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Oral Development

and Histology
James I<. Avery
Third edition

~Thieme ,

Oral Development
and Histology
Third edition

James K. Avery. D.D.S., Ph.D.

~ ~o.ntisuy..-l.<r.Ntomy

SChool 01D<roslry and MediuI SChool

l..Ir'oMnlly of ~
Ann Arbo<. Midl ~ USA


P.....line f. Steele. 8.S., R.O-H., 8.S. (Educ.). M.A.

Prof<o<_ EmeriI:'" ~nd DirKtorof OenUlli)'\liene
SChoolof Dentktry
Un~ity ofMi<:hi9,m

'",," Arbor. Michigan. USA

Awx"'te Editor
Nancy Avery, B.F.A.

Ann A,b()r. Michigan, USA

850 .....I'al;oo ' , p<irtly ill color

III "t~M
St urt qart - New York

Libmry of CmlUCss (o tologing-in-Publim r;on Dara

0 '.11developme nt and histology I e d ito',J~mes K. Avery: asso d ate edito t, Pauline E Steele- 3rd ed,
p.: cm.
Includes bibliograp hical refere nces ~ n d index.
ISBN 3131001933
ISBN 1-S889O028-2 (TNY)
1. MOUl hAn~tomy. 2. Teeth-Anatomy, 3. Mout h-H isto logy.
4 , Teeth --Histology. 5. Embryology, Humdn. I. Avery. James K.
II. Steele, Pauline F.
[DNLM: L Stoma tognath ic System--a natomy & hislology. 2.
Stom .togn~thic System--g rowth & development. WU 101 063
200 11
RK280 ,0683 200 1
6 11'.31 --d(2 1
200 1027523


Im po rt ant Note: Medicine is In eve rchJ nging science undergoing continua l de velo plMnl. Research and clinic,' 1 expe ri_
ence are cont inually ex panding our knowiedge. in Pi' r t i c u l ~ r
our know ledge of proper \fea tment " nd d rug: thcr"py. Imofar
as this book ment ion' any dosage or a p p li c~ t i o n , re~de r< may
rest "ssured that the aut hors, editors, and publishers h~ ve
mJde every effort to ensure that such refercnces are in accordance with the , tate ofknowledge J tthe time of produetion of
th e book.
Nevert heless. this docs not involve, imply, or express any gUJ r~n tee or respoll-'ibility on tbe pdrt of the pu lJlishcrs in respect
to any instru Ction<and form' of applicatio n stated in
the book. Every user is requested to ex,1mine carefUlly th e
m~nuf~cture r's leaflets "crom panying cach d rug and to check,
If nece" . ry in consul t~ tion with" physician or spcdaii't,
whet her the do, "b'" schedu les ment ioned therein or th e con\f.lind ications stated by thc manufacturers differ from the
't~teme ntS mJ de in the pre., ent book. Such exam ination is
particularly importan t with d rug' that are eit her r"rely used
or have been newly rele. sed on th e m. rket. Evel'y d os~ ge
sched ule o r every form of application lIsed is en tire ly at the
user's own risk ~nd re-'poll-'lbility. The aut hors and pllblishe"
requ~st every user to report to the pu bli<hers any discrepa n( ies or inaccuracies noticed,

2n d edition pu blishe<1 1994 by Thieme Medical Publishers,

Inc.. 333 Sevent h Avenue, New York, NY 10001

Any re fer ence to or ment ion of ma nufacturers or specific

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Som~ of the product n" mes, patent ' . and regi st~re d designs
referre d to in this book ~re in fact registered trad em arks or
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is not ~ lwJYs m~de in the text. There fore, th~ a ppear~nce of ~
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p" I)lic do ma in.
This book, Includ ing ~11 pdrt.' thereof. is legaliy protected by
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Typesetti ng and repwd u(tlons by Men hir Produ zione,

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12 3 4 5


mlI~ [he Sltdent of d~[i$by to

lel, n the un6cJlying cI,nic. llrealmenl of [he
pat ient Oral Slructu",s . re d.""riOed in microscopic de tail in
Ihis book. A' in the p,o<t editions the book is dividl'<! into six
>tioos. The first secti oo desaibes ~lopmenUI details of
Ihe heood md nKk md how \htsle WUCfurn ",late 10 the body
;os a whole. Akodnaibtod is tM ",lariombip of celli to ~ ~ up otJolIIS., .nd how org.>rtS ~ to tbe
IOUI bring. The develOl'UlS body is to!low<;d posma..11y
through posl. do le>.<""",. The second SKIion dnaibe< [he
de""loping crown, and roots of tile t_ h . nd 1M tilSue, sur_
roUnd ing . nd , uppo rting them , Tooth eruptio n and , hedding
is .1<0 Included In rhi. secncn The third se<;tion is i descri ption of rile <UuClU",.nd funct ioo of tM Ittth in thnr ma tu re
form .IS _11 .IS comparison of the pnmary .and pe1"ITW>f1lI
drtItklons. The I'ourm >tion do'Kribes the oupp<:lftllll tissut<
of [he rem. inc1uding rile lingiw .nd dte pO!'riodonlium.
which ~ of the cementum.1WQI.o. bone. nd periodon I Iig.lmen. Tbese " ""lures. Ind udil!ll tlleir innerv.tKrn. re
fully des cribed. The fLfth section descr ibes th e gland, of the
or.1 eily . nd 'l\eir produc t<. The s.ixt h .nd 1i ",,1 """tion

The lim of tIlis IUt is 10

<lescribe< llIe ptrior.1 [issur$. sud!;os tbe bil.ter.ol ..... l.inus-

es . 00 the temporomand,bul.r joi nl S, Also consideted in Ihis

section .... tooth movement. tooth implant. lion. a<\d he.ling
of or. l tissue s. In comPJ.ri",n wi th tile pa.1 edilion. we beliew
this Ofi<Iniuotional p;lttem is more ",Ie nt to tile teodling of
This _ l'<Iition is updored.nd""l>'nded. l:>", l'orth _
information gained since pmduction of the IN l'<Iotion. we
JIM, included ~ "CIin>cil ApJJIiations" to better relate
basic . nd c1illicalloformatioo. The "''' I contains.
nwnbe, of illustr atiOn! that enh. nce understanding of the wri lten
descript ions. In this edition color h.s been added to furt lle,
cI.rify tile hislO!oPc phoromkrogr. ph' ,nd Ihe di. g ms. This
sho uld .o:sisl in .,uning infolll'WOOn .aboul lhe struoute 01
complex tissues. A JlOSQlY is...,;n iDdudM to assist in defining l.MnS l!I.>t ""y be unWniliar '" tbe stu<Iml. All ollhr
. ",hon wish to fllllf= their hoP<' ttuI the ma ~ 1:s pmo1lt_
ed .~ ~ar . nd PIe.... wnd . ny questions
Ih n.. to me o r to the . uthors di""tly.




Acknowl edgements

The first ed ition of l his text was developed with th e alst.nce

of a group of student s of the oral histology cu ss at lbe
University of Michig.n School of Dent istry. Dr. Donald
Stracha n. one of l he instructors of lhe cou rse. had encouraged
developm ent of a series of slide-tape sequences to stim ulate
interest in th e sUbjeet. From this effo rt class m" Duals were

developed. which then evolved into a textroo k. Most of lhe

slu de llts involved are now teaching at u niversitie s or are in dental pr.clices Some of them have w rine n eh_Plers of lhis book.
Again, the med ical illust ratio ns in th is OOok were p rodu ced by
stude nts of dentistry. The first waS Jeff Clark w ho prod uced
much of l he a11 througho ltt the book. The secood
Evans, then a dental studenl , w ho listened to l he needs of each
of the authors and provided excellenl illuslrdlions. Both dre
prJct idng dentistry toddY. Much of the phOlOgrJ phy was dlso


donc by students such as Steve Olsen , Cary Bilyk, dod Tho mas
Simmo ns. dll of w hom creared the photogTdph)l for yca rbook s
at the univers ily and found it d chaiicngo to produ ce the
delil M d iH lI strations requ ire<! to pu blish th iS book.
I ~ m also grate ful lo Drs, Dan iel (hicgo. Donaid Strachan, and
Chdries ( ax, wh o assisted in teJching th i, m urse and m n
tr ibuted in mdny WdyS to the evoimion of this text. G"i,lonc-e
was also provided by Dr, Thom as Greenc of the Department of
Educ~lionJI ReSOUl"ceS w ho evaiual ed ma nusc ripts an d in
maO)f ways os, i,ted in lhe productio n of cia.., IOJ nusc ripts and
uitimatel y this text. /lit hough maO)f of the,e peop le were nol
on the scene for this edit ion. they heiped immeasm ably on
earlier ed itions from w hich lh i., ed il ion was developed .

10m,'> K Av",y

_ ___ _ ______ _ ____ ___




Robert B. O'Nc.... ().M.D~ M5., M..ftl .

K.!lOftY, 1l.D5. 1'lI.D.

Prol'C'SSOI EmtrinJs, DenllSlI'y lind ...... l~
Sdtool of DmIimy lind ......,iuII SChool
l.IniYenity of Midl ig.on
Jllln Arbor. Midli!li'n. LISI\

~ty o f ~

Sol Brrnic k, Ph .D.

Nicbol.u P. Piesco. Ph.D.

.....5OC;" te
Depart ments of 0 ..1 Med id ne " nd PJthology .nd RellO,af; vt'

Professor Emeritus of Anatomy

Department of An~ lOmy
Uni ~i ly


of Southern California

Anv'"- Cal ifomi.l.USA

o..niel 1- ChltIu. Jr. M5.. PIl.D.

" " " " - I'ruttnor of Dmlisny
o.p.uTrntnl' of C>r<liokIIY. Itl '$IOn tiYoe ~


~ d ",, ~


W.o<hington, W


0.0(. 1SCience'
SdIooI of Den UI Med lclne
Uni...... '!y of Pimburgh
Pitubutgll. PenIlsyIvlIni.l


.nd Endo<IonrK-s
School of Dentistry
Univl",i ty of Mi chjg.>n

F... nciKo IliftB-Hicblg6,

D.M.D~ M.S... F.l.C.D.
OirKlor <JI bw.rd1
Dfop;I~ of hriodonrk5
Iloylor Colkgr of Dem lmy
The Tex.os " l!l M Un ~ ..;ty SyMem, H."lrh Scienre Cenf<'r

Arm Aroor. Mich igcin. USA

D.Has. rex. ' . USA

M.rion J. Edge. 0.101,0.

O>air~'lOn lind A<soc"t. Pmfes<or
Dtp.artmmt of Di.lgn<JSl:ic SCifflces

j,o mn W. SimIDC'l ink. Ph.D.

Associate ProfeSliOr of R...roratiw Dent'Slry
Di~ of
SChool or Dentist ry
~ 'Wrstnn Rnerw l.-.inVty

I'rosfhodonlia lind ReslorOliw- O"'"is1ry

School of Dmlistly
l./niYn'<ily of ~
Louisville, Kmtudy, USA
Cdr]d A. EVd.... D,D.S. D.M.Sc.
Profes"" of o.nt ist ry
Chair of Ort l1O<1 ont k '
Uni""rs it y o f lliinoi'
Olic.lgO. Illinois, USA

o.vid c.johnsrn. 0. 05., M.S.

0.." ;md """"'sor of l'Pdiau;c: Dmtimy
Uniw1'<ity of Iowd
College at Dentiwy
low.l City. I_ol., USA
R()bert M .I( I ~ ln, Ph.D.
Profess or a nd Diren or of Medic,,1Educat ion
Dcpartm.nt <>f An.ltomy and Cell Biology

SdIool 0( MI i<:ine
Un~rsiIY of k.1~ Medi<:dl Cnlter
Kms.a. City. Ka...... USA
rIlII'i.... ""~u

_~ ~ ...


0tYNnd. 0Ili0, USA

Gwffrey tl S ~., lions. &05., M.s.. Ph.D~ FJ .c.o.
Pto~or EID<'fit""
Facol ry of Med icine and Denti' t ry
Un i ~ r s lty of Alber ta
Edmo mon , Ca nad a
Domld S. StnodwI. DDs.. I'ILD.
Professor Emeritus of Dmtimy
SChool of Dmtimy
Mwci.1~ I'totnMr at ....... romy a nd IAlI Bioloo'
Medic... SChool
Uniwn:ity of Miclliloiln
Ann Arbor. Mich illa n. USA
[)(,nn is F. Tu rne r. D.D.S.. M.R A.
Clinical A' soci at e Prof~s",r of Denti Stry
oepalt~nt of Cardiology
Rie<ltdt~ SCien'S a nd Endodontics
AuiSWll oedn for Pdfim t Strvia's
ScboDl of Denti>tJy

Aon Arbor. Midlipn. USA



Section r
Deve lopment and Maturation ofthe Craniofacial Region
1 GeT1e r,11HUnl;ln Develop nlent._..."",,..,,"....._...,," ...._.....". 2
j Qme$/( Avery Qnd NrlgQf M. f INe"

2 Development of th e Pharynge.1 Au;hes and r ace



j omes K. Avery

3 Develop ment of C;lrlil;lge ;lnd Bones o f Ute

Craniofacial Skele to n.._.........


ja mes K. Avery

4 I\Jstn.t,,1Faoal Growth. Birth lhrough l\J, tadolesceoc e.,... 6 1

CarlQ A. fwm.>

Section II
Development of the Teeth and Supporting Structures
5 De,elopment OfT""t h: Crown Form.d on...,.....
NichQ!Q, P. Piesro Qndj a mes K. Avery
6 Development of t he Teeth: Root . nd Sup porting
" " " .,
St ruct ures
",__ ", "
Nag<lt M, ElNesr QndjQ mes K. Avery


7 Tool h Eruption a nd Shed ding...

Nagai M. fl Nesr Qnd Ja mes K. Avery

8 Agen l\ Affecting Toot h J nd Bo ne De,elop men t.




j Qmes K. Avery

Section III
Structure and Function of the Teeth
9 Histo logy of En. mel" "" "" ", ", ", ".....
" 153
Nld wlas P. l'i esm alld jam es Simmelink
10 Histoiogy of Dentin.....",.....",.....",.....",....",.....",...."" ......"....." 172
NichQ!Q' P. Piesm

11 Histology of t he Plllp""...."" ....",...."" .....",....""....


D.). Chiego.jr.

12 Co mparison of Primary .nd Perm. nent Teeth

David C.jQhnsen



Section IV
Structure and Function of Supporting Tissues of the Teeth
15 Histo logy of Ihe Ging l, a a nd Epit h ellal llttachme n t. ,.,. 263

13 tlisrology of th e Period ontium ' Alveol. r Bone.

Ceme ntllm, a nd Per iod ontal nt .,.,. ...,.,......,...... ,. 226

j ames K. Avery

14 Histology of the Orai Mucosa and Tonsils.,".,.,.,.,.,.,.""".,".,.,. 243

Donald S. Strachan and james K. Avery

j ames K. Avery

16 I rrn~rvation of Oral Tiss lles,....."" ...."" ... ",....."" ...."" ....",....., 274
Danie! J. Chiego, jl', Dellilis f. Tum er.
and Donold S. Stracil all

Section V
St ructure of the Glands of the Oral Cavity and Their Products
17 Develop ment, St ruct u re. a rrd flm n ion of t he
Saiivary Glands.." " "
" ", ", ", ",,
Robert M. Klei n


", 292

13 Histology of Saliva, Pellicle. Plaque , and Calcul"s ..

lome; K. Mery

Section V1
Related Functio na l Tissues of t he Oral a nd Pa raoral Areas
19 Histolo gy of rbe N ~ s a l Muco<.l and Pa r~n~ 'kl l Sinuses ... 341
Goff'~ H. SpeIW r
2OSr.ructu ~ ~ nd Function of , he TemlJORlrmndibular



)tnnn k. ,,~""" Sol Brrnict

Glossa ry

- -- - - - - _

I n d ex.".".......

21 HiSfOlagic Ch~ng<!s d uring TOOfh Mo""me nt

22 Histology of EndosW'OUs lmp l. nn..


_- ",

.." "" ,.". ..." "..". .. _ ".... .. " , 427

llobm It 01tftJl"lId M<lri<Hrj.


' rulldsm 1IiwnI-HidoI/g6



.._ .._



- - -- - - -- - -- - -- - - - - - - -,

Development and Maturation of the Craniofacial

I Develo~nr cnd Maturation ofthe Cron;pf(l(lal


1 General Human Development

ja lnO'S k. Awry . OO Nagat M . E1Ne.r

r-'"",PI~ Oulli ~


Inl roductIon-.. Z
ObjKtIw$.. Z
Origin of !he Ii """,.. Embf}<l_.1
Funda","",Yk of ~ .4
0<-1.... of tM Prohf....-~ion ~
Emb<vooic ~ ... 6


fml ~ .. 7
DewIop","",t of th e Ne"""" Sysl..... ... 7
Dtwlapmertt of t tlt ea. l roi"",. ti nal System, .. 9
Oevtlopme..t of tI1e Muscular Syst~m ... 9
Skeletal Muse;. 10
Smooth Mu.d~ 10
Cardiac M u , d ~ , . , 10
De""lop me nt of t he Heart and Blood- Vascul., Syst~m... I J
Heart ,., 12
S "~letal Developmen t... 12
cartilage... 11
Bon~ ...


Morphol ogiCChang es d uring Prenatal Dtwlop ment... 11

Birt h... 15
Abno"TIIII Oewlopment.... 16
li ertditary Ou~ of ConQeoital Mal!o<matior><... 16
ChromosomaIAbnormar~; .... .. 16
G....->ttiC Abnormalitits... 17
Envi""""""'al Causn of Congenital MaIfonnation .. 18

InftJousAatnts... 18


Drugs.. 18

liormOr'ItS., 19
NutriborIII D;sorderl.._ J9

T....-aogenk: Hatm: Smol<i.-.g. Alcohol. ood Cafft<ne... 19

Summa<y _.ZO

StIfEv.olualton ~. _ ZO

Tht 1lU'PO'" of !his chap!.... is to dtscribe lIIMlY of tilt
imponant ckw"",mental ewnes th at t.>kt place
bttwttn eonctptio n and b1nh In tilt hulNIL f.orly
.........15 Itad ing up 10 and foil_I ns COlKtplioo ""' discusstd. such .... end""""rial d..."P' in p..."..",tion lOr
impla nta lion of lhe fertitized ovum. Changes io th e
mdocrine kvd of esrrogm and proseSl<'fOne are noted
and facilitate cha~ in the ut~ri ne wall and the fenilized ovum , Growth of the fertilized ,,"um into "n
embryobi<lst sur"'un~d by a function ing . 00 prote<:tive
m~ mbr"ne system i, next described. T1le embryo is the n
seen to uOO~rgo differentiation of vario u, org<ln .yste ms
t hat w ill give r i5" to t he brain , th e sp inJ I cord , .. nd t he
gastrointestinal lUhe and it sscclared 0llla n. Som ite ' .
~ seri e, of soft-tissue block. l<>Cl ted on eit her . ide o f t he
neural tube. ~ppear ~12 , 5 """, "s. The", so mite, enl arg.
10 prov ide muscle ~lId skelel~1 ~uppon of t he body.
Blood i,laOO, ap pe~r in t he yolk laC and plllCenta.. Blood
vtSS<'1, and a>U. ot t he ~ascu l~r sy<;tem d,"",lop .000 then
prep.1~ (or the initl.otion of
first he~nbcat. Blood cir
culare-s first from l he yol k sac (vite lline ( ;rcu tation) to
pmv;de nutrition for l he nm few ~ks of embf}<lnic
life. lbe vascular ;ysI..... then conductll oxwe tM
blood from me pLacenl.i. As me emb<yo roolin
grow. ~ number of tissue type s ~ppeir, .....I>linz !he
embryo trJ .........p many spe<ia li'C! funcrions. By 9
months ItIe feru> Ius deve\ol>td "","",lal rea tures and
gmwn in siz<-, mlar$>", sufflC!mlly 10 be prepved for
!he dIange'I ~ted wit h blnh. f1JwI1y, a numb....- of
~iwy .ond mYinInmmlal lacton !mown 10 ( ause


~ 6tfuet:s

.ore dMcrfbed.

After read ins this chapter. you should be .>I:Jle 10 di'lCUSS
!he importaot drwlopment~1 ew-nrs suell .... femliutiOO
and further gn:rwlh of ~ fefli1~ ovum. You .hould
.01.., be able to discuss tM deve lopment of the ~ .
inc! organ systems of t he ..... bryo ~nd rhe fet us. some of
th e ~it~l ""'nges ~t and n...I]y. ""'"'". or t he
im portant l>ert<Ii t~ry and environmental (~u... of
abnorma l development.

________ _ _ _ _ _ _ _ _

-', ,,
Human DMlopment~

Origin of the Human Embryo

Hum..n preD.. t.. , development bogins wllh processes

i"""lwd in Itw, ov.trl.ul cycle .on<! "'rti ~ul io n [Fig. 1.1 ~
"" me 0VUfIl <Irw'Iaps. me urm~ W<ln thkkm. "ld
ductS ..00 upilw r>es prt>lif"'. le in m. ~nclnl)'i n,
mclc>mffiium. Tht .. r....... is thus ~na: fOr lilt'
.."iv.l of ~ ftortilized ovum. 1M umiAe d",ngeS rrom
<lays? to 14 Can be ollservl in Figure 1.1. Blood ~I$ of
tile ha rmon .... m ogen . nd progesterone nl"1uale cscnc.lly; bod! funcb".. In ulerlM' .... ~ Il de""l.,..,me n!
[fi&.1.1 ~ f'>0jll'St<10Re " Iso ~s in II..- <tIl1W..von oI lbe
tn\IlIY.-rWn roI~ inlO thr lilt' ccapII$ l....,..m. The
_ .
~1'U.l.I ~ is 28 <LIys. .ltboul/l!his ~
with lbe indlvld..... L If the' cyde is ddined fl"Om me fira
day of momSlTuolI flow. ovul.u ion will OCt .., .OOU{ 14
days later, Ry th is l;me, " follicle rupt ure$ on the surfa.e
of {be OVdry rel...,i nll , m..ture ovum. Note both <)\Id rl.ln
. nd uterine ch;lnge<In F"opre 11 .
~rtiliulion fi!Wlly occurs in lbe diml ..........third of
ee lKrone ""'" (ft&. 1.2 ~ III1W)' occur .. I$( "bel~ IeIdITlI to .. n "ClOPic prqn..ncy. It besins witll me deposilion of some 200 m ,lllon spmn. t.ozoo in 1M v.agin.l d.. ,
ing coit us. Tho ,~rm.tazo:a """'. 1.5 10 l rom per
minu te tOWilrd ~ n d into the uteru nd u(er l"" tub es to
the poinl of fetti liu tioo. Iiowcwt only 300 to 500 s~r
nNtUOil ",nuin vi.bIe to sunound thr O'VU"'- Finilly.
onty .".. ",","""WOlIn (V. -;a)lyl P"'f"'U.~ thr ovum.
~ owm Is surmuncIN by lhe zorw. ~lllCick whOctl
.hft rettiliUlion becomn . fn! iliution mombr.... th.ol
Pl'~t. other . pnnN t"''''' from .... tering Ihe ovu m.
FUl ion of the mili. ilnd femilie pron udel then occurs.
e",h prontlClw. car ryll1l 23 chromo><>nles. Th;. proce1.
COflIPIetC'S l he fn!iJit,uion proo!"is. Tho fmiliu<l ovum
is Ift1DCd "zygocr: whidl t hen undcrp;Ieos de....
(WI di'mion).md besins MCI'l'eInml inIo !be uterine
fUbe, w~ It p.t>S1e$ t-.rd the ul<'rine UYity. fl uid on
the oviduct: .s>lon the Z)'gOIe on j f!; JJ>OWml'fII 10 lhe
uterine (a~ ity, It t.l.k~ 4 da ys for the ch.l.nglng z\,&ote to
...",h the ut er ine (a~;ty w here u wlU ;mplan t into the
w.1I of Ihe utMUS (fig. 1.2 ~ ~ lygofC mNnw hlle Ius


@OOO " :/~



~~ a ~ 0 ,

, " , , ,
" "



I ~t ond Maturatloo

o{rhe Cronio{aciol ~iOll


m.ngnl in'" multi-ulltd rn=; this is tnmnl the

II>OfU1.J .... (fiJ U~ .... 1M mlula, ""'.. d ividoos. "


enlarges _



rog .1 4 ~

pins " nuid-fil~ m,-- c.ovily ~rmtd the

blom>cdo. Tht' bllostocde wpllr. ..... the cell< dUO lWO
JWIU: on ""1ft" Il~. ee h O"'~ .oo ~ inner
all mHS. the embr)' t ' .... This iI all! the ~
~ (fi&-1.4) mel occurs j ( 45 d.>y5 .tier ~Plion
" nd shonly ~ irnpLinution.
On the sixth lUy. impllnYtion tol= pWC1!. Tlw 110pbolIl.r<l at the =bryonic "'" '" the cell au;,,"
to the sli cky ,0donlC,\]1.1 sul'f.1C1!. \I$Uo>lIy on the ~
or wall oJ rhe body Dllhe u~ru. ( Fig. 12). The uterine
wall. in l he "",,,nl ime. h.l. i"".... S<'d it' va",ularity in
.~ pec eal io n of f'f'Celvlnllhe cen mJ.''- The . urf. c. ceus
of the t,ophoN,," prodU' hydro lyti<: , "'ymes th.ll
digest the eod omen i. 1ce lll, olUow ing " d " p" r p<'"etr. _
tion of the ""II rna" (Fig. 1.4 ). This event is termed
- im pla nta tion."

Fundamentals of Development


In the I"' st <:\outI ~. rs me mol<nt4r biololY 01 Ye "~

b",,,, ~mml hn bHn the subjM: of inm- study.
yet lOday"'" ~ orinno! ab~ 10 undersl:.ond I1WIY of the
/lfO='S<'S Yi~ to fUlllWntrtW ~ _ F esempit." sm" moy " - dL1feftn1funcrioos a' tlirrn- periods '" ~ f . Ako import.Jnl. but no( unclontood,
is ee ... of mUUlll Iorms 0( lk.elop",enu!ly Imporf. nf ~ (po _ o< op nul which 1"""'-': ~ eeus
to rumor cr ib. Rutoft' lh.1n .mmlXing d istUSSion oflhis
",p.o_ su b;toct. on ly """mples or rnoIa"ulMcon lrol of
<ie'Y<eloping SUUCfu!n will be lIS':<! ..he ..... ppropri;l~ In
ch.pleJ$ in Ih is h'X t Many of l he moleo:ule<. Ih.>f gu ide
e mbryo nk dtvriopmenl C' n br ~up<'d inro sm.lll
numbrr of cot~ries. Some molemles ....m. in In lhe
cd. fha l pr<)duce t hem and a<:tas Ira n ocrip l ion f' <101'!1,
Transcription factors are fho,e p ro ~i n, thaI POlse15
domains a nd bind 10 DNA (de nxyr ibon ucldc .cin) in
en h. nce r regin n< of genes. The....a re mony kind. of 1I. nscription factQf1;. Some act.s ime=lIular effect ors s!lmu lafing .ldj.lce m cell. or Ih_ cell, d ist.nt from t he one
from w hich they origi,,"~, Howewr. e.lCh contain sl, .
""mng JJlo lerules lhal .ffect growth_ Sign.lliing moleroles are mnIi.tors of IllOS( ime rxtions OT indUClions
between f'MI groups of embryonic cells. Tra nslonm"ll
growdl fa<tor (TGJ'.B ). fibroblHr growth f.-for (Fe!').
. ... Jttodgdq pnxeins ..... famil ies of molecules dl.J1
~ imporunl induettve phenomena. I'Inw , . - h
bctor is;l/l rownpIe 0( ..... wbich stimulatrs me JI'OWfh
of >nlSOl)'.nd 'I)'R1ll"the(lc ~ and ~ - . . srudiN
for mony ~~ Other ~ function as reprOrl
1oc.I~ 00 ceO surtaees and can function from .. ther an
inmllular or extr~llul.. . location. Eumples of some
or [/,.,,;e molecules ..,II br de srnlJed as their dtvriopment is d iscu ssed

Periods of Preoeta l DewIopmeot rion ind mLolJ"mtnt: alllv ~ whid!
con ..ins ~ embryonic l issues. _un with in II", iiI"$! 2
....eb o r Mvelopmenl .00 ;. deKribed .. the proli~.
il~ peliod.- During Ih;' l i_ , fffliliZ<ltion. imp lintilIkln, all<! formol ion ofllle em t>ryonic c. ll lllil" hos lokon
place_Aflor the s"cond w""k t he embryonk m. s.s begm.
10 t. ke t he ' I,..,. of on embryo, so tlte .,.riO(! of 3 to 8
is i pprOjlriolely tem...<l l he "embryo nic pe riod:
During t his pe riod tn. embryonic ,.,nn Loye'" co mpowd
of It'CI odE'< ,,~ mesodornn. ilnd en d<><\l:i m di~ntim
.00 form tim>H. wbi ch Ibm form orpn ~ w,lhin
the rmbryo. N. .. Wft'ks the lINn form .00 brJins lO
bfm. the _ill tubt form$. the pslroin~ lroKt
den lcps. .oo the W lOons, N. 8 -..b the emllfyo
beSins '" loot human, iOOicitillJ the beginnillJ of the
fe..1 ~ th,u .."Iends u nfll binh (Fig. L5~ AI.., 00
incre. "" in body ~ght oDd m e refl1S llIe increi~ o r
li"lI<'5 ond org;on systems d uring Ihe fetal pe riod_


r"l-l _"~01"'_"I_"'_II '

Deta ils of t he Prolife r at ion Pe1'lod

In the SNUnd -..k blaSfO<y>l a-llsofrlle inner oellmilSS
d ifJerenli.ll e into two oed moo,"" e.Kh co mpri .ed aI di'
fermr cdl types (fiI. 1.6~ 'J1>eK.m col"",rw 1t'CfOdftrml a Ils ilnd Cllboidilf mdodmlW iJs thilllie slde by
fonni"l I"" mlbryonic disc (Fi:J. 1.6 ~ A cil'Vity,
~ the ilI1lniolic cwity.dnelgps ~ the tod=n.1 cel ls aI I"" flJlbryonk disc . 00 the mls of llle
OUI... Willi of llle tropboblilSl: (Fig. 1.6). Thefl il SIt'COIld
;nle rnal coviry. I"" yol k ..,c. ppe ors (Fig. 1.7). n...~ cells
give rise to yolk, ur nulri tion or t he . mbryo, unl ll blood
ve"els 'orm and ea,lY food rrom the mo the r's clrt ulation to tile em bryo. IloCh cavil"'! lie on eit her . id e of th e
HI1 bryoo ic d iK (Fig_1. 7 ~ n,., om niol ic cavity, liM<! by i
rr...mbr. ..... mLorpos even more ropidly Ihon Ille C1IIbryo
ilOO i"""sn II iu mnnbr.ltle.1be Mveloping embryo is

~ 1.5 Tho: """1* '9 _ _ P"'_llloGurjh _

lht proIIfer_t~pmod.-..he<o ll cIvi5ioni l _
Itnt tAl;""'. mbo ,,"'" peOod. _h ...1<!ft<k r""" lht >ond
to"", e;ghth _
(8); "",lei" ,,",lOd. lrom the oighth-

tobi.- lh (C).

fC"I_1.7 ~"'" <ifill<

.11 "


I Development and Maturotian af the CraniofackJl R<'gian'


",.o k

P rochordo l p late
NOloohordo l pn>ce..
P,i m~i""


prov ide d with nut rition by cells of the oviduct an d ut erine giands uatil th ~ he"rt beg ins 10 funct ion at 4 week s
and nutritioo i< ,u ppHed via the umbilical blood <\ll'p ly.
During t be <econd week. the bldstocyst be<;om~5
em bedded in the en dometri um of the ut er ine wdll.
Fibrin plugs the e ndom~rriai i mpl~ntatio n 'i te. The placenl. develo ps from the vasculdri, ed ti,sue tb" <ur_
rounds the en larging blastocyst. The placent" is Ihe lOne
of exchdnge of matem~1 oxygen .nd carbo n dioxide from
lhe em bryo. From the sm fdce of th e bl.. ,tocy, t, cells
grow ~ $ finger_li ke eXlensions from the ,u r fo < ~ of tbe
tropho bl" , t to inv~de the spongy vascu lar placenta, As
Ihe<e cells grow into villi, the p l ~ cen t,' c~n begin to
become funclional d uring the third week (Fig 1.7).

