GOOD AFTERNOON

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DEVELOPMENT OF TEETH AND
SUPPORTING STRUCTURES.
DEVELOPMENTAL DISTURBANCES OF
TEETH.

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CONTENTS
 Introduction  Hertwig’s epithelial root sheath
 Initiation of tooth development and root formation

 Dental lamina
 Formation of supporting tissues

 Vestibular lamina
 Developmental disturbances of
teeth
 Tooth development
 Conclusion
 Developmental stages
 References
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 Introduction

 Tooth development (ODONTOGENESIS) is the complex

process by which teeth from the embryonic cells, grow, and
erupt into the oral cavity.

 For human teeth to have healthy oral environment, enamel,

dentin, cementum & the periodontium all must develop
during appropriate stages of fetal development.
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 Tooth formation occurs in the 6th week of intrauterine life with the
formation of primary epithelial band.

 At about 7th week the primary epithelial band divides into a lingual
process called dental lamina & a buccal process called vestibular lamina.

 All deciduous teeth arises from dental lamina, later the permanent
successors arise from its lingual extension & permanent molars from its
distal extension.
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 Initiation of tooth development
 The primitive oral cavity, or stomatodeum, is lined by
stratified squamous epithelium called the oral
ectoderm or primitive oral epithelium.

 The oral ectoderm contacts the endoderm of the

foregut to form the buccopharyngeal membrane.

 At about the 27th day of gestation, this membrane

ruptures and the primitive oral cavity establishes a
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connection with the foregut.

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 Most of the connective tissue cells underlying the oral ectoderm are of
neural crest or ectomesenchyme in origin.

 These cells are thought to instruct or induce the overlying ectoderm to

start tooth development, which begins in the anterior portion of future
maxilla and mandible and proceeds posteriorly.

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 Primary epithelial band formation

 After about 37 days of development, a continuous

band of odontogenic epithelium forms around the
mouth in the presumptive upper and lower jaws.

 The bands are roughly horseshoe-shaped and

correspond in position to the future dental arches
of the upper and lower jaws.
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 Thickening of epithelial band occurs due to change in orientation of
mitotic spindle & cleavage plane of dividing cells.

 Each band of epithelium is called PRIMARY EPITHELIAL BAND. Quickly give

rise to 2 subdivisions

- vestibular lamina.

- dental lamina.

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 Dental lamina
 Lingual (inner) process of primary epithelial band. Primordium
for the ectodermal portion of deciduous teeth.

 Permanent molars arise from distal extension.

 Successional lamina: lamina from which successor permanent
teeth develop.
 Fate: Activity of dental lamina extends over a period of 5
years. Remnants of dental lamina persists as epithelial pearls or
islands within the jaw as well as gingiva are called Cell Rests of
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Serres.
 Vestibular lamina

 Buccal (outer) process of primary epithelial band.

 Lip Furrow Band

 Cells rapidly enlarge.

 Becomes the vestibule between the lips and cheek & the tooth-bearing area.

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 Tooth development
 At certain points along the dental lamina each jaw
represents the location of one of the 10 mandibular
& 10 maxillary teeth, ectodermal cells multiply
rapidly & little knobs that grow into the underlying
mesenchyme

 Each of these little down growths are beginning of

the enamel organ of the tooth bud of a deciduous
tooth 15
 First to appear are those of anterior mandibular region

 As the cell proliferation occurs each enamel organ takes a shape

that resembles a cap.

DENTAL PAPILLA

 On the inside of the cap, the ectomesenchyme cells increase in

number. The tissue appears more dense than the surrounding
mesenchyme and represents the beginning of the dental papilla.
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DENTAL SAC/ DENTAL FOLLICLE

 Surrounding the combined enamel organ or dental papilla,

the third part of the tooth bud forms. It is known as
dental sac/follicle and it consists of ectomesenchyme
cells and fibres that surrounds the dental papilla and the
enamel organ.

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 Position and number of tooth germs

 The Pax-9 gene is one of the earliest mesenchymal genes that define the
localization of the tooth germs.

 Shh gene have a role in stimulating epithelial cell proliferation and its local
expression at the sites of tooth development.

 Lef-1 is first expressed in dental epithelial thickenings and during bud

formation shifts to being expressed in the condensing mesenchyme.
 Ectopic expression of Lef-1 in the oral epithelium also results in ectopic
tooth formation. 18
 Tooth type determination

 The determination of crown pattern is a remarkably consistent process.

 Animal teeth are all the same shape (homodont), different (heterodont). In
most mammals they are heterodont, falling into three families: incisiform,
caniniform, and molariform.

 Two hypothetical models have been proposed to explain how these

different shapes are determined, and evidence exists to support both.

