EARLY TOOTH DEVELOPMENT
– There are: Three phases, overlapping each other
– Initiation: Sites of the future teeth are established → Tooth germs appear along the
invagination of oral epithelium (dental lamina)
– Morphogenesis: Determination of a shape of a tooth (by cell proliferation + cell movement)
– Histogenesis: Differentiation of cells proceeds further → Full formation of soft and hard
dental tissues
– Characterized by complex epithelial-mesenchymal tissues interactions
Initiation:
– Condensation of mesenchymal tissue and capillary networks appear under the dental
epithelium of the primitive oral cavity
* Mesenchymal cells are derived from the margins of the neural tube, migrating into jaws
– By the 6th week:
Formation of primary epithelial band ← Oral epithelium thickens + invaginates into the
mesenchyme
– By the 7th week:
Epithelial band divides, forms 2 processes:
* Vestibular lamina – buccaly located, precursor of the mouth vestibule (space between
lips/cheeks anteriorly and teeth-bearing regions posteriorly). Vestibule forms by:
Proliferation of the cells of vestibular lamina → Degeneration of central cells → Formation
of vestibular sulcus.
* Dental lamina - lingually situated, development of teeth occurs here, increases in length.
– By the 8th week:
Swellings develop on the deep surface of the dental lamina
* Dental lamina appears as an arch-shaped band, follows the line of the vestibular fold, with
each swelling being completely embedded in mesenchyme
Tooth germs:
– Classified into: Bud, Cap and Bell stages; according to differentiation of their epithelial
components (enamel organs)
– Close to late bell stage → Rapid change of tooth germs in size + shape (by cell division +
morphogenesis)
– At the late bell stage: Formation of hard tissue, crown growth – mainly by deposition of
enamel, reduction in cell division
Bud stage:
– Enamel organ: Simple, spherical-ovoid in shape epithelial
condensation; poorly differentiated; surrounded by
mesenchyme, separated from it by a basement membrane
Early cap stage:
– By the 11th week:
* Morphogenesis has
progressed, enamel
organ changes from bud-shaped to cap-shaped.
* Histodifferentiation is poor. However cells in the
central portion of the enamel organ become more
rounded, than the peripheral cells → External and
Internal Enamel Epithelia (EEE and IEE) are formed
Late cap stage:
– By the 12th week:
* Cells of the central portion of the enamel organ
become separated from the periphery, forming stellate
reticulum
* Cells of the EEE – remain cuboid, cells of the IEE –
become more columnar
– Dental papilla – part of the mesenchyme below the
IEE
– Dental follicle – part of the mesenchyme that surrounds the tooth
Early bell stage:
– By the 14th week:
* Further differentiation of the tooth germ
* IEE maps out the occlusal pattern of the crown
← Cell mitosis ends at the sites of future
cusps/incisal edges, while it continues at the areas
of future fissures + margins, increasing the height
of cusps/incisal edges by the downwards growth at
margins/fissures
* Dental lamina breaks down, enamel organ loses
connection with oral epithelium
* Histodifferenciation progresses further →
Enamel organ has 4 layers: EEE, SR (Stellate
Reticulum), SI (Stratum Intermedium), IEE.
– During this stage, any space restriction in the bone
(e.g. caused by bone resorption abnormalities) may
result in the increased folding of the IEE, changing
tooth shape as a consequence
EEE (External Enamel Epithelium):
– Outer layer of cuboid cells, limits the enamel organ
– Separated from the adjacent mesenchyme by
basement membrane
– Cells have large central nuclei, relatively law
amounts of organelles of protein synthesis
– Function: Maintains the shape of enamel organ,
exchanges the substances between the enamel organ
and the environment
– Cervical loop – situated at the growing margin of the
enamel organ, where EEE meets the IEE.
SR (Stellate Reticulum):
– Most fully developed at bell stage
– Inter-cellular spaces are filled with fluid
– High conc. of glycosaminoglycans
– Cells are star-shaped, with conspicuous nuclei +
many branching processes
– Cell organelles: Little of ER, few mitochondria, well
developed Golgi complex
– Synthesis of collagen takes place here (Type I, II, III)
– Cells contribute to the secretion of extracellular material
– Function: Protection of the tooth germ, maintenance of tooth shape
SI (Stratum Intermedium):
– Appears in bell stage
– Composition: 2 or 3 layers of flattened cells over the IEE
– Same shape of cells as in SR
– Small intercellular spaces, more alkaline phosphatase
– Function: Protein synthesis, transport of substances to and from ameloblasts
IEE (Internal Enamel Epithelium):
– Cell shape: Columnar at bell stage, become elongated, starting at the sites of initial enamel
formation (future cusp tips)
– Cells are rich in RNA
– Separated from the dental papilla by a basement membrane + cell free zone
Dental Papilla:
– Until the late bell stage – composed of closely packed mesenchymal cells, has few fibrils
– Becomes rich in glycosaminoglycans
Late bell stage:
– By the 18th week – formation of dental hard tissues
– Dentine starts to form before enamel
– Lingual down-growths of the EEE appear from
the enamel organs:
* Produce tooth germs of the permanent
successors in deciduous teeth
* Disintegrate in permanent teeth
– Dental lamina growth backwards behind the
deciduous 2nd molar
– 4th month – first permanent molar appears
– 6th month – tooth bud of second permanent molar
appears
– 4-5th year – tooth bud of third permanent molar
appears
Nerve fibers:
– Present in the presumptive dental epithelium at the earliest stage of tooth induction
– Form plexuses below dental papilla at cap stage
– As the dental follicle develops → Nerves from the plexus spread into the dental follicle
– Penetrate the dental papilla as dentinogenesis starts
– Innervation may be fully developed only after eruption
Blood supply:
– Small blood vessels reach the dental papilla at the early bell stage
– Also found in the dental follicle adjacent to EEE
– Vessels do not penetrate the stellate reticulum
Clinical considerations:
– Disturbance of the epithelial-mesenchymal interactions can markedly disturb tooth
development
– Splitting and joining tooth germs can alter the number of teeth and/or shape
– Damage to deciduous teeth has been known to cause malformation in permanent teeth, can
be:
* Altered size of a tooth, structure of a tooth, shape of a tooth and/or number of teeth
– Macrodontia = enlarged tooth
– Microdontia = tooth of a reduced size
– Common variations of shape:
* Peg-shaped maxillary lateral incisors, “double” teeth, teeth with fused roots,
Hutchinson's incisors, mulberry molars
– Anodontia – complete absence of teeth
– Ectodermal dysplasia – condition where few teeth are present
– Hypodontia – few teeth can be absent (e.g. permanent 3rd molar)
– Hyperdontia – increased number of teeth, can be:
* Supernumerary teeth (abnormal morphology)
* Supplemental teeth (normal morphology)
– Odontome – tumor-like mass of hard tissue, can be:
* Compound odontome – many small, discrete, simple, tooth-like structures (denticles), with
each structure having normal arrangement of dental tissues
* Complex odontome – mass has no tooth like structures, random arrangement of tissues
– Odontome can prevent adjacent teeth from erupting and can also cause swelling
– Other conditions include: Amelogenesis imperfecta, Dentinogenesis imperfecta, hypo-
mineralized teeth