ENAMEL

Introduction Enamel forms a protective covering of variable thickness over the entire surface of the crown. On the cusp of molars and premolars the enamel attains a maximum thickness of about 2 to 2.5 mm, thinning down to almost a knife edge at the cervical region. The shape and contour to the cusps receive their final modeling in the enamel. It is the hardest calcified tissue in the human bod because of its high content of mineral salts and their cr stalline arrangement. Physical characteristics !ecause of high mineral content, enamel is extremel hard, a properl that enambles it to withstand the mechanical forces applied during its functioning, this hardness also makes it brittle, therefore an underl ing la er of more resilient dentine is necessar to maintain its intergrit . The specific gravit of enamel is 2." another ph sical propert of

enamel is its permiabilit . It has been found with radisactive tracers and d es

that the enamel acts like semipermeable membrane, permitting complete or partial passage of certain molecules like c$labeled urea etc. Enamel is translucent are varies in color from light ellow to gra ish white, because the various in thickness that 2 to 2.5 mm the colour also changes i.e. the underl ing dentine is seen through the enamel. Incisal areas ma have a bluish finge where the thin edge consists onl of a double la er of enamel. Chemical properties Enamel consists of %&' of inorganic materials and (' organic materials and water. The inorganic content of enamel consists of a cr stalline calcium phosphate known as h drox apatite which is also found in bone, calcified cartilage, dentine and cementum. Various ions ) Introtium, magnesium, lead and fluoride, the ions are incorporated into or absorbed b the h drox apatite cr stals if there ions are present during enamel formations. * fine lac network of organic material appears between the densel packed h drox apatite cr stals.

The bulk of the organic material consists of the T+*, -T rosine rich amelogenin protein. peptide highl bound to the h drox apatite cr stal as well as nonnuelogenin proteins. Structure of Enamel Enamel in prepared ground sections can be studied under the light microscope b means transmitted light, such sections show it to be composed primaril of elongated structure termed rods. Structures +ods the enamel is impact of enamel rods or prisms rod sheets and in some regims a cementing interprismatic sultanae. The number of enamel rods has been estimated as ranging from 5 mm in lower laterals in users to #2 millem in to upper first molars. /rom to dentinoenamel for the rods run tortuous cause ofward to the surface of the fork. The length of most rods is grater than the thickness of the enamel because of the obli0ue direction and tortuous course of the rods. The rods located in cusps the thicker part of the enamel are longer than those at the cervical areas of the teeth. The diameter of the rods averages (mm, the diameter of the rods increases from 1E in towards the surface of the tooth at ratio of #22.

Enamel rods have a cr stalline appearance permitting light to pass through them, under light microscope the appear henogonal round or oral. In cross section the appear ) as 4/ish 5cales6. Submicroscopic structure The rods are c lindrical in shape in made of apatite cr stals whose long axis rods parallel to the la itudanal axis of rod, this is applicable to cr stals in the cervical axis of the rod, the cr stals flare laterall to an involved degree as the approach the rod peripher . The inter rod regions is an area 5urrounding such rod is which cr stals are oriented in a different directions from the those making up the rods. +od sheath2 the boundar where cr stals of the rod must those of the interod regions at sharp anal sis. * more common pattern in a ke hole pattern or paddle shaped prism in human enamel, when cut longitudinall , section through the head or bodies of one ow of rods and to 4tails6 of an ad7acent row. This interrod substance. These rods measure about 5mm in breath and %mm in length. The bodies of the rods are nearer occlusal or incisal whereas the tails point cervicall . Striations: Each enamel rod is built up of segments separated b chak lines that give it straighten appearance. These striations demarcate the rods, the

striations are more pronounced in enamel that is insufficient calcified. The rods are segmented became the enamel matrix is formed in a r themic manner. In humans there segments seem to be uniform length of about (mm. Directions of rods 8enerall the rods are oriented at right angles to dentine surface. The cervical and central part of it crown of 1eciduous tooth the are approximatel hori9ontal. :ear the incisal edge cusp tip the change graduall to an

