‫باسم الله الرحمن الرحيم‬

Last time we started a new topic which is Development of the tooth & its
supporting structures; we will continue this lecture and start a new topic.

The hall was going to be occupied by the faculty of science so the Dr. told us that
he was going to release us early “yotleq sara7na”…

We said that we have different stages of tooth development, the first stage is
the Bud stage when we see the tooth as a spherical invagination at this stage we
cannot identify anything related to the enamel organ or any structure.

After the bell stage we have the Cap stage like in slide #10 and invagination in
the oral Epithelium into the mesenchymal tissue,

It has actually developed a concavity there that is why it is called Cap stage, and
this tissue that invagenates and goes down from the dental lamina into the
mesenchymal tissue we call it Enamel organ, and it will lead to the formation of
Enamel.

As they find it is very important in the formation of dentine but it will not form
dentine! It is there to send the signal that is responsible for the formation of
dentine <so it has nothing to do with the actual formation of dentine, it has
something to do with the actual formation of Enamel; that is why it is called
Enamel Organ>.

Enamel Organ: is an epithelial structure that arises from the dental lamina, finally
it will give the enamel of the tooth.
Slide (10) so the whole structure is called enamel organ it has a concavity that
looks like a cap so it is called Cap stage of enamel organ, at this stage we can
identify different groups of cells, we can identify the border line/ or the
Peripheral cells and the core , -like the outer cells and the inside cells-.

So there are:

 Central portion & Peripheral cells.

The peripheral cells are divided into: External enamel epithelium EEE; outside &
Internal enamel epithelium IEE; and the IEE are very important, because they
will finally differentiate to become the ameloblasts and secrete enamel! (Ya3ne el
cells el mawjoden fe manteqet el concavity).
Later on what happens? … This concavity deepens; starts to become deep, until
the tooth looks like a bell that’s why it is called the Bell stage, as u can c slide
#17 the enamel organ has now the shape of a Bell! And this is actually what
converts the shape is actually the division and proliferation of the cells, these
cells that are called IEE they start to divide, and to orientate themselves
(bewajho anfes-hom) to give the 3D shape of the crown, (lazm yetnazamo b
tareqah monasebeh jedan 7ata yekon shakel tholathi el ab3ad lal crown), by this
way they establish the three dimensional shape of the crown!

So this is called morphodifferentiation or morphogenesis; because it involves

processes that will give out the shape /morpho of the tooth.

And we called the IEE that will make those cells capable of producing enamel is
called histogenesis; because it will lead to the formation of hard tissue -- all the
time when we have a question in the exam about those two points students don’t
understand them! -- So we have to understand what is said not just memorize the
written words --

The process of differential growth /differential cell division that leads to the
establishment of the three dimensional shape of the crown is called
morphogenesis, but the internal process that takes place inside the cells to make
those cells capable of producing enamel is called histogenesis /or
histodifferentiation.

Notice in the picture that we have the two cusps!

Let’s give an example let’s say that this tooth that is going to form is a premolar
because it has two cusps, in case of an incisor we will have an incisor edge, in case
of the canine we will have one cusp and so on.

So the shape of the enamel organ in the bell stage is related to the shape of the
crown, so when we talk about morals it will be different from canine different
from premolars different from incisors and so on!

What happens in the early bell stage? We have Differential cell division along
IEE, those cells “IEE” in the cap stage they start to divide but not in a haphazard
way (3ashwa2eyah), they divide in a very organized way to give the structure
/shape of the crown.

It is called differential because division is not the same at all of the places in the
IEE cells! (B ma3na a5ar sor3et el inqisam ma betkoon nafs-ha) the rate of
division is not the same, so it is differential at certain area we will have a very
fast division at another area we have slow division; because we want to build the
three dimensional shape, if the speed of differentiation was the same what are
teeth would look like? (law kanat sor3et el inqisam motasaweyeh b hal amaken
kolha sho shakel asnana betla3?) … It will look spherical (koraweyeh), but they are
not and that is why this division is not equal it is differential.

<<Differential is a term used in mechanics in fact when someone turns his wheels
as a curve the speed and the movement should be differential &_& which
distributes the speed on the wheels>>.

So if the rate of differentiation is equal among all of the cells our teeth will look
spherical, and they are not that is why this division is not equal it is differential.

Some fish has spherical teeth!

