Griffith University Oral Biology 2 1009 DOH

Tooth Development
Dr. Mahmoud Bakr Lecturer in General Dental Practice B.D.S, M.D.S (Cairo University), ADC (Australia) Member of the Australian Dental Association (ADA), the Australian Biology Institute Inc. (ABI) and the Egyptian Dental Union (EDU)

Learning objectives:
After completing this lecture you should be able to: 1- Describe stages of tooth development in writing and by drawing a diagram and demonstrate understanding of the process of tooth eruption. 2- By observing the histological details of cells and tissues, you should be able to use a microscope to identify different morphological stages of tooth development and understand the histological processes involved in preparing slides.

 All Microscopic images are taken from the Digital Library of the Oral Biology Department (Cairo University).

TOOTH DEVELOPMENT AND GROWTH

Front view

At 5-6 w.i.u. Embryo

Head

Lateral view

Heart Stomodeum

The embryo at 5-6 w.i.u is formed of three germ layers: Ectoderm which forms the external lining of the body and oral cavity later on Mesoderm from which intermediate tissues such as Blood, Cartilage and Bone are derived Endoderm which lines internal organs (Guts)

The primitive Oral Cavity is called Stomodeum

and is lined by Ectoderm Which is formed of two layers of : 1- Basal Columnar cells 2- Superficial flat cells
From both of these layers + Mesenchyme all teeth and oral structures are formed

Flat cells

Columnar cells

A
ECTODERM ( S.SQ.E. ) Stomodeum

MESODERM Connective tissue

Basement membrane

Ectoderm
Neural Crest Cells Dental lamina Future dental papilla

Stomodeum

 During CNS development a new type of cells appear called NEURAL CREST CELLS They are Ectodermal in origin. These cells have the ability to: 1- Migrate to other tissues 2- Differentiate into other types of cells 3- Send signals to neighboring tissues
So they migrate from the dorsal surface of the embryo to the Stomodeum where they reside in the mesenchyme changing it into Ectomesenchyme. WHY?????

 It is called now Ectomesenchyme because when of Neural Crest Cells which are Ectodermal in origin migrates to the Mesenchyme of the stomodeum it turns it into Ectomesenchyme. i.e: Mesenchymal tissue that contains Ectodermal cells

BRANCHIAL ARCHES DEVELOPMENT

3 weeks IUL. embryo

The Embyo is flattened dorsoventrally, so six pairs of finger-like projections extend from the Endoderm of the foregut to the outer Ectodermal lining. These are called the Branchial arches and they are lined by Ectodrem from the outside, Endoderm from the inside with Mesoderm inbetween.

Note: The 1st Branchial arch is lined by Ectoderm from outside and inside.

T.S in Branchial arches

 T.S in Branchial Arches

 Branchial arch
Branchial cleft Pharyngeal pouch

 Ectoderm

Mesoderm Endoderm

Derivatives of the first branchial arch (Mandibular Arch):

1-The mandible and maxilla 2-The lower lip, part of the upper lip and cheek 3-All the teeth 4-All salivary glands 5-All muscles of mastication 6-The anterior two thirds of the tongue

Remnants of Meckels cartilage:

-incus and malleus

-lingula of the mandible

-mental ossicles -sphenomandibular ligament

Nerve supply of Branchial Arches

1st Branchial arch (Mandibular Arch) Mandibular Nerve 2nd Branchial arch (Hyoid Arch) Facial Nerve

Note: Nerve supply of different structures correlates with their developmental origin. i.e: All structures derived from the 1st branchial arch are supplied by the same nerve that supplies the arch (Mandibular Nerve).

STAGES OF TOOTH DEVELOPMENT AND GROWTH

STAGES OF TOOTH DEVELOPMENT MAY BE DESCRIBED ACCORDING TO: 1- Changes in the morphology of the developing tooth (MORPHOLOGICAL STAGES) 2- Its physiological changes (HISTOPHYSIOLOGICAL STAGES). Note: both the morphological and the histophysiological changes are shearing in the different tooth development stages.

MORPHOLOGICAL STAGES
1- DENTAL LAMINA. 2- BUD-STAGE. 3- CAP-STAGE. 4- BELL-STAGE

(EARLY AND LATE).

Early Late

HISTOPHYSIOLOGICAL
STAGES
1- INITIATION.

