NEET MDS Lessons
Dental Anatomy
The very first histological evidence of tooth development appear during the second month of intrauterine life. Calcification of deciduous incisors begins at 3-4 months in utero.
ERUPTION
. Root completion (approximately 50% of the root is formed when eruption begins)
Generally mandibular teeth erupt before maxillary teeth,
Primary teeth
I. Emerge into the oral cavity as follows:
Maxillary Mandibular
Central Incisor 7½ months 6 months
Lateral incisor 9 months 7 months
Canine 18 months 16 months
First Molar 14 months 12 months
Second Molar 24months 20 months
The sequence of primary tooth development is central incisor, lateral incisor, first molar, second molar
3. Hard tissue formation begins between 4 and 6 months in utero
4. Crowns completed between 1½ and 10 months of age
5. Roots are completed between I½ and3 yearsof age 6 to 18 months after eruption
6. By age 3 years all of the primary and permanent teeth (except for the third molars) are in some stage of development
7. Root resorption of primary teeth is triggered by the pressure exerted by the developing permanent tooth; it is followed by primary tooth exfoliation in sequential patterns
8. The primary dentition ends when the first permanent tooth erupts
The pre-dentition period.
-This is from birth to six months.
-At this stage, there are no teeth. Clinically, the infant is edentulous
-Both jaws undergo rapid growth; the growth is in three planes of space: downward, forward, and laterally (to the side). Forward growth for the mandible is greater.
-The maxillary and mandibular alveolar processes are not well developed at birth.
-occasionally, there is a neonatal tooth present at birth. It is a supernumerary and is often lost soon after birth.
-At birth, bulges in the developing alveoli precede eruption of the deciduous teeth. At birth, the molar pads can touch.
Dentin
Composition: 70% inorganic, 20% organic, 10% water by weight and 45%, 33%, and 22% in volume respectively
Hydroxyapatite crystals and collagen type I
Physical characteristics: Harder than bone and softer than enamel
Yellow in color in normal teeth
Radiographic appearance: More radiolucent than enamel
Primary (circumpulpal) dentin: forms most of the tooth
Mantle dentin: first dentin to form; forms the outline of dentin in the adult tooth
Predentin: lines the innermost portion of dentin (faces the pulp)
Secondary dentin: after root formation dentin continues to form, continuous to primary dentin but with structural irregularities
Tertiary dentin: reactive or reparative dentin; may or may not have characteristics of primary dentin; produced in the area of an external stimulus; osteodentin
Dentin is formed by cells called odontoblasts.
These cells derive from the ectomesenchyme and produce the organic matrix that will calcify and become the dentin.
Formation of dentin initiates formation of enamel.
The formation of dentin starts during late bell-stage in the area of the future cusp.
First coronal dentin and then root dentin.
Completion of dentin does not occur until about 18 months after eruption of primary and 2-3 years after eruption of permanent teeth.
The rate of dentin development varies.
The role of the internal (inner) dental (enamel) epithelium
Cuboidal - Columnar (reverse polarization)
Ectomesenchymal cells of the dental papilla become preodontoblasts - odontoblasts
Acellular zone disappears
Histologic features of dentin
Odontoblasts
Dentinal tubules
Extend through the entire thickness of dentin
S-shaped (primary curvatures) path in the crown, less S-shaped in the root, almost straight in the cervical aspect
Secondary curvatures
Tubular microbranches
Presence of fluid
Intratubular dentin
Dentin in the tubule that is hypermineralized
The term peritubular dentin should not be used
Sclerotic dentin
Dentinal tubules that are occluded with calcified material
Most likely a physiologic response
Reduction of permeability of dentin
Intertubular dentin
Dentin between the tubules
Interglobular dentin
Areas of unmineralized or hypomineralized dentin
The defect affects mineralization and not the architecture of dentin
Incremental lines
Lines of von Ebner: lines associated with 5-day rythmic pattern of dentin deposition
Contour lines of Owen: Originally described by Owen they result from a coincidence of the secondary curvatures between neighboring dentinal tubules.
Granular Layer of Tomes
Seen only in ground sections in the root area covered by cementum
Originally, they were thought to be areas of hypomineralization
They are true spaces obtained by sections going through the looped terminal portions dentinal tubules
DE junction :Scalloped area
Enamel tissue with incremental lines of Retzius and dentin tissue with parallel, curved dentinal tubules are in contact at the irregular dentino-enamel junction. The junction often has a scalloped-shaped morphology
DC junction Dentin Cemental Junction
Enamel
Structural characteristics and microscopic features
a. Enamel rods or prisms
(1) Basic structural unit of enamel.