increasingl obli0ue direction until the are the are almost vertical. The permanent teeth is similar in the overall two thirds of the crown. In the cervical region however, the rods deviate from the hori9ontal in an apical direction -wa course mention.. Deviation: Example it the middle part of the crown in divided into thin hori9ontal disc, the rods in the ad7acent discs bend in opposite directions, i.e. if an discs start from the dentine in a obli0ue directions and bend more or less sharpl to the left side, whereas it ad7acent disc the rods bend towards the right. This alternating clock wire deviation from radial direction can be observed at all levels of the crown if the discs are cut in the places of like general rod direction.

If discs in cut in obli0ue plane especiall near the dentine in the regions of cusp tips or incisal edges, the rod aggregate appears more complicated, to bundles of rods seen to interwine more irregularl . This appearance of enamel is called 8narled enamel. The enamel rods forming the developmental fissure and patients concern in their outward course. unter schile!er bands ;hange in directions of rods in responsible for the appearance of the hunter schreger bands. There are alternative dark and light strips of var ing widths -seen in longitudinal sections and obli0ue reflected light.. The originate at 1E<n and pass outward ending at some distance from out enamel surface. 5ome investigators claims that variations is calcification of the enamel that coinside with the distribution of the bands of hunter schreger. =unter 5chreger bands are composed of alternative 9ones having a slightl different permeabilit and a different content of organic material.

&

Incremental lines of "et#ices *ppear as brownish bands in ground sections of the enamel, incremental pattern of the ename. That is successive apposition of la ers of enamel during formation of the crown. The incremental line have been attributed to periodic bending of the enamel rods, to variations in basic organic structure, or to a ph siologic calcification rh them. Incremental lines if prevent in moderate intensit are considered normal due to metabolic disturbance during formation of enamel broading of the incremental line take place and reading them more prominent. Surface structure * relativel structures la er of enamel approximatel 3> mm thick is seen ?>' permit teeth and all deciduous teeth, seen monthl over cusp tips and cervical area, in this la er prism outline are visible and all apatite cr stals are parallel to one pillar and perpendicular. To strike of +et9ines, it hevil minerali9ed area. Other microscopic details seen are like newl erupted teeth as #. ,rik mata 2. +od ends. 3. ;racks -lamellae. ?

 ,erik mata are transverse, wave like grooves, believed to be to external manifestation of the strike of +et9ines. The are continues mound the tooth and usuall lie prallel to each other and to the cemetoenamel. Enamel rod ends are concave and var in depths and shape, the are

shallowest in the cervical regions and depth near the incisal or occlusal edges. ;racks are the outer edges of lamellae and a right angles to 1E for. Enamel lamellae are their leaf like structures the extended from the enamel surface towards a dentin enamel for and also ma penetrate dentin. The consist of organic material but with little mineral intent. @amellae ma develop in planes of tensins, where rods cross such

plane, a short segment of rods ma not calcif , if it distribution in more seven a crack ma develop. 3 types of lamellae are seen. Type A ) @amellae composed of poorl calcified rod segments. Type B ) @amellae caristing of degradation colds. Type C ) @amellae arising in erupted teeth where be cracks are filled with organic matter. "

If has suggested that enamel lamellae ma be a site of crack in a tooth and ma form a road of entr for bacteria that initate caries. Neonatal lini or Neoratal rin! The enamel of the deciduous teeth develops partl before and partl after birth, the boundar between the two portions of enamel in deciduous teeth in marked b an accentuated incremental line of +oti9ices, it is as a result of abrupt change in the environment and nutritions of the newborn infront. Enamel criticle * delicate membrane called :asm thAs membrane, or primar enamel cuticle careers covers the entire crown of the newl erupted tooth but a

probabl soon removed b masticators. This membrane in a t pical buccal lamina found beneath most epithelia. -+e basal lamellae is secrated b the endoblast when enamel formation is completed. Enamel tufts Enamel tufts are at dentinoenamel for to the enamel to about one fifths to one 3rd of its thickness, the are narrow, ribbon like structure and resemble tufts of grass, so the are named enamel tufts.

