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Dr.

EBTISAM ELHAMALAWY
MFDS RSC (Edh.), MJDF RSC (Lon.), BDS (Misr International
University)
1. Intiaiton
2. Bud
3. Cap
4. Bell
5. Apposition
6. Maturation
• One of the earliest signs in the formation of a tooth that can be
seen microscopically is the distinction between the vestibular
lamina and the dental lamina.
• The dental lamina connects the developing tooth bud to
the epithelial layer of the mouth for a significant time.
• Disturbance at this stage will lead to????
• The stage technically begins once epithelial cells proliferate into
the ectomesenchyme of the jaw.
• 8 weeks old.
• Along with the formation of the dental lamina, 10 round BUDS
epithelial structures
• Permanent tooth buds develops lingual to them.
• Disturbance??????????
• 9 -10 week in utero
• A condensation of ectomesenchymal cells called the dental sac
or follicle
• Morpho-differentiation and histo-differentiation occurs.
• Enamel organ / Dental follicle/ Dental papilla
• 11-12th week in UTERO
• Enamel organ separate into four important layers:
1. Cuboidal cells outer enamel epithelium (OEE)
2. The columnar cells inner enamel epithelium (IEE).
The cells between
3. stellate reticulum form
4. stratum intermedium
Cervical loop
• Histologic slide showing a tooth bud.
A: enamel organ
B: dental papilla
C: dental follicle
WHAT ARE THE STUCTURES THE ARISES FROM:

1. Enamel organ?
2. Dental papilla?
3. Dental follicle?
1. Preameloblast
2. Odontoblast
3. Perdentine
4. Basement membrane disintegrates
5. Predentine becomes mineralized
6. Preameloblast changes to ameloblast and start forming
enamel {Amelogensis}
• 1.cerival loop
• 2. Epitheial root sheath of hertwig
• 3. Epithelia diaphragm
• Rests of malassez
Enamel:
• Hydroxyapatite crystals
• 96% by weight , matrix tyrosine rich amelogenin
protein
• Knife edge neck of tooth (cemento-enamel
junction)
• Hard/ acellular/ avascular
• Inter rod region – area surrounding each rod, here crystals have a different
orientation to those making the rods
• Rod sheath – boundary where the crystals of the rod meet those of interrod
region at sharp angles
- the x-section gives a keyhole pattern to enamel
• Enamel rods
• Striations
• Hunter-Schreger bands
• Incremental lines of Retzius
• Surface characteristics
- perikymata
- rod ends
- cracks (lamella)
• Basic structural unit of enamel
• In turn are made up of enamel crystals
• 5 million in lower laterals and 12 million in upper first
molars
• Run from DEJ to surface – wavy tortuous course, hence
length is greater than thickness of enamel
• Rods in cusps are thicker than those located in cervical
areas
• Diameter approx 4µm, Length - 9µm
• diameter at surface of enamel is double that at DEJ
Perikymata
- external manifestations striae of retzius
- transverse wave-like grooves
- run circumferentially (horizontally) around the tooth
Enamel lamelle
• Type A – poorly calcified rods
• Type B – degenerated cells
• Type C – organic matter from saliva
• Enamel Cuticle (Nasmyth membrane)

Primary enamel cuticle, also called Nasmyth's


membrane, is thin membrane of tissue also known as
reduced enamel epithelium produced by
the ameloblast, that covers the tooth once it has
erupted.
The primary enamel cuticle protects enamel from
resorption by cells of the dental sac and also secretes
desmolytic enzymes for elimination of the dental sac,
allowing fusion between reduced enamel epithelium
and oral epithelium. This process allows eruption of
the tooth without bleeding.
• Enamel Tufts
- small, branching defects that are found only at the
dentinoenamel junction (DEJ), projecting into the
enamel, and are of no clinical significance
• Enamel spindles
- linear defects
- similar to enamel lamella
- found only near the DEJ
- entrapment of odontoblasts prior to or during amelogenesis
• Formed by odontoblasts
• Odontoblasts differentiate from ectomesenchymal
cells of dental papilla
• Rate of coronal dentin formation - 4µm/day
• Primary dentine
• Secondary dentine
• Tertiary dentien
• 70 % inorganic
- mainly hydroxyapatite
• 20 % organic
- type I collagen, glycoproteins, proteoglycans, phosphoproteins,
some plasma proteins
• 10 % water
TWO TYPES: Mantle and Circumpulpal