2- PROLIFERATION.
3- HISTO-DIFFERENTIATION. 4- MORPHO-DIFFERENTIATION.

5- APPOSITION.

1- Dental Lamina
Under the influence of Neural Crest Cells proliferation of Ectoderm occurs to form two band like structures or two Dental Laminae. One carries the upper teeth and the other is for lower teeth

1-DENTAL LAMINA
Flat cells

ECTODERM

Columnar cells

( S.SQ.E. )

MESODERM

Basement membrane

(Connective tissue)

DENTAL LAMINA
1 2

EPITHELIAL PROLIFRATION

Dental lamina

MESENCHYMAL CONDENSATION

2- Bud stage
Again under the influence of Neural Crest cells 10 rounded projections (ENAMEL ORGANS) appear on the labial surface of the dental lamina, corresponding to the ten Deciduous teeth. Each Bud (Enamel Organ) is surrounded by Mesenchymal condensation which is the Dental papilla + Dental Sac In this stage the changes are Morphological only

2-BUD STAGE

EPITHELIAL PROLIFRATION

MESENCHYMAL CONDENSATION

A simple equation
Tooth Germ= Enamel Organ + Dental Papilla + Dental Sac Enamel organ gives Enamel Dental Papilla gives Dentin and Pulp Dental Sac gives Cementum, Periodontal ligament (PDL) and Alveolar Bone

QUESTION
What is the difference between Enamel organ and Tooth germ?????????? ANSWER: Enamel organ is a part of three parts forming a tooth germ

ANOTHER QUESTION
Which tissue of the tooth is Ectodermal in origin???????? ANSWER: ENAMEL which is derived from ENAMEL ORGAN which is Ectodermal in origin

Note the E

3- Cap Stage
Under the effect of Neural crest cells the enamel organ of bud stage undergoes unequal or differential growth to change in shape from bud to cap. The enamel organ of cap stage has an inner surface lined by columnar cells called Inner enamel epithelium or Inner dental epithelium. It has an outer surface lined by cubiodal cells called Outer enamel epithelium or Outer dental epithelium. The inner and outer enamel epithelium meet at the cervical loop.

3-CAP STAGE
Histological structure of the tooth germ

Outer D. E. Stellate R. Enamel knot

1-Dental organ

Enamel cord

Inner D. E.

Cell free zone

3-Dental sac 2-Dental papilla

 The polyhedral cells in the middle of the enamel organ change into star shaped cells called Stellate Reticulum due to secretion of a hydrophilic substance called Glucosaminoglycans (GAG's).

The enamel organ is surrounded by dental papilla and dental sac as in bud stage.

CAP STAGE
TOOTH GERM

1-DENTAL ORGAN

2- DENTAL PAPILLA

3DENTAL SAC

CAP STAGE
TOOTH GERM

1-DENTAL ORGAN

3DENTAL SAC

2- DENTAL PAPILLA

There are transient structures in the cap stage: 1-Enamel knot and enamel cord: rounded cells that connect I.E.E and O.E.E and a- is thought to determine the future site of the cusp or incisal edge. b- may give rise to another type of cells called stratum intermedium. 2-Cell free zone: separates the dental papilla from the inner surface of the enamel organ.

 So the changes in Cap stage are MORPHOLIGICAL as well as HISTOPHYSIOLOGICAL

C A P S T A G E

Enamel cord

Inner Enamel Epithelium

Cell Free Zone

4-EARLY BELL STAGE

Histological structure of the tooth germ

Dental Sac

Inner Enamel Epithelium

Odontoblasts

4- Early bell stage

Under the effect of neural crest cells: The Inner enamel epithelium align themselves on the future dentino-enamel junction, so the shape & type of the tooth Can be determined in this stage. Lingual to the enamel organ of the deciduous tooth a downward proliferation from main dental lamina appears and called Successional dental lamina which carries the permanent successor.

 Histological changes take place in the cells of the enamel organ: Inner enamel epithelium (I.E.E): become longer and rearrangement of the organelles take place (REPOLARIZATION) and now it is called Preameloblasts. I.E.E elongate towards cell free zone leading to its disappearance, so Preameloblasts become in contact with the peripheral layer of dental papilla leading to INDUCTION of ODONTOBLASTS. Stratum intermedium: 2 or 3 rows of flat cells above the Preameloblasts rich in (alkaline phosphatase), these cells arise from the enamel knot and cord.

