ENAMEL Physical properties of enamel Enamel is an epithelially derived hard protective covering of the tooth Enamel is the layer

ayer that covers only the crowns of human teeth ** In some animals (e.g. Rodents), enamel covers both crowns & roots of teeth Enamel doesnt have an even thickness over all sides of the crown Enamel is thickest over cusp tips & incisal edges (2.5 mm) Enamel is thinnest at the cervical margin (knife edge) ** If a cavity is drilled in the area of cusps or incisal edges , then, we can go deep for about 2-2.5 mm without exposing dentine, and thus without causing the patient any pain and without needing an anesthesia since we are drilling within enamel which isn't vascularized or innervated ** If a cavity is drilled in the cervical region, then, we can maximally go for about 0.5 mm and after this depth we might expose dentine , cause the patient pain, and need an anesthesia Enamel is the hardest biological object and the most highly mineralized (96% mineralized) Enamel doesnt undergo replacement or repair after tooth eruption If dentine is injured after eruption then it can be replaced/repaired because there's still functioning odontoblasts that remain in dentine after formation of the tooth BUT once enamel is injured after eruption it cant be replaced/repaired because there's NO functioning ameloblasts that remain in enamel after formation of the tooth (ameloblasts after formation of full thickness of enamel merge with other cells of enamel organ "become part of the reduced enamel epithelium" and become dys-functioning and unable to form enamel anymore) If 1 mm of dentine is lost from the enamel side , it will be compensated by another 1 mm of dentine at the pulpal side Enamel has low tensile strength BUT high compressive strength Tensile strength = ability to withstand biting forces that tend to stretch a material Compressive strength = ability to withstand biting forces that tend to compress a material Enamel is brittle BUT yet it exhibits certain degree of resistance to withstand fracture What gives enamel its strength is the fact that it is supported by the resilient dentine which acts as a shock absorbent Once caries reaches dentine and gets inside it, it will make a hole under enamel, and once we bite on that enamel it will be easily fractured because it is very weak by itself Enamel is white in colour with low translucency that increases with age reflecting the yellow colour of dentine Translucency means passage or transmission of light Enamel is white while dentine is yellow Enamel of young teeth has low translucency it doesnt allow the passage of light that much it doesnt reflect the color of underlying dentine it appears WHITE (enamel color) Enamel of old teeth has high translucency it allows the passage of too much light it reflects the color of underlying dentine it appears YELLOW (dentine color)

1/10

 At cusp tips and incisal edges , enamel is thick, and thus its translucency is less and it reflects its own color while at cervical areas , enamel is thin, and thus its translucency is more and it reflects the color of underlying dentine instead Chemical properties of enamel: Enamel is composed of Organic and Inorganic components The organic matrix of enamel is made from non-collagenous proteins and enzymes o Amelogenin (90%) o Non-amelogenin (10%) enamelin, tuftelin and ameloblastin The inorganic component is made of minerals , and these minerals are organized in form of crystals (Hydroxyapatite crystals) Hydroxyapatite crystals: o Formula = Ca10 (PO4 )6 (OH)2 o Mature enamel is mineralized 88-90% by volume and 95-96% by weight, the remainder being the organic material and water (10-12% by volume or 4-5% by weight) ** Immature enamel is mineralized 25-30% by weight ** Mature enamel is more mineralized and thus more brittle & easier to fracture than immature enamel o Mineral content increases from EDJ to the surface Mineral content of enamel is not the same in all parts of enamel (but the average mineralization is 95-96% by weight) Surface of enamel is more mineralized & hard than deeper enamel Mineral content near the surface of enamel is very high because it is in contact with saliva which supplies enamel with minerals all the time o o o o Unlike other calcified structures in the body, enamel is unique as it is totally acellular Crystallites are hexagonal and they are 70 nm in width, 25 nm thick and of great variant length Crystallites of enamel are much bigger than those of dentine, cementum and bone Prisms core is more soluble to acids than prisms peripheries The basic structural unit of enamel is the prism and each prism is made of two parts: head (core) and tail (periphery) Organic components tend to accumulate at the boundaries of adjacent prisms since crystals there have irregular orientation and many spaces are found in between them Within the core, crystals are packed parallel to one another, and this makes it entirely inorganic & easily dissolved in acids to attach composite fillings o Ion replacement may occur in this formula: HCO3 is a replacement for OH Mg is a replacement for Ca F is a replacement for OH Those replacements occur after eruption when surface enamel gets in contact with any of the replacing formulas in saliva