Embryonic Pe riod
Th~ ~mbry<)nic

Fig. 1.9 Formationof tl.. mo""'", m.

Prochor dal plat.

Neura l plate

I",riod ran ges from 3 to 3 week> ond i'

the d iffere miat io n period for the three w sic tissue typ ~s
and thei r specidlil atio n into org.J ns and organ syslems.
The embryo nic d isc i< mod ified d llrirlg the 15th doy as ~
groove, called tbe "primitive <freak: appears on its dor
<al surface (fig. 1.8), At Ihe poqer ior end of the primitive
streak ~ knOI of cells ap pears, w hi<h is known a.s
"Henson', node." From thi< no de. cells prod" d rlg the
notochord grow omeri otly to provide the prim it ive dxis
of the em bryo (Figs, 1.8- 1.10 ), M~sodermal cell, from
the prim itive str~a k and noto chordal process grow lofer"
dlly between the "'loderma l and endod erma l I"yers
for mirlg the embryonic sbield or Ihim ger m layer, called
the "me ' oder mal layer" (f ig, 1.9), Duri ng the ll,im week,
mesod erm~1 c~lI< grow anteriorly, post er iorly,and 1001er
ally from the midline, co ntriburing to the formi rlg
embryo and un iting laterally wil h l he e" tl'aembryonk
me soderm of the amniot ic membrane " nd yolk sac wall.
Mesode rm, bowever, fail< to intervene betwe en Ihe ecto derm and endode rm at the rostral Olnd caudal, giving rise
to tbe prechordaland cloacal membr,ne, of tbe or" l c~v"
ity " nd on uS. Tbe neural lu be ar ises d ist,,1 to the notochord by the infoiding of neural fold , : from here these
crests give rise to ne lLral cresl <"lis tb ,'t behave like
me soder m, ~ n d are hence called ~ ( to m~ , e n c b y m e .
Anterior crOlnial derivalives of this tiss"e a", the conneC"
live tissues and bone' of tbe f"ce.
The ect odermal cells contribut e to tbe nervou< sysle m, lhe covering of Ihe em bryo and its appe ndage.'
(ndils, hair, ' eb"ceous ~ n d sweat gland, ). the ep ithelium
lining the oral and nilsdl cavitie s and sinu ses. a parI of
tbe intraoral glands, dnd the ~ n a m ~ 1 of tbe leet b. The

1 Cenerol Human Devel~t

embfyonic en<lo<lemwl cells fonn the lining of m.. ~

Il'Olmesd....1 tr.ld. th e uonwch. ~ .lSSOCioI1ed orpn.
slldl oK lUll&'. ~11O'NS. liver. JoIl1bbddn nd urilW}'
bbddn (f'iJ. 1.
Durins !he nnt ~ weets ee ~ ~ .rn..s
~.u .IS Iloril>:lnt.olly po!Ilrionfd tullulN II'I>$Sl'< lomr
ins lhe ""'lIdibk of l he bee -:l ti:uuet of !he ned. The
aeodt;"",al Lo~ giYes ri<e 10 tbe m usdn. ~ suucrum <IeIlv!:d from collMttiw tissues sudl .IS !he e.ni1'"1"- bone. dmrin. """""rum. pulps 01 the Ift'tb. ~
pe11odonl.l lig.l=nl . re of neu l.1 (re<! Iissur- origin.
The f.loCl!! I. kes develops duriTIJ tbe fifth to >C'V",th ,...,.,ks.!Is these lisSlOO'$ begin to fonn. the embry on ic period bee"",.. the ret.1 period . t lh e eight h ....eek.
This is m. rl;oo by the first ~p pearance of ossifLcation
cen t ~ rs thai fonn bon~s.

~. s.-y

__r-,' - -

-., -... '" . . .

. Eplll'
. ...


.. " ,



..... _

_aet ~

fill. 1.11 Deriv.r;"", 01germ I



Fe u l Period
The embfyo nk period i.o the u dl'It for the felOl pe riod. All =;Or and mosr of the minor orpn' bq:in lkwIo proenl in Ihe embfyo nic period..nd then It'''W . nd

..,' d uring !he feul period. This Is the period of

~h. II i' tbil ' i f _ COnl inued to ""'" for !he
I'l'U 01 our lives .t this ,a'" Ndl 01 uS would ~ 1.0.....
11wI lIIe ~ in whidt _ e,,,U. N. !he end 01 !he kW
penod. " '" is ~leIy ~ COIfIlW"'IIO
the Itss _ U-de... k>t;>I posra.lllial rqion ("--I S8~ If
tile embryonic pmod is tile suae of oopn differmfW_
tion, men the kW period is lhe ~ 01 org.>n growth
.nd ph)1iologic ""'IU"lion. T1le ...... indcr of this c:bapIei' Is descripl io n of ,he .lIOoUS orpn . ystnns INI
~Iop .nd ""'lure during lhe feul period. TItis period
~res the fcl US for its enrr. nee imo Iif.. as an ioo..pendl'nl "" ing.



t.1 2O".lupolle'~ofthe




~'-... ~

Developme nt of t he Nervous Syste m



proce" by w hich the emhryonk head and r.ce a",

p.otlemcd i' a ",mhnuu m. ""ginning wi m ,peo:fic.otion
0I1 he .nlerior ~ ral pla le. T1le inilially n.t neu r. 1plale
~Iops <'lev.te<I folds aI its Lilter.l ~ges. w he re Jat....
.l1y lou1<'d cel ls become 1oc.1~ OOrs.llly .. m.. pl. te
rur1, 10 fonn lU""- This rube i. lhe tornun...... 01 !he
brain.nd ",i...1 conl (Flp. 1.I2 . nd l n~ ~I"'oclll""
medially in !he ""w;oI pion. w~1 je IocJt~ _~ly in
l he dn<lo..... ~ tube. T1le SHH (Sonic \lcdsriJOg) prol<'im
.... ..."",lWllO I"" p.otl<'fninl: 01 1M ~ rube. The
medially Ioc. t<'<l lIoluc:hood ClleIU i rnIe in induction
fnlm in pooition undmying the lWUt~ p1a~ ( fig. 1.I~
The nnu.ol pion. bends aJona: in (ftllr~ allis to li)rm.
cr-.nd Ihc r. i""" marsi", lbI1n lhe .........Iru""- Tbl'
nt\Ir~l folds llrMlu.ol1y .ppn)iCh~.Kb OI""' .t the midline wllne tbey fu,;e.Conl;><l of I~ fold. begins in !he
(mu , l body ~ion and proc~. in a ~phalic(.n_rl
.nd ..00.1 ( posl~iorl d ire<:tlon. T1le fold. ... m. in le mpor~rlly open ~l the cr. ni,1 and eaud.ll ends fo rming II><
anlerior and poster ior ""uropo res. Tho.., close during

fig. l .UDe

t ..... '"'... oIthe _


.. ~ .


The obs<1V.1ion t!wl wou nds a1 without suning before

birtlllw proIIided an idNl oil lioo for COIRCIing malforma.
tions such oK deft ~p .nd p.l1.lte. l~ng dcv i= ~
to COIle<1 nwlfonn.riono pren.t.lIy In
utero. Such operaliono . ... pe,fo"" ed near l he lime of bin I\.
Feral wou nd . ..... 1wi thout . ny InfL.>mma tion in l he pl.....-a
or t ylokinin, . which ini ti'l~ epit llcliali"alion.


I Develop,ment andMaturotion o[,,.,,,Cro


the foun h week. which SigMls the esta l>lishment of the

nervous system. Upon closure of the neural tUbe. a
unique population of cells known as "neural crest" cells
separate from the crest oft he folds (Fig, 1.13). These cells
immediately l>egin to migrat e ventrally olong the later al
wolls of the neural t"be, This is especially apparent in
th e head and neck region (Fig. 1.14). Neural crest cell<
give rise to a variety of differen t ceils that form compo nents of many tissues, such as the sensory ganglia. sympathetic neurons. Schwann cells. pigmen t cells. lep_
tomen inges, and cal'tilage of the phal'yngeal arches. They
also contl'ibute to the embryonic connective tissue of the
facial region, which includes dental tiSsues such a.' pUlp,
dentin. and cementum. Although the nemal CreSt tissues
al'ise from neural ectode rm, they exhibit propenies of
mesenchyme, As a re, ult, the tissue they form is called
"eclOmesenchyme." Growth and differentiatio n of the
neu ral tube begIns anteriorly. By the fourth week the
neural tobe has formed three primary vesicles: forebrain, midbrain, and hindbra in or prosencepholon, mesencephalon, and rhoml>encephalon. Secondary vesicles
rapidly develop from these primary vesicles (Fig, 1.15).
" lateral view of the developing broin is seen dt the
third, founh. fifth. and sixth week (Fig. 1.16). The brain
enlarges rapidly, bending anteriorly and expand ing laterally. The cranial nerves grow downwo rd from the laterai nellral tube and floor of the ora in, early enough to be
included in the organization of the developing face.
neck. and lower booy tissues (Fig. 1.17). Growing evidence suggests th~t the molecular mechanism medi.t
ing craniofacial morphogeoes;, is the , ome as the molecules that regulote p<tneming and differentiatioo of
other system, in the M y.

'm''- OO

0 "000P ..1001



Metenceph alOO


Fig, 1.16 Devetopm<nt oIthe cranial nerve, .

Mooode rm

Fig. 1.17 Dellelopmom of the


enera! Human On'e'opmenj__'

Development of the Gilst roint estin ill

The dNriopinl MU"'l t..... ~nd thO' g;lStroinl <"<li~ 1 rube
li1' .-l~ 10 ~och Ol!'tt'r. In ~ =~ betwffn I~ t\lI/O
~'" lUbes. tM somj~ IOrm .hm> of mufC~
from ~.......oenn (fiI.. 1. 19~ As th<" "",bfyo IJOW$ in
ImgtlI. llle .Ii....... t>ry aJUI Imgthen< .IS
un.>1 nltnds from lhe ~l pl.1~ 10 llle ~
pLI~. f h 01 wIIidI will <>pm ro pt<Wi<le an mlr.~ 10


oM mf from l he ..,....... !My UlW1.

T1w next J1I in *'e' opn.. m is llle apppu an 01
~... QUlpouclliJlp l~f 1M pllTOi",eu"wl
tube. Cran iouudJ,lly. llle fin{ and s.eo:ond pouct'ots pn:>Yick the ~,athyRlid~ s, th<" tbyroid from the my..
~I duet. the lullp. the enl.uginz: am of 1M <10m~ IMr. ~Il~lkt'. md p;mcre"": IIIlm' ~~ ior1)
the urinary bWJder dcYI:lops (Figs. 1.1811. and 8 ~ ~
thyroid &Wnd ap po'a rs duri", thO' fourth - t from me
junct ion of (he body and 1>.1", of the' ronguo'. nd
~s in rile midline of the neck. Nat the bib...... l
lung bod. d,rr.......,liate.rod mla,!:". but <i~ !tk'y .~
fillN wit h nuid rlwoy ",,.,.,i n no nfunction.>1 u ntil birth
whO'n ll!<'y innalC with ai r. The stomach d . ""lop1 ' "
loc.liz~ enl'fgt',ncnt of the anterior gut and gradually
develo ps a. a mix ing and digesti"" org an , The liver
grows r,tpid ly and by 6 wt"eks fu nclions in red bl""d cell
formMinn, th . conve" lon of g luCOse to glycog<'n, .nd
the , !ora g<' of nutritional elemcnlS, The pane",a, and its
prod uct, In,ulin, de .....lnp rly a nd by 20 ~ek, . re fu<\Ction.>1 in t he p rodoctinn of growth ho rmon e. later
becom ing imp<ln:.lnt in c.rbohydrate li, m. The
midgut rot,,".nd push"" into th e um bilic.1 cord at 6
but b',r the 10t h ~k t he
h'" incru st<!
fKie nlly ,.. ti u to .Uow ret um of t he gut. The m'dgul
form s the duodmu m, the rcma indc'r of the small inttst,...... nd the _ending mol Ir.nsvc= colon ollbe Iargoe
intesfi ...., TIlt de<andinx.nd Ienni... l p;l1IS 01 tho, . 11ow nury ( . ...1 dcvdop fmm the hindgut. TIlt un... ry
Illo<Idcf is the fi...1OUlpoudli", o f the . linwat.vy e" n.lI
" nd deYriops in (onjwKtion w ith the gmitou"n.ary 'YSlftIl (fit. l t8~ The alinwat"ry ""nat iI filled with kuI
mc<onlum dunnc lhe e" fly pcnwtal b~ Mecunium iI "
~ of shod ~heliaJ
Ia<ougo llai rs. " lid


"""'""tM cIctwU.


" ~J

fIoJ. l_'.~of lhcGl tr.(I.lA)~S .... (lII S_ _



Development of the M u~Lar System

Ttlc m U'IeU"'r sy;tcm iI composed of <pc('illizood cdls
" risi'" from tho, mesoderm, In which lbe propcny 01
contr. culiry Ius been h ,gh ly _loped. On the basis of
01;(1_""-=t!r'UClU!"C " nd function. th"", {ypc'$ of m us-

cle, "re I'f'<'Ogni:ced (Fie. I.ZO): 1) . kel..",,1 mu$Clc.

. ttadlcd to "nd I'P'SpOIlSible fur moverTJCnt of ttw body
~lcIon : 2 ) smooth muoclc found ellar. <I'fflst ie.l ly in
lhe w"lI. of lhe hollow vi=r., d lKlS. nd blood vcswls:
.nd 3) t...di.c mu<;(I"". foond on ly in t he h n:

Olnic" I AppflCation

Ovul" tion is , /DOOthly cydit rvcnt con lrolled b',r the

eno:Iocrinc ..-oetions ~ " nd progt'SIC'nIM. Ttlc owm
m.l lu!"C' ,,00 Is o;pcIlt<! from the (IV"ry Ind. if fntiliud. will
implant . nd "" nourished in the ute rillt' w.11 7 &ys
fi>rt i lizal ion. The function or "'" roolf.KCj>I M " pill " i' to ma;nu ;n .n incrc. std level of progestero ne ,,00 "" UQg('Il IhJ.t w ill
prevent fo Uid e m.luratinn (of lhe ovum) or ovul. ti on.
Without the ovum prcgn~nC)l will not occur.




At Ihe end of 3 wee k5 the OOdy h. s """" pairs of

<omitei Iyin): t;,te ral l<>.he ,,"ur.1t ube, The 'Omil<"5'rl:
rrwses of tissue thill conlribu~ to
!he.axw skritul lis ..... mllSdr.nd connrcrM
1M body _II. Iy the )5th 4Iy. 44 !Win of 50mires Mil
Iw<ve fo...-:l: lout will ~ oaipj..,t ~sfd ceMc.t 12
lllor.Kic. rIVe lum b.1 r".e s.u.L .nd tigln 10 to'll coc~ntd as $qffiffile<l


cyge. ' , M=1e ""'" ." following th e $.Ime <egmtnW ioo

pall t'" g row from the somite, along the body wall and
(f ig. 1.Z0A~ TIlt fi rst occlpi t.1 an d tht la,t
fwe 10 !i<'Vm coc<w. l ",mites will r dis.lp ~.r_ The
somit.. COJIlnbutt ~ to the ~ntbr.1 column. I....
6crmis d 1M skin. mll5des of !he trunl<...., Iitnbs, .nd
SOI"M musdH of Ihe 0f0lKWl ~ (IC.. l2OC}.

By 10 Wtth. lh t myobLo$lS(m usc'e (~I$) ~ mivated

and begin spccl. lj2ing imo elongated , mullinuclN ltd

muscle fibers (Figs. 1.2M and B), These fi t>ers divido into
group" <,pi mel\'1. which supply tbt dors.ll .uff~ of the
limbl. .nd ~ which supply Ibntnt,.1 p.>rts of

!he lImbs.lbey ilsosplillmo superi'"ocW.nddHp lq=

01 mllSdr. In eMIr ~nt. the mUKks follow the
>q1JWntill p,ot~ of ~ ",m~ but by the elglllll
\\o'ffk th iS p,ollffn dis.>ppta15 (Fi g. l 2OC ~

Smooth Muscle

Fog, IlO ( ~).
(C). O;I1_

oI, keIeI. 1rJ>.JKlr C81, Musdo types

;"t "", of '~"""' , I muK'-


N. a ony eilr1y SfaJ" of ~l,

IIlfSEiochyrn.1J lis lnCmfTate 0fIlW>d 1M IPpit!lflw ~ nings
nlludI struetu~.os the IIJI lubf. Urogmlt>l dlKlS, ~nd
the 1.."Be ""$C\II~r c""nllfls. Tbo>sf I11f>fDChyrnil cells
arrange IbemSfI= in lOnes wh ere involllnt.,y mll\.C!f ,
(smooth ).", deuined to develop. and then k "lll lltn in
tllt di""'tion ~i r m ntrK tile powfr will be CXl'lted.
~ do:'vdoplna smooI h and ~rdi.K musclf <:fils ~'"
both ronuol lNl by the ~utonomi<: nnwus 'Y'h'm (Frg.

Cilr d liK Muscle


In tllt early Slolil'S of d ifferent iation. cardiac m uscle cells

are packed d lt'ly tt>gether around 1M d"""laping hean
tubf and exhlbil no dri"lnl!<' plan or ~rranv'....... t (fig.
121 ~ .... the dc-.dopilll lissw is pulled inIo <pili! bonds
~ 1M ctwnben nllhe lINn. lhe m~nds bu.".,
IlloOrr ffgUl ~r in ~ffil ngm>mt until they aplH'~r 10 conli nue in g' IIff~1 pa rallel f~shion. The "'Sfcharact.".iSfi<
fealur. to ap pear in lhe d..... lopme lll of card iac m u, d .
are the intercalated discs (Fig. 1.20 8~ Electron microscopl' Slud ics have shown the", tr~ ns.....rse ma r1<ings to
be hiShIY modiflC'd cell bou ndaries. Myofibri ls on either
sOdf of the d isc an. atuchfd in ...c1l a rna""", that tbO'ir
cootraaile ~ c~n function lllftlUlh the int....roon
of mony crUs.

I Geflf'rol Human ~Iop'!'.~n!


Developme nt of t he Heart and

glood- vescular System
Th~ d~IOl'i.., .....bryo 0' '''''lIS i. att~ 10 1M pLi<I'lll. by conntive-tlss"" $l.Olk lhat ..... nJillel d urins
d....,lopmml 10 bomc 1M umbilical cord. Bodl .~

.IJ mol Wl"IOOIS bloo::d ~ form in thi s cord . nd catTY

~ dio'dd~ _ q from tM r rnbfyo 10 1M placml.O
and 0ICYZ'!"1 and nunirion 10 tM <'111br)o Of ~ (fi:&.
1 .n ~ Blood fIowIlO 1M ~ d uring tM fi f'll 2 ~
IIIrou&:h lllt viM liM cimdotoly systm1. ....id1 arrlts
""'rilion ' rom 1M )fOlk ..c 10 tM ....m. OUrinlt.... ",in!
~ 1M " mbolic..1l ctrculation t al<el "...... canyilll 01<"1&"'" and nutrilion 10 It>t fHus. Yolk-wc~ nulrirlon
" muctl ~ prtwllrnl in \own anima ls th.1n in tilt
hUJIWL AI. 1M ~nd of 1M first month. thr rmbryomc:
hr.n btgins to boNL OXwn is then lran"""ntd from
Ihr mate1"l\;ll capillaries '" m r pl;ocenU aem.. a eembr...., rh~ twO sysceros. TIlt fcot.1 ~ blood
Cl'lls a... <kYeloprd in thr r mblyo..lloIh v.scular syste1M
. ... sllown ,n f,$"'" 1.22. In tho um bilical cord. a ~n
r.II,N than . n .ntry carri<!s o:cygma~ blood to I....
tn. 1 M.rt. x ner m is blood circulat.... throughout the
ferus. it is then '.<Tk'd by lW<> umb ilical arte , i to lhe
placenta (f ig. 1 .22~ At bi, "' the lun gS t pla centa. and the pulmonary a'te, i", will th on cond llCt
oxygonattd blood to the newbor n's hea,t.
l1le pld,'~nt. f""ctiom as . nutritional link between
m(}{ l1~r and f~U1 1 (Fig. 1.23) dnd serves as . slo,a ge ban k
of nutr ilio n and a sltr of rxch ange of oxygen and carbo n
dioxide. Howeve,. there i, no direct contact of the blood
ole~nts in the pl.lcenta . s bot h s)"Stems a.... separated
by membr. .... The "",!(or"",1 blood 11""" r rrl'CliV<'ly
~ ui e Was\"e prodllClS that cross the placental

... .".
,, ~ . ,


fig. 1.2)I'\o<ef"O;;o..,d =ha~ .


~ . " , . . . . . 00


I ~n t on<! MotufO!loo '!L,the Cronio(ociol Rtgioll


no. nnbryonic hem

;R1li.1lly o:lI'vrlopo> by fusion of !WOO

........1> into" ~ blood ~ Iorntinz tht m clod . 'klII
hun tube. In " wries of $R'p$ { F;g. l14 ~ thiJ ~
~ lIlId bmds on ' tsel f. " ,.;I its tisst>ediffe-nml:llIlft.
Then " <f'J'IUrtI diYi<lo-o "'" hun into right .uad Itl't
dwmbn-s. sepu. .uad """-" ~I"" which
"uto from r.........tricll!s. In "'" eonbryonic hem. blood
colle<:fs in tht right " tn um ~ mosf 01
into rhe k1t " ,rium tftrougft ~ ftlf"mm ov"I .
BIoocl t ..... PlIsstS to the ltft ""ntrick wft.~ It ii
pum ped thro~""t the body by the aoort. (Fig. 125"' ),
Very litlle ~lood p.l$ 5I!' f, om the right m i" m 10Ihe r ight
vennicle. where it 15 pumpe d to the dc Vl!lop ing \ungi .
Blood byp ass. , lh. lun gs. pass jng t hro ugh the duct u'
. , te rio, ,,, to lh. "ona (Fig. 1.25A). Th. fetal hea l't 15
at iVl!ly larger . Lld l><'.IS mo... rap idly tha n t he po'l natal
hea rt. ,ince it carries blm to lh. bod y a nd thr pl. cen





~irt ll. = r .1 "",jor clunges OCUlr

1258~ When lht inf.nt Ute. it<; fim


10 lite he.rt (FII

br-." h the lungs
inllat ,.;1 . """I sUp 01 muscle slide.
for. .... n
""ale. whiclt is t he openif\l bt1 .. . . n ,.... right . nd Itft
. 1Ti.I. This ctosun: !oms .n "'" blood in the nV't arrium
in to tht righl ..... tricle .,.;1 to t'" lung<. no. blood is
IhI':II rerumeclto lht Id'I: " m um from the IUIlC' by the


pu l"""""Y "";ns. After biftb. lhe dUCIus lIItmostts

10 ~ whidt ~ blood from P""i'"
di fa"tly from tile pull1lOl'1MY .--ies to the aooru (fi&.
I.2SB ~ Thesl!'ctw>&ts lll: ~i rth .r-. vi.., l to prevent .1llu.
b.>by" (oxyzen rlriicienl~ As . mull. postn..>Wly lOU lhe
blood is ~rod befor-. be,ng ci",,,la..d to lho! .n li~



Skeleta l Development

FiSI . 1.25 '" ",,","t, 1hea' t. Both o'j'genolled . nd """""l'9<'oa..d blood ,01
I...:~ In tho rigM 'tri"", t o ' ho riqllt "" ntrJ<1< , nO mixed blood pumped to
t he body. Bl'o<t "" ,aI..... rt. '" bOth tho !oromM "".1< (bet"""'" olIlIo ) ,ioo0'S, f<>td"ll blood to t!>e l'i{lht
t hM to the I,"'g'. ft retu"" 0<)"
~!<'d to the loftmia ood ""'" the loft ~ and;o pumped to tho!


_ ride.

The skeletal dnd . rt icu la r ' y, ,,, m, de ve lo p from rhe

""" "dermal somile s. w h ich diffe re nt iat. inlo s<: lc rolOme, and de rOOOlllyotomes. The s<:leroto""" wi ll form
u rti lagc. bone, .nd ligaments( FiJ, 1.26). 'ieIIc..1type s of

_ CliniQl Appliuldon


an. dQm.>oc dwniIe.l birth is the n.nsfOnNl:ion

from the doSI!d $ySlI!m cI the he.on to m open one .
~ birtlt thii is olCCOrTIPllshed by utilizinz blood
lkrw from lht plllCent> , nil conductillJl " 10 " nil
th "",gh the ... art. fhen circul.ling it 10 Ihr ~" of
th~ body. At birth ' he hedrt forttS the blood into lhe
lu"&,, where ;1 is oqge ""ted. The blood Is lhen
Tetutn<>d 10 t he
an d pu mped thr""gh<>u t lhe



1General Human Ckwlopment

U f1,lage d~IOtlIO supply til<' bOOys ~<. Hy" line

<" rt, lap' forms throughout til<' ~mlxyonic; md f~lil body
md i5 III<' mo$l promin~nl type. H........,.....,. ri.o"i~ u m
Loge forms to the ~ars " nd Iibmus GlIrti~ form:!; in the
..,.,,1 minot\. !lone lim ~Iop$ ~ ""'" ty l"'S of ronnt<tM-lissue for m"tion. O'ilhrr endoch<>nd r,,1 Of
inum>tmbr"nous {r ,!,- 1.27 md l.2l1~

Tht first sttItaln IOdtriop in III<' <'mbryo is c~

01 <miIiJt; if do,cl .... in a sqrnmtll Polrt<'f1l. ~
" PPCMl rh roughoul: lht body: in t!It ni.ol sl<ritton, til<'
bHt of !he cra nium. "rid t ilt ~ (~ 127~
Clrtilagt ceus fil"Sl ap lI""r dufinz" the lOultII iRd fifth
-..t. " rid GlIrtilagt lri:< ""'" aplI"" rs throtogtw:>ut the
body. , ,,nil. provi
Ihe sktltt.ol sttmgth " rid form:!;
a .... lm whtrt bonot eens will bier fOnll boJ>to. L.1~
nUlritnl blood \'tssds mtn tho' UrtibgtS. "Ad boot
form. 'n",,,11y ,n lloe sh.lfu and .. ~ in til<' proxim.>1" Ad
di sr" l hcad. of Tilt l>onts (Fig. 12' B~ By lh~ 20fh wttk.
of lhe u Ttilage in III<' body.
bone ha. rtplaetd _
(mila,. w ill ulTi mately t.. limitNI lOth e coYenng: or lh e
hea'h or long !>ones. lilt Odsat septum. th~ trach. a, and
sped ailled cart ilages will provide support I", th e ear s
(. lostic) ~nd the , pll1dl column , ( fi b ro " . ~

.............'" Bono FgrmIIi!!!l

Booe m ay <!e'wlop lh roog!l rep laceme nt of ' aTt il" ge by
endoc hondral me" " s, or frans lonnatiO<! 01 conllrive
tis<ue 10 bone by flit inf,,,membr.nous roule (Fi,"\.2l1~
Rtg.l<tlless of l he me"... by which bunt lo rm<. the
,...,.ltonT skeleton wil1 l\.tw u... same "Pl"'" r"l><e " nd
f" nct ion whel htr tomp.a<l (den"" bone ) or sponzy " n.
<tllou. bont~ The e<rmw.1 portion of bontS i$ u~ty
<OrIIP"CI " nd !he inltmll pa rt .urroundi"' lht .... rrow
!.paCt is ("nctllou. or spongy_The _Iopi", $kuD i, "
d.1ssi< example is iI ron t" i". boIh """"",,""""'us bone.
whic;h COOo'tn lloebr"in "Ad ~. "nc! r.mi~
<OII\PClOltIlU IIW "'I'I""ft t!It bHt of the loin. Thty
function in lY"C1ltorI1 '" support md prolNt the br"; n
.and f.Ioct. T1Ils wil be " esaibed in detail in Chap:er 4~ 128 .,." l he iniml formation of rnttnbr"nous
bone (lIM bontsl wIlich forms in rooneail't tissue. is
weU ... " ~ t.1I 01artilagt W t i5 modified
by tndochondril bunt lOrm.1tion.

Morphologic Ch.mges d uring Prenatal

Embryos inert... in size first by tell multiplic;~lion. St(.
ond by I'owlh in ;nTHeell ul~r depo sition. ~ n d Third
lhrough " mod iflc~lion of $;Ime w ll <i, . Fre>m T~ {(on il.
i;red ovum ll~1l" until birth , th e hum.o in<,.."lOS In
length from ll llll io more lh~n 50 em , .ncl in ......ighl


12 18 20

2. :Ie

fig . 1.2~ I"" re. '" in weighl and "'"9t h ofl>ody.



from few II'\IUilJams lU _

tIwllOOO J in appnsUmaldy 266 days (fie. 1.29) Th.... fnKD fntIIizac"", 10

tnnh the body ;~...,. ;n me about million rimes.
The MIbryonk period i< 0 "'" 01 rapid IJIJINth and differentialion 01 'lIs. Ofj\ans, . nd olJoln sy>~m .. All INjor
~aru. ", are es l. blilhed duri "i Ih,s li"",. (;rowth may be
intemi.ia!. involving an inc",ase in bu l ~ wil hin a d lS" e
or or&dn. or appoliliondl. involving enlargement by surra,.., deposilion of ' i..ue. lo,erstitial growth is a characto:ri' tk '" soft !iss ue. where appositiooal growtll is a
char.lCtm sric 01 mineraUZl'd tiSSUl' uch .. I>c><le and
den ral h.ord tissues. ..... exp(ioll is canilage. a hard lis.... l:Iw.l illClUlft in me by both ;"'e"'''''1 .nd appositional JI'OWIft. MucIt 01 the inmsIitial Jf'O""Ilt occvn
dllti ng .....d Opl1lell( when !his ttssue is >Oft Oft in a . . .
mi.......hZl'd state. fol mal nnw e~ cd! Of cell IJ'OUP
dO'J>O'i ~ a _ rix utMlnd !be cell .
Diffe....t .. l ,.-th is ....... Iial ,o prod uce cba"itS in
sil e . nd !hope 01 dilfE.renl body parts, An ~mple
would be the chango in proportion of hoad . i, . by the
end of the emhry{mic period a, 8 wee. Du. illg the f. t ~ 1
period from eight weeks to bi. th the' body inc"'alel In
Ii..., at a (d' e :reate r lilan lhe head, The he'ad "'prf""ms
one-ha lf or rhe IOUl body al 1 moot .... one--tbi, d lIt ~
months, and on~fourth .n binl\{ fis- \30 1During !he Ilm 2 prepayl mont ... rhe'hea" devdops.
blood bel>ftS to cimllate. the body etong;o.... and the
human fan! d""elop> (fIe. Un fol lhund otibt Itlird
rnonrh ibt Uppe1" limbs MaC!l altn&th p<UIl<lO't_ 10
ibt nest 01 tile body. By the end 01 the fourth mont ll.
ossilk.nion cenren ~ made their 'Pllea",,,,,, in most
01 rhe' bon.. and individtul diffe<~ become .pp;ll_
en" Ar lhe end oflhe fifth moolh rhe fi1us is ~boul t lll'
leng'h of . fUII-l:erm ~t~S ; however It weigh, about 500
g. which is one s;xth it' birth weight, By the end of the
i;xth month the Iaceis infant-like. lttlO ~ g h the skin Is
wrinkled because of irs rdpid growth and Ia<~ '" developing adipose titsue. By lhe' end or Itle """,nth monrh.
bowevet". ibt fetus ""' Moidoped suJ:>cut.'Ineou
..hmi nali n: !be Ibn wri nkles.. Ai this time. Itle tJ"lids
no ~ fIMd lOi"IIIn. Body lDOO'IIX'fIIS now
bO'comO' p~ moR 1>I:;Ilia. . .. Mow...... ollhe
~ j.lw bqins as e>rIy" !lie ellhlh """,k. but SUCh "
minor """"""leI IlllOf leI, by the rrKKlie'r. Ann and
flexing begins as ,loin.. matUT"f. and rhese JnOW1I>O'IIt
. ... quite notice"ble to the morhO'r. Duling the ~th lInd
ninth monlhs. lwir dnd fingernail. IIl< .... se in length and
the body becomes mO'" plump. In the late ptenJt.1
month, the body ;ncrea... , in weight unti l the fetu,
rf a""". abou t 3.2 ~g. lhe ave ge ~ghr of an inf. nt.,

rOJ. 1.31 0r\9n oIltIo _1'Il>Ce'Il.

