DEVELOPMENT OF TEETH

Development and growth of the crown initially and the not later results in the crown occupying an intraoral position and root occupying an intraosseous position in which it is anchored in a bony socket. Six stages are explained for the tooth development and growth process namely: 1. Lamina or initiation stage in which germinal tissue is formed dental!. ". #ud stage $ere the analge responsible for enamel development forms. %. &ap stage. '. #ell stage. (. )pposition and calcification stage. *. +ooth eruption.

,urther it is to be noted that the dental tissues not only vary in si-e and shape but also in their development pattern as well as period of growth and development. +he development of tooth is a study of prime importance since many of in of clinical conditions are associated +he study with of

disturbances development

developmental teeth involves

process. many

complex

biological

processes. +his includes epithelial mesenchymal interactions. differentiation. minerali-ation. /t is at around *.( weeks of gestation or when embryo is 1%01' mm in length stomatodeum i.e. primitive oral cavity when is examined under light electron microscopy shows a primitive ' to ( layered epithelial cells covering a band of connective tissue. +his connective tissue based on its site of origin from neural crest is termed as ectomesenchyme. +he ectomesenchyme here consists of a few spindle shaped cells separated by a gelatinous ground substance. " morphogenesis. fibrillogenesis and

Primary Epithelial Band 1evy 1234. 5uch 6.7. 128'! /t is around the *.( weeks of embryonic life. there appears a continuous band of thickened epithelium around the mouth in place of future upper and lower 9aws. /t occurs by fusion of separate plates of thickened epithelium. +hese epithelial thickenings are roughly hose shoe shaped and correspond in position to the future dental of upper and lower 9aws 1evy et al 1234!. +his resulting thickening of epithelium is not mainly because of increased proliferative activity of the cells but rather is because of change in the orientation of cleavage plane of dividing cells. +hese bands of epithelium upper and lower! are termed as primary epithelial bands. $ence formed primary and band very :uickly given rise to two subdivisions. the vestibular lamina and dental lamina. +he division of band in to these two

layers is so fast that ma9ority of investigators consider them laminae! as separate entities. Vestibular Lamina 1evy et al 1234! /f coronal section of a developing embryo at * weeks is examined at head region. no sulcus or vestibule are seen clinically. /t is the vestibular lamina that proliferates within the mesenchymal tissues and forms a vestibule or depression between developing 9aws and cheeks. +he formation of vestibule occurs by enlargement and

degeneration of cells of vestibular lamina. Dental Lamina /t;s the first stage of tooth development increased mitotic activity in a specific portion of stomatodeal ectoderm of both upper and lower arches produces prominent thicknenings that dips into underlying ectomesenchyme. +he epithelial

thickening seen now produces two horse shoe shaped bands defining the prospective upper and lower dental arches in the

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stomatodeum. +his germinal band of ectodermal epithelium circumscribing the future maxillary and mandibular arches is termed as Dental Lamina. )t certain points along dental lamina each representing the location of one of the 14 mandibular and 14 maxillary deciduous teeth the ectodermal cells that grow into underlying mesenchyme. <ach of these little down growth represents the beginning of enamel organ of the tooth bud of a deciduous tooth. /t is found that the mitotic index as well as epithelial replication rate is slower when compared to that in underlying ectomesenchyme. +hus the down growth of epithelium is also a result of a growth of ectomesenchyme +encate 1234!. =nce the cells from tooth bud proliferating. they assume different types of 00000. 1ow the bud resemble cap shape. +he ectomesenchymal cells in the cap proliferative more rapidly

and appear more dense than surrounding structures. +his represents beginning of formation of dental papilla. 1ow surrounding dental papilla and enamel organ a third layer of cells develop. +his third layer is called as dental sac. +his consists of ectomesenchymal cells and fibers that

surrounds the dental papilla and enamel organ. +he function of individual structures will be discussed later. Successional Laminae +he portion of dental lamina ad9acent to developing tooth anlage retains its connection with the lingual aspect of tooth primordium via Lateral Lamina. +he free terminal end of dental lamina begins to proliferate at the end of forth month />. +his newly established growth center is known as successional lamina. /t provides anlage for permanent teeth replacing deciduous teeth. Parent Dental Laminae

/n the 8 t h week of tooth development tooth anlagen for 14 primary teeth is produced by the dental lamina. +his lamina also provides germ for the permanent molars which does not have any predecessors. #ecause of this the dental lamina providing for the formation of /. // and /// molars is called as ?arent Lamina or Lamina for ?ermanent @olars. +he mechanism involved simply is one of the continued distal growth i.e. the dental lamina after having established the growth centers for 14 primary molars on either 9aws keep growing on distal aspect. +he growth of this keeps in pace with growth of the dental arches. +he buds of first permanent molars appear at ' month of time. +hat of // and /// molars appear after birth 2 month and 1 year post natally respectively!. +hus activity of dental lamina begins at *.( weeks /7 and lasts for about '0( years postnatally. Sta e !! or Bud sta e"