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Field model Clone model

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 Developmental stages

Morphological stages Physiological stages

 Bud stage
 Cap stage
 Early Bell stage
 Advanced Bell stage
 Initiation
 Proliferation
 Histo differentiation
 Morpho differentiation
 Apposition

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 Bud stage
 The bud stage is represented by the first epithelial incursion into the
ectomesenchyme of the jaw.

 The cells of the epithelium proliferate faster than the adjacent cells. The
enamel organ consist in this stage peripherally located low columnar cells &
centrally located polygonal cells.

 As a result of increased mitotic activity and migration of neural crest cells in

to the area of the ectomesenchymal cells surrounding the tooth bud
condense into two areas.
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The area of condensation immediately below the enamel organ is the Dental papilla.
The ectomesenchymal condensation that surrounds the tooth bud & the dental
papilla is the Dental sac.

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 Cap stage
 Shallow invagination on the deep surface of
the bud.

 Consists of three different layers of cells

Peripheral cells are cuboidal, cover the

convexity of the cap– Outer Enamel Epithelium.

Cells in the concavity of the cap become tall,

columnar– Inner Enamel Epithelium.
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 Stellate reticulum

Polygonal cells located between the outer and inner enamel

epithelia begin to separate as more intercellular fluid is
produced, as a result polygonal cells become star shaped but
maintain contact with each other by their cytoplasmic process
and form a cellular network.

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 The cells assume a branched reticular form. The spaces in
this reticular network are filled with a mucoid fluid that is
rich in albumin, which gives the stellate reticulum a
cushion like consistency that may support and protect the
delicate enamel-forming cells.

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 Dental Papilla

– Ectomesenchyme undergoes further condensation

Papillary cells proliferates and Later differentiate
to odontoblasts.

 Dental sac

– Marginal condensation in the ectomesenchyme

surrounding the enamel organ and dental papilla.

Becomes more fibrous & distinct.

Known as “Primitive dental sac” 28

Transitory structures :

 During the early stages of tooth development ,three transitory structures may be
seen , they are:

- Enamel knot : It’s a localized mass of cells in the center of inner enamel
epithelium. E. Knot thought to play a role in the formation of crown pattern by
outlying the enamel fissure. E.Knot soon disappears and seems to contribute cells
to the E.Cord.

- Enamel cord : It’s a strand of early bell stage of development. It arises in the
increasingly high enamel organ as a vertical extension of the E.Knot ,it’s termed
E. Septum when E. Cord extend from E. Knot to outer E. Epithelium.
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- Enamel niche : It’s an apparent structure in the histologic section, created
because the dental lamina is a sheet rather than a single strand and often
contains a concavity filled with connective tissue, A section through this
arrangement creates the impression that tooth germ has a double attachment to
the oral epithelium by two separate strands.

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 Early Bell stage

 Enamel organ enlarges further and changes shape to

a Bell

 Consists of four distinct layer:

a. Inner Enamel Epithelium

b. Stratum Intermedium

c. Stellate Reticulum

d. Outer Enamel Epithelium

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 Inner enamel epithelium: Consists of a single layer of cells
differentiate prior to amelogenesis into tall columnar cells
called Ameloblasts.

 The cells of the inner enamel epithelium exert an

organizing influence on mesenchymal cells in the dental
papilla later differentiate into odontoblasts.

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 Stratum intermedium: Composed of 2-3 layers of squamous
cells, strongly attached to each other and to adjacent layers by
desmosomes.

 Cells are metabolically active and rich in alkaline phosphatase

enzyme, therefore assisting ameloblasts to synthesize enamel.

 This layer is essential to enamel formation. It is absent in the

part of the tooth germ that outlines the root portions of the
tooth that does not form enamel.

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 Stellate reticulum: Before enamel formation begins, the
stellate reticulum collapses, reducing the distance
between the centrally situated ameloblasts and the
nutrient capillaries near the outer enamel epithelium.
This change begins at the height of the cusp or the incisal
edge and progresses cervically.

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 Outer enamel epithelium: Cells become more flattened and
separated from dental sac by basement membrane. Cells are
attached to each other by desmosomes and to basement
membrane by hemidesmosomes.

 The outer enamel epithelium is thrown into folds which are

rich in capillary network, this provides a source of nutrition
for the enamel organ.

 Before the inner enamel epithelium begins to produce enamel

peripheral cells of the dental papilla differentiate into
odontoblasts. These cuboidal cells later assumes a columnar
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form & produce dentin
 Advanced Bell stage

 Also called crown stage of tooth development.

 All four layers are seen in enamel organ

- Inner enamel epithelium/

Ameloblast layer

- Stratum intermedium

- Stellate reticulum

- Outer enamel epithelium 36

 Dentin is the first hard tissue that is formed. Enamel
formation can occur only after a layer of dentin is deposited.
The interdependence between ameloblasts and odontoblasts
is called Reciprocal induction.

 During this stage the boundary between inner enamel

epithelium and odontoblasts outlines the future dentino-
enamel junction.