Clin ica l App licat io n



All ",II. h.o~ . limited lifi1inw, The life ....n of. w h j~ blood
cell is only f!'W hours 1<> f!'W doY5- On ~ 0' ,," h.olld. "'"
blood 'lh live .pprox:i.... 'ely 120 .s.y,.nd . re lIltn dmruycod
~ ~ Cells 01 the slin. IW. OJ ... il. I'ftleW ;r< tbty
Io<t. cells 01 the .....pir. lOfY. \IIilWy. .ond ~...rln.lI
met ~ '!UI:>UIhOUt h~. O!tler<:rib in the bcldy do nat nor....I/y mww . fter m.uurity unless tbty h.ow btftt inj urnl,
such .. 'lis oIlhe livr . kidney1. and Ihymid gland.; mm
they may ~'l:e !O <OfI'lt elll:enl NefWS have.n exll"1.'ITIeIy limi led eap.><ily and if dam;q:ed are not Ilkdy fO be
.e placed.

Partu rition or Id oor begins with m uscular ,ontraction.
when U", fetus h;n atl.lin..d t he PfOl)<'t posillo n deep in
the privis. ~ ilmniQ(ic "uid is liqUC'<'zed inm the lhlD
JW1 of the chorion ~ ~ 1M Ulniroe rnvix. TIns
KtJ .as the pno!imilWY diLator of ,.... arvicoll (,In.ol. As
conlT-'ions btco"" 11lO~ JIO"IlfffuI and fmlu,,"l. ,....
investilQl memt>ralles rupeur. and t he infam i. frff<!
from the fct.l enve l0Jle. The am niOlic fluid S' dr" to flow
from the moIher, w hictl lubricalcs lhe birth unal (Ai1.l2~ Ilo'<-~ r.... ~ of binD uSIIol11y 1.&5 ..........ll
boun. it is imporunt th.ol the ploanLl ........,"" attMiwd
!O the ..-us. If the retus ~ CIIt off ~ rrom
its r,..I1.......1 ...socio.tioJ!s. It could not survrw me proIonge<! imerrupcion of its OX)'!:<"D supply.

Comhined contractions of smOOlh muscle in the

uterus, . ide d by contracHons of Ihe skelelal muscle' In
!be ilbdomM, Jim-ally sq.....,... llie r.,' us ;nlO ~ slowly
di l~ing CftViuI Cil"'" WJw>n dU~ion is ...rr~It. the
krus is ~ out "'!be u.......... This is tilt fine ~ of
labor. ~ <e<ond ~ is mudl men: llrWf lIwn I....
Iirv, The fetus ...."'ins through the ~.l c....1 ~
prompt!)' th rough ' M v.S i.... an d p~nI5 Its, l'. The
vulval orifice dlla'es rapid ly, and whe n the head passes
tho OUt~ l ho ...,t or l ho body emerges ""idly. With
d<olivery and the tyi"l and CUlti"l of tho con:I.
lnilftnal co"neui"OI' .are ~ted ~ fer
Iinw. the .... boI" sublim in<IepeTIdnllly of .nodw,.
individual .


Approximately 15 10 20 minute. after the binh of th e

baby. me uteruS begiru ano ther serie' or ron tracrio n,
which 'Ie"'" to loosen and expel tho pL>cenU ..nd . mni
otic 1l'ffi""R1. This entire min Is o ereOl ~ 1<1 ;IS tile
This abrupt: shrddinS of tis<ul' from lhe
utefus ilMl""" <OmI' he...o"b.!$. but the conlinued
contr.. cru,n< of tho uteru s /fllll,m ize blood loss by c0mpressing the ruprured ves..,), . whi ch tl>ereby f""Hitam
<oagu l.rion. Following pa rturitio n, there is a period of
"'I"ir or tbt: uteri "" lininl similar to !he one thilt occurs
..rrer mensrnutlon.


The prucns of birth <>mIrs.about 9 10 !l5 months..ttft'

COJlCeptiUR- A romplete envio"Ol\ll'lefllaJ trinsformalion

takes pl<Ke at thilt lime. The inr..m i. <ilta pu lted from i

warm. dark , an d relatively quiet environme nt. having
been sU ~rged in nuid at a body te mpe rature or l 7 ' C,
intO i lighted , noisy environmenl apptO;<i ...... trly 7"C
rooIer. in which it mUSl support il$elf by breathi"l olir
tllrough its - . . Iun:&s iIld tiVl' indepeilde"dy. Th.... it
birth the jnWl[ must .lIfYMo i number or pItysioloJX:
changes, such i . Ihe in. piration of air 1I"""gll its Junp,
<hang in the circulatory pathways, shun tin g of bIoo<l
thrO\lg h the lungs, ora l ft'l'd ing, use or tne gastroin testi nal tract. utilizing ...ns>! organs of sighl, sou nd, and
.....11--..11 of which create new and complex r.eliop.

Rg.I .32_


I Dewlopffint and Maturation of the Cranio(adal Region

Abnormal Developmen t

1 2 3 45e7 8

Emb ry<>ni<


F. ..I

The causes of congenital malformatio n' m.y be hered i_

tary .ndlm environmental (genetic aLld epigt'netk~ The
majority of congenital defecl< are the result of inter~(
tion belween heredit~ry .n d environmen lal f.lClOr,
",~ur rin g at a specific time of developmenl. 1l was
recent lyreported Ih3{ SHH protein pres~ nce is ne.;e ,sary
for growth of the fronton,ls~1 prom inence (, t.lgo 23
chick). Sign3ling from this protein i' critical 10 nor mal
development of Ihe mid .lnd upper face.
Beyond prenat.ll examination' and p;lren t~ 1 counseling.
not much c~n be done to reduce hereditary h3z,lrdS in
human, . Re<."nt experiment' are being directed IOward
ailering the effects of abnonn al genet ic endowment
through changes In Ihe environment ' uch os <Iress
reduction J nd dieta ry changes.
Our increased knowledge of noxious envil'On menti1 1
. genlS (Ieratogen,) and the time of their maximum
effects On fetal development is of great impo rlance in
the understanding ~ n d prevention of <uch malformation, . The developing human is le. ' t susceplible 10 te"i1lOgenS during the proliferation period (fLrst 2 or 3
weeks). At that lime d3ffiJge ,,",y be compensate<! for by
the remaining c. Us that have not yet be<;ome committe<!
or differentialed. The embryonic period (third Ihrough
the eighth week ) is the most critical time r>criod becau,e
il is Ihe period of differenti~tioI1 of tissue< and organ,. At
Ihi' time. teratogen ic agents may be highly effective and
re,,,h in numerous malforma tions. Dliring the fetal period (end of eighth wee k unlil birth) susceptibility to teratogens rapidly decline, and mJy cause only minor
defects (Fig. i.m .

Hered itar y Causes of Conge nita l

Hereditary callses of congenital malformations can be
.1l!ribuled to either chromoso m.l Or genelic abnormalities.

Chromo so mal Abn o rma litie s

Many corij,,,,nitJ Idefects are now known to be the re, ult
of an abnormal number of chromosomes. The abnormality in number is expressed as either J decre.lse or

;nrn,_ in

I ~ nonn;Il n u_
cI d\tOfnMDInn (46 in
euploidy. A de<:rN~ In _
moOO$Omy (4 5 chTOO'lOSOlTles). is uSlJollly Jel:hal. Turner
synd rome (XOJ is noI let hal. An increase in on e or more
chromo wmes is (e rotoge nic dnd res ults in co nge nitdl
"", Ifomanons. TIle extra ch romosome nuy be an au to"""" or a so; ch~rtIC'. If an ""tra cbrornosomo.o
membe1" IS ponmt. a condition known as trisomy d<wIcps. The bt"lt koown ~ is trisomy 21 or Down's
wndlllml! (Figs. U4 and 1.35). In th is condition ~
IIIoO<r\l:lefl of ~ 21 ;ore prnent in f~ "''''''he
cell< of I~ affected Ind ivid lJoll. wh ich I'\'s ,dts in tIM> cells
e<>m~i ni n 8 47 ctlro mOSOTI!<':l each. The nulfoTll\ilhon is
ch"rd(l..i,ed by ment~1 rer.n ddt ion. upward slal1ling of
the JMlpeb<.1 fissures. a na t "..",1 bridge. a nd . r,,,ure<l
pro trudillj roog... (nuaoglos lia). ....... ~r """mpl e of
chrnmosomal abnormali ty is Kleinfdter syndrnme.
Th. ... a... """,ral rypes. one is the XXV indicoIri1\l an
mcr._ in I~ fmWe 1ft d\romosomI' The.....1eis ull
of RaW,... has defkkm l"Rel d~lopmoenl. and
requires addiliONI ~ to funchon norm.>lly_
OCh.. more ..riom a nd sevn. fon m of fh is condilion
a re t he XXXV a nd XXXXY syndromes.


ltu m ~ n s ~

1 2


4 5

J''lU' al:t .P,

.. ..... . .... .. .

7 69 1011 12

' 314 15
l tl20





X ffi, - ~


Blea kage " ""

_ _ ,,,,






_ ~ on





Trisomy z t

Down's Syndrome

Genetic Abnormalities
Gmes a re oegrnems of the OI'IA elwin fur -.:I info<moIrion lhat an pet"pel:~ from ..... ...-a1ion lU
anor,,". Abnorm.>l dewlopment may be tile "",,II of
""preuion of d.feai~ ~ w hicllmay be domi"",nl
o r ,.,,<. ssi...... A d om;na nf geM expre. ses itself wtlcth.r it
is presen t on on. me mbe r of th e pair of homologous
d Ht>m<>some> (he leroZygouS) or on bot h pa irs (ho mozygous). A ~siw sene exp~ 1""lf only w hen il is
presenl on bOIh members <Jl the '''''DOzyplUS pair <Jl
duornosomes. (fiI. 1.J6). no. followi ng al>nolm.lh lie's
.r ..umple> of ~lowm.ol domi"..nt ~ ~
cepb.olosyndaclyly (F"l&-1.37), achondropl;lsia, deidu<, ....
ni.>I dysoslosis. mmdibuloEaci.oI <Iysosto<is. and denlinogenesis imperfea~ AchondropL.lSla is ~ defectiw <levelopment~1 condi t ion of bon.. o'lincd in <a ni l~ge (pa n ic-


","1 0

,,".._ p

Ai ,

" ",w,g' y







I ~t andMotllTlltion ofthe CTll/liQ{rxkJ! Regioll



ul'lrly Io"i

On the otbrr hand, d<'docraoial

a condition of

dl'fecrivl' ~I of
baM CJ!Si6td in mtII'Ibfa~ (n a nial vaull f.oce. nd cb<Iides ~ Some of the dmom a re fMial.nd den.... nWform.tions. MandilMlkUcial dysosrosi.. .bo called
T"'acbrr (011",,' syndro<ne. te<u lts from driecI_
sme dlar !i<'mIS III cau,.. .. disnlrba""" in the miSrarion
of neural
ulls. This is exp~ '" a n ~
oped fan' (Fil- u n Denl;~s impnfe<U. a
hemlit1ry <OIIdilioo. results in driecliw dentin formadysosfosts is


Environmen t al Cau ses of Conge nita l


Em lronme n lal ,aUR S of <;ongeoilal m" lfo rm,l l iol1 ' may
be class ified n infectiou s <lg<'nt' ; ,.dlatio n, dru g.. hor
mo ne" nu tri t;on al disord"r1, . nd le r.togenlc h.bllS
such . , ,molting or ran,uming caffeill<'--COf\!aining subna",,~ or ~ .lrohoI, ~pedally during pregoon

'.37 (,."ioIad o! ."d d;git ,yndrome.


(T . -.,,_.~


affMinc the It>IIl!...- d urillll early

1nCrongmil.1 mal formations. "

I<nown """mple is rubella vi rus. whidl causn (;ernwl
me........ Whr n a p<e$JIoInt wom.n is i~ wilh
rubella, many ~ in Ihe duld ca n .-=.k. indudinc
c1rlt palate, nlral ~s ~m and
Viral inlectiom
nancy can


ftrI: : '

eatararn (~ U9~


fOg. 1.38 Lack 01 n.,,,.1 Cl<"t cdI milJr..."", tn\>Iting in ~ 1><Iol

.bno<m.l llin.

Rad iation
The direc t le,alogcn ic effects of X-rays o n t h. e mb ryo
,.." u lt in , pecir. c congcn ltdl m~l formations, including
cleft pa lal e. The ind irect effect of irrad iat ion ca uses gene
mu t.hon (a ltl'rat;on ) in the I"nn cells. Thi' lead, 10 lite
O<'C1Jrn'nce o f CtNlg<'nital ma lfomutions in SUCCeedmtl
generation.. To alievi" e !lle d.ngemus eff~ of radia
lion. all personnel d ealIng with X-rays should use pr0per pmtecrivl' me~",," for both !lIemse1vn . nd Iheir
1Htimts. They should .bo prote<"t women of repot>dllC1M age as thougtl thew ..omen ~ J'l"'gtwll.



nlc ~

_ n-

p p l i c at i o n

~ pmod "') to 9 Wffl<s is _ '" lJl'a~ semitiYity 10 1M

.Ktlon of t""alogens. Aft...- 8 - n s 1!lc'Je i. a deol:asi"i RnsllivitY to e nvironment.1 fanors. ~ tiss.,.,. are no 1ooZt'f
undergoing . , ma "ll d jffcre nlialing f.crors a, in the .arty
"", s. The ri' k of m. lform..>llons l! greal.,r dur ing I'm bryogene,,,.

Although specific drop uso<l duri", p~ncy haw 110(

bem implicalfll as causing ~~togenic effel:ts. d rop
should be avoided unleu n!US... ry during early p rq.
n;lncy_ Reme mbe r lhe Itagie erfecrs of thalidomide. a
d TUl! 0T'In' considelfll to be ~ ...fe hypnotic and an lina...
..,a nl. Ir C<lUsed p,lrtla l and total aboeoct' 01 1M limbs
(Fig. 1.40~ Aminoprer;n i' ..nolher d" ngerou.< d lui used
to indoce an a bortion, when nece" ary. Tetracycline

~dm,nislc~ ;os ~

useful ~nlibi"nc. ukn1 during toodI

duri", l he sond ~nd third
tri~ e>""'" pnnwntnl ~i:sh d,fCOior.Ilion of
denl ln.mol lrypopb ' i.J of tire e<wmel of de6d""'" I~

.md 1><>M



wi<:Idy used """'" ~ ~MS . . ~ drup

~ """" 10 ~ ~ ",""t {(>(by.

~oo... ~ ~~ lOgtIlniS cI tire


To d.I~ lime is mown




H ormonn

hOlIflOJleS suetr ~s '"~IOl ~ns .... not d eMIy been ~mostrate<l in "um~n s. Corti$Olle. how<wr.
has ~n shown 10 ca u", c~n tip and palate in so m~
~xpoeri mental an imah . The se d feclS have nGl b""n
show n In hu mans, The u<e of sleroids by some at hlele s
may cause sid e effects, al though 10 dat~ th e", i' inad equat e Informa tio n.
~ aclion of


Nu tritiONlI Di....-ders

Nut,il;1"",,1 disorrle.--. IY\Ie been Ie..... IN in



r;e.s oftru.....n.. HlIlWCYCf. tIresie reports are few and most

m.t~ 10 tire

effects of n ulri riofloll disOldt1's on developlnIlO'Hlr. Yllam m ~ .md Irypeniuminosis A.

C. and D IY\Ie been reported.lS 1eI.or:....'oiC in some: V1oiIIWIls. HyperYitaminasi< A is i~ In effectsin emy
presrwncy in h urNJ'lS,. TfuImo1I{ w ,th vitom in A fOr <kin
dOOrden i. lWW ;M;Mded in YInIen 01 ctri~ri",
~~rs. folk acid deficiency h.u been implie>ttd in no:u~
tube dekcts leading 10 .pilY bifld~ ~nd ractri<dlisi. (f....
S"'~ In spilYl rolumn ~ folic ~cid is IlOW lOIJ>mended
dUlinl ~arty pregn ancy.

Teratog en ic Habits : Smoking, Alcohol, and

Infan lS of heavy-. moking mothe.. .......'" . how n to "'''''
offspring w;lh higl>ef incidence of cleft lip and I'dlate. In
..... ny c~sts. the birth _ ight was decreased, Alcohol d uri ng .... rly P"'i""ncy may ~Iso p rod uce cooge niul ~fecU sudl ~ meoW ~d.lli"n. v-tb deficiency. and facial defects. This is known as ~al okoItoI syn drome. ",",xillary hypopLosi~ h.u "Iso bem ... ported.
hm r>otflSivoe c~rJeine comumpI"'" tws bem i...-plie>l tel in """'" _
Iopmenul defects.
In pnn.ll, 10 rl'd uce leutopnic twzMds, " R _ _ 01
should .Mli<I dlUlCS and quesrioNbIe
Nlllts at
lime o f tire fi nt mls<ed rnenmu.ol period
and for ~I ~.ost 12 """,ks tlrerufter. This will prolKt tire
developillj human embryo dur;1lj l he time wben il is
su<ceptible to I...-~togenic effe,;t...



I D~opment and Maturotion of the Craniofado! Region

Su m m a ,.".


Self-Evaluotion Review
The contact or t he ' perm and the ovum in the di' tal uterine
tube results in ferti li2ation and production of the rertilized
ovum o r zygote, wh ich then rapidly divides as it moves lOward
the uterus. lit the end of the r.rst we ek, the zygote implants in
t he uterine wall and the re sulting bl,1Slocy-,t, with an embryonic disc developing within it. lit first this disc i' compo,ed of
two layers, ectoderm and endo derm. A notoch ord then develops and the disc elongates. On its dorsal su rface a groove
appears. which i' the prim itive streak. A th ird germ layer. th e
me soderm, develop, between the ectoderm and endoderm.
The neural piate elongates. and its lateral boundaries bend
upward to form a tube, This tube enlarge, and form ' the bilat eral cerebral and cerebellar hemispheres of the bra in.
A yolk S<lC rorms beneath the noto chord and el ongates to form
the gastrointestina l t ube with an enlarge ment that becom es a
Stom~Ch and an outpouching for lungs. pancreas, liver. gallbladder. and urinary bladder. Above this tube segments or
somites ex te nd ~ Iong the body wall on both sides of the neu ral tube.
These somiles. 38 in numl>er, d ifferentiate into a portion form ing the dermis and a cartilaginou, portion teTIlled t he sclerolOme tha t o ssifies inlO the vertebrae. There is al' o a muscle
portion termed myoto me, which supports the ga strointestinal
t raCl. body wall. and limb mu scles. By the end of the eighth
week. all major organ systems , uch as the neural , gastrointestinal with assod ate<:! organs, reproductive . and uri nary. an d
systems such as the va,cular have dev elopt'<!. The face appears
human by the beginning of the ninth week, at the start or the
fetal peri od ,
There is a general incre ase in body length. and the n an
increase in weight occurs. At this time. specialization ta kes
place as the body prep;lres for birth. At birth. a number or very
rapid and important changes take place. One is t he sh ift from
placental oxygen and carbon dioxide ex, hange to that of th e
lung ,. This shirt is as<ociated with dramatic changes in the
healt and cirrulalOry pathways. At birth the lungs inn ate and
the baby goes through a change or environment. ftom fluid to
air. th e new environment t>eing 'ome 7' C cooler than thaI in
which it has exisred ror 9 month"

I. Define the terms: ovulat ion, fertili2ation. and

impl an ta tion ,
2, De<cribe the two vascular systems of the embryO
and the con tr ibution or each.
3. What do somites con tribute to embryonic deveiop ment ?
4. From what does the ga strointestinal tract develo p?
Which organs develop from it?
5. What is t he COmmOn feature of muscle tissue?
Name the three type' tha t develop and the functions
of each.
6. Compare the prenatal an d postnatal heart and
describe the important changes t hat OCCur at birth .
7, What is the origin an d function o f neural cre st cells,
and what is derived from th em ?
S. Name t he three germ I~yers and t he derivatives of
9. oe<cribe th e deveiopment of each type of cartilage
and bone ,
10. What may develop from geneti c and chromosomal aberrations?
11. Discuss the various env ironmental agents t ha t can
act teratoge nically on the hu man.
12. De<cribe the birt h process.

Dr. Alplio " ", R Bum i prov i ~C<1 Fig" ,", n.s. 137. nd 1.3S

Sugge, t<><! Ro.d lng s

A'IOr; JK. oel'lop mo nt ."d structure of cell" nd t ;,s ",, ~ In:
Steele PF e~ . Essenti.l, of Oral Histo logy and
Developm, nt, St. loui>: Mosby Inc" 19'J9: 1- 16,
Cl rl'on BM. HUlll1ln Eml>ryOlo81/ ond Develop ", e" ", ] Biology.
St. I.o"i<: MO' by Inc,; 1999,
England M. Color Atl.. o f l ife Relo re Birth. Cilicago. Ill ' Ve.,
!look Me<I;,,,1 Puhli.,her>: 1993 .
Cuggen heim tl. Sll. p iro S. Or,1Biology ot th. Turn or t he
C. otu ry. B,,.I: Ka.lrger, 1998.
Moore KL. E"ontj, l, or H" man Elllbryology. T", ,,,,to, Be
ll k<r Inc.: 19 88.
Moore Kl 1"h< Developi"g Humao . 4 th ed, Pllilad, lphj" P"
W B s.." nder<: 199 3,
Ni,hmu" H. m"noto N. s<q""nti, 1A, la, or H" m. n
Conge ni"l MalfuT mation'. ll>ltimo re, Md: Un iver<ity P".
Pros" 1976!'osw dlo D. Th< P>thogenesi, of t il< first , nd se<o n ~ b" nchiol
. rch ,yod mme . Or,,1Su ;, 1973 ;35;302 -328.
., . d le, T ed . longm:," ', Modic, 1[mbryology. 6lh F.<I.
iI.lltimor<, Md: William, & W i l~ i", ; 199(1.
SI"'rb<r CH. '"njo r..,;. 1Embryology. 4 th ' d. london'

Bulto......,'th; 19&9
Sl"" be r CH. C"n;ol.., i. 1DeY<lopmenl. Toroow ; ~C Decker
I"'.: 2000 .
Torw e> Gj, Principl., or H"man An,mOly. 8,h od Menlo P.rt.
CA, Add;,on wesloy [..,gllla" Inc.: 19')')

--~------------------ "
:2 Development of the Pharyngeal Arches and Face
Jan'le" K. Avery

aptl!f Outlin


Initi.on"n or lilt oral c.Mly occu rs in l ilt rhird pR1Wtol

~.-s a 1"1 or ;nv4iIWtion <Jl 1M tissUl'S underlyins
lilt forebrain. ~ pit 1......,;0
in length ~ tM torrlJrain
""p,onds .lOteliorly allhi, d
This p it willl"'.... ~op i 1110 t M or.1 elVity. anclthe tiss..... surroondillJlI wi ll
p.1rt ollhe f~ and ned: .~
form tilt f.~. n..,
formed by tilt pl>.lrynl!<'al arrlJes IlI.>t ,urmund Itlc 01,1.1
pit on bolh sides of the nf'Ck. 1M pll.>ryngeaJ .,m ... COntri bute marh or the fMC and n&k. In thO' t hird ~k the
r'r<! ph,u y nS"J I a rth (",m. t he mJ rodibular
a nd
<~h CrOOVM S<'p.l rJ le tile p haryn geal ,....:Ms inilially.
Gradu"lIy. h"w ew r. the ""m po"" " t, of the fJce unify.,
they gL'OW, J I1 'lWi n ~ them to merge into til. cheeks,
m,, ,,d il,le, a nd n"," <!ruCl u,. s, FJ cial de velopme nt 15
fairly rapid. ' I>.ln ning only J 2-week perio<l f rom tlNo forth
to the ~en l ll prenata l W<'f'k. Init ially, t h<ore are four pri _
m.>J)/ tl"u~ "" ' '''', terlTl<'<l t he from,1 or fro"lo",,",al
prom inence. lhat l i~ ,bove the or,l pit. two "", xill'J)1
IN'St'S o n , he rig!ll and Idt ,ide<; of tl1~ or,l p it.. an d tlw
or first ph' I)''W',1 arrh below II (fiB.
2.1~ I" .lddltio" 10lhese pri"", 'Y proces"".. ,mall lh lck
enings appf'ar In tM ~Ihelium of the two pUoco<les thaI
IOrm ~n<n of lhe f/Ye. Biuterill nasal plJcoo:Ic< also
d<'vdop. Th~ Ull~r """ louted ,~ me d.-..elo9ina:
Upp<'l" lip. ~ also appe,r biuterillly: thesr Iom1
OW" orpnJ of Ilearina:. ~ nn.almido'ning< vadlUlly
devriop ;nl1l pol.. U'rll1or'd>l pits. whidl dotepefl 111
~ our OIP'" of smell OIhtr mdodleliJlthic1r:ftli"l' appNf inI"""lly in ,be oroplwynp'al """... IorminI the glands: piruiury. p.aralhyroids. d1)'mids. and my..





rocus in

~ . 2 1


Do ..
of"'" Primilive Cranium ,nd On:>nasal (mIy_.12
Pha<yngeal ~t ... 23
l'hyro;d G~n.:L 24
Pituitary GLlnd ( 14
facl.ll ~ ... 1S

Ear ~opment. .. 17
[ xternal""'... 17
Midd~ .nd inne r ~ar...l7
oe""lopment of facia l fe atu re. ... 1 7
Pal't. ... 18
P,kltlne She lf Growth , nd EI abo n... 28
Tongue.., 19
Pal' l lne Shelf Clo,ur. and f u. ion... 30
oe"" lopme rn of Structural Component. of Ihe Hoad and 31
V' K ul.t ure... 31
Skelet.1 [Ie ment' ... 33
foc i, 1Mu. d
, 34
Inne rv<>tio n 35
Oe\t.lopm....tal " no mali
Co"",al Cyst< .nd Fistul.> 37 Cyst, .nd Fistulas... 38
Miindibulofaci.ll Dyso,tosis 0' T,~... her Collins' Syndrome ... 38
Cloft Lip... 38
Cloft Palate... 40
Summary... 4 1
~-EvallUtion Re-t;ew 41

.... ,

l!tis ..... plef is on ,"" ...cond monm of


I'IftI,lYl lire. W'htft It. tissues 0(

l:.>cf, and or'" C.M1y
""" ~nt dlffftmli.llfll and bfgin to form.


_P'*r _ _

, .,..)

" h e r 'Ndi",lhi' cb.l1ll<1".YOU should be able 111 de5Cli~
me fonn.ll~ p~' or the primitive oral c.wily. Ihe
.ppeara llr~ .nd modif",alion of lhe pll,lryngeal ard .n

fl\IU r~ 2.1, ~Iopm""t of t he

f.ooe . 14 weok.

Th~ .pI'lOO~".,.,_


I P!w!/oemrof and Maturation 0{ the Cronio{ocial !!!'gl(ltl

."-- You 'hould ~I.., ~

pouo::tIes ~nd lhC'ir (OIln>budon 10 or.ll ,,"",Iopmrnl ~OO d<'5<Tibe l~ ~1Qp
menl of !be IOngIW .and ~"" sIrdYrs. fioWly. you
shoukI ~ oIIk to ~ ~_ "",Ilorrrwtions of !be
Aa.and cfuotn '-1'- ""'Iform.>tiom occur.
~ .... lheir contribulian IG I~
~blr 10 ddine !be plI.Il)11III'.II

... G

Development of t he Primitive CTanium

and Oron.asal Cavity
The I'rimi~ ou l pil. or sromodeum. i,.n inv~ gi n.ll ion
of Ihe ,urf~<e epitM lium pos itioned .nteriorly bet .......n
1M forebrJin .nd lr.e . dj...~nl ve nl rJlly d.......lopi"g
hean (Fig . 2.1). Thi,l nvaginalion Jppl'o1tS . res ull of
Ihe forobrai a', anl erior g rowlh dnd onldrge merll or l h.
develop ing hea rt The or. 1 c~v ity i'jXlsitioned in . ' p'
und., the (Figs. 2.2 -2 .4~ During the th ird pt"\'.
nat~1 week tho det-p end ofl h. oral pit is hne<! wil h eclOdenn. wh ich is in do... ronl.let wilh the endod.nn of 1M
l"oregul (rig. 2.1 ~ The Jre. of conlJet of Ihe two epithe
lia i. tennC'd Ihe -oropll.ll)11lll'.1 since u
form' I'dn of !he orJI .nd plI.IrylW'Jl ~rolies mol sepirates [~m. Tho:- orop/wl)11lll'.II membrJ"" tllm dislnlr
;rates 10 erNIe .lO .lOtel'lor extem.11 opening of !be pslrointestin.ol t1Xt in lhe I'ow1h -n of lile {fiS$- 2.5.nd The ori1:in of me heM! J OO is !be R...........lI
pWte ~ lies ;" !be .lnmlor
oll~ embryonic cD;
.H 18 <Wys. The .... ,.11 pLItt lhm bends inoo lube 10
form !be The Im....l "",rzj", of lhe' .........lI pWe
lhen J"""" don.ol position. Jnd nnJ'JI ern( nil1
~ ..... from !be dc>r$.l1 ....,.1 tube. Tbeso' cell< then besin
IJxoi' m~lion dowtllhe ourndo' of lhe n""r~llubrJOO
give ri... 1O lhe cel l' l/wl form the d ssues of lhe he.>d ~OO
fJ ce. The dewlopmeOl~1 p.1tlem of lh e... murW,," i,
lbo ug ht to be J conJinu urn from l h. iTIitiJlion of mese
<eli' to their ce. , ing 10g row. SHIJ ("'TI i~ hrdgeIH,g) prelein i~ essenli, l for mediol' l_r.'1p.1ltern il1g of the nell,.,1
pIJt~, " nd late' do rsoventral p. lterning of the ncural
lu be.