 Outer enamel epithelium (O.E.E): cuboidal cells as in cap stage but shorter. Stellate reticulum: same as cap stage but the processes are longer & cell body is smaller. The dental papilla: same as cap stage but cell free zone disappears after elongation of I.E.E. The dental sac: same as in cap stage.

EARLY BELL STAGE

Histological structure of the tooth germ

ODE SI

DP SR OB IDE

EARLY BELL STAGE

Histological structure of the tooth germ

DENTAL LAMINA PROPER

LDL
Cervical loop

SUCCESSIONAL LAMINA
DENTAL LAMINA PROPER SUCCESSIONAL LAMINA

SUCCESSOR PRIMORDIUM LATERAL

DO

DENTAL

LAMINA

5-LATE BELL STAG

Histological structure of the tooth germ

5-LATE BELL STAGE

Histological structure of the tooth germ

STRATUM
INTER.

STELLATE RETICULUM

INNER DENT. EPITH.

PREDENTIN

ODONTOBLASTS

 The difference between early bell stage and late bell stage is the deposition of the 1st layer of hard dental structure (DENTIN). The enamel organ loses its connection to the dental lamina and the remnants of dental lamina is called EPITH RESTS OF SERRES or SERRES PEARLS. Inner enamel epithelium: Preameloblasts elongate more to form AMELOBLASTS. Stratum intermedium: same as in early bell stage. Outer enamel epithelium: become flat and its plasma membrane becomes folded to increase the surface area available for obtaining nutrition from dental sac as nutririon from dental papilla cannot be obtained after deposition of hard dental structures (ENAMEL & DENTIN). Stellate reticulum: cell body is smaller and processes are longer. Dental papilla & Dental sac: same as in early bell stage.

SERRES PEARLS

LATE BELL SATGE

Histological structure of the tooth germ

OUTER DENTAL EPITHELIUM CAPILLARY LOOP

AB
ENAMEL

SI

DENTIN

SR
PREDENTIN

ADVANCED BELL STAGE

Histological structure of the tooth germ

OB PD D E DP ODE SR

DS

PULP

SI AB

ADVANCED BELL STAGE

Histological structure of the tooth germ

E
D AB PD SR

OB

PULP

SI

ASG

NOTE
EARLY ADVANCED

ASG

FUNCTIONS OF THE ENAMEL ORGAN

1- OUTER ENAMEL EPITHELIUM. Active transport of materials specially, after hard dental tissues formation. 2- STELLATE RETICULUM: a- Act as a buffer against physical forces that may distort the configurations of the developing amelodentinal junction giving rise to gross morphological changes. b- It permit a limited flow of nutritional elements from the outlying blood vessels to the formative cells, so it acts as a store house for the nutritive materials. c- It keeps room for the developing enamel.

3- STRATUM INTERMEDIUM. not understood:

The function of this layer is

a- It is believed to control fluid diffusion into and out of the ameloblasts. b- It provides the enamel organ with alkaline phosphatase enzyme needed for mineralization.

c- These cells plus the inner dental epithelium are considered as a single functional unit responsible for enamel formation.

4- INNER ENAMEL EPITHELIUM. a- It exerts an organizing influence on the undifferentiated cells of the dental papilla to differentiate into odontoblasts. b- Transport of the nutritive materials from the dental papilla to the enamel organ before dental hard tissues formation.

c- Arranged in a pattern to determine the future morphology of the amelodentinal junction and the crown. d- It lays down enamel matrix and helps in its mineralization. e- It shares in the root formation. f- It secretes primary enamel cuticle, after the full thickness of enamel is deposited, to protect the enamel of the unerupted tooth against resorption and preventing deposition of Cementum. g- It shares in the formation of the reduced enamel epithelium.

FUNCTIONS OF THE ENAMEL ORGAN (cont.)

4- INNER ENAMEL EPITHELIUM.

Morphology Nutritive Root formation. Enamel matrix Reduced enamel epithelium.

Organizing

Primary enamel cuticle

FUNCTIONS OF THE DENTAL PAPILLA AND DENTAL SAC

The Dental Papilla Gives Rise To Dentin And Dental Pulp. The Dental Sac Gives Rise The Cementum, Periodontal Ligament And Alveolar Bone Proper.

