DEVELOPMENT OF ENAMEL

EPITHELIAL

ENAMEL ORGAN

Enamel Organ : gives rise to enamel and the surrounding tooth follicle or sac gives rise to dentin, pulp, cementum, periodontal ligament, alveolar bone and gingiva. The layers of the enamel organ are 1, inner epithelial cells 2, stellate reticulum 3, stratum intermedium 4,outer enamel epithelial cells. 5, cervical loop

Enamel formation is a 2 step process. 30% mineralized enamel matrix is deposisted in complete thickness. Once the complete thickness of the matrix is deposited then only does mineralization occur. These are called the Secretory and the Maturative Phases. During matrix formation a continuous layer of enamel matrix is deposited along the dentin and this is termed as the dentino-enamel membrane. The organic matrix contains enamel proteins and enzymes e.g. metalloproteinases and phosphatases. Enamel protein Amelogenin, Enamelin, Tuftelin and Amelin.

LIFE CYCLE OF AN AMELOBLAST :

The life span of an ameloblast can be divided into 6 stages: 1) Morphogenic stage 2) Organizing stage 3) Formative stage 4) Maturative stage 5) Protective stage 6) Desmolytic stage.

The changes are first seen at the cusp tips and then extend down to the cervical area. Reciprocal induction: the action between the Inner Enamel Epithelial Cells and the Mesenchymal cells is called reciprocal induction. The dentin is formed first before enamel formation begins and this happens under the influence of the IEE cells. The first layer of dentin leads to the activation of the IEE cells and to the formation of enamel.

1) MORPHOGENIC STAGE
Cells are short columnar and have a high an large oval nuclei and abundant organelles. Nuclei is present towards the basement membrane (distal end). These cells are separated from the underlying connective tissue a basal lamina. There is a cell free zone, seen in the connective tissue.

2) ORGANIZING / DIFFERENTIATION STAGE :

There is interaction with the underlying connective tissue cells and these form Odontoblasts. The IEE cells undergo reversal of polarity i.e. their nuclei moves the opposite edge of the cell. The cells become taller. The cell free zone in the dental papilla is absent and here the differentiated odontoblasts are seen in close contact with the IEE cells. Once the first layer of dentin is laid down the nutrition supply from the dental papillae is cut off and the ameloblasts derive their nutrition from the dental follicle. The cells if the stellate reticulum layer collapses causing an inward folding of the outer enamel cells and this brings the blood supply closer to the cells.

3) FORMATIVE / SECRETORY STAGE

This layer starts once the first layer of dentin is laid down. The ameloblasts form blunt processes on its distal that penetrate the basal lamina and enters the predentin. The first structureless enamel is laid down against the Dentinoenamel junction(DEJ). As the ameloblasts move away from the DEJ there is the formation of the Tomes process. This contains mostly secretory granules and cell bodies. Secretion of the enamel protein occurs at two sites

1st site is adjacent to the proximal part of the process around the periphery of the cell. This along with the adjacent ameloblasts results in the formation of a wall around a pit. Into this pit the Tomes Process fits. The orientation of the crystals in and around the pit are different, the walls form the Interrod enamel and the pit the rod enamel.

4) MATURATION STAGE
Enamel maturation i.e. full mineralization occurs once most of the enamel matrix is laid down in the occlusal/incisal area. Formation of the matrix is still continuing at the cervical areas. The ameloblasts become shorter and the stratum intermedium becomes spindle shaped. The ameloblasts remain attached to the matrix and they aid in the removal of the matrix substance during maturation. They form 2 types of ends: ruffled and smooth ends. The ruffled introduce inorganic material and the smooth remove the protein and the water.

5) PROTECTIVE STAGE :
Once the enamel is fully calcified the IEE cells, the stratum intermedium and the OEE cells together form a stratified epithelium called the Reduced Enamel Epithelium. This protects the newly formed enamel from the surrounding connective tissue. This REE may retract from the cervical edge and here a afibrillar cementum may appear over the enamel.

6) DESMOLYTIC STAGE :

The REE proliferates and causes the overlying connective tissue to degenerate and fuses with the overlying epithelium.

DEVELOPMENT OF TOMES PROCESSES :

The projection of the ameloblast into the enamel matrix is called the Tomes Process. These are partially separated from the ameloblast by an incomplete septa and contain secretion granules, rough endoplasmic reticulum and mitochondria. According to the relation between the keyhole shaped enamel rods and the ameloblasts one rod is formed by the influence of 4 ameloblasts, 1 in the head area and 3 in the tail area. So 1 ameloblast is involved in the formation of 4 different rods.

MINERALIZATION
The mineral component is derived from the dentin and from the blood via the ameloblasts. Partial mineralization seen immediately in the newly secreted enamel matrix. No predentin or osteoid seen. Enamel matrix deposited directly on the dentin which is mineralized. The hydroxyapatite crystallites present in the dentin cause the enamel matrix to undergo partial mineralization. The crystals grow in size and the proteins are removed by their breakdown under the influence of enzymes.

4 STAGES OF MINERALIZATION :
1) Primary Mineralization : Partially mineralized enamel matrix around 30%. 8 microns nearest to DEJ is heavily mineralized. this proceeds from the DEJ to the surface. 2) Secondary Mineralization : Surface to the innermost 8 microns. 3) Tertiary Mineralization : From innermost layer out to the surface. The surface 15 microns mineralizes the slowest.

4) Quaternary Minralization : The outer layer mineralizes rapidly and heavily and becomes the most mineralized layer of enamel.

CLINICAL CONSIDERATIONS :
Hypoplasia matrix formation is affected . Hypocalcification maturation is affected i.e. incomplete or lacking. Both of the above can be caused by systemic, local or hereditary factors. In case of local factors single teeth can be involved. In the case of systemic factors single or multiple teeth may be involved. In case of hereditary factors the entire enamel of both deciduous and permanent dentition are involved.