_ _ _ _ __ _ __ _ _ _ _ __ _ _




Phar ynge al Arch Developme nt

The lIiS O'" bor<1crin~ Ih e ora l pit infe riorly " nrl lalef .Uy
d......lop into five o r ' ix I'di rs of tha t farm l lKo lower
.,. n 0( t he fa",' or ne"',. ~ bJr< all' Iffmed ph~ryn
gl!~1 tl>ts-' ~ firR four pl\;Iryn~a1 uctlc's (nllfllbtR'd
I II) IV crmioc:Ndi.lllyJ .... >Wil d..e1 o;>td in h..........
Only the.- firu ~nd ....,ond txlmd 10 (/Ie midl"w
.and e~<1I MCh is prog.....,.~ sm.olltr from t he tiD( to
t he l.lSf, The m.lnd ibu la r ph.lryngl"al an:1l is thO' fim to
M...e lop (Figs. 2.5 ,md 2.6)
the hyoid i' Ihe = I\d.
Thm tht.>.... i' an am , m lX'. "" io r growth gradient (FiB_


2_7 ~

T1w th ird. founh. .and firth MChe 1"" comi.. o f

""i,...j b= of rp;IMlidl~ ~ whicb ....
dMdtd in lht midli"" bf i do:fI in Wl\Idl l lKo hurt is
po<itiono<l (fi J- 2.4 ~ EiIdl ~n:h lin hoIi%Ont.111y In lht
nod ~nd i' ...""Wed from ~j.Kn11 . ",tws by .h.llow
groovt>, extern ally (Fig, 2.1) dnd by d"'l' pharyngl"dl
pou , he, in " moll y (Figs. 2.5 a nd 2 .6). The o uter .I urf. ce
of pharyngeol .,ello, is ' '''''''''d by ..<:loderm . nd the
in"'" (pl\;Irynl!<', lj w rf.Ke by O'fIdod<onn. """'pt for Ihe
ftm ' reb w h ich is liTll:'d !If l00t1 01' of ~ OQI mUCOA.
Wi'!Iin ..h ~.l mil . ... ....r.. <JO'Sl ~1Is.
whidl lio .round. cor<' of mnoo:lcrm.I.l air". In..h Meh
lh ..... w ,11 bO' diffi,...."li.l' ion of musclH. urtil.lpos.
bones. blood

V<"$~Is .

and ne lVl."S.

Fig",.. , 2.5 a" d 2 .6 .. 1'" i!lu'll'.ll io n, of lhe ex,. r" al a'

~I as Ihe pl wyng<'.1 views of Ihe . n:ll Syslem. thO'
ptwynv.I .n:he'S .... denotf'd by Ronwn numer" , 1 10
V; ,I><' JlOOW'S.nd ~ corrnp>ndi"l im .......1 ph.aryngO'. 1 pouches eee ~,f'd by Af.bK

numer.I,l 10 5 .
The n", ph.l)' ng....1gi'Oov. Me]>e", ' 0 form lhe ex,. ma1
.cous, l< m""t u" Or e~ 1' canat The ectodO'rm. 1 mCm
br~" .. In 'he ""Plh of me g roove lX"" i' IS . nd form' Ih..
lymlU"ic m..mbr. ".. lOi"lMr wilh mnoderm . nd
' I.......... 'm from!hl' .ad~l first plwyrtJN.1 pouch (ft&.
2.6\ The I!'XlHf\iI fe.iU~ of me S'OIliI, lhiod. Mod
fourlh ph,uy"P''' gro<M'S.Oft obIicn.,ed by 1M <Wf'I".
grow'h '" th.. seconcI plI.I'Y"3"" . ",h .m<"liorly. w hich

.... cI~

fig. aPb>ltrior ........ _ d ~ ~


d in iCo11Applica tion
The IMt. of norm.d &'OWlh ~ in !he ph.arynge...reIIes
Coln uuw cIl'fects 10 ~r in 1..... I.l,..... olSPlS of the """"ThO'se .... fts ~ ........ 101/ imo <y>ls. causillll Ioc.lil<'d
' ....Ilings 01 fiSlul.l, ' ha l mucous """",ion. on ,I><' neck.


" _ _I Qe\l~!gR'!'.ent and Maturobon of the CraniofacialRegii!!7' -

after Imioo w it h the fifth a r<h prov ide,,, smoo t h , ,,rfan"

for t he neck (Figs. 2.7 a nd 2.8).
Endoderm.1 epit heli um. w i,ich line.> tile phJ<,/Oz e.l1
pouches, deve lop, into a v.,ie,y of n rg"',,_The midd le
ear ilnd e us tach ian tu b<' d eve lop from the first pouf h,
the palatine tonsil, from the seco nd , dnd the inferior
p;>rathyro id dod th~ mu< from [he tll'rd. From t he fourt h

pouch. the superior p.1T,' thyroid glJnds develop. ,' '' d

from the fifth the ultimobranchial body (f ig" 2,SB and

thymus is rel,>tively I,lrge '" birtl, ~ ll d contillues

to grow until puberty. Th ~ re a ft e r it gra<l" ally atroph ies,

dl"' pl"'.lring later in ilfe. Tho ultimok m ehial body fuses

with the thyroid ~nd cm\tribute< p",o folliculJr cell, to
this gland. The parathyruid glands funnloo throllghout
lifo in c" lcium regul" tion: the tonsils f" netion in lymphocyte development ,1I1d I"'LllunoloRie fesponS" f"ctor$.
f ig. 2.7 Pilaryogeal "", he, I to V,

Thyroid Gla nd

Il! br:


, , _ _; "''''';Or


e:;c-_ .ThymU"


f iq. 2.8 A Q.mgtOWl h at t he ""an d phoryngo. 1,,,h to th e fift h arc h on th e

exte rnal ," rfoce, 8 Devel0l'l"ent of th e I1. ,yng ea l pouc h., . nd the ;,- oo' '''" ivo< in t ho ph" rynx

In the foun h week the thyroid glond appears as an

ep ithelial primordia in the fi oor of tho mouth; it is 10c<1ted io " dep ression Jt the junction of the hody J[\d b.''''
of the dorsa l surf" ce of the tongue (Fig, 2.7)_This area
becomes a blind duct, the "for" men cecum: from which
the tllyroid priLllord i.l will develop, This ,mJIi "''' ss then
l en gt h ~ n , to d~ >c ~ od in the mi<lI iTle of the [l eek J, J
bilobed diverticulum, reaching its fi nal destination io
front oft he trachea il1 the sevent h week (Fig. 2.9), During
thi, migrJ tion, the gland remoins connecte d to the floor
of the mouth by " n epithell,,1 cord th"t I"t er develop"
lumen " nd becomes th ~ thyrogloss,,1 dun. 1h is duct
I" ter become, J solid cord of epithelial celi, that ,u i>,e <Illemly di,i ntegr,'tes " od dis.;ppe"rs. Tlte thyroid gland
b ~g i ns to f'," <lion by t h ~ end of t h ~ third pren. t,,1
mont h. when colloid-containing follicies begin to
appear. Its ,ecretion, will 1,1ter i,ove ~ n effect 01\ tile
body's metabolism.

Pituitary Gland (Hypoph ysis )

A' the or,,1 cavity ~ n l a r g ~ s , a s ~ co n d import. m
eodocrlne gland develop' in tho roof of the or,,1cavity as
,' " ectoder",o l_lined pouch, termed R,ll hke', pouch. The
pouch gLUWSdorsally in til<' f onnenive t i "u ~ tow.rd the
ventral , urf" ce of the briliLl (Fig, 2,6), where t h ~ middle
ol1d poste rior lobe, of the anterior pituit,u y deve lop.
Both t h ~ mi(ldle and po' terior l o b~ , of thi, gl,H1d <Iewl_
01' from or,,1epithelium, The posterior lobe- the n ~ lLf O
hypophysi' - develop" li'omthe Infundibulum, which ill
tu rn d~ve lops from the b",io. The pitLli l,'ry gl,md is the
master endocrine gland "nd im~r"ets witll " II the other
endocrine gl"nds of the body.

fig_2.9 Sile of "ndoc rlno gi, nd, in the pharyngo, 1pouche , in t he

<>rOpl,"ry''' ,

Fadal Development
n.., fiKP <I"""lops <lu"ng t~ nlth to """'nt h we<> k of
""rill(' life from fou r primord ia t h.t sur round . ,e rtt rJ I
dep re" lon, ti><' prim lt lv ~ or,1 pit. Th~ f" iJ I prlm"rdiJ
..... , Ihp fl'O<lt.1 p~s" ~ ' ingle p~" IOC' led above
the or~l p;t: lVWI mnill~ry procnsr< Ioca~ Iater~11O
thP or;al pit: .ltJd t/>p m.ondibular .rdI. or promi~. below !be or.ll piL The fWO mu.iIWy pronosses
Mi'" fmrn t~ liN pIw'Y"P'<ll ~rrh (FiJ. 2. 10~ Thew pOmordi~~';'" be<:.a"'" of ~ll'rs of
~ <Itoriw<I
from mCsOOpnn,1 cell prolifer.>tioo ~ " d difJe....n'i~tion
!Iny intorruptions in tim ing or intoroKlion .t this e. rl)o
't , ~e c.n """ It in m., lfo rm' tion. The m .n d il,ulJr
proc~'s ~ppp,rs initially a, ~ p.1rtially divid<'d st"...t"",.
b"t >oon melX"" atlt'K' midline to form ~ <ingle structure
(fig<. 2, to and 1. 11~ This p""""" or ~rd1 g;...... ,;... IO!IIP
mandilW, lhe ~ ...." ottk fM'p _ !lIP body of tk
tor'Ig~. 11le upper faa ~ fmrn , he frontal proce-;s
That""""oe-. !lIP fordJI~in. 11le fWO mu.illary PfOCPU':S
~re ;ncompicuoos .1 4 Wttks, bul 1~ler will 101m t~
chee ks and mo<t of t~ upper tip,
By t he tate fou nh week , nasa l placode , develop bilatcrJ lly at tl10 low er m,ltg in of t he front J I p rof P' S, These
placorlt1 q.. ickly bomP "",,,,....t ~s thE' ti.o;,.... ~ro.. nd
thm\ JlOWS, (~using thtm 10 apput ~ The$<.'
depres>ion. ~'" now 1,,""1'd !lIP ... wI pit';, ~nd lhe ~ ....~
in whidl ,hoy ~~r ,he "frontonawf I'fOttU. '" !lIP
nas,al pits ~ lllP)' room 'he 1lO$b'iI5: tilt I.......
~mund 1M pill; pnlatJft. ,,"",Iopiros; into I'IofKo1.hoe'hapc-d elevJoon. wilh t!x'ir o[JC'n md. in conl.Kt wi'"
the or.1 pit below WI&. 2.t l ~ Tho mPd iJl llJ sal prOCf''' is
the ti'we m", li., 1to the "a,,11pit. The lateral pro". 1,'1_
eral to the pit. i, in doS<' mnl.>cl w ith t t'K' maxillary
proc~ (Fig. 2. 12~ 11le con tact ZOO<' of t ~ ppilhelialCOVPf'ed ml'<lia1 .....,1 ;ond nw<il"ry proo:esses t>o""",
!lIP f .. ,.;on si.... oJ I~ UPPC'f lip. " It oJ fusion '" this
si.... R'SlIlI. in ~ dPft lip. "'!lIP "';'helUi M'Iinss ofme



!l'o oe., '



Oral p/I _. ',:


Fig. 2.11 ~ 01I""" .. 6 - "


~.~ __'_De"!i~pment and Maturation



f i9. 2.13 Bre,kdow" of t tl<> n,,,,1 fin Arrow, indicate zone or cell inte nn i,,gling

Lateral nasal



6.5 W

f ig. 2.14 Format iun oJ th. ""W il '''d prim, ry p, lat e. Arrow> indicate
of ponot rol ion.


m, xill, ry . nd medial no",1processes come into contact,
they normally fus~ to form ~ ""0<.11 fi [\" (Fig. 2.1 3), Tbis
vertically rositioned s he ~ t of .p it h ~ l i a l (. 11$ is in the
proce>s of groWing ond , Iso dlslnteg,.ting, As these ti, su ~ ma" e, exp~nd. tlte epitltelial sbeets allow corrn",,tive-t isSlI. (ells to penetr,'te tlte , 1,eelS, o"d ~,,,,d s of
connective tissue then bind tlte lip cont. n "'". t" gell,er.
A numbe," of factors can interfere with tlte fusion
p"x~", , uell ~s gt:netie preaisp<l.'i tjon ,"'dlor a lack of
blood supply, roor nutrit ion, (h emi".1 .1g. " (S. l' hy<ie"1
interference, J nd timing. Fusion of tbe ep it h ~ l i , I - (ov
ered proces<es occur' .lntcrloJ'ly, but not post~riorly
w h ~ r~ the fl oor of the no,tril rem,tin, 01,el1 . However.
wlten fusion of the lip OCCllrs, conn",tive tissue , nJ
muscle cell, grfYW througlt the nasal fin (b ,rri~r ) to form
tlssu~ bands that strengthen the lip fu<ioll site (Fig.
2.14). Normally the n.s. 1fm will di" ,I' p".lr in , lew d<ly<
and the lip will proceed to form.
D,,,i ng rhe sixth week. the two mediai nosal processes merge in the midline to form rhe i[\termJxHlJ ry segment of the lip (fi g, 2,12), Thi, remove' lite midline
" OtCh " nd ~lIow.' tbe primary pa la t~, immedi' tely posterior to the lip. tlle oppurtu"ilY 10 develop J nd J iso provides a site for the four m. xill.ry inci' o' t""t lt to develop. t..ltl'r, the segment of tissue in the ,.~nter of (lte lip
forms (he philtrum, The pltiltrum i' limite<l lateraily by
the two venica l ridge, of ti" ue ",,,l er ,Ile nom ils (Fig.
2.12 ). Inltlaljy. at the l' ter, 1bound. ry of the me,li,,1 seg
men! (the philtru m). thel'e is a fi ssure wbere the Une of
fusion of the m"xill,lry o"a meai" l nas,,1 process meet
(Fig, 2.13). This is the vul". r" I,le " rea of the lip: di,j ntegrJtion of tbe fusion site will ",suit in , ,.Ieft lip (Fig.
2,12), The uPI,e, lip i' titus composed of three p.1rt5 : the
two m.x lll.ry processes grow inwJrdiy from tbe sides.
" nd the mediai maxlll. ry segment grows in J downwJ ro
di""tion from J oove to inte rdigitate be-tween the m. , il
i, ry pro<es, e,. The, e even ts occur dUl'i ng the sixtl1 week
of int' outeri ne life,
The floo, of the no<tr iJ lllen fuses in on aL1tcrorosterior
direction. "nd , t its mOSt posterior Iwint there Is " n
opening into tbe roof of the or. 1c, vity (fig. 2.14). Tltu' ,
(lte no' tril, 0l",n on tile front of the developing f. ce and
n-rmin. t. i[\ ., n openi ng in the roof of tlte moutb, This
will soon change when (he p" I,'line sI1elve, . which " rise
from the maxillary processes (( lleek (i" ue, ). g]'(jw 10
meet in the midline of tbe palate. The p, l, ti" e , hf lvo.'
f" se. , ep. raling rhe n<,,~1 J l1 d orJ I"ovitic<,
The "Yes aevciop dUl'i ng tlle fifth week of pren. ",l life. A
loc.l ized thicke" Jng of the epitheH um develop, on th ~
sides of tbe hOdd, fl'o m whir-It Ie'" pl<)C(x les for m. These
are po,itioned betwcen the maxill.ry process., ,md the
fronton.1$,,1 processes (Fig. 2 ,11). Growtb of th<' 1.n-r.1
forebrain c. u, es 1.(el'.1 ~x p~"'i on of the face. The
bl'OJdcn lng of the dllring the , ix(11 wee k c~ u <e < tlte
eye< 10 be positioned morc anteriorly on tlte fr<) rlt of tI,e and the n ~ SJI pits to oppcar more (e ntl,1 in t h ~ f<l ce
(fi g. 2.12). The di, t,lTlC<:' helween tile nJsa j pits docs not
decrease. aithough It , p!""" to do <0 , ,IS .' cen in Figures


""'''''''' o{~~Atdlt"SondFlJCf'

2.11 and 2.12 In. tNd tbt wid th of !be "'lft'al r......
~ 1.,...,-.1 e><p.In,ion or 'ho! brain, which Cause.
fh ~ ey<'S 10 m",,~ 10 rho! front of rho! ' .ICe, This widMing
of the I,u', occu" during the sixth " ,..,nJtat werk (Fig.

Ear Deve lopme nt


Erterrwl rOW. Duri"l lhe <ixlh

lilt olftNl ear
(.lurid .. ) dewlop. from .... IDMftI(bynul . o'cllinss or
hillock.; Ih,..,., from tho! fi rst ph.>ryrl&"al arch and IhJ~
from the sond or hyoid arch ( Fig. 2.15\ Th.... six
hillork ' .,ppm, in l h.. " 1'1"" and low er part of th .. chee k
that sur round , the first branchial ckoft. Thi' ck'ft will
d"""l 09 into:> t he .... l auditOry ,.""l TM hillods
will pow lInd mO'fP' 10 form , .... nlnnol en (Ag.
2. 16A~ As lhr t. JI1'W' fOlWOrd and downward. rbe
<,;oro; wi ..".;ntain ~r posi tion on tilt' W."..lI ~ {Fit2.11 \

Middle . " d inne r ea r.

n", midd~

fig . 1.1S ~ 01"'" fir,", _

6 ..-.d 7.

ear i. bo"flded

ext' ''''ally by rhe tym panic membl'ano ( rdrum ) and

internallY by a th in, bony partition that com ain.' two
'mall membrane-bourod Ojl<'nings. n.., middle ear co ntain, th= $lN11 00,,": m e m.>IJeus [ ha m lm' r~ which is
.ftiId>t<I fO 1M- tymponjc: mmtbr.M; thr illCUl {.nvi l~

which is lbr ....cond baM; ~ 'br wJln {S1:irrup~

wtDch is OI1.lChed fO thr owaI windoW lInd ~ infO m.inner ~"r (V1g. 2168 ~ n... tb'ft' br"ring bonn "'"
. ll.><hed ~ m in u l~ (~) lig;",... n... n... function of
lh"'r th, ... oone, i' to . mplify and (o nd ue! "'und to lru.
inller ca r, where LlNVe r" ding' c.rry im puJ.e, 10 t h'
broin. Th. inner ear 0( labyrim h collSist' of a eomplicatrd.eriei: 0( ca""l.. n... """""'" pan o(lhe iOll('r Nr i. the
vestibule. wbidl is con'rne<I wi lh balontt. [Fig. 2 168~

Development of Facia l Fea tures

Fig. 1. 16 ...O<\.lop< ,... ~ 01 "'"

The co nlln"rd develop"",m 01 1 fr alUm

i. II.....,ull or different i. 1 growth brtllLgh t abo ut b)I the

inere.", in breadt h of lhe medial . nd l' INal n. sal
p","",s,"s.nd by the inoNse<I growtll of II..- nla.Kill . ry
pn:IC1'sst'S. By tl..- sevftlth -..k, II..- r"" has acqui red"

Clink . 1Applk.tlon'


Alter. lion, in the de velo pm, ntall iming of " , I,u elU,," ea." result i n dowlopm.nul defect . In lh ~
v.sculo, .upply ol thor face. for allnlple. " cIcfr(f
may mult ifll..- I'IOlll\lII shifl flOnl i"r.mal lOf'l<tn"..... ca.roIid .~ oun. e....."1 v.ucular dd"1Omcy 1 Ibr nnw or orpnizarion . nd diffi:n'nlo..
lion 01 II..- f.><iJ.1 {~ . V"C\lI"t .nd nutritlon.1
b.ll.l~ Is crifie.1 durilll th. _nIh w..-k.

n""""" _.
E" orr,oI _


mo re human a p",,",~n< e (Fig. 2.17 l. A' thi, lime (I' e

mc dial p"n of the face increases in on anterior direction.
As ver(icJ I height increases the bridge of the nose will
develop. '0 th, t the nost rils J nd eye< will nol be o n tile
same horil.ontal pl. ne, The mou rh is very large olr the
fifth week, but merges at the ang les to lim it the size by
rhe ,e venth w""k.
In the newborn , the nose i' not yet fllily ,I evelup~d ''''d
doe s not acquire its inherited size and shape unt il pllberty. '111 . eyes hJve moved from the lateL'a l aspe ct of the
face to the front, ~ n d ,1S the orbi's develop the eyes do
not protrude ", in the ' eventh and c;g hth we-eks, In normoll development, the distance se para ting the eyes
grNtly infiuences tI'e ,ppeJr,l nce of the b ee. A nolrrow
interoclilar distance (hypotelorism ) ( o nfers a ' harp foxlike appear ance. An increased int erocular di ' tance
{hypertelori, m) CJ uses the fJce to appear I>roJ d. The
o rbital covities att,in their .' du lt dime n' io"-' when J
chitd is aoo ut 7 years of oge.
Fiy, 2,17 De-elope",nt ofthc f, co at 7 ",,,,k, .

Mfjd>al pal",oo. p roces s

{lulu'. ",ema, iUa)

Lateral palat ine proces>

of ma>:illa

f iy. 2,18 rNveloplno n( althe ",Iatc

During e.> rly de yelopment. the mJ ndible is at first snlJiI

in comparison to the upper part of the f.l<e. It then grow,
at a more rapid p<lce in the eighth to tw elfth week s.
Crowth of the mJ ndil>le then IJgs behind thJ ( of ti, e
maxilla, so the f<"lu5 di ,p l ~ ys a ' ma ll lower j~ w (microgn at hi a~ In 2 weeks, the fLfth to s,",,"nt h. a recog ni, .ble
humJ n fJce tJke s shJ pe. The face is for med from five
un. ssoci. led m. ,ses: th e fronto n,''''I , mJxillJ ry, .md
ma ndibular processes. The de velopment or the f.l ce is .1
marvel, the primord ia growing, fllsing. merging, ' ml
en lJrging to become a tecogn izal>ly human face with ail
the a"l "ire<lheredit" ry fe' tu"'.' .

Pal at ine She lf Gr owt h an d Elevation
The term p.l IJte- refers to th e tiss ue int er posed
betw een the or, 1. nd nOS.11c. vities. The p.ll.lI e develop'
from three p" rts; o ne medial and two lateral palatine
processe' (Fig. 2,18:. The med ial palatine process is al'o
c, lled the pr imJry PJ. 1 ~ t e - becJ use it Jp peal" before the
, econdilry IMI ~ te , at the beg inning of the sixth week. A'
with the lip. the prima ry palate develops as an int ermolxiilary segment (a wedge-s haped mass) between the
maxillary processes of th e developi ng j.1W(Fig. 2.18) . The
pre maxillary bones, which Sllpport the fo ur m,lxillory
teeth. develo p in the primary palate,
At the end of the sixth week. the laterJI p.llatine
processe, that form the secondary IM I"te develop fro m
the medial edges of the maxillary processes that bound
the stomodeum. The lote,,1 p, latine processe' (, helves)
first grow medially (Fig, 2.18 ), then grow dowo w<1!'d or

_ _ _ _ __ _ _ _ __ _ 21'''''"""","
of the f'/la~
Io~ and~
_ _"

on ~llltr si(k, or !he' tons... (Fig. 2. 1'~ N. Ihis

SU&'" cI
1",,,,,,,ol.l~ torI&tW is tlIIl (fls.
2 201.llllMt tOi loplelEly fiJlillllht ~ c.>vily. mel
INChn t!I<' n.u.ll ..-plUm. Elevation or m. Po'''fl~
S~ 0CCWl .rt~r d<'S<nll of Iht long.... which allows



lor th<'ir mffling in l lx- mid lin<'a nd fllSio" .

Tongu ~


",",auSO' Ill(' tongI.. is bel""""d to l' ~

in p.ol.1ww
.",,"If ciosure. it Is .lP\l<Ol>fiilt.. ro d,ICu" its d"""I"I""""
a thisli".,... 11w ' ''''IIX' is.
OtJ'In ~ or
a.. _.nor ~ l""""td lht body, and the pelS_
firm/)' attldlN N... or b<-mdIWl pm. Thr-1OnSW
ori:IiIWtn from Ibr fim. """and. and t!lird ~ I
ardln and from migration of musclto from , he occIpI-


'al ~. (fi&. 22 1 ~ The a"tfflor p,on arising from

the first.reh is (0lTl1e<l f, om Ihlff mol5,..,.. t h.. two ..t....
alli ng" . 1' .......II;"g' and the tul>tm,l"m ;mp.a' (fig. 2,21~
The,. tater. 1 li"8 L1,,1 ,welling' ropidly .." large, llI.. ri"
wit h each ot he r. a nd overgrow l he l ul>orrnlu m imp.l r to

form the or.l


of me tong".., A U-, n..jJ<'d . uk us

develops in front of . 00 00 bom ~ of this oral P<lrt
which allows il to be fJ and ltighly mobil .., expf .ot
!he' ~on ollhe lifllll'li rrmulum ~ il n:m.>.ins
a,ud>n:l to thP floor of the mourh.


I", ; , t _ _
oiI ......

Fi9_~_~ 1 TO"ll""

~ment from
OM to.ben:ukl'"

~ ~_

th_ p<;nury


mH"" two l'lorol..,


~t and M<ltura~ion of theCranio{adol ~oon

T_ _ . . . .



The' b;tse of rile ~ ~ "",inly from tile d llro

p/wryngN1 .I'<tln (fi.S. 2.22 ~ Jllin.11y it is indic~trd b)".
midline rioY.tion m..1 ."""'..... bcltind tbr rubm:ulum
""F. wbich is.!UJr br~ia1 "",i ~ of tile rhird
.nd fuurtb .>rt"'"- lim' rhis ...,;"""" ~ tile
orwnd phaynp'i1 MdI, 10 bnumr Ille
- , 01 rile 1Ofl&UIP. n.. .~ oI union btt-..n rile bow
...... I,,", - , oil,,", ~ is Mllne.trd bf ' V-slw prd
JI"'M' ""lit<! tile 'sulcuo lmnillilis- (fi3. 2.22 ~ M...oe
CI'lt. from Tho occipit.1 IJI)'CIIO'"'" micro<" .nt..iorty
into tile t"IIEu" dUri", th.- fiRb to """,mb ~ks. di.a
cr.m of wIIidl will II<' seen I.>t..r in this chapl In l.u ..r
of do'YrioprTlf'nl , ~.nou. type' of ""'pill will dif
fere ntiale on lho! do .....1murosa th at rove" tho! body of
t~ to ng ue. w he reas lym phatic ti", ues de velop on lhe
branchial IMrt of the I<>n~ue ,


fkj. 2,22 fu l ~ fo rmed body .,ld ~ o! lOOguo,

Pa la t in e Shel f Closur e and Fus io n

At about 8 to 8.S ........ k' of intrauteri"" Iif<'. t~ I.n ..... l
p. J.. line </Ieh<eo< oJilk 0' roll ove' t,,", body of til<' tongue
(Figs. 223 ..nd 2.24 ~ n... proc= of shdf ..muoo
ocru" wII<'n lbe- . II<'tvn ;art ....pabl.. of .Iidilll.,.... lhe
tong""- TIm procns
Ily octUI'$ from tile combined
a<tion 01 botb ~r
tonsuo' tn<M:'I11C'I1t. (Fis. u .. ~
Sl:.-p I:
poolerior pam 01 tile pa!an.... sbefn .. ~
Tho tonsuo' bK...... tbe- postmoo" pan 01 tile
llln&Ut' is ..tI.olod>tfl 10 tbe- Boor 01 I,,", _ til. Sl:1!'P 2:
p.. l.1n... ~f ~ion belill5 ;n this poslC'rior ...... bf
tolling forward. wtll"" ~ Tho \OIIJ...... nd pMn
il forward '" m..t Tho !OIIP tip eXII'nd. out 01 tile



fOg. 2,2l l'al.Ri""
it ilOn",iOrIy.


bfllde t~ to"9"" ~"'oOot!)'


mouth. St"J!l: Thi. forw.Iro rolli"!:;lction rhe

.h..l""", from \:Inlde .nd undo'r tho' tongu<'. ST.-p 4: The'
.helve, Ihe n ..sum .. a po'ition overlying tho! 1011I"" and
~ad".lIy move together .. 00 f",e (Fig. 2.25). It is
b<-Iieved th.lllhe longue
.helv.., (" nnion toget he,
in a combin..d actio n, Shelf elevation occurs as ,,,pid ly as
, w,lIowing
I' therefore diffic"ll to ob'etve, The
import,nt con,id"' .ltion is tha I the , helv.., n" ",e " .....,
the tong ue, and th.t Ih.. tong ue tlien br""don' and uli



fOg. 2.24 p.l.rt"';J>e!r ........ t;on 0Yt!I the tt>ng"". ot>s<.-r.... the """,lion 01
tP>o tongU<' the pol' ti"" '""""" """'" ~ . "'ori<><ly during th<'t ...... otl<l

_ _ _ _ _ _ _ __ _ _ _ _ _ _ _2 DewlopIl)~nt ofthe f'llaryngea.' ~e5 and Face_

li"$ l~

'1"""' originally o<cupinl ~ m. """I...s (fi&-

2.26 ~ ~ s: !lo:'cIuse t!w' musck of 1M '''''''''' ..... -'1 22fil il" possi~
1M ~ to
",",u. r...... ..moo in fhis ~s.mel Ilf"S lI&liMl tht
$l'l<'I'in. .iding in 1M l.ioslR pro<flS.



Min 1M ~ ~ p<Kirionod horizontIlty. lhoR is

Ii ..... JIVWtb spurt ""LI$i"l l he ~ 10 rrWI' cooQ<t
in rhe m.:lll...., (""os. 2.27). '"d", cbsun' Of fus;on of tbr
"'I('f~ p.lUll .....
lim occurs immtdi.llriy po$lfl'ior 10 1M l1'Itdi.n ,,",wine procnJ (As. 2.21l P;tl.linr
,105U'" j"""""'" tht proc= of bolh fusion and mergina:
(f f&. 2.28 l When the shrivM co"", infO inin.l rootlet.
the in_ning "I'ilheli um ~. k. down and rhe >11<'1 ....
arp thm united by .11 ;n,"""ngling of (\'11$ aero " Ihe
micm ..... (Fig. 2. 28 A--<. FI" io nl From t ile ]l<>int of ini li al


com.'t In the J nte rior palate, lhe I.leral p. latine

pmeel,es fu. e with the me d i' l palal ;ne process ante ri

urly IFig, 2,28), I"N eriorly, d O'llre lhen takes place

gra<ltld lly over lhe next ,,"ver. 1weeks by the merging of
me two lato'r.' "" Iali"" proce' '''s. In merging, tl><- depo:h
of ~ ... ".".'ing t he Pf~'o.n is di mini 'he<l by

rrowth uOOc1tying t~ gnxwe (Fie. 2.21lA-C. Mcrging~

Fusioo of t~ JMl.l.ti ".. prtlCTSSn ~150 ocrul"S with
lilt' OYe1lyIllI: .......1 st'pIum (fie. 2.26~ = '1'\
pooIrrioIty wbn<' f!w:' soft p.1I.llt' ~nd uvul.l. ....., uoal~ .........Ily. In f!w:' ioitUI ~ pWt;ne Mion
.1'IOIv6 ful.ion of soft ti ........ bul w..... .01 12 --.b bont


in lhir p;>we from

O$Sifglillll CftlI.... (fis.

