tooth development,
the central cells of the enamel organ have
become separated (though maintaining
contact by desmosomes)
 The resulting tissue is termed the stellate
reticulum
Stellate reticulum
 The main function: ‘mechanical’, protecting
the underlying dental tissues against physical
disturbance and maintaining tooth shape.
 The stellate reticulum also produces
o colony-stimulating factor (CSF-1),
o transforming growth factor beta-1
(TGF-β1) and
o parathyroid hormone-related protein
(PTHrP)
These molecules may be released into the
dental follicle and help recruit and activate
the osteoclasts necessary to resorb the
adjacent alveolar bone as the developing
tooth enlarges and erupts.
 The part of the mesenchyme lying beneath
the internal enamel epithelium is termed the
dental papilla, while that surrounding the
tooth germ forms the dental follicle.
Early bell stage
Further morphodifferentiation and
histodifferentiation of the tooth germ leads to the
early bell stage. The configuration of the internal
enamel epithelium broadly maps out the occlusal
pattern of the crown of the tooth. It is during the bell
stage that the dental lamina breaks down and the
enamel organ loses connection with the oral
epithelium.
Three layers Dental Follicle:
• The inner investing layer is a vascular, fibrocellular
condensation immediately surrounding the tooth
germ. The cells of the inner layer of the dental follicle
may be derived from the neural crest.
• The outer layer of the dental follicle is a vascular
mesenchymal layer that lines the developing alveolus.
• Between the two layers is loose connective tissue
with no marked concentration of blood vessels
Four Distinct Layers of Enamel Organ
1. External Enamel Epithelium
o The external enamel epithelium forms
the outer layer of cuboidal cells
(which limits the enamel organ.)
o external enamel epithelial cells
contain large, centrally placed nuclei
and have relatively small amounts of
the intracellular organelles associated
with protein synthesis.
o involved in the maintenance of the
shape of the enamel organ and in the
exchange of substances between the
enamel organ and the environment
2. Stellate Reticulum
o The main function of the stellate
reticulum is ‘mechanical’, protecting
the underlying dental tissues against
physical disturbance and maintaining
tooth shape.
o the hydrostatic pressure generated
within the stellate reticulum is in
equilibrium with that of the dental
papilla, allowing the proliferative
pattern of the intervening internal
enamel epithelium to determine
crown morphogenesis.
3. Stratum Intermedium
It has been suggested that the stratum
intermedium is concerned with:
o the synthesis of proteins
o the transport of materials to and from
the enamel forming cells in the
internal enamel epithelium (the
ameloblasts)
o the concentration of materials.
4. Internal Enamel Epithelium
During tooth development, the cells of the inner
enamel epithelium of the enamel organ induce the
ectomesenchymal cells at the periphery of the dental
papilla to differentiate into odontoblasts through the
mediation of the dental basement membrane, which
may function in the immobilization and presentation
of the signaling molecules.
Late Bell Stage
 The late bell stage of tooth development is
associated with the formation of the dental
hard tissues.
 Dentine formation always precedes enamel
formation.
 enamel and dentine formation commence at
the tips of future cusps.
 Under the inductive influence of developing
ameloblasts, the adjacent mesenchymal cells
of the dental papilla become columnar and
differentiate into odontoblasts.
 The odontoblasts then become involved in
the formation of predentine and dentine. The
presence of dentine then induces the
ameloblasts to secrete enamel.
Enamel knot
During the early stages of tooth development, three
transitory structures may be seen:
o the enamel knot
o enamel cord
o enamel niche
The most significant in terms of functional
development is the enamel knot. This is a localized
mass of cells in the centre of the internal enamel
epithelium.
Experimental Studies
 Tooth development is a very complex process
involving many growth factors and
transcription factors to ensure an ordered,
and controlled, development for both
individual tooth germs and the whole
dentition.
 Epithelial-mesenchymal interactions are
particularly in evidence and require signaling
between the two major components of the
tooth germ, one derived from the oral
epithelium and one from the underlying
mesenchyme
Morphogenesis and Histogenesis
 Experiments have shown that the epithelium
lining the first pharyngeal arch has
 ‘odontogenic potential’. This potential only
exists in the very early stages of
odontogenesis.
 The result of culturing dental papilla
mesenchyme with epithelium from the
developing foot pad is normal tooth
development, illustrating the importance of
the dental papilla.
 Furthermore, should an incisor enamel organ
be combined with a molar papilla, the
resulting tooth is molariform and, if a molar
enamel organ is combined with an incisor
papilla, the resulting tooth is incisiform.