2/10

 The most important replacement of these is that of the fluoride (F) replacing the hydroxyl group (OH) which changes the formula from Hydroxyapatite into Flouroapatite crystals which results in greater stability and resistance of enamel to acidic dissolution o Fluoride level declines from outer to inner layers because again it is the saliva which supplies enamel with minerals including fluoride Water: o It is about 2% by weight, 5-10% by volume Organic matrix: o It is 1-2% by weight and maybe more : Where crystallites are irregular If crystals are packed parallel to one another without spaces in between (e.g. within the same prism) then no organic matrix is found, BUT when crystals have irregular orientation, a lot of spaces are created in between (e.g. at the boundary of adjacent prisms ) and organic matrix fills in the gaps In the enamel tufts At the EDJ

o The main components of the organic matrix are: Amino acids, peptides, amelogenins and nonamelogenins and lipids Enamel prisms Enamel prisms are the basic structural unit of enamel consisting of crystals packed in long and thin rods They run across the whole thickness of enamel from EDJ to the surface In cross-section enamel prisms show a variety of patterns: o Pattern I Prisms take the form of circles Exists near the EDJ and the surface Inter-prismatic areas exist between prisms because prisms are circular and many big spaces will be found in between o Pattern II Prisms take the form of parallel rows o Pattern III This pattern is the most predominant It occupies the bulk of enamel ** At the beginning there will be a thin layer of aprismatic enamel at EDJ, and then a very thick layer of prismatic enamel by Tome's processes , then another thin layer of aprismatic enamel on the top surface of the crown Prisms take the form of keyholes 1 Keyhole = 1 prism = Head (Core) + Tail (Periphery)
3/10

The tail of the prism is located between four heads (one above, one below, one right and one left) The head is formed by one ameloblast while the tail is formed by four ameloblast For every prism (keyhole pattern) we need four ameloblasts Change in crystals orientation is gradual within a single keyhole BUT sudden at the boundaries of adjacent keyholes (40-60 degrees) Within the same keyhole in the central area of the head crystals run parallel to prisms long axis Within the same keyhole away from the central area of the head crystals diverge in different directions So in the center of the head crystals run parallel to the long axis of prisms and as we go away from the center of the head these crystals start to diverge in different directions but this change is gradual within the same keyhole but gets sudden when we reach the boundaries of adjacent keyholes

Within the same keyhole In the tail crystals diverge at 65-70 degrees from those in the head but divergence is gradual Terminology: Prism = rod + inter-rod Prism = head + tail = keyhole pattern Head = core = rod Tail = periphery = inter-rod 1 Prism Hexagon because hexagon represents the head of the keyhole only while prism represents the head and tail together

In longitudinal sections enamel prisms appear to run in straight lines from EDJ to surface Prisms meet enamel surface at different angles o At cervical margin long axis of enamel prisms meet the surface at 90 degrees (right angle) o More occlusally/incisally long axis of enamel prisms meet the surface at 60 degrees o At fissures enamel prisms meet the surface at 20 degrees These degrees are important when designing a suitable cavity for amalgam restorations , because if we prepare the cavity in a way that these prisms are NOT supported then these very weak prisms will break off easily under occlusal forces leaving a space behind between amalgam and the tooth which is NOT good because it will attract bacteria and cause caries to develop around the restoration

Hunter-Schreger bands These bands are feature of ground sections of enamel and they result because of different directions of enamel prisms ** Ground section = a microscope slide of enamel that is prepared by taking a large piece of enamel and placing it between two pieces of abrasive material. Enamel is ground down until it is adequately thin to transmit light in a light microscope , allowing for observation of the enamel structure
4/10

