DEVELOPMENT OF TEETH

By Shilpa Maria 1st yr pg department of oral and maxillofacial pathology

Contents

Introduction Formation of epithelial band Vestibular lamina Dental lamina Bud stage Cap stage Bell stage Hertwigs epithelial root sheath Transitory structures Histophysiology Clinical considerations

introduction
The primitive oral cavity is called the

stomatodeum It is lined by stratified squamous epithelium Also called oral ectoderm or primitive oral epithelium oral ectoderm contacts the endoderm of the foregut to form -buccopharyngeal membrane

 At about the 27th day of gestation this

membrane ruptures
Primitive oral cavity establishes a connection with the foregut Most of the connective tissue cells underlying the oral ectoderm are of neural crest origin These cells are thought to instruct or induce the overlying ectoderm to start tooth development

 FORMATION OF PRIMARY EPITHELIAL BAND 1st histological sign of tooth development is the

appearance of a condensation of mesenchymal tissue and capillary networks beneath the presumptive dental epithelium of the primitive oral cavity
By the 6th week of development the oral epithelium

thickens and invaginates into the mesenchyme to form a PRIMARY EPITHELIAL BAND

Primary epithelial band

 By the 7th week the primary epithelial band

divides into 2 processes

1) VESTIBULAR LAMINA 2) DENTAL LAMINA

Vestibular lamina is buccaly located Dental lamina is lingually located

Vestibular lamina
contributes to the development of the

vestibule of the mouth Delineates the lips and cheeks from the tooth bearing regions To form the vestibule of the oral cavity the cells of the vestibular lamina proliferate subsequently there is degeneration of the central epithelial cells to produce the sulcus of the vestibule

Dental lamina
contributes to the development of the teeth

Further development of the dental lamina is characterized by an increase in the length

By the 8th week a series of swellings develop

on the deep surface of the dental lamina Each epithelial swelling is almost completely surrounded by a mesenchymal condensation Epithelial swellings indicate early developing tooth germs

 For descriptive purposes tooth germs are

classified into
Bud stage Cap stage Bell stage

According to the degree of morphodiffrentiation and histodifferentiation of their epithelial components

Bud stage
enamel organ in the bud stage appears as a

simple spherical to ovoid epithelial condensation Poorly morphodifferentiated and histodifferentiated surrounded by mesenchyme Successful development of the tooth germ relies upon a complex interaction of the mesenchymal and epithelial components

Bud stage

Cap stage
By the 11th week morphogenesis has

progressed Deeper surface of the enamel organ invaginates to form a cap shaped structure greater distinction develops between the more rounded cells in the central portion of the enamel organ and the peripheral cells which become arranged to form the external and internal enamel epithelia

Cap stage

Late cap stage

By the 12th week the central cells of the

enlarging enamel organ become separated intercellular spaces contain significant quantity of glycosaminoglycans The resulting tissue formed is the STELLATE RETICULUM cells of the external enamel epithelium remain cuboidal internal enamel epithelium becomes columnar

 The part of the mesenchyme lying beneath

the internal enamel epithelium is termed the DENTAL PAPILLA The mesenchyme surrounding the tooth germ becomes the DENTAL FOLLICLE

Early bell stage

By the 14th week further morphodifferentiation

and histodifferentiation leads to the early bell stage configuration of the internal enamel epithelium broadly maps out the occlusal pattern of the crown of the tooth This folding is related to differential mitosis along the internal enamel epithelium

Bell stage

 During the bell stage bone resorption defects

that restrict the space for development of the tooth germ are associated with the increased folding pattern of the internal enamel epithelium leading to changes in tooth shape dental lamina breaks down and the enamel organ loses connection with the oral epithelium At the same time the dental lamina between the tooth germs also degenerates Remnants of dental lamina are called CELL RESTS OF SERRE

 Interposed between the enamel organ and the wall of the developing bony crypt is the mesenchymal tissue of the dental follicle
It has 3 layers: Inner investing layer

Outer layer
Between the 2 layers is lose connective tissue

with no marked concentration of blood vessels

 The enamel organ shows four distinct layers External enamel epithelium Stellate reticulum Stratum intermedium Internal enamel epithelium

External enamel epithelium

This forms the outer layer of cuboidal cells

which limits the enamel organ separated from the surrounding mesenchymal tissue by a basement membrane cells of the external enamel epithelia contains large centrally placed nuclei Contact each other via desmosomes and gap junctions

 It is involved in the maintenance of the shape of the enamel organ Exchange of substances between the enamel organ and the environment The cervical loop at which there is considerable mitotic activity lies at the growing margin of the enamel organ Here the external enamel epithelium is

continuous with the internal enamel epithelium

Stellate reticulum

Most fully developed at the bell stage Intercellular spaces become fluid filled Cells are star shaped Conspicuous nuclei and many branching processes