Root Development
Topic 1 - Root Sheath Development
o The root starts to develop after the crown is
completed
o Epithelial cells of the inner and outer enamel
epithelium proliferate from the cervical loop
to form two layers of epithelium called
“Hertwig’s Root Sheath”.
o The first formed part of the root sheath bends
to form a disc like structure
o The rim of the disc like structure is called the
epithelial diaphgram
o The epithelial diaphgram encloses the
primary apical foramen
Topic 2 - Formation of Root
o After the formation of epithelial root sheat
and the epithelial diaphragm the root grows
in length
o The diaphragm maintains a constant size
while the root sheath grows in length at the
angle of the diaphragm and not at its tip
o The cells of the lengthening root sheath
induce the adjacent dental papilla cells to
differentiate into odontoblasts
o The newly formed odontoblasts then form the
root dentin
o As the root lengthens the crowns moves
occlusally
Topic 3 – Single and Multiple Roots
o For single-rooted teeth the root sheath grows
like a cuff or tube around the newly forming
pulp
o Development of multi-rooted teeth takes
place in a same manner until the furcation
area
o When the furcation area is reached the
epithelial diaphragm develops tongue like
extensions that grow until they contact each
other
o This the divides the root into two or three
CEMENTOGENESIS
 The outer and intermediate layers are
mesodermal in origin. Cells of the inner layer
of the dental follicle differentiate into the
cementoblasts.
Tissues are divided into 3 layers:
1. Adjacent to the epithelial root sheath is the
inner investing layer of the dental follicle,
which is said to be derived from the neural
crest.
2. Adjacent to the developing alveolar bone is
the outer layer of the dental follicle.
3. The outer layer is separated from the inner
layer by an intermediate layer.
Primary (Acellular) Cementum
 The process of cementogenesis is initiated at
the cervical margin and extends apically as
the root grows downwards.
Appearance:
 Structure less at first and later glass like
 So the appearance is responsible for the term
hyaline layer that is given to this
(approximately 10 μm) layer once it is
mineralized
 There is evidence that the epithelial root
sheath cells secrete enamel-related protein(s)
into the collagenous matrix of the hyaline
layer at the cement–dentine boundary. The
enamel-related protein(s) has been identified
as amelogenin and its function is concern in
epithelial mesenchymal involving the
induction of odontoblast and cementoblast,
and the process of mineralization
Mineralization Phase
 Mineralization of the first-formed-dentin does
not initially occur at the outermost surface of
the hyaline layer, but a few microns on it.
Mineralization spreads both inwards towards
the pulp and outwards towards the
periodontal ligament.
 o During the subsequent mineralization of
cementum and the hyaline layer, the enamel-
related protein(s) is lost, although remnants
may be retained in the granular layer of the
root dentine
o development in the formation of acellular
cementum, the delayed mineralization front
in the hyaline layer gradually spreads
outwards until this layer is fully mineralized
 The collagen fibers in the adjacent
periodontal ligament are parallel to the root
surface and got no attachments to the fibrous
fringe
The subsequent development of acellular cementum
involves:
 Its slow and increase in thickness
 The establishment of continuity between the
principal of collagen fibres of the periodontal
ligament with those of the fibrous fringe
surface of the rood dentine
 Cotinued slow mineralization of the collagen
NOTE: Once periodontal ligament fibres become
attached to the surface of the cementum layer, the
cementum may be classified as acellular extrinsic
fibre cementum
Matrix Formation Phase
 Refers to a continuous phase in which a
composite or two-phase alloy is formed in a
microstructure of metals
 Mineralization of the cementum matrix does
not appear to be controlled by its cells and
initiation of mineralization probably occurs
from the dentine
 When mineralization of initial root dentine is
interfered with, there is inhibition of
cementogenesis. The adjacent periodontal
ligament fibroblasts are rich in alkaline
phosphatase and may also play a role in
mineralization
 Mineralization proceeds very slowly in a linear
fashion
NOTE: Cementogenesis occurs rhythmically, periods
of activity alternating with periods of quiescence.
Structural lines may be visible within the tissue,
indicating the incremental nature of its formation
Secondary (Cellular) Cementum
o Cementoblast - is a biological cell that forms
from the follicular cells around the root of a
tooth.
o Cementocytes - are cementoblasts enclosed
in a self-generated matrix.
o Secondary cementum - Is hypothesized to
develop when the tooth assumes occlusion
and function, covers the remaining 1/3 of the
root, it is thought to act predominantly as an
occlusal load absorber during mastication
 This type of cementum is associated with an
increase in the rate of the formation of the
tissue.