** Stained section = a microscopic slide of enamel that is prepared by decalcifying w piece of enamel and then staining it to be viewed under the microscope Prisms follow a sinusoidal path in longitudinal sections Prisms run from DEJ to enamel surface, but this path isn't straight in longitudinal sections but rather sinusoidal Layers in a block of 10 -13 layers follow same direction Each 10-13 layers have the same sinusoidal path of enamel prisms but blocks above and below these 10-13 blocks follow different direction Since different layers of enamel prisms exist in different directions , they will transmit and then reflect light of the light microscope in different directions too, and this produces what are called "Hunter-Schreger bands" Periodic changes are important to have enamel prisms laid down in different paths to give Hunter-Schreger bands The fact these bands exist explains why enamel is a stable structure and resistant to fracture and explains why fractured enamel has a grinding surface (rough surface) Hunter-Schreger bands appear as alternating dark and light strips of varying width Crystals in outer run in the same direction NO Hunter-Schreger bands When you take a piece of enamel and cut it in any direction, and because of the sinusoidal path prisms follow, then some prisms will be cut transversely (Diazones) and others will be cut longitudinally (parazones) Gnarled enamel o This enamel is located underneath cusp tips & incisal edges where groups of prisms spiral around others since they are crowded and don't have adequate space Aprismatic enamel First and last layers of deposited enamel are aprismatic Aprismatic enamel doesn't have prisms and we find this enamel in: o Permanent teeth in the outer 20 70 m of enamel thickness o Deciduous teeth in the outer 20 100 m of enamel thickness ** The outer aprismatic layer of enamel is thicker than the inner especially in deciduous teeth In aprismatic enamel, crystallites are parallel to each other and at right angle to the surface ** Aprismatic enamel doesn't respond to etching and thus can't be used to attach composite fillings Aprismatic enamel is more mineralized due to absence of prism boundaries In prismatic enamel, organic components tend to accumulate at the boundaries of adjacent prisms since crystals there have irregular orientation and many spaces in between them
5/10

In aprismatic enamel, prisms don't exist, and thus NO organic components tend to accumulate peripherally at the boundaries , and thus more minerals are found Aprismatic enamel occurs due to absence of Tomes' Processes at late stage of enamel deposition because these processes are responsible for the formation of the prisms

Incremental lines: Enamel is deposited incrementally (layer by layer NOT in one bulk) and between each increment and the other there's a line called "incremental line" Incremental lines are produced because periods of activity alternates with periods of quiescence There are two types of incremental lines: o Short period incremental lines are called "Cross striations" o Long period incremental lines are called "enamel striae" Cross striations o They are structural lines at right angles with long axes of prisms o The distance between one cross striation and another is 2.5 - 6 m o In cervical enamel the distance between one cross striation and another is 2 m because enamel forms more slowly o Cross striations reflect a diurnal rhythm Cross striations reflect a daily rhythm of enamel production and this means that ameloblasts are active everyday and they take a break for few hours at the end of the day and then they get back to their job which is building of enamel If we want to calculate the time needed for ameloblasts to secrete the full thickness of enamel (e.g. at cusps tips & incisal edges) then we need to divide the required thickness (e.g. 2.5 mm) by 2.5 m (e.g. the amount of enamel produced daily) 2.5 mm/2.5 m = 1000 days = 3 years (e.g. the time needed between first evidence of calcification & crown completion) Enamel striae of Retzius o They are structural lines running obliquely across the prisms in longitudinal sections

o They run circumferentially in cross-sections (Similar to growth rings in the trees)

6/10

o o o o

Appear as brownis h bands in ground sections of enamel Enamel striae reflect nearly weekly intervals There are 7 10 cross-striations between 2 subsequent striae Striae overlapping cusps & incisal edges do not reach the surface Underneath cusp tips and incisal edges enamel is built layer by layer, and each new layer tends to cap the old one underneath it in a circular way, and this results in preventing the enamel striae from the reaching the surface At cervical region, enamel is still built layer by layer, but each new layer tends to parallel the old one above it, and this results in allowing the enamel stria to reach the surface NOT all enamel striae reach the surface of enamel

o Enamel striae occur due to metabolic disturbances during mineralization o Enamel striae are absent in enamel formed before birth so that we cant find them in deciduous teeth o Neonatal line It is a marked stria formed at birth reflecting a sudden metabolic disturbance at birth because of the different physiologic changes before and after birth The neonatal line is a particular band of incremental lines seen in histological sections of a deciduous tooth It belongs to Striae of Retzius but it is darker and larger than the rest of the striae of Retzius It is formed in Enamel at the point of birth. Therefore, only teeth that are developing at birth can exhibit neonatal lines (e.g. deciduous teeth)

