The Dental hard Tissues

 The Physical Characteristics

 Chemical Properties
 The Enamel Structure
 Life Cycle of the Ameloblasts
 Amelogenesis
 Incremental lines of E
 Structures near DEJ
 Surface structures of E
 Defective Amelogenesis
 Age changes in enamel
 Clinical considerations

By:
Dr. Sabreen Sami (B.D.S., M.Sc., Ph.D.)

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 It is the only ectodermal derivative of the tooth. It is the hardest calcified tissue in the
human body, with highly mineralization. Forms a protective covering of the tooth crown
to resist the stress during mastication. Enamel dose not contains vessels and nerves, and it
is the only hard tissue which does not have collagen in its organic matrix. The enamel
presents in the fully formed crown is totally acellular, because the ameloblast degenerates
once enamel formation is completed. Therefore, all the enamel is formed before eruption.
Enamel is firmly attached to the underlying dentin at the DEJ; and meets the cementum at
the cementoenamel junction (CEJ) at the cervical area.

The Physical Characteristics

1. It is translucent, its color ranges from yellowish white to grayish white.
2. Its inorganic constituents account for 96% by weight and they are mainly calcium
phosphate in the form of hydroxyapatite crystals.
3. The enamel is brittle with low tensile strength (like ceramics).
4. Its thickness is varying, on the cusps of molars and premolars the enamel attains its
maximum thickness as an adaptation to functional demands. While it is thinning down
to almost a knife edge at the neck of the tooth.
5. The enamel was found to be thicker in the lingual surfaces of maxillary molars and in
the buccal surfaces of mandibular molars.
6. It acts as semipermeable membrane due to the presence of cracks and microscopic
spaces on the surface which allows complete or partial penetration of some fluids,
bacteria and other products of the oral cavity.

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Chemical Properties
1. Enamel consists mainly of inorganic constituents about 96% by weight, they are mainly
calcium phosphate in the form of hydroxyapatite crystals, and only a small amount of
organic substance and water (4%).
2. These apatite crystals are arranged in the form of rods, differ in size and shape from
other hard tissues of the body (dentin, cementum and bone), they are longest and
hexagonal.
3. The organic substance consists of some unique proteins of two main groups found
exclusively in the enamel the amelogenins and the nonamelogenins.

The Enamel Structure

Enamel is composed of the following:
1. Enamel rods (prisms).
2. Inter rod substance (cement).
3. Rod sheaths.

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Enamel Rods (prisms)
1. Enamel is composed of millions of enamel rods extending at right angles from the DEJ
to the surface of enamel.
2. Each rod is formed by four ameloblasts.
3. The rod’s shape like a cylinder and is made up of crystals.
4. The heads of the rods are closer to the occlusal or incisal surface, while the tail points
in the cervical direction.
5. In the transverse section E. rod appears as a rounded head and a tail, like a keyhole.
6. They have an interlocking arrangement, provides enamel with additional strength and
stability.
7. At the cervical region and near the incisal and occlusal region, the E. rods become more
twisted to increase enamel strength.
8. The enamel rod consists of segments separated by dark lines, because the enamel
matrix is formed in a rhythmic manner. These dark lines give enamel a striated
appearance.

Rod Sheaths
It is a thin layer in the boundary between rod and interrod enamel. It is less calcified
and contains more organic substance (enamel protein). It stains darker and is more acid-
resistant than the rod.
Inter-rod Substance (Cement)
Cements the rods together. The crystals making up the interrod enamel have same
composition of rod but they are arranged in different direction.

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Life Cycle of the Ameloblasts
Depending on their functions, lifespan of the ameloblasts can be divided into:
1. Presecretory stage.
2. Secretory (formative) stage.
3. Maturative stage.
4. Protective stage.
5. Desmolytic stage.

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1- Presecretory stage:
During this stage the IEE begin to differentiate into tall ameloblasts with large nuclei and
more protein synthesizing organelles (like Golgi complex and granular endoplasmic
reticulum, numerous mitochondria and secretory granules are also present). They interact
with the adjacent mesenchymal cells of dental papilla to differentiate into odontoblasts
producing dentin.