Development of St ructural Compone nts

of t he Head and Neck

p h. ryn~ 1

r.g. 2.n

...... morgOlg 01t"" pa/atI"" ~ Ar""", - . . . , tM

ti<ection 01 gM1h

Vascu latu re

i D --.J '",,-

_" ehe, or .ortic ar<h ..."se l, su pply

bhld to the f" ce . "d neck, The "",,..1, Jr ise from the
dors. 1 ,'OrlJ, e~fL")'i "g blood from the vent' J ] .lre,
th rough tile Jrchc, dors,lIy, and return blood to the
beart by S<'r~ of bra nmi.1 ...,;0. The"" arct>c, are'
to be wstigial ",m""n,S of fi' h and amphibian>Ihdt axy gen.>te their blood by "",an, of gill, and gill 'I ii' whic h
circulate thl' .urrou nding water. No!' an of JMired
atdle, are p~m at tl1l' '''1ll<' time. The ~rior right
and IriI olfCtI<'s a.-..-Iop first duri"l the faun h ........... and


fiQ. 2,28 ~ 1>eIf <Io, m e


32 _

.I~pment andMaturation of th.e Cro'!~fadal Regioo' -

~n to drgrn.....t. . . mar<' postrrio< .n;hrs ....1.1#'

. nd ~n to funetion {fIs. 229 ~ Ils thr
V6sri ~ns '" <!windl. rte third arch "",sd .... WFs .and
~n , ro functi<>ol. T1lis third .....,...:I will mai"",in its


function .nd ronn. IIw rom~ (.JUlid lFil<-2-lO n

2..l1 ~ Tbr l<>urth ..... lim. .rm on""s
..."t. 1!It'
fourth arch W'<sdl: ",""ina t!lt' d<lnal .-u wppIyina
blood ro thr .... i~ bady. Tbr filth arch .....,...:I1htn dis"PP".... .and tlw "~Ih
rormillll IhI' pWR1(IlI,lI)"
m"'J $UpplyiJII blood I" Ih. lungs. n...r..-tor... of 1M siJl
poi... of b<ano:hi.ll ~scb 'hat _lop. only lit<' third.
fourth. and sixlh caQ[inUl' to funeti"" Ihmughout Iif.
(f ig. 2 .29 ~
figu<e 2.30 iIIUSllalt'S tM embryo al 4 Wffh: the
pair ed br,mchiaJ blood v.... ls are ,hown passing
through the pharyngt'a l-.rch ti"ue, The he.rl i.' localN
ventr., 1to [he a" hes, a" d ~Iood p.lS' . ' dorsally Ihm"gh
tho a,,~e< to t~ e face, brain." ,a re,t of the body. Bythe
fifth wee k (f ig. 2, 31 ~ the first and """"d a"hes ha~
disappeared; blood tn the race. bra in. and body passe-s
through the carot id cirr"lal ioo. which is lit<' third lIlLaI)'ngNI . rdJ. Tbr common urolid I...... divides inro lh
."remal and intr-maJ CUOfid .,-n,ry. Tbr .",emal c.JUlid
artny suppln blood to I"" facr ("'-r !>On ).and lit<'
intr'rN1 CUOfid am'I)" lUppiin bIa<>d to thr {M,.
2.ll}. In thr rqian oil"" t"" inlr-mal CUOfid art"Y
&M"< "'" ro. .....n .......... thr suprdial .-...y. wllictI
supplirs blood 10 thr upprr pan 01 thr faa and .....(fis. 2.n ~ IlIood ~ ro thl' fa<1' by thr in~
o=ntid a.-...y is dwra<U'l'isJ:ic allhe ...-nbr)'o
silUh .and srvmth wnic..
An impoxunl elLa", i" 1M vasc"lar supply t" tM
huma n fae<. nd pa!att' Ukros ~ in the ........,th p......
1. 1 \ttk. AI thaI ti" ... tilt' Slaj>W;,,1 artery suddt'nly
OCtludes and ..." from I"" i"t.mal caTOt id .rtery.
Th. vas.;"lar supply la , ho upper face .nd p.llarr is
immedi. rrly terminated, A Slrange developme nl 'hon
occurs: the trrm inJI porli"ns of the , I"pea ial anery

' ppc''''


fig. 2,29 """I~ arch . , scubr _-k>pml'l'lt ; ,.. t"'..... corotid; 1< ,
"IN", I carotid.

.1 I""


..I.ach lh<mwlYn 101M tnmi.... bra~ of {!I(' ,",,101"_

a~ ~ blood bqins l\owins in !hie oppo-

" ""id

di=tioo throu:&h 1M supfdi.ll W'....ts.. Tht M'N of

thc" UIlP<1" (;,a ~nd p.ola~ thm ~ a ~ blood
supply ( Filt- 2.34). Tho inte'M1i", aspKl of this is th.ol
bk>od now ing Ih'O<'8h lhe supcd ial artery ro its t~rmi.
nal ca pi lT~,iI'< then Tl"V~ itWlf. starting in Ihe fuK'll
( ~ p Hl a r i e , and n,>Wing 10 I h ~ art ery. If thi , event occurs
100 iOle or 100 early. or if Ihe v~".l s do nol fuse prol"'r
Iy. thi, U n m ult in far ial malfonnalion, .",h a< cl~ft
p.olate 0' f..-~I clefi. The """"nth Wft'k i. important for
f.>d.Il growth and fusions. and al"" for f.oc~1 vaKu",
shift. The shih in blood supply from ee i.......... ro 1!>C101"~ c.rotid artC'l)" is shawn in Figurrs 2.n mel 2.34.

The initial skde1 0n of the ph.ryngc.1 arch... and fOtt

develo ps from th~ m,...e ncl!ymaltille within II>t .rch.
In Ihe fLf.t .lI'l:n tn.", cMI ilage b.lrs ..... termed Mt"Ckel's
cartilage, _, Iter lil ~ man wllo r.r<t desctibffi " <l d D.lllled
lefl Meckel', c.rti la ~e b.lrs pt'rsill
them. The right
for lhe first few ......... ks of embryonic ~ nd felal Iif~_ bu.
!.ltc', t hey al'\' rep la'(l by the bony mandible_The carti
Iage bars ~..,lUlly disinl~l~_ Ie.v,. p.on of !hle pf'richondtium .. the splv,lI>lTIoilleola. hga......, ' (an.........
I;,........,t of ,he ..... I~) ...... p,m .. ''''' <pI>enomand ibuLar ~ (fiI. 2.15 ~ Tht postnioo tnmi~
p.ons of Med,,,. . cartilage ar<' the ....11nts and incus,
mlJll cartil"V"l Ih.ol ",sily and thm funCliOll .. middle


..... bones.


fi<}.l.14 \.hIltU D)( Kl f;o;:Ul bioo<j >Ul'Ply from Int.m~ 10 oxl"",.1 , 00000 Kl


In II>t.....:DOd arch. R<-im...n s ( m ilage d......lops sup-



,0. ~""loor

.og. U5 9o<'IrIon 01ph>ryr>gNI -,,",,-

f OJ. 2.33 f oKiaI blood "'WIY 01i<n.....l , MOlid .,le<y by "'~

ped"'I.,t..-y, l<lol. ~ bo", of
, orOlid

..t.. >es>tJ_,-

<0"''''''"_ "",......

~ ~,

earoticl ..IO'y

~ ~_t o:ln~L
M<:l tur a!ion

af!l>e Cr" niofaci<l1&gJon' -



Syn,hom.'. ,l$$Od.ottd with I~ ph,IJ}'I'I#.I.l ~rd>n .... I~

qumlly...m diniG>Uy
crouP of dc*m.. They Qfl ind......:
......Ir""""" eM Oil m>ndil:* ...wl mourn. .....W'ged ~
Of lIIlfqUolI
of tM sides of ~ 1OngUt. molo<dusioon of
Ift(II. cItfr p.U.Ue. 00 ,-,Iilll (~ by' cy<t or drlts on
1M JidH of !be lW'd<. llmolly snn.ll or IIIln ~ .p~.r.
wh;dllP.Ids to !be cUuirlQtion .as' 'Yftdto""'. Thtse ind~
Tre.KMr Collins" syndrome (m.oooibulof.ori.lJ dY'O'tOlls).
Goldotntwr's $1'00"""'" (h<'m,r.Ki.l1 mi<:ro.omi.j,..oo lbe 01"..
(~h.liC lim arch syndrol!>l'.



porting''''' runo:tion 011"" pIwlYlW'.J bor. This uni~

lat..- b....h ~ Vii... ~ 10 m. third middHM
...,.,." st.1~ styIood potnSl. ~ hom. mil !be uppn
p.lIrt 01 lbe hyoid body. The >l}'Iohyoid lipJntnl i$
lUnne<I bV!be po:rid>""dlium . fm.- sil<' 01 dis.lppNr""'"' of mil. S'Odd tit (.ni~_


Illird pAorynp'<IJ-.udl c.rti~ fOrms the IfNI...

hom and ~ ~ of lhot body oflbe lhyroid (fi~ 2.)5J,.
The fourth.n:h c.mi~ foons lhe llly"'id c.rtiWpo: 1M
firth has no adull d...,,,.Iiv6: .Dd ,hi> ""tlt'n:h roni
l;oge. form tlte Iaryngr.l c.rti1.lg<'S. Further .I'~.I
<frum nn .... di<cusscd in ('h.:Ipler 3.

Fa cia l Muscle.
During the fifth dnd sixth week,. myobl"m within the
first orell begin proliferotion (Fig. 2.36 1. n,e m usdc cclls
become or iented M tM . it"" of ori.gi14 <;.I.rry i'lg their Ini
tidily C$ldbli<lIcd 11(' ''''' sup ply (ma ndibular division of
trige minal). ~ In)'ObLJsts will lbcn initiate in...nion of
Itte<l' muscle< of m.1<1iGotiOll, which will continue to
""",,,lop. By 10 ",,",k.. 1M m.lsset:..-, mO'di.lI.u>d ~t("f.ll
plft}'lOid. . nd lempor.ll mu<de< of m.l<fic.t1on ~
emerged (As. 237). Muscle cdl miy"lion 0<X\IfS IlO'fore
1M <~I ",<ifK.11Ofl ttIIlon form ~ In 1M
....ooible. The rnu<de
01 the ~ .-l med~
pb'1,&<>i<! ""'" Jonn .I W'ftic.1 sling. in<ertins inlo 1M
<ite fh.K will form 11v'" 01 the m.1OOibW. The rem~is mu<de di~I"t... in the infr.tempouJ foss,o
.00 in.....u into the de\odopi"ll. coronoid procns. The
l"t.....1pl:.-rygoid muscle fibers "Iso.rise ;n tM inlmem
pou r [0< .... eo<tending ho.-izom"Uy 10 inserl in tM IIKlc
of the co ndyle "nd tM li..1W ,uHoonding thc "
di<e(r ,g. 2.37). The len<Of Pdldtin;, mylohyoid, dOO dnte
rior belly of III<' d igd<t,ic 01<0 . rise from III(, r.r<t .lreh
myobl.lst, . dnd .let' inne"'olted by fhe hYI>Dglo.l 1 rK'TVt'.
111 the hyoid Dr second ph,lryngc,ll " rch, mu>tle cells
~PPC'" d ifferen ti,l t,"" in tl1e ...venth W<'e . Musd e cells
in the ocdplt.ll myot' ''".,s Iwve . J", di fferenti.l' ed .nd



1.J6~ '"

_ _ """ .......... '0 ph;IryngNl 0fd'I01.,

Fig.2.37 ~" t k w"y Irn.=etor.
1jOi,1) ","",Ie> , t 10 >'1<'> "_

''''''1''"' ,1<1.rod """"" I;md !.>tor. 1pl..y-

_ __ _

2 ~of!he PfKlll!)!i'~(lI Atches andFau

In' u~ng .l1ltCfiof

miv"'ion.. lOmtilII rnuKIes of

lilt' IOO&U<'. This .l1lIMor millJ"hon will Iollow 1M p;tth
ol ..... lopm<nf ollht' IOnglr (Fig.. 237~ By 10 ",",ks.
musdf, noll< dlhe ~ M'dI conlin""
mu<cle m.u>tS,>nd ""tend upw.rd _


first ."'''

fJlCf:. an. group 01 mun lis JlOWS upw,lrd intffior to

1M ~.r. OO """
posterior to th~ ~ ... Thi' ;,shown
.,.,. ir'l'OWS in Figurt' 2.3lI. l1l<"SO' r...,idl mu,,1e <~Il. follow
a p.llh nol un like lh.l l of t he plaly<ffiol muscle. up the


' ide urlhe nf<k a nd ovt'.

tr.. m andible. The folCi.ll mu s-

cle, .ri'ing from the nyuid arch extend upw..d over the
race. They furl he r dcV('lop. su perficial and deep group
of fLbc" that anac" l h~ m 'le l"", to s keletal c lc l11<'nt , of

the r. C<' (Fig. 2, J8,~

AI U......nle lime. mu>cleull' of~ third . nd fo unh

ire"... lonn the' brinehi moKI....; srylobrinctliil.

<ricoIhyroid. ~.IOf p.ol.olin~ .1Id consIriCUIr muKb of
1M pb.orynx (ft&. 2.38 ~ ~ mUKIe's Ihm ~ ;
tf>t;r function is COIt$tri(tion ollht phorynx


2.J7 ~

All m...o.s ol'hc lllro.ilr ~ .....l.> f.Ia wia COIllin

"" ~1opi1lJl 10 mfft tbe inm:'ui", functiolwl

In nl!ni3tion

week, the fIlth nerve h ~ s en teTr<l the

nll"de m.,s and the se v~ nt h nerve the second "'ell muscle mo... Thl' me~ns th.l the neTve, ~re
il'KOrP<'f~!ed in l!lese mu><:k' m~sse s eorly ' 00 "~d o r
follow the mu<de cells ~s they m;gt~l~ arod differenh ~l e_
The trigemi""l (V) neJW inlX"fVores the mllSCles of mosr;c~lion ~nd tho f.ori.ol (VII) neJW innefV~l" the mutcle,

l ho

~en th

m ,lIl d ibu l ~ r

cf ~ expression {fiJ. 239 L

The fifth _
supplies senso<y fibiers to lbe
....ndible ~nd 1IW<~1.l,.,.j lJIOlor fibers to me row m", -




I ~nen~ and ~Murotlot1 ~ the Craniofacial Region~

=.. .-

cit'S of nu<tic.olion ~nd 101M mylohyoid. I...,..". ""I.olon,.

tymp.ani. ~nd ~nlf1ior Iwlly of th~ dig.oSloic mustks. TIw ~ ~ fellow> 1M miV~lion of 1M
f.xi.ol mun ~ from 1M nk 10 tIw f~. wbo't'!' M: 10
~ lhis loop of ................... ~.... Iw ..,." di5lribule'd
10 lbC'sit" mll$do."$ (fiC. 2.40). T1w.......,[/l ~ mo WI>"
plit'S 1M ~ MId suptdius mU>dfos ~ nd tIw paslf1ior bdly of l M d~rio: r1lU5C1n [Fig. 2.40). TIw ninth
rx IIo$$Obr.u>dti.llllf1'\'l' supplon lh . slylobrdl.dt,~1 ~nd
UPIX"' br. ndti~ 1 musc\t'$: tIw lC'nlh cr~n"l _ . or
vol:8US. suppl i... 1M constricloT ~nd
As 1M occipildl musel~ m.>~ migr~te d nl~JiDl1y.lh.
ninth .nd ~lflh nerves an:' (a ,ri~ d along in tho' migral_
ing IOLlgue musd~ " '.... This musel. m.'" n ,i~ r. les
ant. riorly . nd . ( Quires Ihe ","wnth and fiflh n~rvt." ,J< il
reache' Ihe ",al cavily, The ~ fth o ~",e ' uppUe, the ,~n_
s:ory n ~",e, and Ihe seventh neTV.lh ~ 1", le
to I h ~
. nterior two thirds of 1M IOl\gue (Fig. 2.4 1). The ninlh
T>I:'IW <uppli"" sensory I~.r~ robe" to tho' posI..rior Ih ird
of the tongue. dll(\ the 12ltlll<'IW supplies the inrrinsic
muSlYs (Iongilud i""l YCftKaland lr~nsverse).l< well
.1$ I"" exlrin<K musdn (styloglossus. hyoglossus, ~nd
....iojI;lo5su< ) of ~ tonpP.


dinicaE Appliuotlon


1br =bf}onic pftiod is from 1M m ini to tIw

e;zhlh \Wd. This is ~ hilh drlM Ii.... when t'fIViIlIlImO'flWl ."..,ts .m most li~ to CJU><: r..rial
m.>lfomwtions. f.Kial rrwlfomwlion< rt'Lue to lim-

FOg. I . 'O<...... longo.>t~~ 10 _ , -

ing because tIw f~ ~ durins 1hC' liflh 10

"",",Ih .......tls and 1M body li<SUes.m ~Iso con_
cu....ntly di rr~ nl i. ling during 1M Ihird 10 eighth
Wttk. TIw ~dvnse eIlcas . rt' likely 10d![er doWn:'
and djrfercnti.tion of Ihe n cur~lliss "e, ahmenldry
c~ na l and il<d,,,,,i.[ ed 0'Sd'''' .nd vdscul.r, gl.n.
dular, ,k~ leldl , . Ild muse" I. , formation.

Deve lopme ntal Anomalies

F~,i~ 1 mJ lro r n1~tioTl\ ~l'e

usu"lIy due to ~nv ironment~1

fan o" t11,l1 moy off~llhe liming of proliferalion. migralion. or tW1l the dr.III of ti"u~. f. ilu....
0( ..-tII. "'"Sing. or fu."", of the v.riou< ~mbryonic
unilS oJ 1"'-' fl ~[< In the ~ 0( droriopmenl.l' !~ .100 1"'-' fomwtiol'l 0( <lefts. 1l'Inor
drfts ..... ID05t common in m~ lip .00 JW.o~. Most
dM'f'lopm<>nul dnomdlics of 1"'-' ne.:k .ri~ from tr~ ns
formdtion of the b" nchiJ I sysl~m inlO Ih~ adull d~riva
liw I. In ",,-r ill oXp<'ri nW11I1 on chi"k .nd m ou , ~ , l h ~
inlrodll<lion of ~X< "" Sim protein to lhe fronton.>'-'I
~ led 10 th~ pt!'Sslon of (lt~r proW", (II i . nIl
bmp2 ~ Thi, txIlf=ion INd>. fO r1p'nsion of 1"'-' midfl .ond d~f1 of m. S<'COnIIMy ",," I~.
~"d h~r"" iU"y


Ce rvica l Cyo;ts a nd fi stula s

Caud.11 ovcrgroWlh of th ~ ... m nd . ",h grddually """,rs
m. lotCOIld Ihillt . nd fourth (N1c.1 Iro<:Wt'S. 1lt<'se
pOCM"S ...... conYcr witll 1"'-' ,urfoa 0( the .-1l .00
InnpOrMily fonn . n U fOW Im-linrd em!}'. the n'IVic.aI
sinus. which _Id roorm,llly diupp:dr (As. 2.42~
f~i1u re of romphm' o/:llilff.tion of Ibt ""rvical sin...
"",,,II. in. nrvic.1 cyst If lhe cy,t OJ'"M 10 "'" ' ''' I''''''
of Ih. "cck, a {'~rv icd i fisllll~ develops, Cervical cy, ls or
fi't ul. , an> found ~ nywh('R:" M the side of th ~ nee\( along
Ihe an~ rior border of lh ~ 5[em <>dridom~stoid m u st: l ~

(fi&. 2.41).
............. e...... of ~ cy'A Of f!Stu" is lncomc.-l.ll ~lll of thc SOI'Id iUCll. wllKh
Icd..:-s.n optniJlll on It., surf~ 0( I"" ~ (fit.. 2.44).
" .. ,~r condition i, an inl~rnd l p,,",ryngcdl fiuuld. in
whkh lite cervi,,! cyst il conn",led to 11>0 plw ynx by ~
, mall Cdn.11 t1l,lr ,,, ,,oily "[>('11' in the ton,l lldr ....&ion (Fig.

2 _4 2~

riel . 2.43 IOC'lioo of p<>!PI1Ii.>II>r,,,c!>M ,y>t; 01footu",' .

Thyrog lossal Cys ts and Hstutas

Cy, ts ~ n d fistulas fou nd along the m id line of the neck
usuolly develop fro m rem n.' nl;< of t he th yroglo"1 duct.
Gener"lIy. t hyroglo"ol cysts moy be foum l ,,( " ny point
along thc coursc o f t he t hyroglo" ,,1d uet as it Mscends
in t he neck. TIle most com mon sites of tllcse cysts ~,."
the area , of the hyoid hone ~ "d thy roid c ~rt i l"ge (Fig.
2 ,45). I'Ilhyrog loSS<l1 cyst Is " blind swelling commonly
locate d in the te gion of t he hyoid bone, 1'1 t hyroglossa l
f"tu l ~ is ~ <welling t h~l open' to th e surbce of tl\e neck
by . sm ,,11 ta nol (Fig. 2.46 ). It u, u,l lly resu lts from " n, pt Ul'cd cyst

, -,---.'

Mand ibu lofada l Dys ostosis or Tre a ch ~r Collins'

Syndrom e
fig, 2,45 Site; of Urycog lo,," cysts .od n'tub, , long """ont p<t hof t hy_
mid gl' nd,

Man d ibulofacial dysosto sis. or lreacher Co llin,'

Syndl'Omc, I'c sults from f~i1 l1te o f com plete m lg l'~t l on of
th e neural cre,t cells to t he facial tegio n. As its n ~ m e
implies. it is ch"r"Cleriled by " nde rdeve lop ment of t he
mandible "nd ot he r facial bones. The zy go l11~tic bone is
severely hypop lastic, The fae<' ~p pm fS to be d l'ooping,
and t he N fS ~ p p e ar to be malformed. Tile lowei' bord e'
of t he mand lblc "ppc ars conc" ve. <1 nd dcft p<1 I" te is
occasiotl<llly seen (Fig. 2 ,47),

Cleft lip
Cleft lip is ~ m~ t fo ,.m Jl i on of t he m ~x H I ~ L' y lip. It may bc
u n il ,t te r~1 Or bilJlerJI. The cleft "drieS from ~ notch in t he
verm ilion bord er to a cleft exte nding into t he floor of t he
nnst, i!.

rig. 2 .4 6 Clinical viewof midline thycogl"".1duct <y, t.

T,. ache' CoII",'S synd''''''''


Ab""mal hoi' growtll

on Ohe"k

Mie<ognalh.. m
Hypcpl, ..iC',gomatic

Fi<]. l .47 f ir<t phoryngcal archdeled'

Mofformoo eo

Unil"ter,,1 deft lip re, uits from a f" il" ", of lhe m,l xill,l '"
process on one side to meet and fusc wit h t he me d ial
nJ ,., 1 process. w hich re' ult, in ~ d ivi<iO<t of the lip in to
medi,,1 " nd 1" le,,,1 p,m,. Unil. le,,,1 c l ~ f! ing rf ' uh , in
na sal d isto rtion as lip and nasal tlssuc s ar~ p" llcd
tow~r d lhe alt.lche d side (Fig, 2,48),
Bilater al clef! lip occu r< in much tlte s ~ m " w~y on
bot h side, . The defecls m,ly be sy mmet ric Or ~ , y mm el
ric. In bilateral d eft lip, t he mcd ial mass int erposcd
be tween t he two maxillary ptocesses g LOWS dO W L1w~ l'd
follow ing a pa th o f m igrat ion of neu <J I cre." cell, from
t he dosing forebrain, TIle timing of t he prolih,rat ion,

migr~tion, positionifll, ~nd 1i.rlion Is or vit.>l impon~ ....,.

for """""I lip do'vriopm,.nt . In ..,me caSC'S, thr mrdwl
11.1",1 process has nOl descendrd inlo proprr po,ition
and a bilater.ll Clr ft lip occu rs (Fig. 2.49 ). ~ntly,
fibroblm growth Iactor (fGF) h.l' ~ n notl'd In the lip'
or O'Clodcml. comprising me medi~1 """,I and maxilla ry
p ro<n~ .. and can act a, an orp niU'l" in th ..... f..,ial primotdi.l. If thr nw<i1l.1'Y I"""C"' ~ are widtty wp.arated.
a unil.1Ift'~1 or bi"'leu' drfI lip an ~ ~rrd wilh a
ddl ...... te. ln """"'c...... be .. r>er.adrfi lip WIn nOI ~
assocwt~ WIth. a dr/t or Ihr ...Iate.
A mrdia n d ell lip Is ""tre me ly rare and ~ulls from
parrial or co mplete failure <>f thr nte<!i.l! na..l proc.., to
meL'ge in Ihe sixt h w k (Figs, 2.12 ., nd 2 ,50) . Thi' has
boeen comp.>red iflCo rr\,<t1y to a "Mrr lip" of rahhits, as
thei r ..... ~i l la 'Y pro<nSl'S mr<'t ill the midline leaving a
oorrh in the upper lip. In the h u..... n. thr med Ian .....1
procru inlrrp:>sn brIwrrn the two nwcillary 1"""C"'srs. lotmilll l hr upprrlip. Humon drfts
i'K....,f(l'ly rrprdtd '" "lI.Ire lips-: lhis trm"I should be
left wit h the rabbiB.
A mrd ,all cleft of thr lI,andiblr is a lO re co ndition that
re" ,It< 110m failure of thr me<ench}' "",1 lIl.l, ses of Ihe
mandi!>ula' proce"., to merge together at 5 week' o f
prena tal life, The mandil>lc can thrn develop with no
MIdlissue un ion in the m idline (fi&. 251 ~ A dim ple in
the min is the s1iJhIffi fonn
iocomplrle ~Ill:
the two .... ndibular "",""",srs.



fog. 2.49 BilaUtai ~1Ip <loft.

Clinica l App liu t lo n

Cleft lip, and polare' are two oflhe mosl Common
congll'flilal ",a lfor""'ti,"" in the hu"", n popul ation
!<><Lay. They aPf'('u in 700 li~ Cauasian births and
one in 2000 in the Afro..Arneoric. populat ion In the
unirrd Sta~ 1Oday. Such drfras .... ~ roorr
ccmmon in thr 0rirnt.>1 population. lbry appear in
one in 500 birrlts In Ch.i ~.ja ... ~. and ... t ive
AmerIcans, suggest i,." a stlOllg Ilrfrdi'.ry faetOf.


" __I Development and Maturation of the ~ro niofa cial Regioo

Cleft Palat e
Cleft palate i' less comma n Ill"" cleft lip_ It ( on re, ,,lt as
lack of gmw lh or f"ilure of fusion Ix-tween the medial

" nd I,' ter"r p,llot;ne processes dod the nilsal septum.

Other cause, . re initial fusion with interruptio" of
growth at any po int .llong its course ,' "d ime rfere n,-e in
~I.v.ll ion of the pdl" ;,,e , helves. Cleft, of the p"I"re- Cdn
he unilateral or bilateral (f ig. 2,52) and arc da >s ifiod .lS
clefts of the primary palate. ,c cond Jry pald,e. Or [,n(h.
Cleft' of the pr ima ry palale. 1IIJ t is. cleft, . nterior to the

fig. 2.52 , ,,,,mp"', of dd t lip and p;ll ' t~ , (A). 'loll Hp

IB). def l of ' oft I>"I' l. , (C). Un;",l e,,1,"h lip and p;ll' te, (0). 8'la1e,. 1def t
lip and p31"te.

f ig. 2.53 Clinical vi ew of "n ilate,,1 cldt.

f ig. 2.54 Clj"ka lv", w or bilale,, 1cldl.

incisive for_men . res ult from faill" . of the lateral pal<ltille processes to meet and fuse with th e med ian p.lIJ tine pro"'''cs o r prim,1I'Y j><ll,lt e. TIle four m,'xill"'y incisor, de velop in the _nterior med ian palat;ne seg me nt;
can ine ' and molars develop In the lateral palatine segment . Clefts of the primary palate ar e lI su,llly d" oc;,lte d
with mi>sing or mJlfol'med lee,l, ~ dj dCe!\1 to I h ~ cleft,.
<uch ~ s lateral incisors ~ n d ("~ n i n e, .
B",a", e f"'io n of the secondary palate begins in the
anl erior rt'gion dnd progresses poster iorly, Ihe degree 01
d eft can vary from the <imple" form of bifid uVll la to a
co mplel;(' deft involving both the ha rd dnd soft palates,
TIl .rt'fort' <lefts of the secondary p" I" tc, Ihat is clen s
P'Osterior to the incisive foramen. are the ..e<ull of p~ rl i,' 1
or inco mplete f.' il"re- of Ihe laleral palatine proce>ses to
meet, fu,e. and merge with e,lCh ot her " nd wi lh the
nasal sept um (Figs. 2,52B- D).
Clefts of the primJ ry and secondary J~l l" le, . re the
result of fail"", of g rowth o r la( k of fllsion of the three
1 ' ~ W i n e pro( esse, with edch ot h ~ r dnd with l he overiying nasai sept um (Figs, 2.53 aL1d 2.541. Clefts of rhe
l", late cre,lle mJlly I'rohle m , . the s(verit y varying
aCfOrding 10 th eir extent. Altho ugh . hifid uvuia ( aU5e S
pra( ti,al ly no disco mfort dnd is usu"lly accidcnt aliy discovered . a cleft of the sof! pdldle CJ uses v" eying degre e,
of speech d ifficulty , ,,d -,w" II"w ing prohlenlS. Cleft' of
both the h. ,,1 and soft p.1 1" tes usu. liy prod uce a severe
feed il1g problem. as food CJn be d'pir,lle d into the lung,.
Ear ly co rrection of thi, problem ' houl,l 0( ,ought.

Su m m~ ry

The primitive or~ 1 c~ _ ily appears during th e fourth pre ...1.1 W<'<'k, ;nitiaIJy~s a p it Joe~led ~ n t he growing f=br~in <7~nially ~nd 1M JTO'o'l'ing he~rt
The ~~I .lI'tbts lkwlop ~ 1M or m: polin of
horizon~lly posirionfod ~",hym.>l boJrs. Joealed 1.>1_
.....1 ~nd VC'ntr~1 10 lhe or~1 pil ~ n d surroundi ng lho
o ropharynx, The first p h.lryngeal .lreh gi.....' ri, .. 10 th..
mal1di ble, w hich in tum form , th .. mOl.xillary proce"".
Fronlih.. nwldi bular ~rch, the bo ny m/ondible and Ih..
m.luicalory musclC's d......,1op. The mid upper f.o' is
fOlmC'd from tho froot~ mod IWs.>I ~ from
wtlidt the mhoad, ....,... nd ntid upper lip (phillOUmj
dnoelop. Tho expans..... growth of tho SC'COnd, or hyoid.
arth gives ri~ 10 bolh lhe su~rflCial.lnd d""p muscle,
of l he face and ".lIp, The ec looer mal lin ing of t he oral
c~ _ i ly prtw idcs twO e ndocri ne g la nds. lhe lhyroid gla nd
from the llKlgllC' .nd lhe an le rior pifUi~ry gl;lnd from
lho rod of lho mourlL E.>ch ph.o ryngC'~1 ~reb giYM- n~
10 specif" blood Y\"SSris. m~ <keIH.>1 comporom~
.nd .......r~1 t'lcmC'nu. Contribulions of ..~ ~reb are
shown in the su m mary d i.>gram {Ta bl.. 2.1 ~ Ol:h..r <0<1tr ib u,ion, of th e pharyngeal pouche, are phary ngeal
ton, ii, fro nl the second pouch , l h. parathyroid gla nd,
from Ih.. lhird .md fou rth pouch. and lhymu, gl~nd
from lhe third ~nd fourth ~rchrs.
The roof of the
from lhlN Iiss~
are.., 1M amnior fIlral p(lftioo, from t ho median ~ prt>CO'SS, and l ilt two wftral poslerior PoIlU
from lhe p.ll~h"" proe.."" ..ising from l he m.lxill~ry
The pa latine pr<X<.'e, "ele_ale" from be, ide
lh.. IOngu.. 10 position lh..m"'I....,' a!><we if. Thi, action
is believed 10 begin wilh l ho 10ngu.. sliding torw.rd,
aliowj ng lho s-/IeIW'S 10 moYl! ........ 1M Iongu<'. The poIlati... sJ1colw's ItIm m.lkC' COIltKI ~nd fusC' wilh t he medial poIwri... proc=; an lmOOy; l ho righl ~nd IC'ft shrivn
fu~ po,lniorly in Ih.. midl;n..,
Malformalions can arise from the p arch .., .
whell" d..fective dC'Vclop m.. m results in cleft, or fiSl ula,
bee""""n Ih.. ~rch .... Th..", dC'f~IS 'll" louted ~Iong lhe
~n~ marz:in of lhe stemoclC',domastoid ml&lC' in
llle Iat...-~ ntct. Thoey un 0C(Ul' ~ ~ rMulr of
..... rwowth of 1M SI:WOd . reb in lbe fifth pren.l~1
-.,1:. lkft'Cl:'l l hat ap~.. in lhe ~n1C'lior IlC'd; are u....
ally due 10 thy roglossal duct C)"ISor fislula 5.Clefts may
aPP<'~r, u nilaterally Ot b ilaterally. in th ~ maxillary lip
This is d ~ 10lack of COnt act ~ nd fusion of lhe maxill ary
and medial .....1 tissues dUring 1M SiXlh prenalal
wtd<- "'idli~ clefts tbe maxilla or mandiblC' aft w ..
and 0C(Ul' duo IO~ lad< of mertil1lof ~ in IboJl Sj)('eifK ~rt;l. Palal.. MIs occu, becwee n lhe medial p,lwlin.. PO)C('$$ ~nd lhe lioftr~l p.llat ine proc,,~s and can
be i,ol Ol.led 10 t hai area or ~ xlend along the palaline
margins 10 lh. back of the throat. Any _arial ion ill lhe
I..ngth of lhe dI'ft can occur.

mouth doe';'C"""''


" _ _I Development.and loi/0tumtian_onh",Jroniofodal Regioo



T bl 2 1 c In!>lor'0"' 0tb roch'. I ar, h. ,






( ra nTa l


ArdJ no.

lA. ' udltorym""",


, /,



Bra n,hiomeric
m u,de.