Tufts consists of h pocalcified enamel rods and inter prismatic stubstance. Dentinoenamel function The surface of dentine is pitted at dentioenamel function, shallow depression of the dentine facing to dentine fit round enamel pro7ections, in assure to form hold of enamel cap into the dentine. In microradiograph of ground sections a h pominerli9ed 9one about 3>mm thick can sometimes be demonstrated at 1E<n. $dontoblast process and Enamel spindles Occlusall odontoblast process pass across to dentino enamel functions into enamel there are formed as enamel spindles. The direction of the odontoblast process and spindles in the enamel corresponds to the original directions of ameloblast ) i.e. at right angles to the surface of the dentine. A!e Chan!es #. Bost apparent age change is wear of occlusal surface and proximal contact point as a result of mastications.

#>

2. 5urface of unerrupted and recentl erupted teeth are covered completel with proximal rod ends and perik mata and later gingival loss of the rod ends and perik mata disappear completel . 3. @ocali9ed the certain elements such as nitrogen and fluorine have been found into superficial enamel la ers of older teeth. (. *s the results of age changes in to organic portions of enamel, their resistance to deca ma be increased. 5. Enamel become harder with age -eg. Of reduced permeabilit of old teeth.. Clinical Considerations #. ;avit cutting Cnsupported enamel rods are not lift at the margins, the would break and produce leakage. 2. !rittleness of Enamel Enamel is brittle and does not withstand forces in thin la ers or in areas where there is no underl ing dentine. 3. 1eep enamel fissures *lthough these are not considered pathological, food lodgenet and difficult clear it area ma lead to dental caries, caries penetrate the floor of fissures

##

rapidl become to enamel in there areas is ver this. *s the destructure process reaches the dentin, it spread along to 1E<n under rising to enamel. (. 1ental lamellae ) ma also be predisposing locations for caries because the contain much organic materials. %luoride There has been a reduction b (>' or more in the incidence of caries in children after topical application of 5odium fluoride

5tannous fluoride Incorporate of fluoride containing dentifriceAs. /luoride containing mixtures such as stannous fluoride parts, sodium fluoride rinse are used to alter the surface of enamel for more substance to caries. *d7ustment of fluoride level in commercial water suppl to # parts per millimeters. &' Cervical re!ion 5hould be kept smooth and well polished, if it rough, food debris bacterial pla0ue accuratel and gingiva coming with this cause ma lead to gingival inflammation and progress to even severe periodontal disease. (' )lue of pit and fissure sealents'

#2

=istological clinical considerations ypoplasia Banifested b pitting, following or even total absence of enamel and h po$calcifications in form of opa0ue or chalk areas. This ma due to #. 5 stems 2. @ocal 3. 8enetic Systemic inflame :utritional deff. Endocarinopathies /ebrile eliseases ;hemical intoxicationAs 1entist should exert has inflame as his patient to ensure sound nutritional practices. +ecommended immuni9ation procedure during periods of gestations and postnatal endogessor. = poplasia and h pocalcification If matrix formation is affected, enamel h poplasia will ensure. If maturation is lacking or incomplete h pocalcifications results.

#3

#. 5 stemic origin h poplasia is termed as chronologic h poplasia. 2. = poplasia due to congenital s nthesis. =utchisons teeth in anterior Bulberr molars 3. Enamel h poplasia due to h pocalcemia 1eveloped level of calcium in blood -mainl C < 1. it caries molar pitting variet of h poplasia. (. = poplasia due to berter in7uries Caries traumatic birth prematurit born children children who suffer from treatment hemol tic disease at birth. 5. = poplasia due to fluoride Bottled enamel -ingestion of fluoride coating deficienc molar during to time of tooth formation ma result melted enamel. Canal ) distribution of the anelo blasts during formation stage of tooth development. There can be white spotting on enamel, white opa0ue areas, pitting and brownish staining corroded appearance.