2- Secretory (formative) stage:

The ameloblasts enter their secretory stage after the first layer of dentin has been
formed. Secretory ameloblast is polarized tall columnar cell with distal extension called
Tomes’ process a very short process. The secretory granules migrate to the distal end of
the cell, into the Tomes’ process. The secretory granules are released against the newly
formed mantle dentin to form an initial layer of enamel that does not contain enamel rods
called rodless or prismless enamel.
As the initial enamel layer is formed, ameloblasts migrate away from the dentin surface
and the Tomes’ process develops a distal long portion to from the enamel rods. As the
secretory stage is ending the distal portions of Tomes' process is lost and so the last formed
layers of enamel are also rodless or prismless.

3- Maturity stage
Enamel maturation (full mineralization) occurs after most of the thickness of the enamel
matrix has been formed in the occlusal or incisal area. During maturation, A brief
transitional phase involving a reduction in height of the ameloblasts and a decrease in their
volume and organelle content occurs. Also, about 50% of the ameloblasts undergo
programmed cell death (apoptosis).
Next the principal activity of ameloblasts is the bulk removal of water and organic
material from the enamel to allow introduction of additional inorganic material. For that,
the cells alternate at their distal extremities between possessing a ruffled border which is

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responsible of mineralization by promoting the pumping of calcium ions into the maturing
enamel, or a smooth border which is responsible of active resorption of water and intact
proteins from the enamel matrix. Also, cytoplasmic vacuoles containing material
resembling enamel matrix are present.

4- Protective stages:
At this stage the ameloblasts lose their differentiation and become short cuboidal cells
which together with the remnants of the other layers of the E. organ form a multilayered
structure, namely the reduced enamel epithelium (REE). This REE remains on the surface
of fully formed enamel until the tooth erupts. It separates the enamel and protects it from
being in contact with the cells of dental sac. If this contact happens, either enamel is
resorbed resulting in pitting or dental sac cells in the contact area may differentiate into
cementoblasts and lay down cementum on enamel. Fusion of REE and the oral epithelium
form the dento-gingival junction of the future erupting tooth.

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Amelogenesis (enamel formation)
It is a complex process occurs after the deposition of the first layer of dentin, in 2 stages
which are:
1- E. matrix deposition (occur in secretory stage).
2- Maturation or complete mineralization of the E. matrix (occur in maturation stage).
1- E. matrix deposition:
It means the secretion of the E. matrix by ameloblasts. The freshly secreted E. matrix
contain 30% minerals as hydroxy apatite crystals, 70% waters and E. proteins which
include 90% amelogenine protein and 10% non-amelogenins. When the first layer of E. is
laid down, the ameloblasts will begins to retreat from DEJ towards E. surface and begins
to secrete the next layer of enamel. Enamel matrix appear as a deep staining layer in the H.
& E. staining sections.

Mineralization of the E.:

When the full thickness of E. matrix has been deposited, mineralization will be started.
This process involved additional minerals with the removal of organic materials and water
to reach 96% mineral content. These minerals make the initial E. crystals that formed in
first stage to grow wider and thicker due to the deposition of large amount of hydroxy
apatite crystals.

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 The source of minerals during maturation are from the:
1- Ameloblast itself and other cells of E. organ like stratum intermedium.
2- Capillaries from the adjacent dental follicle which are approach to the outer E. epith.
or very close to the O.E.

Incremental lines of E:

1-Cross striations: Cross striations are periodic bands that appear

along the full length of enamel rod,give the enamel rod appears like
a ladder. They appear at regular intervals that is in agreement with
the rate of enamel deposition (which is approximately 4 μ m per
day).
2-Striae of Retzius:
Striae of Retzius also represent incremental weekly
growth. In ground cross sections they appear like
concentric growth rings similar to those found in trees. In
ground longitudinal sections they appear to be dark line
extending from the DEJ to the tooth surface. Striae of
Retzius often extend from the DEJ to the outer surface of
the enamel, where they end in shallow furrows know as perikymata (or imbrication lines).

3- Neonatal line: In deciduous teeth, It is an accentuated

incremental line of Retzius as boundary between the two
portions of enamel develops partly before and partly
after birth. It appears due to the abrupt change in the
environment and nutrition of the newborn (infants).
Only deciduous teeth and 1st permanent molars possess
prenatal enamel and will have a neonatal line.