FUNCTIONS OF THE DENTAL PAPILLA AND DENTAL SAC

Dentin

The Dental Papilla

PULP

Cementum,

The Dental Sac

Periodontal Ligament Alveolar Bone Proper

FUNCTIONS OF THE DENTAL LAMINA

1- Initiation Of The Entire Deciduous Dentition ( 2 MIU).
2- Initiation Of The Permanent Successors ( 5 MIU. For Central Incisors, 10 M. Of Age For Second Premolars). 3- Initiation Of The Permanent Molars

( First Molar 4 MIU., Second Molar 1 Year, Third Molar

4 Years)

It is thus evident that the activity of the dental lamina extends over a period of about five years and disintegrates completely or remains as epithelial rests of Serres.

Root formation
After complete formation of the crown, i.e when Enamel & Dentin formation reaches the future CEJ root formation starts. Root formation starts at the cervical loop. Epithelial Diaphragm: is a horizontal proliferation formed of I.E.E and O.E.E leading to primary closure of the apex. Secondary closure takes place through deposition of Dentin and Cementum at the apex. Epithelial root sheath of Hertwig (ERSH): is vertical proliferation formed of I.E.E and O.E.E that forms the shape of the root. A proliferating zone of dental papilla occurs with epithelial diaphragm and ERSH.

EPITHELIAL DIAPHRAGM

ASG

EPITHELIAL DIAPHRAGM
Histological structure

PD
D

E AB

SI
SR

OB
DP ODE DF

 The peripheral layer of dental papilla is differentiated into odontoblasts. Odontoblasts start formation of Dentin and when complete formation of Dentin occurs ERSH is degenerated. Remnants of ERSH are called EPITHELIAL RESTS OF MALASSEZ. After degeneration of ERSH dentin is exposed to Dental sac, so UMC's (Undifferentiated mesenchymal cells) become differentiated into: CEMENTOBLASTS: which lay down cementum matrix and FIBROBLASTS: which form periodontal ligaments, and OSTEOBLASTS: which form alveolar bone matrix.

SINGLE ROOT FORMATION

SINGLE ROOT FORMATION

image

ASG

SINGLE ROOT FORMATION

Epithelial diaphragm

Hertwigs root sheath

NEWLY FORMED ROOT

ASG

MULTI-ROOTED TOOTH

 In case of Bi-rooted teeth two tongue-like projections develop at the level of Bifurcation. In case of Tri-rooted teeth three tongue-like projections develop at the level of Trifurcation.

Tongue Like Extensions

Epithelial diaphragm

Epithelial diaphragm

Tongue Like Extensions

Epithelial diaphragm

MULTI-ROOTED TOOTH

ASG

CLINICAL CONSIDERATIONS

All clinical considerations are related to the Epithelial Root Sheath of Hertwig (ERSH): Early degeneration of ERSH before Odontoblasts differentiation leads to Accessory root canal

ACCESSORY ROOT CANAL

Accessory root canals can form as well as result to: Blood vessels interrupting the course of ERSH Failure of fusion of tongue-like projections in multirooted teeth

ENAMEL PEARL

On the opposite hand late degeneration of ERSH after complete formation of the whole thickness of Dentin leads to formation of Enamel on the root (Enamel Pearl)

INTERMEDIATE CEMENTUM

CEMENTUM

DENTIN

Intermediate Cementum is a tissue that has intermediate properties between Dentin and Cementum. It occurs due to degeneration of ERSH AFTER Odontoblasts differentiation but BEFORE complete thickness of Dentin is formed.

DILACERATION
It is the severe curvature of the root.

It occurs due to trauma of a deciduous tooth pushing the developing tooth germ and bending ERSH.
These teeth with dilacerated roots may fail to erupt, difficult to extract and impossible to perform Endodontic treatment on these teeth.

Dilaceration

Important note: Epithelial rests of serres (serres pearls) are found in the crown as a remaining parts of Dental Lamina and may proliferate to form Eruption Cyst. Epithelial rest of Malassez are found in the root as a remaining part of ERSH and may proliferate to form Periodontal Cyst.

GUESS THE STAGE !

ODE EK SR

CL

DS