M, ,,,I,,,of

rrohyoid, t <n>o<
t ym ~ oI ,


r" I,1


, nt.,.;", l>elly<iig.,t<k.

M rt ,

de rivat ive
"'11,"" ;OCU,.
>p/>>om<l " diOOI" lig. m""t,
spher>om.llool.>r IIg, m"'"


' "" ,or",l.>ti,,;, (Me<kcI ",<t;ug,,)

"'''''''', oH,,~1

""",,,>ion. ,t,p"'""
>tylohyo<l, ~t"'""
l>elly <ligos''''

Sta"",. ,, ~o;d ",oc-., .

,<yIo/>yQid I;g" m,"" Ie,,..<om" !>yor<i. " 1'P"fport







Glo, ,,,,,",,ynge.1


C..,W <omu hyoid, I ~

Sty loph. 'l"'9"V>

$p;",1 " "'''0,,/


por' bOOy !>yolo


l , ,,,,og..1
ptlaryngeJ' """stri<tor,

5t""od<Idorn>" "'"
I" "" , ;",

Mlddle e>r

(os"""""' '"b<

00dy !>yoid

/ /

Adult derivative

l" l'f\9N1" rtlldgos

'" ,,


p~ , t;neton< ; 1

Thymus , iol" ior

p.l r>thyroid

Sup'"", p>rothyrold

UI,Imot>" n<I,,, ' body


Se1fEVQIUfJtifJf! Review
1. Describe lhe process of the eyes migraling from the
side 10 lhe fronl of the face.
2, Descrim, the origin of the thyroid gland and its
descent ln lhe neck to ilS loeolion in lhe newoorn .
3. Of lhe five va<cular aorlic arches that develop in the
emb ryo, which ones diSdppeo' and which continue to
function? What is their function in adults>
4. De, crim, the relatiw timing, functio n. and impor_
lJn ee of the shirr from the internal to lhe external
,arOlld arrery in the face,
5, What mu,des develop from lhe semnd phary ngeal
arch and what al'e lheir funclion<?
6. Name the four inil;al maSSeSfrom which the fa, e is
fonn ed. What doe' each of these cont ribute?
7. De,c rim, the development of the maxillary lip,
8. De<cribe the process of j)4latine shelf " Iev~tion and
fu,i on,
9, What cafl ilago dements " ri,e from the first pharyngeal arch. Do they make any contr ibutio ns in the
adul t?
10, Describe lhe contributio n of the str ucture, that
arise from the pharyngeal pouches.
11. Desclibe the origin of the longue mu'cu i.lture and
its innerv'tion.

_ _ __ _ __

"'d u lO .. 1 d; ...." ..
Thr ....' - .,t.....kdzle< ,lit ~ .... - . . _ of Do.
El,,", ,,,,h"
Dr _ _ Burdi til>llly pI'O'>'idrd F\sUr<
1.<[7 r""" ......<>rrh in hi , Wlof.tory.

_ pi".

~VIll_ C~olthtpol,l,i""""""'dUfl,,*
_ry~_IDpmoftI ..



.... 1117]:52 :27J_2Ill

w.....1lF. TIlt NJly' ~,; , af "'"
'w loclll ................_ i o I ....... - . - .

.I'f.-..... _ ........"'"...
01'' '''' " ' -_196Z:l:167_l8O.

po .....
Mill.!rd .I~ Will.."" S. _ .... <loft lip> 01'''' ~".,.,.Iip.
l'\.o;Iic . 1Id Roo.". So' s. 1961 ;4l :4- 14.
I'~'" IlIl.11'1< , " ",, , ""-" ' )'>kin in ""'" in ~. '"
develo p'" "" or .>dolt , OOnS" '"'.'" 000 "loti.. to , he

'Tt e," '" ~ mj. Me". 19~ :nll : J07 _ J S6 _

........ 110 D. Thr p.l'"~';' of "" fim ,n<! ><<<In<l
p~ ...rrlI <yo>d........, 0.-.1 Su ~




~ . _.. lmI><yoIooo_ 7,h"'.
, IlRI.

=_ ....



$pMI<f GIl. , ..- . 0 " 0< '"

e-Il. T _
I Dtn>rr...." 2000.
Sulik IOl Cr. .,.,...KioI1 d<fu fn>m ~ . ... It< ......
i ndur<'d dofK iootxio< in
ffilbr)<Is. _h DrIKB.

1lf<"OJI'' '

1984 :20:79 !Ill.

$u lik ~ K . .k>/l""'" Me. . m br)'Olll< orig in or 1001",,=
eoxt ph.lly. 1" \N<el" iol\.n ,p of ,Ii< dovel""I"1 b"in '00
t"'t . So n fl o",. Mia o. 19l:Il:lffi.-ln
Suli. <I(, yudor JM.
IIIL H,.ain ImlJo...... ;OII in



.... miai..,"'""'- "'L~ [loooo. - - . .

'iuIiIllCK.joIIn_ Me. Smdoy

*'..... ~.

'9U:2,:l(I) - n .

S4- Spt;:h< HS.joMl. a.

(T_ ~ $t""""_

_ W-.,I1ur~. p.MfIOp=-Ws. AnI. ~ Mr<I. ~
J9f7 ,l1:lS4- In.,~,,,,,~
lo<Ie:- Al. CIt. . _~. Do
Sr~ ""~ ....,.I""~
v.n _ _ IC. M=<II.II. \Io'nn<y-1C<ft>C. Sr"""'" Ill.



1I. 1I .....-phogm<1" <I.m ifi " h Oll 0(



1'1"", ""'011>(,. SUfg. 19 ~ 1 ; 7 1 :S60_5n.

~~ ~ ~ Arrhes ond rll'~

3 Development of Cartilage and Bones of the Craniofacial Skeleton
j;lmes K. A~

Cha pter Out line

Intro<luction. 44

E..ty SIc"'1 D<wIopmmt... 45

Girti~inou> IIIctJrocranium.. 4 5

~ "Inlroc,anium... 46
Craniol s..... Dn.lopmoooot. .. 46
EMfy Sl<det.aI Dn t lopo ._ of the lIppc< FKt.. 47

CtiaginouI VI$'I'O(.........,.. 47
~V_~ ...


~., ~_ ~of the Upper Fo~.48

Medioal Cart d,,9'" Contribution>-._48 Ptripl>eral Bony Centers.__49

FKIaI Articulation.. so
Palatine Os.ificatlon... S2
Medial Palat ine Ce nte " ... 52

l ater., 1Pal.W lne Cenlers.n 52

Mandibular O""elopmenl... S3
Mecl<ej' , c"rt ilage Contribut ion... 53
Formal ion of l he Bodyand ItornuL. 54

Fate or Meckel', ca ~ SS
~ of the Se<ondy Mond ibu l", Joint... 56

M,rtu-.tion 01 the Mandibu", Body... 57

AbnonniII D<,.I~'L .. '>J
5<lmrN<Y_ SB

W E..... _ ~... 6J)

ThO' facidl . krlrton i. dMM!d From boo:h cartil~ . 1Id
bony clemen!:$. Cftlfm of hya line Urtiloll" forming the
~ of the <l<ull "~M a~ and mt'd,.lto the rorming
lN~illo to support the ckwlopiQl brain. A$ lbt' tx-ain
ftlla~ 10form the bil.l101'<lI cereb<... Rlhe a'R'bdlar
hmli<phefn. the c.~ O':Dlt'I"$ ~ 1.oI.,,-;tIly to
lIfl<IoorIif,.lIId suppon the br.Jin. .l\ilklioll). the n.H.tI apsu'" surrounds IIv oIf..ctof)' ~ "'PRo .lAd Wf<'r~lIy
IIv ork c.opsu'" (.Irtiwll" supportS ee he.lring sen""
org.>n. The "".Iler .100 ......,r wi ng> drwl"" from lhe
sphenoid midline C.lrtilagt' and , up port llv b.>.se of Ihe
br~ln. The Ihr... c.'ll la8..-n. ",1c.p' ule . sphenoid , .nd
h.l. iocclpila l_a re .foi n ~d In lh<: midi" . as a ' in~l e unll,
. ' Ierlding from the n.,al sept um to Ihe f"" ltnen magnum , By lhe ........" Ih week o"incallon centers , urrolln<!
the mro;,,] c. rtila8l"l, . ' 00........'< them Wilh end ocho ndral OOI\C" form.ltion, O" lfic. tio n C.nter. ""Xl
.ppe.r In , he oonlll~ II....., lM'rlying lhe br.lln.
forming 1>0"... lOr proIKlion. TII"",.I~ the fram.l porit'f.l fl'lTIllonJ. .nd oo;ipital """""'- The f.lCi.ll Ilones.......l J'f'f"'W'ilLi, nwcill.l. .00 zyzom,Ilic -dwn appear_
...tI1ctl suppon flv Ofbiu and tbr chreb. As l he>e bone$
JrUW Ia~ .nd oorrM' inlO closer oontKt. syndesmoric
!lU1~ form ~'tcn lbem. 8do:M' in the
.1M bila,..-.I1 <:ar11l.1# b.>... ",ppon IIv finl plutyngNl
.IrdL III add ition to support.. lhey proYicIe flv lTI.1ndibular articulation of rhe m,dl" .100 I"cus. limiled ro.
hi"!!. dC!iOfl_lhe Pflm.lry jaw joint. fIon,e lh.n appe.r<
I.lfl'r.l 10 Mt"<kel's I.lrh lase, lormlng , h. oody or the
mandible. " cartilage co ndyle nex t lorm .Inn wo" fuse,
wilh th e body o r l h. ", . ",llllle. re' ulting In Ingle unit.
TIle te rnpor.ll bone form, a ro, ,,, for an kulJlion or lhe
rondylar he. d<.TIlil ls lhe " ,rondiuy n,.,,,luhul.c jolnl
fhal bt."gins ruoctioning in lhe 16th pren.ll.ll weo-k, as !blm.I ...... .u>d Incus uml.lges tr~nsf,,"" 11110 bo<J,c. n",.,."
bone$then fuoction.15 he.ring t>ono.s In
llln-" is further bone form.Ilion in !he condyle. bul <:ar
liLoge continues lomlllll on I'" oondylar IlNd IhrouzhOUI jlOllfOlILlII ~~ and untilllw 22nd fO 2Slh pool... l'"
~...-. b<ompln of uniWc>r'" and bi...l.....1 fMofts of lhe
poLo.fI' ""lIIORSU.O lad< ofbone "",.(I""m,,,, whnt fhe
50ft: II""" proassn rail fO form.


!IIlrr R'.ldi"llhis ",",,,,,,,".)'0<1 should bI' ~blo- todrlcribo
f ................1 comllO""'n~ th.ll form Ihr stull ~nd dnorl
oping roo. You should 1wY<' o<quirl'd in form.Olion
rt'gdn:li ng I"" <~"i lag", and horwos of lhe <ran;'" base.
",a.iIIa. mand ibl<. . nd primary and "" ond ary
n", ncli l' ul.l' joims, 111'0. you , hould be able to der."e l h ~
vario" nin,l,lI I01" of th~ f.e . ond Po, lale. Finally. YOll
. ho utd be abl . 10 d"""l'ib<' abnorm. 1 d<'Y<'lop",cnr
l'l'lmlling from a unllate'r. 1...-bilalCfal cIrlt palate'.

!:IE c._ (jnoas .........".........,

fig. 3.1 Llrty r...-tib;l<_iOn.

Early Skull Development

Tho..- cortiWJn .ond ~ ck.~Iop;"ll . rou nd ~ br<iin'd - """IO<1". n;"l" ok",...,rs.nd , _ supponing Iix- r""".~ """""<I "tiSCt'rocT.n;"r ~\emenl" T1lt'
(r.n;"l skel"1o n differs from t h" ial and appendicular
skel<to n in Ihat Ihe larter are composed oflWO majo r lis ' "~ !)ipe. an<1 ,I t"<' d~ri ved from on~ ,ing le mc,odcrm. 1
<:<,lI lln"" ge. wh~ IN' Ih" <~ ull Is derived from fUlIr d lffcrenr Ii, ,,,,,, lylK'S and two c~1I lypt'S. The mesodcrm
p"",i~ ~ minor >OUle< whHe Iht 1Njol' ro n<ril)utioll
corn from ('(tO~e origil\.lli"l from , h ~'flJ """r.1 pLal~.


fig . n C.tilow'; 01 tho face Of 6 ..... k<.

u rtilag inous N~rocranium

TIle first c~nil4'" to form in I"" skull .~ """'" thaI

suppon !he ba~ 011"," boain . nd d~1op inilially In Ille
m idlin" a, a (onli""",,, , an il.lgi,lOusb.>r ClCI.-nding PO"
te'riu rly fro", the ""\1 seplum fO Ihe forame" magnum
(Fig, 3,1). IIn , ,,h,d 10 th e m id l i n ~ 1>", .lr' l" liorly arc Ihe
laleral w ings oftlle 11 . ",1""V'ule, tile sphroold (arl ilagc.
nd the I.,,<'ral crk (.psule nd poSlcriorly t hr , upr,"",,_
cipir.1 and pa:r..,hord.11 plarc (fis. l.2 ~ T1r lId....l.nd Uk
apwle, form around I"'" ""..I.1Id audilOfy ~ ~nd
irt&S- All of ~ c. nilall"" ~ and support I.....
~"I twain MId a~ Imntd <artilagi""",
nWl """""'" ( f'". .. U ;' GradlYlly. oss; roralion ~
appe.... wi!h in l'Iww c.niUVS and Ihty oss;fy 10 form
I"" ~hmoid and sphc'noi<l ~ tarcr.1 nf<n.ions of enoid bon<' beromr-lhe w.ser . nd gre~ lcr wings.
Pan of Il>e otic <.psule ("'l ""mou.) a nd b.><iocriput also
bomo t"" !",Im,,, porti<>n of l he t~mporal bon <'(Fig.


3 4).

Fig. 3.4 t>oYeIopm""" oll~ cr","'o.ow_


Membranous N.... ro<;ra n;um

Inl1',,,nembr..,,,,,,,, ..... r"'~ion 5i"" .p.,....- in the mrs_ I l l the braIn .and .,." mT1l<'d
nom nnuocr...uum (fiS. 35). n...... ,.;1..... fiN _
I -n.. the tqinninl of lht rtuI period. ... ouiflCa,ion
Cl'Il~ This ............... lis.... wiD ~ inro I'L/.l
b<Jnts lilt <lruJ1 and l'onn the nas.oL front"'- ~lNL
""ri"";oI, and p,lrt 0( rne oropi.... bon<.>s. n..... bonn.~
each . " p.lralnl by ~'loe1l con....mve'issue sU'ul'l'S.ln
l~ sixth month Ilonoo-fOft~ .. ("""red by ronneai~
Ii....... app".u in (he skull ~W<1'n lion.... "TIl....- Sp.1reS
..... know n .os -fonCal'lClI",-; t il")' ~bl .. the skull to
unde rgo .llc'OI;ons in ' haP<' 0' mold ing at billh
(Fig.3.6 )_


C5] c.'



-- /


".. ,

Fig. 3.6 C'.aoi"", 01 birth. Ob<erve the Iont:o...r~ ;rt , ... <Of..... 01thOl'OrI-

Crani ..1Base Devel op me nt

In th .. 18t h we<'x. the crani. ' bJ , e cart ilage, bt'gi n 10
oss ify l>y endoch ond ral bon.. form" tio n,This proc ell will

(onlinu" throughout p""".'JI."d "olly po'l ll~I. l l i fe. In

add ition, Ih.. or.."I.1 ba"l' "NiLl.S'" transform int o oone,
a"d "",mbr.~ bone cemers ~Iop at th.. I"'riphery of
t~ calti lagn. ~ bon.. C.. n~1> prod""" nlcmbraroe
bon<' ex""n<ion. of 1M cranial ba>e 10 suppon: tM
d......lop;1l8 alld enLal'Ji1li brain (Fig. 3.5~ SUI",... .hen
ap~ar ~ 1M erhmoK! aJld spbmoid and 1M
""",noK! and occipiul bones. Tho:'St' urt;J.o~ sutuI'"the et~ and .",... ,,,,,,,dpit.L are dusiflt'd as
'f"kbolld",;,s. They .If(' Nn>ed ~ .... the bonn Wllh
wtIich ~ .rriculae {fi:I. 3.7~ """" suN""

Fig. 3.7 1.0< ' 1"'" .nd identily uf ,,,to,,,, In 1M ",n,,1



___ _ _ _ _ _ _ _ _ _ _ _ _ __ ~P!!lIe!opment ofCortil09e...<!" d Bones o[tne Craniofociol Skeleto"__"

cont in ue to function, an d. r<' " ,M o f new oonc forma-

tion , r the "" ripl' ery of the cartilage suture, (Fig. 3.8~
The crani. 1bas" for n1S J 135' angle very ely in life
(Fig. 3.9 ). This " ngle is m. int ., ined unt il ea rly ch ildhood ,
w hen major chJngcs in t he roce ~ "d crJ flial base occur,

Ea rly Skeletal Deve lopment of the Upper

Ca rt ilag inous Vi, ce rou iln ium
The ( ,l rt il,1ginou' v iscenx ra nillm (f.l Ci.>l) o riginates from
t he fLrst and , ""o " d phJ t)' Llgeal a[(he, . w mprising t he
cart ilaginous na' J I CJp' ule in th e max illa an d. right J nd
left. Meckel's cartilage b.T> in Ihe ma Lldible (Fig. 3,10),

Flq. 3 ,8

Di.lg,..m of cartilage ; ulu<c d("l('lo p m enl.

The'" m, ,,djbu]ar cartiloges extend from an an{{'rior

locatio n "N r 1110 midline to a pO'I~rior locJ tio n in t he
mid dle e" r. w he n' t hey form an an iculation b Nwe en t he
malleu< J nd Incu< c"nH "ge < (Fig. U t A). Meckel", "trti_
I"ge te rmin,lles in the m" lleu, . w hich is J rounde d b., 11
wit h" f1" t ani'ul.1I i"g fJ ce In contact w ith t he inrus carl ilJge. Dur ing t he 8t h to t he 161h pren"I,,1 w...,k t he, e
",rtit' ges. know n as t he "primJry tc mpo LUmandibulJr
joint" (l ~ TMJ) function a< d simple hil1ge joint. The
lnJ lleus the Ll s~Pd r"te, from Meeker , Cdrtiloge ~nd ossifies
i"to IxJne. form inz t he he aring
of t he middle ear.


In t he 'econd . ,-.:h. a pJrJ llci <drtilage to Meekel", <J form,. It i' te rmeJ "Reic"en, can ilage' . nd forms
tI,e lesser cornll "n d lhe uppe r pan of t he hyo id body.
the <t.pes, and tile stylo id proc e<> (Fig, 3.llA). This di'"
gram <how< t he lhird p haryngedl " reh tlt. l give< rl, e to
t he IxJdy of t he hyoid ( .l rtiIJge: t he cricoid and th yroid
cart ilage Mi., e fro m t he fo u rl h and fift h " reh e,
,,' . rio, ligame ot 01maMe..

'" "

1..' \ ":] carri"'gioo"" ""ur<>c'a ""ffi

MamI;>Ja noos ncuroora" ;c.n

Ca rtifagiOOu, , ;"",roc"", """

Fig, J,10 D;. gr. m of f, ci. 1e' rl;I,9C develop ment,

a . S-pMnorna lleola'
b. Spl1er>orn>nd'bula'
c , Sly k>l1yo>d

Fig 3.11 Di' gram of p ~ " y " g e. I_"e h , kclet, 1differe"li' t ion,

"' __'_Development and Matu[Cltjpn of the Cmniofacial Regi"-,,"' -

Membrano us Viscerocra nium

Tympa nic

,; ~


', _


(' quJmoli s port ion ) 00""' (Fig. 3,12), Th. P,..,,,,,x;lla


m,y or may not form " ,ep","I" ossitkat;on centeT. In

a single center d eve lop' .",0 in others bilatera l(enters appNl' (h.l t soon fuse on t he r,l ei,,] $u rfJce il S
.tn ~"to rj or exte nsion of lhe "'JxiIlJ , For lh ~ ' ilke of di,cu,sion the premaxilla will be de,cr ibed .3 5 s~ pa ,.ate
bilatera l bo n" s ,l< [hey late r form ~ , ,,ture o n t he linguol
1'" I, tine sULfi1ce w it h the maxilla. Mesenchyme in ti' e
m,l Tlll;I,,,I.1f arch t;sslle. later"l lo Meckel's car tilage, aloo
undergoe, membrallo us ossiffi(a l ion 10 form t he body of
tile mand ible. TI' e body of the mdnd ible "ppNt< " a
, m,,11 ",etartgul<1 r pie<:e " f bo ,,~. [t dt!<lche, dnteri"rly 10
Mecke[', cartHaw <1 nd poste r;orly deve lops d carro tshaped piece o f can ilage th .t w ill IJ Wl' for m t he
mandibul<1r co,,<lyle (Fig. 3.13), Th is is all ex" mp [e of t he
coo !X'ratio rr of the 11'10 ty!X's o f bo lle fOnll<1l iull Pl' OOUCirtg J si[\gle bone. Therefore. lh e m,ll1d ible is initially
form ed from mem bl'J nc bone w it h a c.1,.ti l ~gi no ll s
co ndyle. Then t hey fu, e toget her, <1 nd t he (' ,"' il ~ ~e is
tT" nsfor med into borre,


Thyroi~ C'iCoid

[;.i'i.:1 Carli lag; """.


Membranoo. oe """,,,,oium

lID C" tll' go noo. ,,;. cerocran"""

Fi~ .

Meml"" nolJS bone fo rmatio n ;" II," IJee occurs in t h ~

maxill. ry process of th ~ first ph.'Y"geJI J L'ch to form
the pre m,~jll."y. ma xillary, zygomali,-, ,,, \d temporal

Membranous vl"".roc' .... ' m

3.12 Diay,am of Ha niof,,;, 1boo'y ,kd ~t,, 1 developrnenl.

(. ,e.'

La ter Skeletal Development of th e Upper

Me d ia l Cart ila ge Co n t rib u t ions
Fig. 3.13 Di, q,.rn of m,ndib"l" deve[oprne ,,\; body and condyle.

The cartilage t b. l d eve lop< in the upper fat e, note d e,rlier ." th e nasal ( ap sllle, co mprises t he medially po, i.
ll on~d na" ,1seplu m J nd tw o laleral w ing.' , Wll ich form
lh ~ et h mo id. Po, te, ;"l' to thi s cran ial base "lTti IJge. t he
, pltel1oid and ba,iooccipil,ll cartilages will " ssify wil ll
sut o"" , l he el llffiosphcnoid illJ<1 spl,erloorc ipital develop ing betw ee n t hem (Fig. 3.7), These "<1 ' lil,' ge, initi.llly
,u ppor t t he face .ml t he n r, in. J nd t he bone, l lt,ll deve lop ~rou n d th ese mid line c<1fl il,' ge< will . 150 funct ion ill
su pport of Ihe rJce .md brai n,


""ripMraI Bony C..llen

lim ~WC~I "'~ting lho>
nasal (" Iso <o nsiMred a cranial bo"e ), Ihe prem.>xillary,
maxill" y,
mo ,-t" ","Ier lorly Ihe , ygo mati< ""d tt"mpor~1 (<qUdm"us) boll('S, 'I'ho>.' " .ifes the" enla,!" in Ihe
f~,. n.e preomaxilla grows crani~11y u pward """'ard the
....sal a",.. and tlIe """,;I... 01"" J""'"' upward.uoond
,he ""'t' 1O......,.....r me 0IbifS. lis SftII in Fi:pII? 1.14. 01
3 -..I<s lhe fronuI bone C\JWE'I'S!he IomlrJin, forming
lhe fo"'he.od: 1) N<tS.Il bones aDl"',u OIIlhe su~ orthe
....sal c.",,,~: 2 ) l'fnlw.ilLary .ilO'S may ap"".r scpa r~le l y '" un iled willi (3) tho:' n)'} x ill ~ ry , (4) lhe zygomalic. (5) Spl"' l1oid-c" n il,lgt" Center of t he f~ce ; 6) The fernpor~1 .i te, ap pear ",," erio r to Ihe ", ill"ry ce"ters: 7}
in Ille fYldndibuLar arm Ihi' bo"e awcu , Lateral to
M<ocker. CJrtiLall'i' and form, t he body and app"a" fusM
10 the ~fonni"l~ slnp.unif (fl:I.l.14~ ~bony
mandible is deried fnJm l he me'IIlllr~ne I""
CJctiLlV COI>II)- ~ he.>cl of I"" tondyIt fYldinuins a
cap or GUIll. Ihroushoul prE'1lJ.t.lllifeo.
"b"m~n .pe<i"""n, wilh lh e bones ""ined ~nd Ihe
sofl l issue cle. red, i. ' hown ~f 10 wee ks (fiS- 3,15),
Above the orb il' tile fempor,'l b0l1 0l "'" well M ..... lol"'d ,
~"d the prefYldx ill~ry ~nd n'lJxill.lry bon", ~re oN r
fusiolL Ely 12 """"'... Ihe preflldl(ill"ry a"d ",",xilLary cen ..... .ore fused but the a.n;"1 basi: canll.>ges ..... $lill in
~ (fl:I. 1. 16 ~ Duril'll! tM 10l'h we<'!<., mld~ne
bony site ~1'P"'rs briow lhe ~ se,xuffi. ~ 'IOIl'In'
Iorms ......- sh.apn! bone. .as SftII .nte"'PO"lom<lf1y,
growi,,& up either si<le of lhe ...... 1"",,,urn. lis rhe ,...,.,
in",,~"" in heizbt, lhe ~ becomes more plom;....nt
(Fig, 3,17). Thi' i' . 1'0 r vidt"nt in ~ <rO" -""'lio" of Ihi'
~ re. as t he bo,l(' be low .nd on dlher 'ide of Ih. ",plu m

2. PnI- ' . .

!loll)' o><iflc~fion '''''INS

. Z'ygom,o""


5. Sp ~ oId

a. Te<lW'~

f00).1,1 5 _s,b,Ioton~ 10_,- _ethe ... tenlolf"'~_


Clin icill Ap plicilli o n



Tho face h," a p" .. lIel , ut ure sy' lem Ih"t prov ido.
for growt h . nd projectio n or lhe
in . d ownwdrd
and forw. rd di"'-"CtiOll. The suturere sitUdled
1>efwem lhe ma.xillary, zygomalic, and ,""por~1
bones .nd all h.aYe' --t similar in<1i....r:ion. ~
bilaler.d SOIO..... .an:' PJIt of a notwor1< conttibuli..,
10 ra6JI pvwlh t .... 0tt\IrS in the midli .... of the
cranium. paLale.and m.mdible .os wdl .as the
""'I surf""" or Ihe r.e;';'1 bones.




fig. 3.17Inc_ .. IiaI height: _

the ..-oIl!1e _ _ otf>.
mold bo ... ~ blrlh (AI _ in t .... adJIt (B).

(f ig. 3.18), Not e l h.l tbe p., I.1t ille bOlle, .1]'e im medi .1 te ly
bc lle.t h t he vom e r an d ,'o nt.n t h ~ VOme r in t he nl id lille. The re lJtiollshi p of t he , e ptu m , vom e r, .nd sp henoid C.1n be ." 'en duri ng l he fet al pe riod . nd in .1 you ng
"du ll in Fig ure 3.17. The u;,pro pm lio nJto fy I" go eyo
SOCkCl' dfspl. ced infe rforly by t he orain th ro"ghou t t hi,
pe riod by it' iL1creased rel. tfve s;le d llring I. te r pre n" t. 1
life. B<me resorbs on l he superfo r (n"afl 'id e of th e
p,f'te. but forms o n th e orJI p" I," ine ' ide d uring t he
prellJ t,,1period.

f;g. 3.18 Cross,ed ion of t he face, Note lho midp<latine ,u lure

(", row ) and overiying vomer,

Facial Articulations
The l>one, of t he nasomaxilla L'y co mplex co mimle to
en lorge " nd m,l int,ti n , ,,t urdl co ntJCl J t t ho fL'ont omdx ilIdry, ,ygom.r;com.xHl" ry, 'ygomat icote ml'or, 1. Jnd
pte rygopafati ne sites. A com Ddr;, on can be ","n ill t he
~p p"" r,l [\ Ce of t he,e l>o no' a L1 d ,ut ure, at birt h ;n Figure
3,19 , and in t he " d" lt ill Figure 3.20. Note t he gelle,,1
inc",,,e in t he height of t he face ~ " d " J nidl ,keletoll.
The , ,,tures hJve re maine d rel. t l"" ly ;n the ," m ~ DO, it io n. alt hough th e face h" grown In height J nd len gt h,
Simp le ,,,Wre, . .... th ose i" wh ich the bones meet
e nd to e nd w it h con nectl"" t lss" e betw ee n the m (Fig.
3.2n Se rr,1E ed ,,,tures are chJ rJc tc rlzed by int e rdlgita t;ng o PDOsing bon e fron ts, ,,,eh ,< tile CJ lv",j,! l>one'
(Fig. 3.22 ), They exhibit ce lls " nd filler< I,"t wee n the

Fig. 3 .1 9 Sutu"" of the dew loping f." e in ' newborn.

FM: Imntom""illary

ZM: ,yqo m. t ~ "",," i lla ry

LT; , ygol",n porol

Fig, 3 , ~ O >ut"ro, of , dult face. ( ompare the loot,oo 10 t ho-;c ofthe new

oorn ,

FM; fronlo""

, ill"'y
zy<JQmalirorn-,,,,I I. ,y
ZT, ' Y9"m,ticolmpo" l

fi<j, 3 .1 1 Simple Iynde''''''';s " ,I" re, Observo tl10 connect;",

'i"ue between two bony ;oterf" e, .

