DEVELOPMENT OF TEETH

Dr. kadija bamashmoos

 INTRODUCTION

Tooth formation occurs in the 6 th week of intrauterine life

with the formation of primary epithelial band. At about 7 th
week the primary epithelial band divides into a lingual
process called dental lamina & a buccal process called
vestibular lamina. All deciduous teeth arises from dental
lamina, later the permanent successors arise from its lingual
.extension & permanent molars from its distal extension
 VESTIBULAR LAMINA

It is Vestibular Lamina also termed as lip furrow band •

Subsequently hollows and form the oral vestibule •
between the alveolar portion of the jaws and the lips and
.cheeks
 DEVELOPMENTAL STAGES

MORPHOLOGICAL
.Dental lamina .1
.Bud stage .2
.Cap stage .3
.Early bell stage .4
.Advanced bell stage .5
.Formation of enamel and dentin matrix .6
 DENTAL LAMINA

The basal cells of oral ectoderm proliferate rapidly, •

leading to the formation of primary epithelial band
The band invades the underlying connective tissue along •
each of the horseshoe shaped future dental arches
.forming a band called tooth band or dental lamina
At about 7th week the primary epithelial band divides •
into an inner (lingual) process called Dental Lamina &
an outer ( buccal) process called Vestibular Lamina
The dental lamina serves as the primordium for the •
.ectodermal portion of the deciduous teeth
Later during the development of jaws, permanent molars •
arise directly from the distal extension of the dental
.lamina
The successors of the deciduous teeth develop from a •
lingual extension of the free end of the dental lamina
.opposite to the enamel organ of each deciduous teeth

The lingual extension of the dental lamina is named the

successional lamina & develops from the 5th month
in utero ( permanent central incisor) to the 10th
.month of age (second premolar)
Developmental disturbances
of dental lamina stage
ANODONTIA
Anodontia, also called anodontia vera, is a rare genetic •
disorder characterized by the congenital absence of all
primary or permanent teeth
It is of following types •
.Complete anodontia .1
.Partial anodontia .2
SUPERNUMERARY TEETH
Hyperdontia is the condition of having supernumerary
teeth, or teeth which appear in addition to the regular
number of teeth
 BUD STAGE / PROLIFERATION
The tooth bud develops by cell division of dental lamina on its -
labial side to form a bud shape of epithelial structure called
.enamel organ

During the bud stage, the enamel organ consists of •

peripherally located low columnar cells & centrally located
polygonal cells

The surrounding mesenchymal cells proliferate, which results •

in their condensation in two areas
The area of condensation immediately below the enamel •
organ is the dental papilla
The ectomesenchymal condensation that surrounds the •
.tooth bud & the dental papilla is the tooth sac
The enamel organ, dental papilla and dental sac together -
.constitute the tooth germ
The dental papilla as well as the dental sac are not well •
defined during the bud stage, they become more defined
.during the subsequent cap & bell stages
The cells of the dental papilla form the dentin and pulp •
while the dental sac forms cementum & periodontal
.ligament
 CAP STAGE / PROLIFERATION

As the tooth bud continues to grow, the enamel organ •

assumes a cap shape in appearance and show three
:different regions
 OUTER & INNER ENAMEL EPITHELIUM

The peripheral cells of the cap stage are cuboidal , cover •

the convexity of the cap & are called the outer enamel
epithelium
The cells in the concavity of the cap become tall •
columnar cells & represent the inner enamel epithelium
The outer enamel epithelium is separated from the dental •
sac, & the inner enamel epithelium from the dental
.papilla, by a delicate basement membrane
 STELLATE RETICULUM

Polygonal cells occupies the central portion of enamel •

.organ between the outer and the inner enamel epithelium
The dental papilla shows two main parts which are -
peripheral part and central part. The peripheral part free
from cells and called cell free zone or a cellular zone.
However, the central part of dental papilla appears rich in
.cells and called cell rich zone or cellular zone
The dental sac becomes gradually denser and more -
.fibrous layer
 DEVELOPMENTAL DISTURBANCES DURING THE CAP
STAGE

FUSION
The phenomenon of tooth fusion arises through union of -
two normally separated tooth germs, and depending
upon the stage of development of the teeth at the time of
.union, it may be either complete or incomplete
GEMINATION
Gemination arises when two teeth develop from one tooth
.bud and, as a result, the patient has an extra tooth
BELL STAGE / HISTODIFFERENTIATION

Due to continued uneven growth of the enamel organ it •

acquires a bell shape which becomes deeper and called
.as early bell stage
.once the first layer of dentine, it becomes late bell stage •
A. EARLY BELL STAGE
:Dental lamina
The dental lamina proliferate and divides to
.form deciduous and permanent teeth
Outer enamel epithelium
The cells of the outer enamel epithelium flatten to •
form low cuboidal cells
The outer enamel epithelium is thrown into folds •
which are rich in capillary network, this provides a
.source of nutrition for the enamel organ
Inner enamel epithelium
these cells show elongation toward the dental papilla •
resulting in the disappearance of the cell free zone and
causing stimulation of the undifferentiated mesenchymal
cells in the cell rich zone to differentiate into
odontoblaste to be arranged near the inner enamel
.epithelium
Stratum intermedium
A few layers of squamous cells form the stratum •
intermedium , between the inner enamel epithelium & the
stellate reticulum
These cells are closely attached by desmosomes & gap •
junctions
This layer seems to be essential to enamel maturity because •
they contain alkaline phosphate, which is essential for
..mineralization of enamel
Stellate reticulum
At this stage, the stellate reticulum expand by increase of
.intercellular fluid
Dental sac
The dental sac exhibits a circular arrangement of fibres & •
resembles a capsule around the enamel organ
The fibres of the dental sac form the periodontal ligament •
fibres that span between the root & the bone
The junction between the inner enamel epithelium & •
odontoblasts outlines the future dentino-enamel junction
 B. Late bell stage
`
:Dental lamina
By the deposition of the first layer of dentin, the dental
lamina undergoes degeneration. This degeneration may
be completely or partially where remnants of the dental
lamina may persist in the gingivae and/ or the jaw and
.they are called epithelial rests of Serres
:Enamel organ
Folding of the outer enamel epithelium to increase its -
.surface area and becomes in contact with dental sac
Under the influence of the first formed dentin layer by -
odontoblast, the inner enamel epithelium will be stimulated
to be differentiated into tall columnar cells called
ameloblasts which have the power to produce enamel
.matrix
The space needed for the developing enamel -
will be attained through the shrinkage of the
stellate reticulum by the loss of the
.intercellular fluid
Stratum intermedium shows strong reaction -
for the alkaline phosphatase enzyme. Which
.needed for the mineralization of the enamel
 Bell stage