 Cessation of cell division

 At future cups & incisal edges

Cessation means stop (tawaquf), which means in some stages of cell division we will
have some stopping! Where do we have this? At future cusp tips and incisal edge,
look at slide 17 … as u can c this has already established the shape of the cusp so
we don’t want any more divisions, if it continues it will become big, so when we
have cells at the sides dividing we will have at the cusp tip stops!

Active cell division will be: At fissure sites & margins, in the developmental
grooves it continues.

Dental lamina is not needed now … once the enamel organ has established the
three dimensional shape of the crown we don’t want Dental lamina … that is why it
will disappear … we will see it breakdown.

Losing connection with oral epithelium and also loosing connection with the enamel
organ, dental lamina between tooth germs is lost, if we had a tooth and a another
one beside it dental lamina will be lost between them, remnants of dental lamina
may sometimes remain and sometimes may be reactivated we call them Epithelial
Rests of Serres, sometimes they remain in the area but in-active, and sometimes
due to infections or trauma they may get activated, in this case they will join and
start dividing and they will give cysts (akyas fe al fak), next year we will learn this
maybe in-sha2-Allah we will take it in oral pathology! Let’s hope that someone of
us will remember this info’.

We talked about morphology… now at the same time the cells undergo
Histodifferentiation, which leads to the appearance of 4 distinct layers (el 5layah
ele canat very simple epithelial cells balashat tetmayaz w balashat te5talef 3n
ba3ad be7ayth a3tatne b el nehayeh arba3 anwa3 mo5talefeh mn el 5alayah).

Now the EEE cells these are Cuboidal cells… the Stellate reticulum cells these
are located inside enamel organ star shaped cells, we have Stratum intermedium
SI cells these cells support, the IEE cells, finally we have the IEE cells, in
addition to the cells we have the surroundings of the crown, so we start seeing:
Dental papilla and Dental pulp.

As u can c in slide 17:

We have 4 types of cells which are the EEE cells … the cells that are found in the
concavity are the IEE cells … the cells in the middle these are the SR cells … and
we have a group of cells that are directly under lining IEE cells which we call the
SI cells …

Let’s now see the function of each of these cells:

What are the functions of EEE cells?! Maintaining the shape of the enamel organ,
this is very important in the soft tissue stage … because any trauma would
destroy the crown 3D shape if the EEE cells won’t maintain it … and also it has the
function to Exchange of substances between enamel organ and dental follicle …
enamel organ is Avascular (has no vessels), so we have to exchange nutrients to
feed these cells.

*So EEE cells function is to: Maintain the shape of the enamel organ

& Exchange substances between enamel organ and dental follicle.

The EEE cells and the IEE cells when they meet at the margins “below” at the
cervix of the tooth we call them “Cervical Loop”, at this cervical loop we have
increased cell division <because the tooth is still growing very fast in this area>.

The other group of cells SR these are fully developed at this stage, they are star
shaped cells (zai shakel el najmat), they have extensions which are connected
(mutada5leh b ba3dha) and the function of these cells is: protection of underling
tissue against physical disturbance, (hai el 5layah fe benha epitheliam madeh
btemtas el sadamat) it has some elasticity, if the enamel organ has a trauma or
any kind of shock this will absorb the shock, because we don’t want the 3D shape
of the tooth to be affected, so they protect it by having a cushion like material
between the cells it absorbs traumas and shock all the time, as a result of
protection they maintain the tooth’s shape, the hydrostatic pressure ((helps to
pass the nutrients to the IEE cells)) … its hydrostatic pressure is in equilibrium
with that of the dental papilla allowing the proliferation of IEE to determine
crown morphogenesis … inside this area of the SR we have hydrostatic pressure
it has 100% has to be the same as the hydrostatic pressure of the dental papilla
otherwise the tooth will have different shape (ra7 ye5talef shakel el tooth), let’s
assume that the HP in the dental papilla is bigger than the HP in the SR space the
tooth will become more spherical, because all of the cells are going to be pushed
outside, and trans versa there will be shrinkage, and the tooth will become smaller
… all the time remember that we have a state of equilibrium between the dental
.papilla and the SR cells space

The 3rd group of cells is called Stratum intermedium SI cells these cells are
located underling IEE cells, and they are 2-3 layers of flattened cells over IEE,
and they may be concerned with protein synthesis, transport of materials to and
from IEE cells and concentration of cells, so it has a direct relation in supporting
the active IEE cells it pass the nutrients and it has something to do with the
.protein synthesis it helps, so these cells are very important