#(

 If is different o retain restoration in such teeth. The wear and even fracture easil . *reatment: /or cosmetic rains ) blead In race heredit disturbances of the enamel orgats caled odontod splasia, apposition and maturation of the enamel are disturbed such teeth have both eater appearance -poorl calcified teeth.. Tetrac cline stains 1eposition it mainl on the dentin, a small ansent of drug ma be deposited on enamel. -composite can be used.. *melogenesis Imperfeeta -=ereditar brown enamel, =eriditar Enamel 1 splasia. it is a endodermal disturbance. 3 bacillus types #. = polactice t pe defective formation of matrix. 2. = pominarali9ation t pe defective minerali9ation of the formed matrix. 3. = pomaturation t pe when enamel cr stallation remains inmature. C/F if may be present as #. 1iscoloration

#5

2. Total absence of enamel. 3. :umerous parallel wrinkles or grooves. (. ;hipped a show depression. 5. Open contact points between teeth. &. Overall surface or incisal edge abraded. Treatment no ( except of cosmetic improvement. *ooth Development *t certain points along the dental lamina, each representing the location of one of the #> mandibular and #> maxillar deriduous teeth, the ectodermal cells multipl still more rapidl and from knobs that grow into the underl ing mesench me. Each of there little downgrowths from the dental lamina represents the beginning of the enamel organ. *s cells proliferation continues, each enamel organ increases in si9e and changes in shape. Sta!es !ud stage ;ap stage !ell stage *dvanced bell stage

#&

Enamel development starts from the cap stage. Cap stage ) *s the tooth bud starts to proliferates if it does not expand uniforml , instead une0ual growth in different parts of the tooth bud leads to the cap stage. The peripheral cells of the cap stage are cuboidal cover to convexit of the 4cap6 and are called the outer enamel epithelium, the cells into concavit of the cap become face, columnar cells and represents the inner enamel epithelium. Bud stage ) The inner enamel epithelium consists of a single la er of cells that differentiate prior to amelogenesis into fall columnar cells called anelsblasts. There cells are ( to 5 mm in diameter and (> mm high, there cells are attached to one another b 7unctional complexes literar and to cells in to stratum intermedium b dismosorces. Stratum intermedium ) * few la ers of s0uamous cells form the statum intermedium between the inner enamel epithelium and stellate reticulum there cells are closel attached b desmosorces and gap functions. Stellate reticulum ) !efore enamel formation begins the stellate reticulum collapics, reducing the distance between the centrall situated ameloblasts and

#?

the nutrient capillaries near the outer enamel epithelium, this changes begins at the heights of the cusp or incisal edge and forgives cervicall . Outer enamel epithelium ) The cells of the outer enamel epithelium flatter to low aiboidal form, at end of the bell stage and during the enamel formation the surface of outer enamel epithelium is laid into folds, between to folds form papillae that contains capillar loops which provides a rich nutritional suppl for the intense metabolic activit of vascular enamel organ. Dental lamina ) In all teeth except permanent molars in proliferates at its deep and give rise to enamel organs of the permanent teeth. *dvanced bell stage2 1uring the advanced bell stage the boundar between, inner enamel epithelium and odentoblasts outline form future 1E<n and in addition the cervical portion of the enamel organ gives rise to epithelial root sheath of hertwig. Life cycle of ameloblasts *meloblasts life c cle starts in the inner enamel epithelus or omeloblastic la er, and the near through ameloblasts in six stages #. Borphologic stage 2. Organi9ing stage 3. /ormation stage (. Baturation stage #"