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 As the hard tissue formation continue, the nutritional supply
to the ameloblasts from dental papilla is cut off and they
derive alternate source from dental sac.

 Once the enamel and dentine formation reach the cervical

region of tooth, root formation begins. The cervical region
of enamel organ gives rise to Hertwig’s epithelial root
sheath.

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 Hertwig’s epithelial root sheath and Root formation
 Once crown formation is completed, epithelial cells of the inner and outer enamel
epithelium proliferate from the cervical loop of the enamel organ to form a
double layer of cells known as Hertwig’s epithelial root sheath.

 HERS determines shape of the roots and initiates radicular dentin formation. HERS
consists of the outer and inner enamel epithelium only.

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 As the first layer of the dentin has been laid down, the epithelial
root sheath loses its structural continuity and is close relation to
the surface of the root.

 Its remnants persists as an epithelial network of strands or clumps

near the external surface of the root. These epithelial remnants
are found in the periodontal ligament of erupted teeth and are
called as rests of mallasez.

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 Prior to the beginning of root formation, the root sheath forms the
epithelial diaphragm. The outer & the inner enamel epithelium bend at
the future cementoenamel junction into a horizontal plane, narrowing
the wide cervical opening.

 The proliferation of the cells of the epithelial diaphragm is accompanied

by the proliferation of the cells of the connective tissues of the pulp,
adjacent to the diaphragm. The free end of diaphragm does not grow
into the connective tissue but the epithelium proliferates coronal to the
epithelial diaphragm
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 Connective tissue of the dental sac surrounding the root sheath
proliferates & invades the continuous double epithelial layer dividing it
into network of epithelial strands. The rapid sequence of proliferation &
destruction of Hertwig’s root sheath explains the fact that it cannot be
seen as a continuous layer on the surface of developing root.

 In the last stages of the root development, the proliferation of the

epithelium in the diaphragm lags behind that of the pulpal connective
tissue. The wide apical foramen is reduced first to the width of the
diaphragmatic opening itself & later is further narrowed by opposition of
dentin & cementum to the apex of the root.
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 Anterior teeth, premolars and molars all begin as a single
root – root trunk.

 Root of the posterior teeth divides from the trunk into the
correct number of root branches.

 Differential growth of the Hertwig’s epithelial root sheath

results in the division of the root trunk into two or three
roots.

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 Formation of Supporting tissues

 Gingiva

 Periodontal ligament

 Cementum

 Alveolar bone

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 Formation of Supporting tissues

 Gingiva: Gingiva evolves as crown enters the oral cavity by

breaking through the oral epithelium.

 Periodontal ligament

 Cementum

 Alveolar bone

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 Formation of Supporting tissues

 Gingiva
 Periodontal ligament: The development of the periodontal
ligament begins with root formation prior to tooth eruption.

 Cementum

 Alveolar bone

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 Formation of Supporting tissues

 Gingiva

 Periodontal ligament
 Cementum: The development of cementum has been
subdivided into a pre-functional stage & functional stage.
Although cementum formation takes place along the
entire root, its initiation is limited to the root edge.

 Alveolar bone
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 Formation of Supporting tissues

 Gingiva

 Periodontal ligament

 Cementum
 Alveolar bone: Alveolar bone is formed during fetal growth
by intramembranous ossification. The 2 parts of alveolar
process can be distinguished as alveolar bone proper and
the supporting alveolar bone.
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Developmental disturbances of teeth

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 Definition:

Developmental disturbances means an abnormality where the

pathology starts in the embryonic stage of human life , before
the formation of the dentition.

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Developmental anomalies at different stages of tooth development
 Initiation: Anodontia

 Initiation and proliferation: Oligodontia, Supernumerary teeth, Gemination /

Fusion of teeth
 Histo-differentiation: Regional odontodysplasia

 Morpho-differentiation: Microdontia/Macrodontia , Dens evaginatus/Dens

invaginatus, Hutchinson’s incisors, Mulberry molars, Talon’s cusp,
Taurodontism.

 Apposition: amelogenesis imperfecta, enamel hypoplasia, dentinogenesis

imperfecta, dentin dysplasia 52
Regional odontodysplasia

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Hutchinson’s incisors Mulberry molars Talon’s cusp

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Amelogenesis Imperfecta Dentinogenesis Imperfecta

Enamel Hypoplasia Dentin Dysplasia Type I and Type II

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 Conclusion

 Development of tooth forms the base of dentistry, a thorough

understanding and a sound knowledge is required by a dentist
regarding the development stages of tooth & the anomalies
related to it, so it helps to identify & treat them properly.

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 References

 Orban’s Oral Histology and Embryology – 15th Edition.

 Ten Cate’s Oral Histology – 9th Edition.

 Shafer’s Textbook of Oral Pathology – 7th Edition.

 Neville Oral and Maxillofacial Pathology – 4th Edition

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Thank You

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