The cell contains:

glycosaminoglycans Alkaline phosphatase Small amounts of RNA glycogen

 Collagens type I II III are expressed in stellate reticulum

Possess few mitochondria

minimal endoplasmic reticulum

Well developed Golgi complex Microvilli are present on the cell surface Numerous tonofilaments present in

cytoplasm Desmosomes and gap junctions present between the cells

 Functions:

protection of the underlying dental tissue against physical disturbance maintenance of the tooth shape
Contribute to the secretion of extracellular

material

Stratum intermedium
First appears at the bell stage

Consists of 2 or 3 layers of flattened cells

lying over the internal enamel epithelium Resemble the cells of the stellate reticulum Intercellular spaces are much smaller

 Functions : Concerned with the synthesis of proteins Transport of materials to and from the

enamel forming cells in the internal enamel epithelium

Internal enamel epithelium

The cells are columnar at the bell stage At the regions associated with the future cusp

tips the cells become elongated

Cells are rich in RNA

Do not contain alkaline phosphatase

 Desmosomes connect the internal enamel

epithelium cells and link this layer to the stratum intermedium

The internal enamel epithelium is separated

from the peripheral cells of the dental papilla by a basement membrane and a cell free zone 1-2 micrometer wide

Late bell stage

Associated with the formation of dental hard

tissues Commences at about 18th week Dentin formation always precedes enamel formation Down growths of the external enamel epithelia appear from the lingual sides of the enamel organ

 The boundry between the inner enamel

epithelium and odontoblasts outlines the future dentinoenamel junction

The formation of dentin occurs first as a layer along the future dentinoenamel junction in the region of future cusps and proceeds pulpally and apically
After the first layer of dentin is formed the ameloblast which has differentiated from the

inner enamel epithelial cells lay down enamel over the dentin in the future incisal and cuspal areas

 Enamel formation then proceeds coronally

and cervicaly in all regions from the dentinoenamel junction towards the tooth surface The cervical portion of the enamel organ gives rise to the epithelial root sheath of hertwigs

Hertwigs epithelial root sheath

The development of the roots begins after

enamel and dentin formation has reached the future cementoenamel junction Hertwigs root sheath consists of outer and inner epithelia only Does not include stratum intermedium and stellate reticulum Cells of the inner layer remain short and donot produce enamel

 Once the first layer of dentin is laid down ,

the epithelial root sheath loses its structural continuity and its close relationship with the surface of the root Remnants are found in the periodontal ligament of erupted teeth rests of malassez

 Prior to the beginning of root formation the

root sheath forms the epithelial diaphragm

The outer and inner enamel epithelial bend at

the future cementoenamel junction into a horizontal plane

This narrows the wide cervical opening of the

tooth germ

 The proliferation of the cells of the epithelial

diaphragm is accompanied by proliferation of cells of the connective tissue of the pulp

The free end of the diaphragm does not grow

into the connective tissue

Epithelium proliferates coronal to the

epithelial diaphragm

 The differentiation of odontoblasts and the formation of dentin follow the lengthening of the root sheath At the same time the connective tissue of the dental sac surrounding the root sheath proliferates and invades the continuous double epithelial layer dividing it into a network of epithelial strands
The epithelium is moved away from the surface of the dentin so that the connective tissue cells

come into contact with the outer surface of dentin and differentiate into cementoblasts that deposit a layer of cementum onto the surface of the dentin

 The rapid sequence of proliferation and destruction of hertwigs root sheath explains the fact that it cannot be seen as a continuous layer on the surface of the developing root
In the last stages of root development the proliferation of the epithelium in the diaphragm lags behind that of the pulpal connective tissue Wide apical foramen is reduced first to the width of the diaphragmatic opening itself

Later narrowed by apposition of dentin and cementum to the apex of the root

Transitory structures
During the early stages of tooth development

3 transitory structures maybe seen

Enamel knot Enamel cord Enamel niche

Enamel knot
A localized mass of cells in the center of the

internal enamel epithelium The enamel knot forms a bulge into the dental papilla at the center of the enamel organ It soon disappears and seems to contribute to the enamel cord Disappearance of the enamel knot by the bell stage maybe associated with apoptosis

Enamel knot

Enamel cord
A strand of cells seen at the early bell stage Extends from the stratum intermedium to the

stellate reticulum When present the enamel cord overlies the incisal margin of a tooth or the apex of the 1st cusp to develop When it completely divides the stellate reticulum into 2 parts , reaching the external enamel epithelium it is termed the enamel septum