Finally the most important cells are the IEE cells these are columnar cells
.(toleyeh) that become elongated starting from the cusp tips and incisal edges
Those IEE cells are connected to each other very tightly through attachment
that is called Desmosome, which is one of the surface cell attachments, and they
.connect them with stratum intermedium cells

We have basement membrane all the time between the IEE cells and the dental
papilla cells, so this basement membrane is very important in separating the
!enamel organ from the surrounding ectomesenchyme

Let’s ask a very important Q … why are those cells (IEE) elongated at the cusp
tips but they are cuboidal here? It’s because the process of differentiation
.starts at the cusps tips

Come back after one month and we will find that all of these cells are columnar,
but till now this means that the cells that are ready to form enamel are only at
the cusps tips, so this means that enamel is first formed at cusp tips, in other
words the last enamel that has formed is at the cervical part and the first enamel
.that has formed is at the junction between enamel and dentine

.Dental papilla is still less differentiated than enamel organ

A question about vascular component I guess (not heard)! The answer: is that we
are interested in providing nutrients to the cells in differentiation and they don’t
get fluids (sara7ah el Dr. En3ajag w batalt a3rf afham sho be7ke bs it’s a good
(!question

Dental papilla all the time is behind, and its differentiation is less, notice that we
have blood vessels in Dental papilla and blood vessels in the area of tooth germ,
but we don’t have blood vessels in the enamel organ … and the nutrition of the IEE
(the answer of the Q) can be provided in 2 ways either from the SR cells or
…through blood vessels in the Dental papilla

(= Slide #15 is a very good view of the cells

The late bell stage is an appositional stage … it is a stage when we can see hard
.tissue formation, at the last step of tooth formation hard tissue starts to form

.What hard tissue do we have here in the crown? We have the Enamel & Dentine

Dentine formation all the time precedes enamel formation, although the
!differentiation of enamel organ is all the time ahead of dental papilla

Appearance of a lingual down growth of EEE … this structure the down growth
(emtedad) of EEE is very important in deciduous teeth this structure is very
important because it will give the successor lamina, we have dental lamina that will
give the primary tooth, but the lingual extension of the EEE will give the
successor tooth … if any tooth doesn’t have this lingual extension we are sure then
that this tooth is not going to have a permanent tooth there will be only a
.deciduous tooth

In case that one of the teeth is missing … the permanent tooth for it is going to
be missing too … so some Moms come to the clinic and their child didn’t have a
deciduous tooth and they ask if he will have permanent one … the answer is that
)= he won’t

So loosing the deciduous tooth will lead to the loss of this lingual extension and so
.no permanent tooth later on

Appearance of a lingual down growth of EEE

In deciduous tooth germs successor lamina gives rise to tooth germs of

permanent successor teeth.

In permanent tooth germs, we will also have this but we will have it as transient
structure that disappears eventually.

Non successor teeth will also have such as extension but it has no function, it is
transient (ya3ne 3ebarah 3n structure mo2aqat)

>> All teeth have lingual extensions but they are only active for deciduous teeth >>

Let’s think about 1st, 2nd, and 3rd morals their lamina? Those teeth take their
lamina from the tooth that is in front of it immediately … what is the tooth that
is in front of the 1st permanent molar? Its 2nd deciduous molar … so 2nd deciduous
.molar in addition to having lingual extension it also has a distal extension

.Lingual extension gives 2nd premolar and the distal extension gives the 1st molar

 Behind second deciduous molars dental lamina grows backwards to bud

off permanent molars successively.

Successively means at the same time, in other words we have a distal extension
behind the deciduous 2nd molar for the 1st permanent molar we also have a distal
extension behind the 1st molar for the 2nd molar, and the 2nd molar will have distal
for the 3rd molar, But the 3rd molar doesn’t have a distal extension.
Also in the late bell stage we have an interaction between structures raised from
ectoderm and structures raised from mesoderm, we said that for the tooth to
form there should be some interaction between enamel organ and surrounding
ectomesenchymal tissue, long time ago they made experiences they had an enamel
organ and took it away from the mesenchymal tissue they put it in a tissue culture
 no tooth formation, and then they had an ectomesenchymal tissue and put it
alone in a tissue culture and  no tooth formation.