• Mantle Dentin: outer layer of primary dentin (first


formed dentin)
- matrix less mineralized
Circumpulpal dentine: Highly mineralized, closely
packed collagen fibers
• Lines innermost portion of dentin
• Unmineralised dentin matrix
• Consists of collagen, glycoproteins and proteoglycans
• 10-47 µm thick
• Thickest in active dentinogenesis
Cary Bopiah
• Follow an S shaped course
• Less pronounced in root dentin and cervical areas
• Diameter 2.5 µm near pulp, 1.2 µm midportion and 900 µm
near DEJ
• Primary curvatures main undulations
• Secondary curvatures
• Contain a process of OBL bathed in dentinal fluid and lined by
an organic sheath lamina limitans
• Intertubular / intratubular dentine
• Increments of 5 µm /day after which orientation of
collagen fibrils change slightly
• Superimposed is a 4 day cycle of dentin formation
where collagen fibril orientation changes drastically
and can be seen in ground and decalcified section as
incremental lines of Von Ebner (20 µm apart)
• Neonatal line
• Contour line of owen
• Granular layer of Tomes
- true spaces represent sections made through looped portions
of dentinal tubules
- found only in root dentin just below the DCJ
• Odontoblastic zone
• Cell free zone
(zone of Weil) which is rich in both capillaries and nerve
networks
• Cell rich zone
fibroblasts and undifferentiated mesenchymal cells
• Pulp core
• Occur in greatest numbers
• Particularly in coronal pulp forming the cell rich zone
• Function is to form and maintain pulp matrix which consists of
collagen fibres and ground substance
• Pleuripotent
• Pool from which cells or pulp derived
• Differentiate depending upon stimulus
• Differentiate into fibroblasts or OBL’s
• Abundant in cell rich zone and core of pulp
• Decrease with age
• Macrophages, Dendritic cells, Lymphocytes
• Macrophages centrally located
• Dendritic cells peripherally located
• Capture and present the antigen to T lymphocytes
• Collagen fibres and ground substance
• Fibres: principally type I and type III in a ratio of 55:45,
Initially sparse but increase with age. Greatest concentration is
apically
• Ground substance: glycoproteins, water, glycosoaminoglycans
• This forms an extensive plexus in the cell free zone just below
the OBL cell bodies – Subodontoblastic plexus or Rachkov
• Sympathetic nerves are from the superior cervical ganglion
• Abundance of A delta fibres lesser C fibres
• A-fibers conduct rapid and sharp pain sensations and belong
to the myelinated group
• C-fibers are involved in dull aching pain and are thinner and
unmyelinated.
• The A-fibers, mainly of the A-delta type, are preferentially
located in the periphery of the pulp, where they are in close
association with the odontoblasts and extend fibers to many but
not all dentinal tubules.
• The C-fibers typically terminate in the pulp tissue proper, either
as free nerve endings or as branches around blood vessels.
MORE RESISTANT TO HYPOXIA
• At CE junction thin layer (20-50 µm)
• Thicker towards apex of root (150-200 µm)
• 30 % of teeth enamel and cementum meet at but joint
• 10 % there is a gap between enamel and cementum
• 60 % cementum overlaps enamel
• Primary / secondary cementum
• Specialised connective tissue
• Lies between tooth root covered by cementum and bone
forming socket wall
• Width 0.15 to 0.38 mm
• Thinnest around the mid-3rd of root
• Width decreases with age
• Consists of cells and an extra-cellular ground substance
• Cells : osteoblasts, osteoclasts, fibroblasts, epithelial rests of
malassez, macrophages, undifferentiated mesenchymal cells,
cementoblasts and fibroblasts
• Alveolar crestal group
• Horizontal group
• Oblique group (most numerous)
• Apical group
• Interradicular group (only seen in multi-rooted teeth)
• Five groups
- dentogingival group (most numerous)
- alveologingival group
- circular group
- dentoperiosteal group
- transseptal group
• Free nerve endings : most abundant thought to be
nociceptors or mechano ceptors
• Ruffini ending : around root apex thought to be
mechanoreceptors
• Coiled ending : mid-root of unknown function
• Encapsulated-spindle type ending: lowest frequency
found near root apices
• Formation of the tooth germ
• Calcification of the crown begin
1st molar BIRTH
Age changes
In general:
Decreased microcirrculation, decrease reproduction, decrease
tissue repair , decrease metabolic rate, increase fibrosis.
Degenration of elastic and nervous tissue. These result in reduced
function of most body systems.