Aithin days after formation of dental lamina knoblike structures start appearing on the vestibular aspect of dental lamina in ten specific approximating areas in maxillary and mandibular arches. +hese are the primordial for the deciduous teeth and are variously referred to as tooth buds. tooth primordial or dental anlagen. +he first primordial to form are those of incisors of mandibular arch at the end of seventh week ambryo 13mm in length!. +hen the maxillary incisor buds start appearing. )t the 8 t h week when embryo is about "(mm in length. the buds for all primary teeth are formed. Since the main function of certain epithelial cells of tooth bud is to form enamel those cells constitute enamel organ which is critical to normal tooth development. /n the bud stage. the enamel organ consists of a peripherally arranged low columnar cells and centrally located

polygonal cells. 1ow many of the cells of tooth bud and the surrounding ectomesenchyme undergo mitosis. )s a result of this mitosis and the migration certain cells from neural crest into the area of ectomesenchyme. cells surrounding the tooth bud condense. +he area of

ectomesenchymal condensation immediately ad9acent to enamel organ is called Dental ?apilla. 1ow the ectomesenchymal condensation that surrounds both dental papilla and enamel organ is known as Dental Sac. Dental ?apilla and sac form pulp and dentin! and

cementum and periodontium! respectively. )t this stage the cells of dental papilla start invaginating in the center of bud and next stage i.e. cap stage begins.

Bud Sta e Stage II or Cap Stage +he cells of this dental primordium starts proliferating and growing. )s these proliferation continues the intercellular spaces are enlarged particularly those of the core. +his proliferation is not uniform in all the areas of tooth bud. /nstead an une:ual growth is seen in the bud. Like more amount of growth is seen in the inferior border of bud. +his leads to an inward growth of mesenchyme below the bud with expanding growth of mesenchyme more and more amounts of mesenchyme is

accumulation in the enlarging concavity and the epithelial bud is rapidly transformed in to a cap or cup shaped structure. +he connective tissue bordering the lining epithelium of the cap is dental papilla. &ontinued cell movements or rearrangements effected by growth forces result in a change in the shape of the cap. 1ow the cells in the tooth forming structure are no more of uniform si-e or

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shape. +he cells lining the concavity of the cap become low columnar and is called inner enamel epithelium. +he cells lining the convea portion of the cap are cuboidal in shape and are called as outer enamel epithelium. +he polygonal cells that are present between inner and outer enamel epithelium begin to separate as more amount of fluid starts collecting between them and form a cellular network called as stellate reticulum. +his cells in stellate reticulum assume a branched reticular pattern. +he spaces between these reticular forms are filled with a mucoid fluid rich in albumin. which gives the stellate reticulum a cushion like consistency that may support and protect. delicate enamel forming cells. Enamel #not and $ord +he cells in the center of enamel organ are densely packed and form enamel knot. +he knot pro9ects in part towards dental papilla. so that the center of epithelial invagination shows a knoblike structure that is bordered by the labial and lingual enamel

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grooves. )t the same time in the increasingly high enamel organ a vertical extension of the enamel organ occurs called as enamel cord. #oth these structures are temporary that disappear before enamel formation begins. +he functions of enamel knot and used may be to act as reservoirs of dividing cells for growing enamel organ. Dental Papilla +he changes in the dental papilla occurs concomitantly with the development of epithelial enamel organ. )lthough epitheli-ation exerts a deminating influence over the ad9acent connective tissue condensation of connective tissue is not a passive crowding by proliferating epithelium. D.?. shows active budding of capillaries and mitotic figures and its peripheral cells ad9acent to inner enamel organ proliferative and differentiate into odontoblasts.

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Dental Sac &oncomitant with the development of enamel organ and dental papilla there is a marginal condensation in the

ectomesenchyme surrounding the enamel organ and D.?. gradually a more fibrous and dense layer develops which terms in to dental sac D.S.!. +he cells of D.?.. D.S.. and <.=. are formative structures for entire tooth and supporting structures. Bell sta e or !V sta e )s the invagination of epithelium deepens and margins continue to grow. four different types of epithelial cells can be distinguished and it assumes a bell shape. +he fourth layer comes from differentiation of stellate reticulum into another layer of cells called stratum intermedium. $ence the four layers of the tooth bud include: 1. =uter enamel epithelium.