That means that there is an interactive interaction both of them should be

together so the tooth would be formed, this interaction is important, this
interaction is said to be Reciprocal (tbadoli) …

(zai lama te7ke l sa7bak 3’asheshne b 3’asheshak bte3tamdo 3ala ba3ad)

*Dentine & enamel formation commences at:

-Cusp tips

-Incisal edges

All the time Dentine & enamel forms at the Cusp tips and incisal edges firstly and
then they continue all over the tissue.

*Developing ameloblasts (Preameloblasts), we said that the IEE cells they will
become columnar and they will be called ameloblasts, but before that it is Pre
Ameloblasts it is a very mature IEE cells, and they induce adjacent mesenchymal
cells to become columnar and differentiate into odontoblast and they lay down
predentine & dentine, this is the 1st dentine to be produced before calcification,
and this dentine induces ameloblasts to secrete enamel.

*mesenchymal cells  columnar  differentiate into odontoblast  secrete

predentine & dentine  mature ameloblasts  secrete enamel.

So cells that form dentine go (back) inside and cells that form enamel go outside.
A pic that we don’t have! >> 1st part of dentine the first layer is the one at the
cusp tip this is followed by enamel then I have dentine then enamel…. And so on

So the cells that form enamel they go outward, but cells that form dentine they
go inward, they are close but going apart (bekono 7ad ba3ad bs bebta3do 3n
ba3ad).

The full formation of the cusp doesn’t mean that the enamel has stopped; there
will be enamel formation at the sides!

All the time the last enamel to be formed is the enamel beside the cervical line.

Q: What is the last dentine that is formed?

A: the one nearest to the pulp.

Q: What is the last hard tissue to be formed?!

A: It will be the dentine.

V.I.I: enamel formation is an ending process it has a start and an end, and once
the last layer is formed the cells that are responsible for the formation of enamel
will disappear… but dentine formation is not an ending process, it is continuous
process, this process of dentine formation only stops when the pulp is removed (if
u remove the tooth or remove the pulp).

So the last layer of hard tissue to be formed is dentine and the first one is
dentine as well =)

A question not heard as well as the answer!

Another Q: why when we remove the pulp dentine formation stops?!

Because when we remove the pulp we also remove the cells that form dentine …

Now we have some Transient structures that may develop, like: Enamel knot,
Enamel cord, and Enamel niche.
Enamel knot: sometimes we see a localized mass of cells in the center of IEE
cells; they bulge into dental papilla, they are Non-proliferative cells, they produce
signaling molecules, disappear & contribute cells to enamel cord … like in slide 20
(3oqdeh bekoon fe)

Sometime these masses of cells extend from SI into SR forming the Enamel
cord, it has no specific function, and they may be involved in mechanical
transformation of cap stage into bell stage.

And they are termed enamel septum if it reached the EEE cells, when an enamel
septum proliferation meets the EEE it might make what is called Enamel navel …
A small invagination at junction with EEE

*Enamel niche

Area enclosed by the double attachment of enamel organ to dental lamina …

those structures will finally disappear.
* Nerves and Blood Vessels:

As we know nerve supply starts as a plexus under dental papilla during cap stage …
nerves spread & penetrate dental papilla with onset of dentinogenesis… when
dentine formation process start dentinogenesis nerves start to penetrate the
dental papilla.

Blood vessels invade dental papilla at early bell stage … we need blood supply to
have nutrients for the active cells.

Blood vessels are evident in dental follicle in close association with EEE which
they never penetrate… important thing that “no penetration“

Because it is very important to preserve the 3D structure of the tooth before

hard tissue formation … after that it is more stabile and there will np … “zai el
sabbeh b el saqif w el 5shabat ta3oon el sqaleh! B3d ma tenshaf awal tabaqet
isment fena ensheel el 5ashab w ne3tamad 3ala el esment el hard“ so bld vessels
after that won’t affect the integrity of the cells.

We are late in this course and the Dr. hopes that we catch up … “or
mayoneez :P :P"

4give me 4 any mistake …

I am very very sorry for being late but it’s not my mistake …

Good luck to all w in-sha2-Allah good marks lal kol bel exam

W…

‫سسسسس سسسس سسسس سسسسسس سس‬

Ur sister: Nada Nammas