7/10

 Perikymata grooves and ridges These grooves and ridges occur as enamel striae reach the enamel surface They appear as series of fine grooves and ridges alternatively running circumferentially They are present in the cervical 2/3rds of the tooth and absent in the occlusal/incisal 1/3rd because enamel striae don't reach the surface of enamel occlusally/incisally They are close together near the cervical margin In deciduous teeth, they are only seen in cervical enamel of second molars Because enamel striae are NOT found in any enamel formed before birth, NO Perikymata groove or ridge is found in deciduous teeth formed before birth

Enamel dentine junction EDJ reflects the boundary between enamel and dentine We have two patterns of EDJ: Scalloped It is found beneath cusps & incisal edges where we have high shearing forces It is more resistant to fracture Convexities of the scalloped shape are located at enamel surfaces Smooth

It is found at the lateral surface of the tooth where we have Low shearing forces Structures visible at EDJ o Enamel spindles o Enamel tufts o Enamel lamellae Enamel spindles They are tubules extending up to 25 m from EDJ into enamel They are believed to be odontoblastic processes that crossed EDJ just before mineralization and once mineralization took place, they got stuck between ameloblasts
8/10

 Enamel tufts: They resemble tufts of grass Start at EDJ and reach 1/5 to 1/3 enamel thickness They travel in same directions as the prisms They consist of hypomineralized enamel rods and they are several prisms wide It is suggested that they result from residual (unabsorbed) protein matrix (non-amelogenin)

Enamel lamellae: They are sheet-like structural fault They run through the entire thickness of enamel (from EDJ to surface of enamel) They represent hypomineralized areas Lamellae may be confused with cracks seen in ground section and caused by grinding of the specimen Causes of enamel lamellae: Developmentally: maybe due to residual (unabsorbed) protein matrix (non-amelogenin) After eruption: maybe caused by crack in the tooth itself (BUT cracks don't run through the full thickness of enamel) Age changes of the enamel: Enamel wear It is the most apparent age change Enamel wear means loss of enamel and this is caused by different causes: Abrasion = loss of enamel due to friction of the tooth with external objects (seeds, nuts, nails, toothbrushes, needles in tailors .) affects surfaces subjected to external objects Erosion = loss of enamel due to acidic materials other than acids produced by bacteria (e.g. citrus fruits , vomiting due to pregnancy or bulimia nervosa issues) affects smooth surfaces such as buccal and palatal surfaces Attrition = loss of enamel due to tooth-to-tooth contact (either pathological "e.g. clenching/bruxism" or physiological "with aging") affects occlusal surfaces & incisal edges Darkening in color Enamel gets darker in color with age because of: Decreased thickness (enamel becomes thinner and more translucent reflecting the color of underlying dentine) Acquired stains from drinks and foods Composition of surface of enamel More fluoride incorporated in older teeth because the tooth has been accepting fluoride continuously from the surrounding saliva
9/10

 Susceptibility to caries decreases Porosity is reduced (permeability decreases) Questions: 1- Cross striations of enamel are: a- At right angle with the long axis of the prism b- Run obliquely across prisms c- Reflect weekly intervals d- None of the above 2- Scalloped pattern of enamel-dentin junction occur in: a- Cusp tips and incisal edges b- At the lateral surfaces c- a+b d- None of the above 3- Enamel spindles are: a- Hypomineralized enamel rods b- Cracks in the enamel c- Odontoblastic processes that extend into enamel d- All of the above 4- Which of the following is a true match: a- HCO3 replace OH group in enamel crystals b- Mg replace Ca group in enamel crystals c- F replace OH group in enamel crystals d- All of the above 5- One of the followings is not presented in primary teeth: a- Enamel tufts b- Enamel spindles c- Cross striations d- Enamel striae Answers: Question number 1 2 3 4 5 Answer a-At right angle with the long axis of the prism a-Cusp tips and incisal edges c-Odontoblastic processes that extend into enamel d-All of the above d-Enamel striae

10/10