 Where the enamel cord meets the external

enamel epithelium a small invagination termed the enamel naval maybe seen
Cells of the enamel cord are distinguished from their surrounding stellate reticulum cells by their elongated nuclei
It has been suggested that the enamel cord maybe involved in the process by which cap stage is transformed into the bell stage Or that it is a focus for the origin of stellate reticulum cells

Enamel niche
It is seen where the tooth germ appears to have a double attachment to the dental lamina

[lateral and medial enamel strands]

These strands enclose the enamel niche It appears as a funnel shaped depression containing connective tissue Functional significance is unknown

Nerve fibres
Present in the immediate vicinity of

presumptive dental epithelium at the very earliest stage of tooth induction and subsequently form a plexus below the dental papilla at the cap stage
From such plexus the nerves spread into the

dental follicle as it develops

 Penetration of nerves into the dental papilla

occurs with the onset of dentinogenesis The nerve fibres associate with blood vessels are presumed to be autonomic Others lying free within the papilla are presumed to be sensory The innervation of the dental papilla remains rudimentary until after birth Maybe fully developed only after the tooth has erupted

Blood supply
Small blood vessels invade the dental papilla

at the early bell stage They are also evident in the dental follicle in close association with the external enamel epithelium

Histophysiology
Stages in tooth growth Initiation Proliferation Histodifferentiation Morphodifferentiation Apposition

 INITIATION: Sites of the future teeth are established with the appearance of tooth germs along an invagination of the oral epithelium called the dental lamina MORPHOGENESIS: The shape of the tooth is determined by a

combination of cell proliferation and cell movement

HISTOGENESIS: Differentiation of cells started during morphogenesis proceeds to give rise to fully formed dental tissues

initiation
The dental lamina and associated tooth buds

represent those parts of the oral epithelium that have the potential for tooth formation
Specific cells within the dental lamina have

the potential to form the enamel organ of certain teeth

Different teeth are initiated at different times

 Initiation induction requires

ectomesenchymal-epithelial interaction
It has been demonstrated that dental papilla

mesenchyme can induce or instruct tooth epithelium and even non tooth epithelium to form enamel

Proliferation
Enhanced proliferative activity ensues at the

points of initiation and results successively in the bud cap and bell stages
Proliferative growth causes regular changes

in the size and proportion of the growing tooth germs

Histodiffereniation
Succeeds the proliferative stage The formative cells of the tooth germs

developing during the proliferative stage undergo definite morphologic as well as functional changes and acquire their functional assignment The cells become restricted in their functions They differentiate and give up their capacity to multiply as they assume their new function

 This phase reaches its highest development

in the bell stage of the enamel organ

Organising influence of the inner enamel

epithelium on the mesenchyme is evident in the bell stage

Leads to differentiation of the adjacent cells

of the dental papilla into odontoblasts

 With the formation of dentin the cells of the

inner enamel epithelium differentiate into ameloblasts

And enamel matrix is formed opposite the

dentin
Dentin formation preceeds and is essential to

enamel formation

Morphodifferentiation
Basic form and relative size of the future

tooth is estalished by morphodifferentiation

Morphodifferentiation is impossible without

proliferation
Advanced bell stage marks not only active

histodifferentiation but also an important stage of morphodifferentiation in the crown, outlining the future dentinoenamel junction

Apposition
Apposition is the deposition of the matrix of

the hard dental structures Appositional growth of enamel and dentin is a layer like deposition of an extracellular matrix It is characterized by regular and rhythmic deposition of the extracellular matrix Periods of activity and rest alternate at definite intervals during tooth formation

Clinical considerations
Disturbances of epithelial and mesenchymal

interaction can disturb tooth development Splitting of tooth germ or joining of adjacent germs can be responsible for variations in tooth number and shape Trauma and infection of the deciduous predecessors has been implicated in the malformation of permanent teeth

 Malformations of teeth can be Variations in

size shape number structure

 Variations in size include : Macrodontia

Microdontia

Variations in shape include: Peg shaped laterals

 Gemination:

Partial cleavage of tooth germ

Fusion:

Union of two adjacent tooth germs

Concresence:

Fusion of teeth at the roots

 Abnormal tooth shapes: Hutchinson's incisors Mulberry molars Odontomes: Are irregular masses or a large number of

irregular denticles found in place of a developing tooth

 Hypodontia: Reduction in the number of teeth Anodontia: Complete absence of teeth Hyperdontia:

Increase in tooth number

REFERENCES
Ten Cates oral histology, development,

structure and function 7th edition Oral anatomy histology embryology 3rd edition -Berkovitz , Holland , Moxham Orbans oral histology and embryology-12th edition

Thank you