 Generally, possess more cytoplasm and more
cytoplasmic processes.
 Less mineralized.
 Sharpy’s fibers are partially mineralized.
 Dentine sialoprotein, fibronectin and tenascin,
as well as a number of proteoglycans
(versican, decorin and biglycan), are present.
 Also formed in the furcation area of the cheek
teeth. (Molar & Premolar).
The early inductive changes are associated with the
development of odontoblasts and dentin.
Incremental lines will be present but due to the
increased rate of formation, are more widely spaced
Cellular cementum – Is responsible for minor repair of
any resorption by continued deposition to keep the
attachment apparatus intact
Tooth Eruption
 Is the process whereby a tooth moves from its
developmental position in the jaw into its
functional position in the mouth. Eruption Is
from the Latin word “Erumpere” = break out
Dental Follicle
Plays the main role in tooth eruption.
Experiments showing role of dental follicle in eruptive
movements:
1. If the developing tooth is prevented from
erupting, the dental follicle still erupts.
2. If we remove the developing tooth, the dental
follicle still erupts.
3. If the tooth is replaced by a replica, the replica
shows eruptive movement.
4. If the dental follicle is removed, eruptive
tooth movements are not seen.
  Resorption and Shedding of a Deciduous
Tooth Occurs to enable eruption of the
permanent tooth (excluding the permanent
molars).
 During the shedding of the deciduous teeth,
there is a resorption of the root of the
deciduous teeth.
Mechanisms of Shedding
 Resorption of the hard tissues of the
deciduous tooth takes place through the
activity of multinucleated, osteoclast-like cells
termed Odontoclasts.
 Increased mastication loads affect the
pattern and rate of deciduous tooth
resorption
Gubernacular canal
 This canal occurs where the roof of the
alveolar crypt of the permanent tooth is not
complete.
 The canal enables the dental follicle of the
tooth germ to communicate with, and be
attached to, the overlying oral mucosa.
 The gubernacular canal contains the
gubernacular cord, composed of a central
strand of epithelium (derived from the dental
lamina) surrounded by connective tissue.
The connective tissue is organized into inner and outer
layers. Collagen fibres of the inner layer show greater
organization and run mainly parallel to the long axis of
the epithelium.
In the outer layer, the collagen fibres are fewer and
less organized
During eruption, the gubernacular cords decrease in
length but increase in thickness and become less
dense
Chronology for Tooth Development
Eruption rates of teeth are greatest at the time of
crown emergence:
 Permanent maxillary central incisors are
reported to erupt at about 1 mm/month.
 The rates for mandibular second premolars
have been determined to be about 4.5 mm in
14 weeks.
 For permanent third molars, where space is
available, eruption rates of 1 mm in 3 months
have been recorded
For permanent teeth, this period may last 2 to 4
years. A tooth erupts most rapidly as it enters the oral
cavity, at which time the length of its root is about
two-thirds complete. Eruption then slows as the tooth
approaches the occlusal plane.
Once the tooth has emerged into the oral cavity it
may take 1 to 2 years to reach the occlusal plane. The
emergence of the crown is partly due to axial
movement of the tooth (active eruption) and partly
due to retraction of the adjacent soft tissue
Present experimental evidence shows that the
eruptive mechanism:
o is a property of the periodontal ligament 
does not require a tractional force pulling the
tooth towards the mouth
o is probably multifactorial  could involve a
combination of fibroblast activity and vascular
and/or tissue hydrostatic pressures
o Root resection involves the surgical removal
of the proliferative odontogenic tissues at the
base of the continuously growing incisor
o Root transection involves cutting the incisor
into proximal and distal portions.
that teeth can erupt in the absence of well-developed
periodontal fibres.
 provided there is a dental follicle, teeth will
erupt without roots and therefore without
attachment of the follicle fibres into the
tooth.
Role of The Periodontal Ligament Fibroblasts In
Eruption
 is based upon the notion that these cells can
exert a tractional force onto the tooth
through the collagen network or through cell-
to-cell contacts.
 Furthermore, there is nothing to indicate that
the fibroblasts can exert a force under
physiological conditions sufficient to move a
tooth in a direction favouring eruption.
Role of The Periodontal Vasculature in The
Generation of Eruptive Forces
 A role for the periodontal vasculature in the
generation of eruptive forces can be derived
either directly through blood pressure or
indirectly by influencing periodontal tissue
(hydrostatic) pressures.
 That vascular pressures can alter the position
of a tooth in its socket is shown by the fact
that a tooth moves in synchrony with the
arterial pulse.