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". Stratum intermedium. %. Stellate reticulum and '. /nner enamel epithelium. !nner Enamel Epithelium +he inner enamel epithelium consists of a single layer of epithelium that differentiate into tall columnar cells prior to amelogenesis. +hese full columnar cells are called as ameloblasts. +hese cells are '0(Bm in diameter and '4Bm in length. +hese elongated cells are attached to one another by 9unctional complexes laterally and by means of desmosomes with cells of stellate reticulum. +he cells of inner enamel epithelium has a organi-ing influence over cells of etcomesenchyme of D.?.! which gets

converted into odontoblasts. Stratum !ntermedium

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) few layers of s:uamous cells form stratum intermedium between inner enamel epithelium and stellate reticulum. +hese cells are closely attached by desmosomes and gap 9unctions. +hey possess a high degree of metabolic activity which is indicated by increased cytoplasmic organelles acid

mucopolysaccharides and glycogen deposits. +his layer is essential for enamel formation and it is absent in the part which takes part in root formation. Stellate %eticulum +he stellate reticulum expands further mainly by an ?.D. accumulation of intracellular fluid. +hese cells are star shaped with pointed ends in contact with one another. +his layer collapses prior to amelogenesis thereby reducing the distance between nutrient capillaries outside the outer enamel expansion and ameloblasts. )t this stage these cells are very difficult in distinguishing from those of it intermedium. +he change begins at the height of cusp tips or at

1(

incisal edges. and proceeds cervically as the formation of enamel progresses.

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Outer Enamel Epithelium +he cells of outer enamel epithelium flatten to a low cuboidal form. )t the end of bell stage preparatory to and during amelogenesis. the =.<. epitheli-ation which was smooth becomes folded into papillae which extend into stratum intermedium. /n these papillary extensions blood capillaries carrying rich nutrients from dental sac are found. +hus nutrition is provided to avascular enamel organ by this modification for its intense metabolic activity. Dental lamina /n all these areas except in the areas of permanent molars. the dental lamina proliferates at its deep end contributing for permanent successors. Dental papilla )t this stage. before the enamel organ begins to produce enamel. the peripheral cells of mesenchyme proliferate and under the organi-ing influence of ameloblasts convert into odontoblasts. +hese odontoblasts are cuboidal in form in the initial stage. Later

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they assume a columnar form and ac:uire specific potential to produce dentin. +he basement membrane that separates enamel organ from dental papilla 9ust prior to dentin formation is called as membrane preformation. Dental Sac #efore formation of dental tissues begins the dental sac shows circular arrangement of its fibers and resembles a capsular structure with the development of root. the fibers get embedded into cementum to alveolar bone and converted into periodontal ligament. +he transformation of cap stage to bell stage occurs when the embryo is about 14401*4mm in length ?roven-a 128*!. &d'anced Bell Sta e" During advanced bell stage. the boundary between inner enamel epitheli-ation and odontoblasts outlines the future dentino0

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enamel 9unction. /n addition. the cervical portion of enamel organ gives rise to epithelial sheath of $eartwig. Hert(i )s epithelial root sheath and root *ormation" +he development of root formation begins after the enamel and dentin formation has reached the future cemento0enamel 9unction. +he enamel organ plays an important role in root development by forming $ertwig;s epithelial root sheath which molds the shape of the roots and initiates radicular dentin formation. +he $ertwigs root sheath includes only outer and inner enamel epithelium and thus does not involve of intermedium and st. reticulum. +he cells of inner enamel epithelium remain short and normally do not produce enamel. +hese cells will induce radicular cells to get converted into odontoblasts. +hese odontoblasts shorts laying down dentin. Ahen the first layer if dentin has been laid down. the epithelium and

$ertwigs root sheath looses its continuity and its close relation to

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the root surface. /ts epithelial remnants may persist on the surface of root as group or clusters of cells or tubules which are found in periodontal ligament as cell rests of malasses. +here is a pronounced difference in the development of $ertwig;s epithelial root sheath in teeth with single root and in teeth with two or more roots. ?rior to the beginning of root formation the sheath bonds into a hori-ontal plane forming epithelial diaphragm. +his hori-ontal bonding causes narrowing of wide cervical opening. +he plane of diaphragm remains relatively fixed during growth and development of root. +he proliferation of epithelial diaphragm is accompanied by proliferation of cells of connective tissue of the pulp which occurs in the area ad9acent to pulp diaphragm. +he free end of diaphragm does not itself grow into the connective tissue but the epithelium present coronally to diaphragm proliferates. 1ow the differentiation of odontoblasts and formation