5. protractive stage &. dismol tic stage Morpholo!ic sta!e The cells are short columnar with large oral nuclei that almost fill to cell bod . =igh apparatus and controls are located in the proximal end of the cell, into enclria are evenl disappeared throughout c toplasm. $r!ani#in! sta!e ;ells become longer and ma7orities of the contribute and golgi regimes from proximal ends to into dental ends of to cell. %ormation sta!e ;ells retain same si9e and arranged as previous stage, blunt cell process or to endoblast cell surface which penetrate the basal lamina enter the predentine, in the stage intiation of secreature of enamel matrix tube place. Maturative sta!e Enamel maturation occurs after most of the thickness of the enamel matrix has been formed in the occlusal or incisal area, in the cervical parts of the crown, enamel matrix formation is still progressing at this fine.

#%

;ells are slightl reduced in si9e in length and are closel attached to enamel matrix. *meloblasts displa microvilli at their distal extremities c toplasmic vacuoles containing material resembling enamel matrix are present. Protective sta!e Dhen the enamel has completel developed and has full calcified, the endoblasts leave to the arranged in a well defined la er and can no longer be differentiated from to cells of stratrum intermedium and outer enamel epithelium. There are la er form a satisfied epithelial covering of the enamel called reduced enamel epithelium. /unction is to protect the mature enamel b separating it from the connective tissue unit tooth erupts, if connective tissue come in contact with the enamel anomalies ma develop. Desmolytic sta!e In this stage the reduced enamel epithelium proliferates and seems to induce atroph of connective tissue, epithelial cells elaborate en9 mes that destro connective tissue fibers b clesmol sis.

2>

Amelo!enis On the basis of ultrastructure and composition two process are involved in the development of enamel. #. Organic matrix formation 2. Binerali9ation %ormation of the enamel matri+ *meloblasts begin their secretar dentine has been laid down. *meloblast lose the profection which had penetrated the basal lamina separating from the predentine. * thin la er of enamel forms along the dentin. This has been termed the dentinenamel membrane, the presence of membrane shows that the distal ends of enamel rods are not in direct contact with dentin. Development of tomes process The surfaces of the ameloblasts facing the developing enamel are not smooth, this is became the long axis ameloblasts are not parallel to the long axis of rod. The profections of the ameloblasts into the enamel matrix in called tomes processes. 2# activit when a small amount of

The

also contain t pical secretion granules as well as rough

endoplasmic reticules and mitochondria. Distal terminal bars Dhen the tomes process begin to form, terminal bars appear at the distal ends of ameloblasts, separating T.,. from the cell proper. 5tructurall the terminal bars are locali9ed condensations of

l toplasmic substance closel associated with thickness code membrane. The function is unknown. Ameloblasts coverin! maturin! enamel *meloblasts over maturing enamel are considerabl shorter than the ameloblast over in completel formed enamel, these short ameloblasts have a villous surface near the enamel, and the ends of the tell are packed with mitochondria. Their morpholog is t pical of absorption cells, organic components and water are lost in minerli9ation due to the obsorptive propert ameloblasts. of

22

Minerali#ation and Maturation of enamel matri+ inerali!ation ta"es place in t#o stages #. Immediate partial minerali9ation. 2. Baturation Immediate partial minerali9ation occur in those matrix segment and inter prismatic substance as the are laid down. - this amount to 25' to 3>' of total mineral content.. /irst mineral actuall is in the form of cr stalline apatite. Baturation ) is the gradual completion of minerali9tion, maturation process starts from the height of the crown and progress cervical . The incisal and occlusal regims reach maturit cervical regims. Baturation is characteri9ed b growth of the cr stal seen an primar phase, cr stal increase in thickness more rapidl than width, same time ahead of the

organic matrix graduall become thinned and widel spaced to make room for the growing cr stals. This loss of volume of organic matrix is caused b with drawn of substantial amount of protein as well as water.

23

Cervical loop *t the free border of the enamel organ the outer the outer and inner enamel epithelial la er are continuous and reflected into on outer as the cervical loop. Dhen the crown has been formed the cells of this portion given rise to =ertwigAs epithelial root sheath.

2(