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4-Gnarled enamel: In the cusps tips of molars groups of
enamel rods twist about one another. This twisting pattern
of enamel rod makes the enamel strong and more resistant
to fracture (B).

5-Hunter-Schreger bands:Hunter-Schreger bands are an

optical phenomenon and are seen in reflected light. They can
be seen in ground longitudinal sections as dark bands
correspond to the cross-sectional enamel rods and light
bands represent the longitudinally sectioned interrod enamel

Structures near DEJ

1-Enamel spindles:
Odontoblastic processes sometimes cross the DEJ and get entrapped in the enamel matrix.
The direction of the spindles in the enamel is at right angles to the surface of the DEJ.
2-Enamel tufts:
Enamel tufts also originate from the DEJ, run a short distance in the enamel or sometimes
to one half of the E. thickness. They represent protein (enamelin) rich areas in the enamel
matrix that fail to mature.

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Surface structures of E.
1-Perikymata:Perikymata are wave-like, transverse shallow
grooves. They are most probably the external manifestation
of incremental lines of Retzius. They are continuous around
a tooth and usually lie parallel to each other and to the
cementoenamel junction.

2-E. cuticle: It is a nonmineralized dense membrane secreted by ameloblasts usually found

between the epithelium of dentogingival junction and the enamel surface. Primary enamel
cuticle covers the entire crown of the newly erupted tooth, probably soon removed by
mastication and its remnants called Nasmyth’s membrane.

3-E. Pellicle: Formed after the tooth is in the oral cavity, acquired from saliva and the oral
flora. May contain factors which hinder the attachment of bacteria to tooth surfaces.

5-Cracks: Its narrow fissure like structures seen on almost all surface. They
originate from dentinoenamel junction and run at right angles to it. They
disappear on decalcification.

7-Enamel Droplets or Enamel Pearls: The cells of the epithelial root

sheath remain adherent to the dentin surface, they may differentiate into
functioning ameloblasts and form small round islands of enamel called
enamel pearls. They may be found near or in the bifurcation or trifurcation
of the roots of permanent molars.

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Defective Amelogenesis
Infections, trauma, chemicals like fluoride (Dental Fluorosis) and metabolic changes
involving calcium or phosphorus affect ameloblasts easily. They produce decreased
thickness of enamel called enamel hypoplasia, or decreased mineralization called
enamel hypocalcification. Also, hypoplasia as well as hypocalcification may be caused
by systemic, local, or hereditary factors like in Amelogenesis imperfecta.

Age changes in enamel:

1. The most important age change in enamel is attrition or wear of occlusal surfaces and
proximal contact points as a result of mastication.
2. With advancing age, enamel becomes darker in color and its resistance to caries may
be increased.
3. Gradually, enamel becomes less permeable, the E. pores reduce in size and number as
the crystals acquire more ions and increase in size.
4. Facial and lingual surfaces lose their structures more than proximal surfaces, as on
these surfaces food rubs during mastication.
5. Water content of enamel also decreases with age.

Clinical considerations
1. Pits and fissures: during development, faulty coalescence of the lobes occurs resulting
in very deep pits and fissures, food and bacteria may get trapped, that may predispose
the tooth to dental caries.
2. Cavity preparation: During cavity preparation, the unsupported enamel should not be
left at the cavity margins because under masticatory forces they break and lead to failure
of the restoration.
3. Shade selection: Enamel appears temporarily whiter within minutes when dried and
when the tooth is isolated from the moist environment by rubber dam or absorbents.
Thus, the shade must be selected before isolation of the tooth.

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4. Fluoridation: Systemic and topical fluoride treatment causes formation of
hydroxyfluorapatite, which is more resistant to acid attacks and thus more resistant to
dental caries. If fluoride is present during amelogenesis, all the enamel crystals become
more resistant to acid dissolution. The concentration of fluoride must be carefully
controlled because of the sensitivity of secretory ameloblasts to the fluoride ion, giving
rise to discolored mottled enamel. Due to the semipermeable nature of enamel, topical
fluoride, fluoridated toothpastes and fluoridated drinking water provide a higher
concentration of fluoridation in the surface enamel of erupted teeth.

5. Remineralization: Etched enamel can be remineralized by sodium and stannous

fluoride solutions. Fluoride ion penetrates the porous etched enamel surface. In low
concentrations, fluoride stimulates remineralization.

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