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of dentin follows lengthening of root sheath. )t the same time. the connective tissue from dental sac proliferates and divides the root sheath into epithelial strands. +hese by the D.S. connective tissue comes in contact with underlying dentin. +hese cells from D.S. once they come in contact with dentin differentiates into cementoblasts and deposit cementum on the dentin. /n the last stage of epithelial development proliferation of epithelium lags behind that of pulpal connective tissue. +he apical foramen is at first established to the width of $ertwigs epithelial root sheath. Later the dentin deposition at a rapid rate causes narrowing of apical foramen to its normal si-e. Differential growth of epithelial diaphragm in multirooted teeth causes division of root trunk into two or three roots. During the general growth of enamel organ expansion of cervical opening occurs in such a way that small tongue like extensions develop from hori-ontal diaphragm. +wo such extension occurs in lower molars and % extensions from upper molars. #efore the division of root trunk occurs the free ends of these extensions grow towards "1

each other and fuse. +he cervical opening of these teeth is hence divided into two or % openings. =n the pulpal surface the dividing epithelium starts dentin formation and on the periphery of each opening root development follows as in case of single rooted teeth. Histopatholo y and $linical $onsiderations" ) number of growth processes participate in the progressive development of teeth. <xcept for initiation which is a momentary process each of these processes overlap each other and many are continuous throughout the various morphologic stages of

odontogenesis. +hese processes include: 1. /nitiation. ". ?roliferation. %. $istodifferentiation. '. @orpho differentiation. (. )pposition. !nitiation" Dental laminae and associated tooth buds represent those

parts of oral epithelium that have the potential for tooth formation.

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Specific cells in horse shoe shaped lamina have the potential to form enamel organ of certain teeth by responding to certain factors that initiate or induce tooth development. Different teeth are initiated at definite times. /nitiation or induction re:uires ectomesenchymal epithelial interaction. +he mechanism of such as interaction is not clearly understood. $owever it has been demonstrated that dental papilla mesenchyme can induce or instruct tooth epithelium and even non tooth epithelium to form enamel. +he lack of initiation results in loss of a single tooth or multiple teeth )nodontia!. =n the other hand abnormal initiation may lead to development of single or multiple supernumerary teeth. Proli*eration /n this stage enhanced proliferative activity from initiation stage results successively in bud. cup and bell stages. +he proliferative growth causes changes in proportions and si-e of growing enamel organ tooth germ!.

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)ny disturbance during these stages may result in defective dental problems ranging from absence of tooth to disturbed tooth formation. Histo+di**erentiation +his succeds the proliferative stage. +he cells of tooth germ in proliferative stage undergo definitive functional and

morphologic changes and ac:uire their functional assignment. +hey differentiate and give up their capacity to multiply as they assume new functions. +his law governs all differentiating cells. +his stage is seen at its peak in bell stage when cells of developing enamel organ differentiate into cells of enamel and dentin formation. /n the process of histodifferentiation under the organi-ing influence of inner enamel epithelisation cells the cells of ad9acent connective tissue differentiate to form odontoblasts. +hese

odontoblasts lay down dentin. +his process of dentin formation causes differentiation of cells of / and < into ameloblasts. +hese

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ameloblasts now lay down a thin layer of enamel ad9acent to dentin formed. +hus the formation of dentin proceeds and essential to enamel formation. /n vitamin ) deficiency the ameloblasts fail to differentiate properly. &onse:uently their organi-ing influence on ad9acent mesenchymal tissue is disturbed . this may result in formation of a typical dentin known as osteodentin. Morpho di**erentiation" +he morphologic pattern or basic form and si-e of the tooth is established by morphodifferentiation i.e. by differential growth. /t is therefore proliferation is very important stage in tooth development. +he dentino0enamel 9unction and dentino0enamel are

different and characteristics of particular teeth and act as blue print pattern. /n conformity with those pattern ameloblasts. odontoblasts and cementoblasts deposit enamel. dentin and cementum

"(

respectively and thus give the completed tooth a particular shape and si-e. )ny disturbances during the process of morphodifferentiation may result in si-e and shape disturbances. <xample: 0 0 0 0 Supernumerary cusps or roots. +winning of teeth. Loss of cusps. Disturbed shape peg shaped incisors. $utchinsons incisors.

&pposition" )pposition is the process of deposition of matrix of hard dental structures. )ppositional growth of enamel and dentin is a layer like deposition an extracellular matrix which later gets calcified. +his type of growth is additive. +he appositional growth is characteri-ed by regular and rhythmic deposition of extracellular matrix which is of itself incapable of further growth. +his process of apposition occurs in periods of alternating rest and activity.

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Disturbances calcification may

during result

the in

process enamel

of

apposition

and

hypoplasia.

enamel

hypocalcification etc. +hese result in formation of teeth.

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