(2) Consists of tightly packed hydroxyapatite crystals. Hydroxyapatite crystals in enamel are four times larger and more tightly packed than hydroxyapatite found in other calcified
tissues (i.e., it is harder than bone).
(3) Each rod extends the entire thickness of enamel and is perpendicular to the dentinoenamel junction (DEJ).
b. Aprismatic enamel
(1) The thin outer layer of enamel found on the surface of newly erupted teeth.
(2) Consists of enamel crystals that are aligned perpendicular to the surface.
(3) It is aprismatic (i.e., prismless) and is more mineralized than the enamel beneath it.
(4) It results from the absence of Tomes processes on the ameloblasts during the final stages of enamel deposition.
c. Lines of Retzius (enamel striae)
(1) Microscopic features
(a) In longitudinal sections, they are observed as brown lines that extend from the DEJ to the
tooth surface.
(b) In transverse sections, they appear as dark, concentric rings similar to growth rings in a tree.
(2) The lines appear weekly during the formation of enamel.
(3) Although the cause of striae formation is unknown, the lines may represent appositional or incremental growth of enamel. They may also result from metabolic disturbances of ameloblasts.
(4) Neonatal line
(a) An accentuated, dark line of Retzius that results from the effect of physiological changes
on ameloblasts at birth.
(b) Found in all primary teeth and some cusps of permanent first molars.
d. Perikymata
(1) Lines of Retzius terminate on the tooth surface in shallow grooves known a perikymata.
(2) These grooves are usually lost through wear but may be observed on the surfaces of developing teeth or nonmasticatory surfaces of formed teeth.
e. Hunter-Schreger bands
(1) Enamel rods run in different directions. In longitudinal sections, these changes in direction result in a banding pattern known as HunterSchreger bands.
(2) These bands represent an optical phenomenon of enamel and consist of a series of alternating dark and light lines when the section is viewed with reflected or polarized
light.
f. Enamel tufts
(1) Consist of hypomineralized groups of enamel rods.
(2) They are observed as short, dark projections found near or at the DEJ.
(3) They have no known clinical significance.
g. Enamel lamellae
(1) Small, sheet-like cracks found on the surface of enamel that extend its entire thickness.
(2) Consist of hypocalcified enamel.
(3) The open crack may be filled with organic material from leftover enamel organ components, connective tissues of the developing tooth, or debris from the oral cavity.
(4) Both enamel tufts and lamellae may be likened to geological faults in mature enamel.
h. Enamel spindle
(1) Remnants of odontoblastic processes that become trapped after crossing the DEJ during the differentiation of ameloblasts.
(2) Spindles are more pronounced beneath the cusps or incisal edges of teeth (i.e., areas where occlusal stresses are the greatest).
Types of dentitions:
1. Diphyodont. Teeth develop and erupt into their jaws in two generations of teeth. The term literally means two generations of teeth.
2. Monophyodont. a single generation of teeth.
3. Polyphyodont. Teeth develop a lifetime of generations of successional teeth
4. Homodont. all of the teeth in the jaw are alike. They differ from each other only in size.
5. Heterodont. There is distinctive classes of teeth that are regionally specialized.
Permanent teeth
1. The permanent teeth begin formation between birth and 3 years of age (except for the third molars)
2. The crowns of permanent teeth are completed between 4 and 8 years of age, at approximately one- half the age of eruption
The sequence for permanent development
Maxillary
First molar → Central incisor → Lateral incisor → First premotar → Second pmmolar → Canine → Second molar → Third molar
Mandibular
First molar → Central incisor → Lateral incisor → Canine → First premolar → Second premolar → Second molar → Third molar
Permanent teeth emerge into the oral cavity as
Maxillary Mandibular
Central incisor 7-8 years 6-7 years
Lateral incisor 8-9 years 7-8 years
Canine 11-12 years 9-10 years
First premolar 10-Il years 10-12 years
Second premolar 10-12 years 11-12 years
First molar 6-7 years 6-7 years
Second molar 12-13 years 11-13 years
Third molar 17-21 years 17-21 years
The roots of the permanent teeth are completed between 10 and 16 years of age, 2 to 3 years after eruption