_ _ __

~3 ~

0( Cortilafle. and ~_ 0{ the~raniofod(1-'_.-sJ<eleton _ "

boooM in .. m.aionship .. ""I.. to m.. oimplt ~

tI'I.Illlvy consist of ~ fibrou:s Iwnc1s txImd
;nz ,lC1O<S U~m. Sq..... mous SU'ur5,. such ~ !be tr1n~""Iie1~1 0rK". aT<'",riz<'d by 0'Il'rl.lp. Growlh
of t he op"""i~~ boon... i. at an an gle to e.lCh Olh<'r (Fig,


In aOditio n ro fibrous ronn"'t ive-li" ue , yndesmOlic

sUI""". II....' " .'" u <1 (wge junctions bN""",n l WO
~ Tht~ ........., ~iMd pI'l' as'uruln found
botween {~ mid line <'lhmoM:!. spbl',ooid. and occipil.ll
bonn.. It is ;n~", .,Us of Cltt~ fh;oI MWy
dNdop {M1'~ stJhJfn lid"
of rarmi.., bo ..... deYdop
nrctiwo_li....... 'uru....
~n lllcm. Sucta emil.- junctions ~ "'''''''''' synchrondrosn (Fig. 2 2" ~ Thts.- .urn," ~ Theappooal_
.mCl of an ppiphyseal pl.,. or " 1;",,- in an X-rd)'. ..., the
nle, of wn sut ure. ne w , ..' ilage ce lls d i n ~t1' nti.te in
the "re_'l ing ~OrJ<''' As t he <e new cell. OJ<<",,,nt iale in the
center of the canil.lginO<l. SUl"re. U", cells that previ_
0u<1y occu p,O'dthi, ZOIX' """'" peripherally to multiply
and ""-":Iop ~ , artikl" .....lIriX. Tht pmplleral ,am
~ !hen ~ and ~~"" .... _
\>on.- fonns.
Growth d ille opposi"l bonts tol= plKl' in I tw. P"'riP"ftY of ttw.w c~r1i l.Jt<' <lKu," { F-'~_ ].2S~
The prev.altm 'ho>ory of CT~ ni.11 <utu.~l np.l"'-"'n i.
grtl'N1h of , he undntying <ffiKtU..., <udl ~s ,h<' br~in.
wh ich ra",~< the bon~, '0 , c p aral~ (Fig. ] ,251\),
There fore, SUIlI,..,1eXp,ln' ion com rensalc, for the intrin
, ic growth process. The grow th of ,he fo ur far lal <ulUr~.
roold he , ..... pon... to ,he force of the fari ~ I -, imJe
growth downward and forward. "'notMr IheOl)' of
. ulur<ll growth i. n... llhe' ~ ~ wilhin, 'Ulll....
and IIwc 1"""'/1 of lhe W lO'>Ult< from Ibis SUlur~

.... .

f ig. 322

serr_ wnn of tho


Oboenoo' "'" ~ bo<Jr

f .... 3,n Squamou; "'I......, ~ tt>e ~ bony front<.

foruo (fis. ].25B ~

r"J- 32 4 (..-.,!ag< wlIn. So,old>oold<O<oi< ,.;rh _

1.. . .-.1 ~ lomIilWj aIot'Ig Ihf bl...II>ouf>d.......

r~ aIh in "'" cen-

Clinical Applicat io n

= 5i"" ofgrowlh bul .lJsop"",,,:lc

~ h;~l,ke Ii""
m.oy be ~h<1x'd
wich fibrous Iw>ds or inrnd i~Yu", or ~III pRlj...-lions forrnotd 10 fulfil !be ntt<b of ~ INrtiC\ll.r Ioutiool. The
~biljlY to /UdP' "'" .amounl ~nd limilll 01growth in ~ INrricuLor sit<' is III considerable clinical imporun", in p~nning
orthodontir and ",rgical pror<'du,".


of"'" Wlil. or boo)' in~ and

"II. l-lSA 0N0j,.... of ll..- urllq _
.... ~ , 10<"""" in
"'" " ....... "".... 8 GrowIh of c.~ ;on..-. ~_
adj ",.....c I>onM..


Palatine Ossification
Medial Palatine Cente rs

n\!. 3.26 Pal. te formation. Ob",,,,,,lhe ossificalion ce<\ler,. A P,I' lh",

,1,.1"",.Blocalionof the ossificalioncenlers.


In Ch" ptcr 2 we learned that the roof of the oral cavity

develop ' from one mod;.>1 J nd two I.He,.>1 !'.ll.ll;ne
pro,e"e, ( F;g. 3.2M). Six l;ny o " i fic ~ t; on ("ente "
appear within these thr ee pnxe" e,. Two <enter" the
premaxillary and maxillary. appear adjacent at the j unelion of the n>ed;al .,nd I, ter"I p" I," in~ I"nce'se< (Fig.<.
3.26A . nd H). The I:>one from the", ,'ente ", grow, m . ~i
ally and then a m i d li n ~ p a la t i n ~ suture forms at this si t~
(Figs. 3,26 .lnd 3.27). The two prem." ill.ll'y c ~n te ,. ,
<Ievelop ;n the m e ~ ; <ll p.ll. (;lle p m( ~ " . The premaxillary
bone has hot h l i ng ua l . m l l ~ b l. l p l at~ ' of bone that surround the four devclopi n ~ incisor teet h. After pdl'tiL1e
bone growth occurs in the l .l te l'~1 pJ IJtine pm", es, , he
mid line , ulure exlends between the r ight 'H,d left , id",
of the p,litte (fig. 3.27). A suru re is then po , itio n~d
between the more posterior palal ine and maxillary
bone, ( F i ~ . 3.27). Th;, sut me J nd tile antNiol' premax illary- m,l xill,l ry sutu re provide for ,, ,,ter;or growlh 01the
palate, an~ t he midline suture provide s for later,,1
growth. These , utul'e , c. n be more clcJ I'ly ,c en in tile
e;ghlh pre<l,tal mOlllh (F;g. 3.28).

Lat eral Pa lat atine Centers

Fig. 3.27 O" ilk ' tion (CntCl> inthe p<llate al 13weok., Observe the location
01 the prem" ill"y. Olaxillary. ,nd p.l.tin~ <cn'or, .

fig. 3.28 Os, iliW "," <"nt." of the p<ll' te at the eighth prenat, 1month.
Nole the 100olion Ol ll", I><' I'l;"" , ulUro, .

f rom the latcral pdlatine ossifLcation ( enters, the right

and left maxillary and palati ne ossification sites ~row
med;Jlly to ' upport the snft tiS>lles of tile 1,,,I,te. A pi'"
n .t~l p .l . t ~ of 13 w ~ e., is , een in f igure 3.27. Thi,
stained f~ ta l skull shows many fin. Trabec ulae of bone
extending medially in the palate. /It this time thcre i,.
white sp;Ke be l we ~ n t)'f mJ xillJr y ~ n ~ p ,' I., t; " ~ (~ntcr s .
indicating that bone has not fo r m e~ the,.. hut will l. ter
fill in this >LN. The palatine centcr then forms a slI tlire
with the m.1xiIiJ . ,1S jee n in J 'I",c imen J t 8 pren,HJI
month , (Fig. 3. 28 ). Th. m. xill. ry bones will w pport the
primary maxillary (U s p i ~ s and molars and later provide
.>lveolJr bone support fo, the pe,mJ l1ent cu, p;d,. prem" l. rs. ~ n d mol. r t e ~ t h . CryPI, for IIw pr im;"y cuspid,
and mol. r l~ eth ( an be seen In Figur. 3.28. lA teral
growth will occur at the m i ~ lI ne suture ., well as laterJ ily on tile surfa", of the pJ I.He. !Interior growth i, provided J t th e pl'e mJ xill" ..y_m.lx;lIa ry .lr,d m.lxiIlJ ry_
palatine ,uture,. There fo r ~ . growth ;n the pal,l te keeps
pace with fad al growth (fig. 3.28).

Ma nd Ibular Oovelopme nt

Me,ke's Ca rti lage Cont rib ulio ns

As the n. ... 1 CJ I" ule blor" me, lile prominent cartilage
, lolelo n of r"" UPlle r r~. M",kers , . rtil. goo is eSlal>lisbo-d bil.rer.1 .upport in {he mand ibular .",h dUring
the ~n,h.1ld eictnh -.oks (fi&. ).2!l~ The post"";", of eu Mtefs cartiWBe b.u enlaf#S 10 fomt tItt
mallnoo .ond .mictJUl... witll die iltC'UO. whidt is the .e<:ond canila8f'. Tbese 1_ minUle , . n i""'" beco me
encloo;cd in bil. ,e rdl eoc r~psuJes .nd Lot...- deYelop o l he m idd le-~a r l>oncs. Thi. Joint is koown .s the
"m" lleoinn,dJ I- Of primJI'y m. ndibulJ r joinl, It is
im ponant J' the mO\1(h i. "i><'nilli and cl"'i og al thi,
edrly lime (Figs. 3.29 -3.31 ~ The pr imary join t funn ioo5
until 1M 16th ...... k when thr- "wrnoda ry tem poro....ndibular joinr (200 TMJ) ...u....... the funet ion.
Duri", 1M 14th 10 15<h ........ l ilt rn.l41eus .ond incus
l:otZin 10 c.akify """ os.ify. Th~ this pn10d thrmalleu>.nd inru ..... lr.nsfonnt1l into ~. Tlvir functio n of . n k ulatio n chJnge, a5 they _ lo p into M J ring
!)one. The stJIIe. , drh ing from rhe se co nd arch
(Reir hen s){.,{Iloge will al, o function as a he,u; ng oo ne.
Th~ rem.tinder of MN'ktl". canilagt' will then d~S" n el'ate
J ' the bony m.1ndiblc enl.rge<. The fMJ begins to devel op .n,erior 10 thr- otk e.opsule.nd will...,.,mP . """"
romplool< (unction 01 1M bony ..... ndi,*, IIwl 1M pimaryjoinl (fit<. 1 U """ ] .n~


F"og.].30 lJIIftoi virwal lhr-.......

Wtd<B"surtiago. ~ Ill; orbaUtion _

thr pMI...... .,-,d aI


Fig. U l fr-..l_ al loIe<", <Mtibge ...... thr ..-ti<.... ion 01 thr

""'..... ~r>d in<.....


I Development~1ld_Maturation ot the (raniof'!.cjaIRegion

Formatio n of the Bod y and Ramus

Mackel'. cartilage

fig. ~ . l 4 Corona lview oJthe m.o d;b"l. f ,ondyle, nd ;l, relat;on to til<
med" llylocorod Meckel", cartilage al 11-11 """ok<.

Temporal bone


f ig. 3.3 5 totoral. lew ofthe w ndyl. , "', d ,,"Id .ppear, nce of the ,iell oullilli nq i!.

Fig, 3.36 Lato,, 1view oJthe condylar head "od ' Pf""'f>OCOoJthe",cond
dell "',tlining tho' rticulard ;skoverlying lhe coody"u "'.d.

The body of the mand ible forms as a rcctan gular piece of

m. m br~ne b<)Tle developlog later,,1 to Mccker. cartila ge
(Figs. 3.32 and 3.33), The C<J rl dyles de oelo p posterior to
thc body as carrot-, hap<d c"rt ilage, in thf 8l h (0 12th
week". JnitiJliy thesc edL1H~c , dcvelo p indcp<nM nt ly.
hu t by th~ 13th wee k they fuse with the body to form a
sirlgle m,nd ibul" r unit. The condyle develnp< In thc J rea
Jnte, ior to the ear and posterior to the lJoo y of th e
m<l nd ible. The C<J Lldy lcs develop fLrst in c."tiiagc befo re
ossifying;", they enl.lrge, the condybr he. ds are formed
(Fig. 3,34 ). The fim appedrance of " TM] ('JVlly . ppe,lrS
In the fet us of 12 weeks (Fig, 3.35 ), The first of the (' OJnpartments to deve lop i< the inferior or mandibuiar compa rtment, A split "pp ears 10 the me, enehyme ove, lyl[\g
the eartiiage co ndyle, and develop, int o " small ('left (Fig.
3.35). W ithin anot he r week. the sllperlor or temp o,,,1
<ump" rtmen t 1$ formed by ' "cco l1d split in the conn ective tissue. p"Tallel to the f,m ( Fig. 3.36). The synoolJ I
cavity outlincs the ('ondyl"r he"d . The preci,e mffl , ~ _
nl<m of tl.<s ue cJvir.tion remains un known, The process
is probilbly dlle 1o prog ramme d cell de,lth (, poptosis).
w hich OCCllrs J long the p" tlJ of "o ndylar rnove l11em wilh
the adjacent C<Jnneet ive tissue, Then " , pk llie of the
te mpo r,,1bone develop' ", lo the forming articular d isk (Figs.3.3S " ml 3,36 ),


With conlinur<l b>no forllUtion, 1M .m.11l

c intt to form tM glenoid fMu. (flg. 1.J7~
By t l6Ih ~ boo~ h.:I. forrntd ~round Ih~ c~rt il ~ g~ , by ~ t><I oc h o nd ra l 00"" form,ll ion, whi<:h t......n !lISt'


with t h ~ body of th. ma ndible. The condyle> and th.

body of t h~ m,lLldibl ~ initially form ~ n angle of 135,
whieb is m.1im~jn\"(j during I...... mn.>inder of p"l'Tl,,1t~1
life. 1..0,... in p ,.. ". 1.1l li f~, ",,~r !>inti, bon<' i< <ltposil<'<1
""....1M ~ngIr 01 1M mmdiblir wboTt ~ IIWSM'Itr ~nd
rn<'di.lI puornuid musc\tr. ~tt.odI. Thi< ~ ~ to
me .....Mn 1M union 01 ~ ~ 011M mmdib.....
tar l>:><Iy ~nd con<IyW. GrowIh 01 lhe rondyl~r M.od
ioc,.a"Cs Ill<: beigh t of tbe condyl~. H lIWf"YM" m<>s1
enlargo-ment of the m~nd i b l. occurs pos tM t ~ lly. 'f""
corono id process bo'rome , ~ prominent part of Ihe
m~ ndible ~nd roo.tinll<" to develop ontil ncar tM timc of
binh (Fi,&. US). Thl' twO halves of tM lIUndib~ brcome
onil<'<1.ol the.- .m~rior midline. whldl b ~ thl' menIal ~ 1hi$ ""loR' <Onlionll6 to . . - ~Imosl:
Url(~ ~ trld oI lM Ii"" po<lNtll )'Nf whm if onir

Fat e of Mecke l'5 Cartll~ g e

The anl~nor asp<" or '''''ck~l'< c. rtil. ge fu~s 10 the
m<'di.ol .... 11 01 ~ bony mandi bWduri ng 1M 10th p,..
.... t~1 ~ Thi< p"oc"< occur< ~ ~ndr.ll>orIt
femuf ion. Thl'",ro, ~ ~ndocbond,,1 ~ i<
fonnnI OIl a mtmbr.,.,., body of tilt m.oo;ble. As f he
nundibol~ l'Tl"'rgM, ",m""n t< of M...,k~I. utlilagr
l:>o:'co<ne .nul.... in nolaTion to 1hc ma ndib!r" as......, in
Figu... 3.n. By th. 15th pm>.>tal ~. the nullt'll> ~ n d
iLlCU' ha..... begun tran,formatio n into bone l>y endocho,ldral\>o". formo ti,, " . (Fig., .)7 ). As M ~(k ~ I < cartilage t!len dogo-nerdtes in U", dre~ on~rior 10 rhr ~ar. the
~ n ~rior ~ . phen om.lndibul~ r Ilg,lm. nts
........-.op in its ",til (!'is- 3.33). Whm tbr 1M) begins
fun<tiDllilll in tM 16dt ~ ..... weol'L Med<d"$!ogt
Ios<-s il1 rlllKtion ~1'Id a1_
cfu.ilPlM'...... Thl' ~
Ih,u <Upporrrcl tM mandi bul.r .rch.lIlI funcllonrcl in
art iculation Ihe primal)' j.lw joint. is replacrd ~ .
bon. wi th ~n acIvancl'd ~rticu la tion c~]b1e of ant. nor,
poster ior, ,md biiatrr" i motion.




Z1VO" ......._ ,



3.38 I~ ""II " bi't~. 0I><m'l' 10<_ 01I~ lac\ol wt.........

Clinical Applkat ion


Two 8row1b , .me" a~ found in . deh of the condy l", ~ nd

,m:ount for their rapid growth ~nd I ncre~se in , i>r, Fi rst, n.w
cartilage c~lI, diffel'('n1i~te in Ih. c. rtilage underly ing Ihe
perichondrium. whicb lie'son ~ surf.., of the oondylar he.od.
Thl'sr ,,11$ proI ifr r~t ~ and deposit a new coni. m.1tri~ a
Ihi< <i~. A wn>nd <nlt... lirs deotptr In lilt a>ndyle where new
bone ~ tIIr ma N ", cmiWzit by~odochotlldral bone dtposition. Thi. bQnr-formins 'tIter .100 .odd. to lilt ooIume of
tilt con<IyIrs.

56__I Development anqMalurotion of the Craniofaciol Region'

Development 01the Second 3ry Mand ibular Joint

Once the com ponent P,l rt S of the TM] h.we been .'ldh
Ii.hod by the 12th prenatal week, no m. jor changes
ocr", other {hall further d jfferr ntalion of the joint tis,u es ~ n d , generJ I incre~se In ' ;' 0 of the glenoid fos>.
and condylar head. Note the . pposi,;"n, 1growth of car_
lil.>ge on the s ll r f~( . of the w ndyle in Fig",e 3.37.

ca rtilage ;3 deposited interstitially around the cells in

the mani , (Fig. 3.39 ), This condition dew lop' ,i l1ce

Hwe<t"'PhY zono

".""pt"" "'M
Fig 3.40 Condylar he<ld.Car t;r<>g"

,tov. an d bone forma'io n below

Fiq.J .41 Front. 1view of l oe TMj at 26 1"""",.1 weok" Dbs",,,, t he d eft, of

(oo n""l l", t i"ue in the coodylar <"t;la<j e.

there is en largement of the (a nil""", cell, and then dep ositioLl of cattilage matrix dround t h e s ~ cells (Fig.3.4(}),
Below the ("~'t il ,'ge m,lSS of lI\e co ndyle, bo ne CJ I1 be
obscrvcd w hich rep laces the cartilage be ne,l th the carti lage cap. New cattilage cclls can be- seen arising from the
,ese, ,,,, LOne (to p of fLguro) and pJ." ing into the multiplicatio n zo ne (m idd le of figure). w here cell divi, ion
occ urs. Below th ~t is the M~tu" ,tio n LOne wh e'f celi>
mJ t ure Jnd enla,ge, Thc cartilage cells e~ la ,gr fll ' t h ~r
into the Hypel1ropl'y lone. Below this zone. the m,mix
surro unding the cells begin, to c~ lc ify. In {[,e bOllom of
Figure 3.40. bone ccll, invade the cell, of the ( "lcifLed
zo ne ., ,,d de pos it bone OLl the cill'lilJgc, Bone al,o
increases in the neck, ." we ll J< II,e he.,d, of [he condyle.
llgai n. the[e is an Increase of bo ne in the ,,,pe r;o, medial wJII of the glenoid fossa Dy n prenatal wed s (Fig,
3.39 ~ The p,im~,y joint begins to funclio n in th e 16[h
week a, a 1 Mj.
The major changc in , tr ucturc of the TM] is an
inCfN Se in ,he , ice ." \d de nsity oft he co ndyle, TIl i, !Jo n"
c h ~n g e , in shape ~ n, 1 size ., the mJ nd ible I>eco",e,
"s soclated with di ff~,entiat lon and f"nct ion of ma, ticator y muscles. One not ewort hy featurc of thc TMJ can iloge DC(ur\ i" la,e pre nJ IJI life. 'l< con" cctive-li<sue
d cfts extc nd int o the ,'a ' t i l ~ ge front fWIll the overlying
fihrous pe richo ndrium (Figs. 3,41 and 3. 42). The fu" ction of the, e cleft< i.s 10 br ing blood vessel, into close
contact wi l h the '"pi,lIy g w wi ng ~lN of ( Jrti l,' ge,
CJ rtiioge is com idercd av~sc u l." but thc m" nd lbu lar
w ndyle is an ex<:eption 10 Illi< rule. Allo rhe r ehJnge in
the co ndyle i, the thinning Of the ( .mil"ge ( " I'. which
occur, in the late pren' t,,1pe riod. Dur ing the eight h and
" inllt pren,ll "l monlhs. Ille endocho lldral!Jo"c rcp l.lCcment of the (.,til<lge is mnre rJI,id tllJ " Ihe c" rlil.lge
dcpo, ition o n the condyla, S\l[fa r-f. AI thi, time , all ( lefts
h,wc disilp ~a re<:i, indicating that the cart il"ge Is no
lo nger in ~ rap id growlh ph asc. Thc nilHOW Dand of c" rtil"ge seen o n tlte COll<lylJr he.,d per<i.m un lil the 2';, 1l
postn at al ye" ,.

____ _ _

J ~~ _oLCnrtikJgeandBonno{!M Croniofocio!Ske/erOl'1 _"

Maturation of t he Mandibu lar Body

A1tllou&h 1M body of ~ m>ndi~ <kYl'Jops from mom>bW~. fusia<> of M<dd'1 ... rti. . to the' ",'ff!or rnedl~I il >pf(1 of r.... mandibf(, is by mdo<!"ondral bono- formar ion, The'" ,H'e '1'.....'.1 m he r <. " llage grow' h <e nte rs
known a. ,econd.1 ry growth c"rt ilJ.ges o f the ma nd ib le
Thc'se <IR': the coronoid {."i~ utti~ ..round !II<'
lOOfh pmI" .one! thr symphysral cani" in Ilk anteri
or midline (fi&. )_4J~ ~ c.ortiLlge In 1M COIo"oid illN

appears In the 14th '0 llifh ~k, and siJn.'1s fOTTndIion

of the ,'oronoid prox ",! , Thi' ( artilage d lsapl'co" by ,m,
16th Wffk. WM " function ~i"... Bone "'l''''~ITI<'nl of
IlIi' cwJ.# thm <XCWl ;tS me tempooolis musde dif
~~ft'> JDd oOPrwIn
Ibis site. Duri'" this
bone form..onon is ",pic!. CR'ilt;ng a !>oM comp.uable to
the condyle .ll birth.



-'.. -

- .-



Tiny si,,,, of cart , urround 1110 St of th e form ing

fO<Kh buds, tsp~lJy On the bl.lC:Ul. The~ .'" SOOn
Ir.onsfonnl'd ;111:0 tbin pI.>Ies 01 bone pn>(tttins thr IODfh
,.....".. Only thr s~.IJ (,IrtiLlgl: ~n til<' lfOWI", h.>1vt'> of Ihe mandible ~i$l' unti l birth or I.ll~,
The,. two c. rt; I., ~e, wr.lp over the . nterior bodie' of the
right ~nd left m.lndibles. 1l"'Y ..... COW'",d by I"' rkhon drium ~nd Me united at me midline. The symp/l)'sfill
c~"i~ undt'l" tndodM:>ndr~1 bo.... fcJrnwtioll
throughout p~~t.ol lir.. ~nd rontributt to ~nt_
Zrowth oftII<' m.nd ible, Sin~ t~ C~rl ilagt'S~ .... posi_
tioned between the .",terio' cnd' of the ma ndible. thi,
c~"ilagr provi<W. ~ n incre.~ in ~ wid th ~s W\'lL Growth
cns.otion 01 thtv unit.,.,. 0CCUI'l in the e.uty postrut.ll
rroomhs. ~Itboush.he sut~ eootrib\ltes to ~n i ......._
in m.lndibul,r width during t~rIy posm.r.d lir..

Abnonnal Development
Unil.t....1 ~nd bilafr'r~1 drits 01 the p; prod"""
dtfects int h. nasOl11a~illary sktl eton ~nd eeees of the
pa.1.te, Figurt 3.44 , how,. clea rffi h" lIIil n p.llat<- at 11
pre ... t~I""",ks. In thi s rIgUrt. ne.r W1tic~1 whitt Ii""
is <em ""tendi", t!m:ItJgtl the .1Ye<IW ridgl' ~nd ""lalt.
Nore.he ~ 01 pmnu:~l.IlY bone ro.m.atlon 011 . he
Itft side. Comp,lrt tM I ,ze ol lht righ nd Itfl: m ""ill~ry
oon... Bone form. tion on the left 'ide il def'cient. In th c
case of. Wli latt ral d tft p.olate. t he bone forms on the
t'OI;>rltUl Ii"" and ""'.... I. bone deficioency whett the cleft
ocrun (fis. 3,44~ II lad: 01 p.;ll.Iri.... bone .IS ~l .IS me
~ oldie bony .~r rirIgt. ~nd toorh buds illt....
'''!lion of tl'>e cu,pid ~nd la,e'.1 inci<or Can he obSE'l'Yt(I


Fi<;I. 3.4] 0;;,9" '" of II'" rn.m d il>tc and TM) at 20 p'.... l. 1
u.. _of ~ e-tibo;tes
1t\C toot h <)mIlS. CCIf<It>(l;d proo:e".


.,.j O)OIIphysd.

in (h i, sped........ .... IvroLilr rldp' de focieocy occurs wlwrT
,"" prl'nuxil100 ltW<ilLil join devo-Iopmmtally ( F1J.
1.'1 5 ~


dtft iUustf~e'$ ~ bony lkfoOm<)r on boIb
"'" Itft.nd rigt>1 sides ( fI&. l_45~ In this p;I~e I~ is
.. ~ of t>on. .. ""'junction of the.........,un...nd
nuxil4. <>< both of rbnI1 bonn .... mum $R'I.lI1er tNcl
lbry woold be nornuIly. ~ l.o,."..lI inciso<s. rusp;ds..
.nd primo'Y ~r lfttl\~ ... mis<ing. dlonl with 1M"
buoy CfYPl". Prior to """'" fonn.otion. . wf!tiuue dtfi
dnxy ........ Jd ~ OC{U~ in Ihe 5t h or 6th prefI.Iyl
wee k. In Figu", 1 45 It ( ;on be not .... t the wte,.l incisors .oo cu,pMl, . ... missing. . iJl' t hey ~re .ld}ac~1 1O

the clrli.



The in; skeleton of the f",e is c~rrildginous ~nd

composed oC lhe n..~1 c~psule in lhe upper f~
and Mkel', c~rtiLose in lhe rm.ndibuLo r.rdl (Fig.
3.47~ r.."t!'f the ""... l premolllill~ry. maxilLory. zygom.l lk. and lemponJ bones .PPl' ~r in tM upper
face ; l>ont oCthe ""'nd,ble .ppear5 in the IowE1" ~
(fig. 3.48 ~
The conntM-llssue , ulul'M Mtwttn the
bones oC the f.Kl' ..... lermnl .~ . (I'ip.
3.19 . nd 320~ ~mme1 may M furthn" cWsi-

Fig. ] ,46 !lila,..., deft l"'i.:Ite in nu""", 01 ' '''''' . Obwrw tOe "" . uJ tx>",
form, tlon ' nteriorly 1<01. ' ;09 the pr"",,,ill. t h.>t
t wo tooth bud"


_ Clinical ApprKa tion

(~,1.Ip ~ncI lJonor fuo>clion In ~ no( only in ItIt dtvdopina ~. but tItrou:l/IOul lht lIulTIiIl .~ . )'51..... to pn>vide suppor1. st..,."rn. and nnibilily. C~rli" <urum conlin~ 10 ..,,,,, in the O"~ni,tl t>-.n, e pilJby>is of t!If 10111
boots. ~nd lK>twN'n t he' ~M. Tll "Y work in ronjunalOll
w ith ,tit """'" at ' itn where ifOWl h ~nd motion is ~.

AOOIOO """,rnple

i< ~

fractu", Slit.

wher~ ~ tempor~'Y "ni.

1.1!" c~lI u, ",rves to $Iabi li~e. borll' rr~r lU re unti l it is repl,lcrd

growing bone.


fie<! ~ sim~. >e1T."'ll. or sq.... mous.nd . ....locate<! her-en lhe fronuJ and rn~ill.ry. tM maxilLory
~nd zygomotir, tbe zygomatic and lernpor.IJ.nd
the pal~line and ~Did Lorni"" or the sphenoid
!>one,. Other surureS in me rnidfaee appe. r
between the elhmoid, sphenoid . nd oceipilal
bones. C~rli l~g. i. p....,.nt boerween these tatter
midline bon.,. and . Ulu....' arc ~rmed , yn
chondro, e," (fig. 3.24),
P. I. line ossifi cat ion apl"' a" at the junclion of
the medial . nd lateral p.>lalin. proce, se,. Ilon~ lrabeeuiae grow ml'd iaily 10 the midlin~ from both
p", maxillary .nd rm.xi llary (~nt~rs. I'Qlleriorly.
Pollatine ossifie.tion c~le ... appear on the periph
~ry of the paLot. ~nd l"OW lOWard th~ midline. By
the 8th monlh or intr. uterine life. bone """'''' the
pa"'l. Prnn.oxiILory-rrwxilLory . nd rrwxil...ry- p.ol.o .
line SUful'M. ' . wril .... midli"" suru.... exte'ndilll
the .mi.... Imgth oC lbe hard ",,"'t . pmvi<le for
"",Loti... growth . Further growth 01 the ""'.......
occurs on the penpbery by . pposi riorW growth.
ClKIlP'"'" the si~ rri.llionship 01 the r..c t birth
with the ~uJt faa (F"tp. 3.49 and It is .Lso
helpful II> rnmp.o.... the I""ition 01 sutunS in 1M
f",. at birth wilh those ;n lhe Mlult f""'" (Fip. 3,19
and 320~
Meckd"' cmil.oge is the primary cartil~ge I>f the
"",ndibul~r ~ rc h and provides ,upport, allowing
jaw movemenl for the fi rst 4.5 month' I>f imr.merin. life. Al th. , ul"' rlor posterior surfac. , lh.

_ _ _ __ _ _ __ __

J ~ o( CtJrti/oge rJftd lloneso( Iht Ctunio(oml Slcelftoo

""'11eoi1l<UCl.a.l c.ln;~ serve as lnicuLoton for

lht ""-r . - ' f 8 Wftb (Fig. U7 ~ TlIe 1M!
bfo<;om.. functiorwl al16 Wttls. ~n Medel",cartilage rt'SOrbs and di,appears. Irs most posterior
elelTl<"nts , lhe mdlleu, and inw" lra nsform into
bone. dnoriopiOi into he.ring bone ' Dl the middle
ur dlont with the SUptS of fhe -:ond urn. The
condyle of me, ITIJ ndi~ ~ns as" ",,*"wptd
(.n; I~. at the posterior superior ,urf,,,. of the
bo ny mAndible, The n-mp ora t bon. (orm, the sock
et for l he TM] by intw"..mbrdnou s 00.... fomwtion.
although IhI' sodt1 soon ~ Jinrd with CMtiw,- Thi$ can i" grdd""lly Irdnsforms in,,, bone.
TIIe,e are sn-e,.1 differ" ""'" in the growth of earn,
lage, in the mandibular condyle, and the growth of
long bone. l.oni bo<le. d~lop primary bone
fronts. ~ . !>en produtt '=oncWy bone (ronts in
their epip~s. Th<'sor ba.... fronts f~ en orMr
with. <."ilag<- boon<! btlween lhnn and . '" ffill'l<"'d
epiphyseal linc. (Fig. 3 .40~ Only d primary oss ification 'il 1l'T devclop. in the condyle. the""ro", no
epip~.lI Ii"" ~JDp$. Also, un; . a1ls aft'
scd nern:l ra rber t/l.ln forme.d in """" .. t""Y.ppear
in long ~ In f ally month' of I'ff""talliff, peri_

chondri um (overs the condylar head and vascular

tr.ocr, ""tf nd inlo the condylar canjl ~. which is
unlikf cMtiLogf., ocher 5ices.


SelfEvalLiation Review
1. N~me the comronents of the primary ma ndi bular
jaw art iculation,
2, Name th e components of the secondary m,ndibu
I... jaw art iculation,
3, Compare the function of the primary and secondary TMJs,
4, Define and give eX<lmp le, of a syndesmosis and
synchnndro 'i ' sutu re.
5. D~,ui l>e the functio n of Meekers <art liage and its
final cont ributio ns,
6. N, me the early de velo ped <artllilg~s of th~ cra nial
base , nd describe their fun ctions,
7. Name and locate the l>ones of the facial skeleton ,
S. De, cril>e t he histology of a simp le. , e rr~ le d . ~n d
SljU<lmo us -'Ullll" .
9. Name and locate the o<slfi(ation <enters of the
palate ,
10. DescrilJe how the p<llale grows. ,' nd n" me the
import"nt suture..