role Cell layers

Protective barrier OEE

Room for hard tissue Stellate reticulum

Supports the production of enamel Stratum intermedium

matrix

Differentiate to ameloblast IEE

Differentiate to odontoblasts Outer cell of dental papilla

Differentiate to pulp Inner cell of dental papilla

Differentiate in to cementum,PDL, Dental sac

.and alveor bone
 DEVELOPMENTAL DISTURBANCES OF APPOSITION

Enamel hypoplasia
Enamel hypoplasia is the defect of the teeth in which the
tooth enamel is hard but thin and deficient in amount This
.is caused by defective enamel matrix formation
Amelogenesis imperfecta
Amelogenesis imperfecta presents with abnormal •
formation of the enamel or external layer of teeth.
Enamel is composed mostly of mineral, that is formed
and regulated by the proteins in it. Amelogenesis
imperfecta is due to the malfunction of the proteins in
.the enamel: ameloblastin, enamelin, tuftelin, amelogenin
Dens- In- Dente ( DENS INVAGINATUS)
Represents a defect of tooth in which a focal area on the •
tooth surface is folded or invaginated pulpally to a
variable extent
Defect in generally localized to a single tooth & •
interestingly maxillary lateral incisors are more
commonly affected
Bilateral involvement is often seen & sometimes defect •
can involve multiple teeth involving the supernumeraries
In case of pulp involvement with or without apical •
pathology, endodontic treatment should be attempted.
However in more severe form extraction should be done
DENS EVAGINATUS
Dens evaginatus is a condition found in teeth where the •
.outer surface appears to form an extra bump or cusp

Premolars are more likely to be affected than any other •

tooth. This may be seen more frequently in Asians

The pulp of the tooth may extend into the dens •
.evaginatus
There is a risk of the dens evaginatus chipping off in •
normal function
Hence this condition requires monitoring as the tooth can •
lose its blood and nerve supply as a result and may need
.root canal treatment
TALON CUSP
A talon cusp, also known as an "eagle's talon", is an extra •
.cusp on an anterior tooth
Of all cases, 55% occur on the permanent maxillary lateral •
incisor, and 33% occur on the permanent maxillary central
incisor. They are found rarely in primary teeth
Whenever the lingual pits are present restorative treatments •
should be done to prevent caries
When talon cusp interferes with normal occlusion •
preventive care should be taken by performing endodontic
treatment
 ROOT FORMATION

:formation Hertwig’s root sheats -1

When the enamel and dentine formation have reached the
future cementoenamel junction the IEE and OEE at the
cervical loop of the enamle organ begin to proliferate to
.form HRS
formation of epithelial diaphragm -2
At first the epithelial root sheath bends at the future CEJ
into horizontal plane forming epithelial diaphragm which
.narrows the wide cervical opening of the tooth germ
proliferation of cells -3
Proliferation of cells of the epithelial diaphragm is
accompanied by proliferation of cells of UMC of the
.papilla which occurs in the area adjacent to diaphragm
formation of radicular dentin -4
The cells of IEE epithelium of the HRS induce UMCs of
dental papilla to differentiate into odontoblast. So the
function of the root sheath is to mold the shape of the
.root and initiate dentin formation
formation of cementum -5
After dentin deposition the C.T of the dental sac invades the
HRS breaking it into a network of epithelium strands.
These strands are moved a way so that the C.T cells of
dental sac come in contact with the outer surface of
dentine. These UMCs of CT differentiate into
cementoblasts witch deposits cementum on dentine
.surface
.Discontinuity of HRS -6
Narrowing of apical foramen -7
The apical foramen is reduced to the width diaphragmatic
opening and later it is further narrowed by appossition of
.dentin and cementum at the apex of the root
epithelial rests of malassez -8
The epithelial strands may undergo degeneration .
Remnants may presist in the PDL in the form of
.network or isolated islands called ERM
Developmental disturbances
during root formation
 DILACERATION
Dilaceration refers to an angulation or a sharp bend or •
curve anywhere along the root portion of a tooth
Condition probably occurs subsequent to trauma or any •
other defect of development which alters the angulation
of the tooth germ during root formation
Can easily be detected by radiographs •
Care should be taken during extraction since these teeth •
are more prone to fracture
 CONCRESCENCE

Concrescence is a condition of teeth where the cementum

.overlying the roots of at least two teeth join together
The cause can sometimes be attributed to trauma or
crowding of teeth. Radiographic diagnosis is mandatory
before attempting tooth extraction