Dental hard tissues: enamel becomes less permeable with age.


• A decrease in thickness of the epithelium , mucosa, and
submucosa is seen.
• Taste bud function decrease.
• With age and increase occurs in the number and size if
Fordyce’s sposts (sebacous glands), lingual varices and foliate
papillae.
• Recent evidence suggets that stimulated salivary flow rate does
not fall purely as a result of age. However, medications or
systemic disease can affect salivary output.
Periodontium:
Increase fibrosis, decreased vascularity, decreased cellularity and
deacreased cell turnover are found with increased age. Whether
gingival recession is pathological or physiological
(developmental) is still hotly debated.
Dental pulp:
Increase fibrosis and decreased vasculrity mean that the defensive
capacities of the pulp decrease with increased age, therefore
pulp capping is less likely to succed. Also increased secondry
dentine and increase pulp calcification.
• Parotid gland supply: 20-30% of resting saliva and 50% of
stimulated saliva
• Submandibular gland supplies 60-65% of resting saliva
• Sublingual gland supplies 2-4% of resting saliva
• Minor glands 10% of resting saliva
• Parotid serous { amylase}
• Sublingual mucous plycoprotein
• Primary saliva is isotonic
• Secondary saliva: Nacl reabsorption results in a hypotonic
saliva
• HCO3 : Buffering
• Antibacterial action:
1. IgA
2. Lyzozomes
3. Lactoferin
4. histatines
• Normal resting saliva: 0.1 -0.6 ml/min
• Causes of xerostomia:
1. Sjogren syndrome
2. Irradiation
• Shock:
1. Septic , hypovolemic, cardiac failure, dehydraiton, burns.
Neurogenic shock is caused by an injury to the CNS
Hypovolemic shock occurs when more than 10-15% of the blood is
lost
Septic shock occurs from the endotoxins released by the gram
negative Bactria
• Acute inflammatory response:
• 1. intial vasodilattion
• 2. tissue edema
• 3. endothelia cells retract and swell
• Eutorphili migrates in the vessels

Clinical effects:
Local: { Rednes ,heat, pain, swelling, loss of function}
Systemic: Malaise, Pyrexia, Rapid pulse
• Primary chronic inflammation:
Granulomatous inflammation { tuberculosis / sarcodiosis/ crohns
disease} autoimmune { rheumatoidarthrits}
• Secondary chronic inflammation {osteomylitis

• Cellular mediatos:: {Monocytes, macrophages}


• Macrophages can fuse and form {foregine body giant cells/
langerhans type giant cells}
• Coagulative necrosis
• Liquifactive necrosis
• Caseous necrosis
• Gangrenous necrosis
• Fat necrosis
• Firbrinoid necrosis
• Atrphy
• Hypertrophy
• Hyperplasia
• Mytaplasia
• Dysplasia
• Drop-shaped rete processes
• Basal cell hyperplasia
• Irregular epithelial stratification
• Nuclear hyperchromatism
• Increased nuclear-cytoplasmic ratio
• Increased normal and abnormal mitosis
• Enlarged nucleoli
• Individual cell keratinization
• Loss or reduction of cellular cohesion
• Cellular pleomorphism
• Loss of basal cell polarity
• Anisocytosis
• koilocytosis