Sugge' te d Re.d ing.

CJr I",n BM. Hum,n [u, b<yoloj<y ,00 De\'olopme nral Biology.
so Wui" Mosby I""., 1'l'l9:166 _170
Di,on AIl AOO S,,-"", 1lG. ed'. Norm,1 And Abo,,,m,, 1 Bone
r.'ow'h. New Yor k. NY: AI, n liil Inc.; 19B5,
DuBru l [ I.-Tile mn iom ,1ll ~ i b " l" ,,, ln ol,, lo". h" S;chd, 0 1'. 1
An"wmy, 7th ,d. St 1.0<,1<: Tile 0/ Mo,hy Co.: 1980 :
74 - ~ IO , 5 2 7- 5 ; 5.

f." low DH. I" ttod ucto ly concepti of tile growt h ~[()"' "
Handbook of F" i. 1Growth. rhi l" I , I~ h .. 1'" W H $<l nn<l<t'
co.: 1982;24- 66.
Gnffin Cj, H,w,hom' K, H"'i' R- An" o,ny ,,00 Ili<tology 01
the hum"" t o "'I ", " " ~ ' OO I I> "I " ,;0;" '- Mo nogr. Or. 1Sci
1975 ;4:1.
j.lool><on A. Emlxylog lc. l ev id en" of 'ile nonexi,,,'r,,,,' uf th"
p rern.lxill. in rn"n, jo um. 1 or tne [ten" l A",,,,1O"OO of
>Ouch Africa. 1955 : 10: 189-210.
Mikie Me. The [Ole uf the " .nd yk In ' h"
wow ' l, or
the u", nJ ilM . Am. J. O't ll"l'. 19 73:64 :50_62
Moo,," KI. M;'; ular '''d ' kelet, 1syste ms: [ " ont i,l, of " " m,n
cmh,yolo:<y. To[Onto. C. n.d,,: f)( [te, ker IrK.: I9 r ~ ;
Ro" RB,j ohm Qn Me. F",' I.I d"", lo l" " O'" f'<lmc1'f' lo rm. tion
'u birth. In: clen l.lp ar\d P. b te. New York. NY: Roile"
K , ~ ; ~ o' PUb.: 1978:68 _87.
S, ,,,,,, BG: Loskin m OM,Tornpo[Om" ndih ul,1rjo int; ~ i""og l ",1
Basi' for Clinic. II'r'etlro. 'l" ,n ~fi ol d , II I: ( "" d ", (
Thorn. " 1979,
S" d ler l W . Skol m l System. I" , l.l ngm.n', Mod ic. 1
embryOlogy. Sth Ed. lklltimo'e, Md' William, .OO Wilkin"
Spe, bo,GIf. C",niof" i, 1[ mDr)'{'logy, 4, h Ed. '''''do''' W, lgh r:
19 39,
Sperbe, GIf, C", mof",i, 1lltvd ol"''''''' And Gmwth. Tom,, ", .
C."" ~" OC lJ<o<k" , ' '' C, : 200 0
rlllo'gO<Jd P, ,;.,,'kor S. More R. SkeIN ogone>i, in tho H ,,, ~ , In;
Oroilliotogy at t ile fum 01 til e Cen'u <y. G\lr,gl'Il I"'i,,' ~
a" d ' I" plm. !lasel: K.,rge<; 1998 ;93.
WO<Jd NK. WrOlzg LE Stlm n: vilk , (lH. The 1" " ," " 111. ,
[ n, Ixy<oIOglr,1 "'id""''' th'" jt does "or exist in m.l n, AIl.l t.
~"' , 1%7: 1 ~ : 435 _390.


4 Postn atal Facial Growth. Birth through Postadolescence

Callia A. Evam

Chapte r Out line

Intr o d u ctio n

bosic OTgolniZalion of llle ""~d I. ~i>IIed Ndy in

llle do: . ( ' >,>jlll ntlbryo IhltlUP a
of <ritiuI Sf<']
involvi"ll diffnnlWion of riM..... mlSration of edt


....SSM. and fusion of (aOJl 1"""". Throughoul t~

r~ n ,ai nd~r <>r the pre period aDd.lltcr birth. grOWl h

phe nomc na w Hlinue until th ~ Mtainn>ent of an aclult

{FiS- 4.1 ~ TIl.. dwpler ""l'la'l>5 importanl
COiiC<pUof """....1...f.orial v-th t"'l cmpb.Isiu van.
OU> l:>ioIocX 1"a>c'S .lIld tbtir rimint in the ~
nl<1llal Kquell<e.growth-conlrol m<dw"i.m>, specific
Srowth , ile, In the facial ,kel"ton. an d ' J rialion, in
abnorm.l d.......lopm<l1<.
n... ""'Iurot ion of an inCanr. f""", inlO its ad ull (o nn
I'(SlJJts from ~Jt. wbicII 1tX'.... an incR'..... in siH.
.lIld <k'o(lopiloc III. wllich ltX'o1IIS ~ C'YOl..ion
roward I~ fi....1 sta re. 'mportanl changes occw In the
slZ<, , hJpc, po"ilion, . nd composl lion of an cra"ial lis' U<s, indud ing i><"IC S_ m" scies_nerve" and SCLlS . orgam .
t\one. ~ n lorge and c\t.lngle shoalX': muscles l ~ngJ.hcn and
altadtm<nl$; innnvalion malum; skin prolif<ou,... 10 aMT tbr If'IWiIll: faa!. The! oral c.Mly and
lI.lSJI s.p.lS. <:y('>. aRd brain ill<l<'. .... In siZe bul at dif
((re n' W.". Sin"..., form within lhe roKl~1 .lIlKtureS.
Ihe tt'<'th erupl and el11t'rge, and Ihe de nt ilion chJ nge,.
The ;>dull f...,.. d ilTers "",rkedly from Ii>< feul or Infanl
f.l in slu'. proport ions. smoctUft'. aRd functionAaillll rurthcr
appearance <is minor sk<Iet.>l modi
riCations""nrin..... skin ...........sticity and wnnklct. and
fJt dc po$;" proo""e jowls urxlet the Iowt"rj.l\v and bags
J round the eyes, The d itler<"" s betwe en the n('Wborn
and ,Jdull .k ulls are .Iriking (Fig. U ~ Tto. calvaria. or
oJ<ull VoOIlII. is much J1KJI'( pronUlK1tl in infancy tlwn
101..... The membr~notrS ......... oil,,", vault are ...... raCtd
by Jtt'aS of f1 brou. lissue k"""", a, ...tntt':< and
"fo md"e ll..: or soft ,pots, "" birth. lhe endoctlo",bal
bo ne, al Ihe b.", of Ihe . kull . ,'. "pa raled by b.u, of
, arlil. , Ihese synchond rose, at( gr,Jdwll y replaa!d by
bone. The! .mt1ior ponion of ' ''"' ......1SIt'\lIUm. another
mIll1.l111 01 "'" emb<yonic unilaJillOU'l skuB. reuolt< its
cartlJasinous compos ition in "'" .adult. MMl at Mmer,
Cdl'1ilJIl(' i. re!.Ort>t befo,," bil'1h, but semdJry carti
lage, thJI de velo p inJepondelli ly of Ihe prim." y cart i
laginou . oJ<ull can Ix'"observed in the Mwbom "",ndl ble,


Introduction... 61
Objectives... 62
TIming 01 Gtowllt. 6J
Growth Proc"'....... 64
Spt-cir", ArN' of GfOWIh... 6S
Growt h Cont rol... 66
Hered ity and En,l ronme nl... fi6
Iobnofm,ol Development... 67

Summary. , 69
'ifoIf..[valuation Review.






rig . . 1 Gro'Mh oro ",.'....bon 01~ tMe fn>m l>O"t~ to old ...,e.


I De1o..Iop'lllll ond MoWrolioo 0( ~ Clooli%ciallleQiM""

11,. .. S<'Co nda'Y ca rtilage, a,.. the man<l illulJr cond~ lo

and the , oono" ified t'Orono id proo.'. " and mand ibul..

fig , 4,2 The adult


num.n ,~" II dirt"" m.otl<..dly 1""", t he infoot .~u~ 10 it.


/'ropoItioJSollly. ~ <nO' ~ ttwn <.Iv.ui.ll growlh

umn attn- bintL Tht nnborn bo. alUiISt'd 55 10
6(l$of ad ult tnadtll. 4(110SOSof adult lIrislK, and JO to
35:1: of ad uft dtph. In I'" post.... ul ""riod. 1M "",ndibl..
grow> proportionally more th an th o Nrly ~ Iop;ng
c' an ial bas. a"d brain. Qu..:lJ1tifical ion of , kull growl h i'
bds.ed o n ~a.u re'YK'nl'S o f 'tand. rdiLed ,~ u ll radiograph.. ",lied -c..phaJogr.m. Of "n'phal<lfn<'lrK radiouaphs.."""","oily. all stull bones ~ t!l~ lile. For
aam~. in lhe nrwbom. tile milndillle .... a wid..
gonial angl... 00 mi n. 'moll ramus. and ..... ry imrrwture
joint an d. ",Iative to the "''' of t h. face, i' Il't n,Hi cd (Fig.
4 , 3 ~ A compat ible , ..Iatio n b..tween ma xilla and
mandible i .Khio'Yrd. ~r. by rap id growth w ithin
t'" first ye.... During ;nfan<y and childhood. ",Iation'
..... pmporrium in
rrwodible cooti...... to dI.J"IJO'
'-"""'Il'. tM &",,1;11 ang~ ~ tllr
mandibular ptaOO' becom.. I<'ss stl'f'P, and a milt d......l01" . lit adoll'<n' OC'-'. tJ'oe alveola' "'Sion bl'<:omc' IMs
p romine m a$ t he u p",,' [.lee and th in p rojo<'t forward.
These dl.J ngc. ~a ... Ih.. conwxlty of tlle profile. if
highly vaNbie now is nor included. SUloial modifj
"'lions tIW ~ indMdual ,.,.t....... olltte faci,ol
Ollltours rotlIln~ in adults. ""-' .IdoIe<crn1 and post.
aclolc-scenl dl.JnlfO" Clltuinur for a Iongn tim.. in mal....
In old age. t~h may ... I....t. th~ mandible loses m ..
and tl,. gonial angle wid..n.

teeth"""'..... t'"


- 1>'_ .

fig, 4 3 lhe m.ondlble

in tl", ' hape 01 t>oo . wi th ~""'.

Clin ical Applicat io n




goode~ lor demomtrOl'ng....... go>


1lfoLoP"" of kJwrr aMmo. dml4l nowdinl a ttn- onhodOillic

~.. ,rle'lu b a coo~ ""sur in orthodonticl. I!<ll:hl.o.t..
adol=t mondibul;lllJOWlh and third mola, """Plr...e PJE''''
, ure, ha"" bi:'cn blamed ,

An"" ...adiltl; Ihis dl.JpWf. you should be allle It> ""pW;n

tJ'oe ;mpoClant con Cl'p1' of postnatal !.Kia] growlh.
..mpha,iLing vario u, biologic p nx..."" and l hoti' timi ng
in tile dl"v. iop m..nt al . ~ u . n c-e. Vou should be able 10
describe growth co nt rol mec ha n" ms. specific growth
,il'" in tlw: faci.ll skdfoton. and anati"", in .dmormal
dc'oc lop''''>!.

TIming of Growth
lnd ividu.lJ dlildfftl dilM nor only in .1Ie ~moonl ol
IfOWth ~nd 'htir ultim;tte si~. but ~lso in m. Iimi llJ ol
d irk,....,1 ptw.... of .ho'ir grow. h.
Crt>'Nlh of llIe r~C\' foil""", .1Ie gmerdl I l m n a b ~ of
l he ,kelelOll. lhe .!>domin.1 J nd Iho'3< ie o rgJ n, . an<l.M
mU",ul,l tur. Periods of r. pid grOWl h (depend ent On l h ~
,y'tem ic conlrol of OOrmo n..) ex"fur . fter birl h. In mid
ch iklhoOO. n<! d uring <><IoI<'=n("O'. Other tissllC$ ha.....
tlleir owo rin>et.lbk's: """,.1 ' i$sues I
br. in) develop
nly. tile ....producrive ti."'"' (
l"'f! il. 1 orpm)
6tYe'I<>p !.>le. ~nd.he lymp hoid tissues ..... v~n..bIe (. ....
m.thyrnus hyp.ruopllies in childhood mol ~ l'
ly .nr;nb~ The tKe G c"'bOI le d 10 tJ(, ;oo"''''~te in
liming. ... i< (01 ........ l he """"tie ptIWIh of m. child.
Wi,hin ptI$OIl. consider~ble "~""Iion ~
lJOWIh ,.Il'S of difT......n' body ports 0Ur'S- For """ m~.
d ur ioog .h. ~o le sc.m grow. h spun in hei gh IIIe
~ lI<'n< . of growlh JC<oI. ... ion i, fOOl. cdlf, Ih,gh.
",,'k . nd ftM lly. weight. The h ~ad ~J;o demon" ,at es
eo n, iM r. ble liMi. tlDn in ' he growl h of its pa t'IS. Th.
upper ". ",1 u, neJ r< ad ult $i,e by I year of '111'. ,he
. n rio r er~niJ I lid... i, e"enti.1 1ycomple.e in size by 7
ye~rs of ;>go. me ma><ill. finishts &rowing be tween 14
.nd 16 ."..~rs or . ~nd m. nwndibl<" finisl>eso ptIWIh
.... alder The ..... ximum JtOWlh rate 01 m. tKe in
is bel~
l.1ke pIaa ~ li tt le !.>.... I.....
doeslfW<i.....1~ in body heilhl.
Tbe ~. &f'M'l h lIW<i..... lor .... rrwcill~ mol
m.ondible oc<ur s,mul t.meoo:<Jy. bill growth sJow!, ~ nd
S1"P> ~I difT..... n' .iml'S (Fig. 4.4 1 The m.oooibl. con'inue. ro in<reJ'" in longth for , ppTOlCimilrely 2 ye~" aher
the r. ci.t ,um"" beco me in."i...... Tho exrended period
"I tn.lnd ibul. r gt<lw.h ma ke< i. d im eul, .0 pt-.d i<1 l h.
final , i, o for surgical co rre<;.io J1 of m. ndlbular O\Ier
growth . 00 m.y be respoosihl ~ fo r th e crowding of
lower incisors
i. often ob:serwd in !.>le .doI MCe~ ,
The specifie cr-th po......... ol.1le hu<I il; jnfluenced
lit" .....11)" VMi.dJlts sud! ~ lI""'lIer. et l'lllil or r.>ci.ll clIar.orImsno. rhj'iql..,. ~l ......... nd nulritional Ic'wI. 8or<
pow "1.Jrer. lonr. ~nd ~ than lim.. Coosequmtly.
&irls .....'_ NrI~ .nd r- thf'OOlb lhe .o<loIMc~.
IJWI{h spUrl n~ ..pidly I...... bo)Is (fis. 4 .s~ A1,houIh
Afrirdn "mt'ric.n bJbies gener~11y weigh ..... , two couc.~i.n bJbir-s ~. birth ~oo du ti ng childllood. thoy . rbi .....
Ih.i, dew lopJ1'l('nldl mi le<'OlX'$ c. rli.r. M ian child ren
lend to be , ,,,,,lIer .h.n botb Afrlt. n AmericJn and
C.uca. iJn chi l,Il.,.". Phy, ique or b. ><Iy build .1", innu
.",-e. llie timing of gruw' lI. ~,ld. (\(ovelopme nl. for ex.m_
Ill<. th e ex'remcly toll. thin person u....lly has idler.
~ prolonJl"d period. of growth duri"i .odolnee. ...
' ....n lhe sboncr. hiJhly museu!.>. ind ividual The nonm"""lu. obese ~ , lISUOlly L.>d<s .." iII..spurt ~nd. iOOSle.od. powlly incru sn in si2e 0"eI".
long time. Ullin. or poor nutri.ion may deWy or ~
....... prtlllt1" pnwt"-.-.....n>cr f.ocror innuo-ndnc limine
olgmw'h is ,h. $Ocoll ed -,ul.r tren'L" Some sur"'-'Y' .uggMol.h io th. d..... l0~
~. of lhe woOd.
chnd rcn . re "'~lur i n g . t inn
ingl y Nrl~ ages.





..... .. . _....

/ '


.. .

. ... .

fig.4.4c..-ane _ _
~of the
~ ..:I1he""- in rc-g mon. The ....., . fo<lhe loa ;o
b<liewd 100 .. sh:>rtIy oItG-lhe ............. i n c _ in heghI:. c . . -


dllIe<ern t ...... ' -.




r"l- 4.S .... ..., ;.nor IOgh .chooIlNChoer will -'/y. gorIs ...-.:110 <N<h otJo.
les<"",e NrIef l bon l>ol'<- Al l-_-oId girl"'"l' be IaIer dod de> ,tJpmeI~
l>1!)i """" m.>t.n ........ 13'~ bol'.


I Dnoor/ and AfrJturcIOOn 0( tht Cn>nio(ocigI R<>gion""..

HOW<'Ver. r(' dalJ iOOk . I".' d I""eling-<lff tende"cy

mmil ion . ",1 prevenl.l ive he. lth me.' u....'
bome ~read.
n... marW VMlions in ~ limill ........ led to
the CtJIIa'PI of bioIo:>Jic whidl ;. Mtmlill<'d fn>m
lhe r.d of malurity rMher than <ttroooIosir .. calMda'
. Typic.lly. 1l;oIogioc'S" is based on ~pmen"l
mil.sto...... In develDpll1enl "r fhe Ioog bones "r Ih.
'k~l~ton (,k . ielill ag~ ) Or in the form"l ion or emer gt'nce
"r th e ~t h (de nlill '8"'~
of skelelJI fn.>IU
rity .." commonly mad. from .... "dwnSi
.00 de'nul maturilY is best dftennined from ,Id;ogr.phs of tM ....... !leadi""'" for tre.Un..,1 is bI1cd on
biologic fn.>lurity lither lhan dll'onologil: .

" iood

F~ .,

In lI>< ... rty I"'riod oI~'"

~ moyoc<u

on" su,IOU"I



Growt h Processes
Bones of the Iw-ad grow on <utfocn. .. S)TIChond.--.s
.-ld . t sut..- buI do TIOl ~ br inlC'rTlal ""I'I""O'L
So...., basic bioIoIir ~ involw<l in ,kelotol
growtll.nd d 0'l0:\1 ck'arIy iII"''<! br
~l(,>m in in g Ih. growth of lhe bo~s of I .... cran;.l v. ult.
In lhe e.l1y ~riod
growlh. bon o i' del"" ired inr....",""IJ lly On .11 <urflC"" of the enl.rging: bones { F!a-4 .6~
This type oflfOWlh coolin..... only for. sbon lime.ul.r
powth ol c.Mwrill bone ;. fOITIIJI<'>;; respon.., to !he
OUIW.rd displocftneN ol the tIoJJ..-. br I,," npandi..,
br.ln {rig. 4.7~ Their t'Rllrgemenl .nd n..ttenC'<l contour
f'\'S Uf, from both Tl"mlXk'll ng "r lh. bone~. ills di,pl.tee<l
a'ld , ulU,,1 ~rowlh at lhe edge, . Remodeling m",line,
bon.' Slrucl u.... by tlw proces' of bone depo' ition . nd
....<OrpIion on lhe bon. $urlce.
Bon"" lisa ma~ lheir posillon in lhe puwi.., tlce
by d i<pI;K'"'ItiK .nd d rift. Dnj>lo<:nnmI i"""""'"
mango' in posilion of .n ..,Ii.... bone .. !he result ol
growt" .t ilS boordH or the lI"IClYern<:nl of
bone. Drill res ul" from dppo ,ilion all o ne 'ide . nd
resorpl ion 0 1l .nolhor, ChJ nge, in proportion as woU. ,
' Ile ..... . chie'Voe<! through di ff. ",n'i,1growth. o r ~..i.
tions in reJ.lttue rat.... iIId . JT1OlUllS of growth. For <'Urnpie. lhe mandll* puws 1'I'Il"'ftiooa1!"1y """" afl....
binh Ulan do OIl\
bonn. _ <Oml' bone ~ on
eilh ... side of ~ suI"n' m.>y grow'l diff. ....n! r,lfi.


''9.4. 7 Ute< ,,.;,II bono ~h <>t\I" . . ,mm--...d ~

..... Murolgoorth.




FiQ. 4.8 M "", I ~ flbe" grow by . dditiO" of

at the ""d of tt.>
myo!ibrik.. The ,"1, in the <(W>ne<li\o't-l.i. ..." , !>Nth. ~. dil'ide

"""""JI>oo the length d

II>< mw:le


~JJd"' dim-,. n"", for , kelO'l,l

m.y M 8ren.r th Jn for
dlmlal age. Because gil1. sUleul maturitY rl;"- Uu o
~ """" gim rrwy ~ malul<' WtiaI tIoJJ..-. bIll .011 h.Jo,oe
prinury _h. A dinicWl who wain for fnnaW pariml 10
~ full pernuroelll cIffllilioo rrwy miss lhe opponuoity 10
COm'CI s"'~ dlshannooy with>1 orrbopedic
appli. ncl'S,

With growth. the chango. in tho f. cldl 'oft tissue ar. I1,1t
e<l the bony chdngo<. lt is know n
tha t muscles ;nCTl'l' in bulk br.n in=o.., in lhe siz.,
of indiYidul C1'IIs. not by In ina.,.... In t!X' nlll1>"'
bel" of <db. Sai.""." .. ...., addtd to the ITI)'OfIl>ril .1 iI<
end ( Ag. 4.a~ TIle <hellh CCM'ri"llhe howt'ver.
grows.s . resul! or a-11 diYi'Mm lhroullhoullhe leng'" of
the mu",lo. The f.<1 'h,1I the mUKul.. p'morn of Ih..
f. ce i< del erm;nc d Itt'ry edfly pm bJbly h. , ;"'pon .n l
oonS<'quences in faciol ~Io pmcm.
a< ....."Iy d<oli"""

Specific Areas of Growth

In II... rn.>ndillk. thTff ~re... '" ~""ry.KroUJlI lor lilt
1) remodelling of the mu.
~nd coronoid process (f1g. 4 9 ); 2 ) IfOWIh ~I lhe ~
(fig. 4.10); . nd 1 ) . Iwol., growth.nd slighl growfh .1
l he in ferio r bolde r. Rm,ooejing of t he Idmu, in . grow ing chi ld provi,I ~. SPi'" fo r t h~ sccc nc a nd thir d mold"
(Fig. 4Jlt Th. cond yle grows by prolifera tion of cartlI.lll" in tile co ndylar hN d a"d endocbondral bone fo"",,lion. n... formed bone i. remod ~IIe<I ~ . it be<:o ~ p.o n
oI lhe rdmus, . nd lbr <.nti~ prolifer. tion continues
(fit. 4 1 0 ). ~liYriy SUllIe .re~. .re Inc.ted di ll inner
bonier of the symphysis. ..,." lhe .... n< Cd
lilt dUn..nd Oft lhl' ron>ur 01 coortt p:mtS bef<::n tOOl
ilonn.nion. (hin growth is dKl'pcive bec...... l he dIln
"lJoINs" .as......ulf of re<ofllOOn '" bone ~bOW' the dIln
r..nber lh.>n deposirion of bone al lhe ch in inelf (F"l&4.12). TilC' ......11.l ch .~ . posilion in lhe growi ng f~n
a, ....." It o f both drifti ng by remode ling, a nd di<pl.lce -

arowth dwnlE'S o~rved :

...... :

Fig. 4.10 TI>e condyle dO<"l n<IC grow by ti>< proce.. '" uniform awo' itlon

but by H

ampleX pmc"'" of (/I'O'Wth ..,d

r.. r<><IoI ir>g . , dl'p<>silioo '" 00<>e.

-. fMOtJIli<wl 01 bone .

f1g.4. 11 "' .. _do" ... gr-.tho,...... n-...t

"""'" _

_ Oinical AppUcation'


Th.iIr denldl .rmn dis pldy- only minor dw. . In

tr~1tSY<'fS(' ~nd ~n1l'1'tlpOS1erior d'mensions durinl
childhood is Il'ftlolrUble. MPwly considm"l
1M rhe In'Ih ftUpl - . -... millillllU'r$ to m.iinr.oin
&rOWS in IYighL This
denldl ocr!u."", .as rllC'
allows the dinici.ln 10 '"""" Il'.SORJbIe pmlic1iom
aoo.l! Ihe nC<:'d 1m Ill'a t"""nl ~ in you ng chol"
d ren.


_10"",, "",".

JorflupljOfl 01 tho _.and lhiOdmolo<l-


I De""kJ~nr andMatuFpoo a(lhe Cruniofacial Region


men t due to growth . t the m;lxill.ey , "turt'S (Fill. 4,l l ),

11>e tU!>e",sity lnerease, in lengt h to c..... I. '1>.lCe for the
molar .... m (Fig. 4.1 4 ~ The<l height of the pal,lle
wi th maturation is due to the erupt ion of teeth careyinl
the alveolar process alo ng. The ate. of INst Ch.lngc is
around the "",op.lI. tin. forame tl. /l.s 111<' """,ill.l tllOYe1
fofwa rd and downward. th n~riOf surf.oce I....... rbrd



/ ....


Aoo'_.. (<kllli

(Fig. 4. 12~

rog. 4.1 3ln lht 1JI""'ing ...... lht ........ JNt~ to lht 'f~ t-< ch,;,~
.... rM<lt ofboth<hlUc..-.t and ~ ldotll~

r.g_ 4.14 no. ..-,.tubofosiry.-.:........ In """"" 10<_ ~ lot-lht

do.. ' . ... <e<ond ...... _ ...........

Dent.ll arch rdatlon, are usually ..... inyined du ril1l

the increase in facial hcight.1I.5 Ihe face .nL"....... t...,th
com p"'n"'t. by "",piing furtber. Eruption of teelh cantin "", througho Ut li[" to mainUin ocduilOll. II.n anltyked primory molar ........ as a sood mart" of ""'ptMm.lll:'" beau'" il is fu<e<l1O Ill. alvoe'Ola. bon. and does
00l keep pac<' wi lll the act,w mowrn.nlS 0( Olher tee1h.
BoIh e.anilagioous and suturall.-lh comribute to the
&WWth oft"" ~ t'Clionand upper Wre. The .....1o;q>tum is a e.anil.llinous fCmtWll 0( the chondmaanium
th.ot ossiftes post.. iooly as ~ .."".,.,. bone. The ~
PMt remains '"' .arti~ and a>nlilllltS ~ ... l.lter
th.on most of 1M rest of the faer. The ll"inSln _lrns1h
and width aR' unrdlolN 10 OC"" f.Ki.aI me"",,",,",I..
Thc forwml u-Ih of the fonohead is due 10 ~ dewIopmet>I 01_ tid,es and fJonlal si"....... These' are prnent .. birth bul ~ nO( ....atl'<I. !l.llhousfllhe
",twn of the Upptf fa' are ne.uly p,><.lI1eI in m..,....
ment. 1M upper lac. does ..,. JfOW in a 1W1i<:ulaf downwanl arid Ii;Jrw.ord dil'l'Ction _"'I from lhe cranial base,
Indiridual sutures may srow in ~ Wt1ic.ll1>ori:ont.ll. Of
" --posRrior di...mon, Of pennil lJ;di..., 01 bones
.>long lhe suturt ~ne. """tow lhe """~U _
~ g;rOW'lh is 00( consisl:""r O'in lime. Cha ...... in
direction are fairly wmrro;)l'L

Growth Control


imporLlnt th.ln descriplions of specifIC<"S in indivirhw bones and rdlotion. or
bones is inform.tion od-llN to 1M qUCSlions 0( bow and
why growth ocrurs. It is ne<l'SSary to der,,,,, rhe fton
rontTOllins gf<l'<th and 10 und..mand It'OW1h mh.lnisms to prr.>m<JI:e nonn.ol ~l ..........,pm.nt .nd ah... growth pa ttern$.


Hered ity and Environment

Clin1C011Applica lion
The prof'Onion of IflIWth oOle.mi"o;,d by he ~dity o r . ""iro,,
me " t is import~"1 from the st. t'ldpo inr of tis,uo;, recept ivity to
alt"'''tion by . uch
as the m<'(h~ ni c.1 appliao", used
dur ing on hodontic trNtmeOf. Su tU~S res pund to mech. " ical
, ti muli. w hich ma ke, it posSIble to inh ibit forw.rd maxi llary
g rowth or wide" a constricted p" l~te. Mand ib" I"t growth.
howeve r, i. nm eh more d ifficu lt to contro l.



He......ity and .""i,on","",t joint ly del.......i the lad.1

growth p.lltern. The close membl. ne. t>f irl uic~1 twins
, how, that the he redity com pon. nl is import.nt.
However, ..nvironmenta l inn ue nces ~ te .J<o acliw. ftlr
exam ple. Inui" de velope<! a much highe r Ilfl"V~len<:e of
malocd " , ion within ~ generatio n of Ih rriv.1 of mod
ern d vilizdtioo. /1.1'0. h"m.n trad itio ns and ~n imal
eXl"'rim..nt s have show n Ihat growl h of bone can be
aUeted. Bouod Chinese feet. nd deforme d Jnd i. " , k"l ls
demo""'dtt' the . d. pl.bility of . kel.tal g rowth to envi
roLl me ntdl inn ut''''''' ' .

Abnormal Development
The biologic rone.."., <k>wloprd in thi' ctw",er Can be
.1PI'Ii~ to Individual, who have abtlormal gfOwth pa!t<'ro~. KnowlO'dge of norm. 1 growfh proce''''' CJn be
helpful in rerogn ir.ins .benalll growth ao<l in planning
t",.tmMI . 1be p", in ou r undel%lnding of devia nt
l!JOWlh poc","" and c....... of fKUl dclonnlly. ~
n . a", major .ond limit ~U~ and ~


Some perple~ ing Srowt h problem, are .....n in lhe V netic syoorom",. for e . ~ m p l e , a p.lfient with Apert , yn _

drome h." . < I,~pcd "."i .,1vault: a ret ruded

mid fJCC with We ",a.ill. ;o meti me'l; fu sed to the , phenoid booc; abnonnalilie, of ee aanial boaS(' and upper
'Pi""; intr""".1 abnorrnalitit's indudiRl\ bulbou, . 1veoLar ~ in the mnilLa and crvwding olleflh; and
fus;on of the d;g;1'l 01 t"'" h.lnds and feft (fi&. 4. 15 ~
I're1TwlU", fusion 01 the .-..niaJ ~ produces an
unusual skull form by pr-..vmting ' kull ~h at the
fused SUture line... Ilecau., e the inc",~scd press ure produced b~ the growi n ~ brain mJy lead to ~ellt're mentJI
J lld neurologic hal1<licap" early rele..e of the fll,ed
$lJlUrcs i, " irkal , tel' in o",im"ing brain """"'lopmenloTre.lment method . nOW in u'" a'" not effect""'.
eou. bridgs betwffn a an"l
however. br<:au",
bones soon ~. II
known whedler the " 'fU ....
a", I ~ deltct~ or ....(Ii'" I "'" ceR. (u nction
through "'rm.11 mectunism5 but .... pond h) an abrlar"",I env,ronmell1.Growt h .bo>or"",lilies .1lO IlO1limited
10 cong~ni lJI m.lform~tio n, or inherited mer.l>olic
defe<:l<. Inju ry to tile tempo roL11J ndihlll." joint in child
can , . usc ankylo,i ' Or Joint d,mJlt' In.t le. d, to J ' y"'metry and undcrd<ovelop me nt of I.... ""'ndibk' on the
rraum.>tlud side {fi&. 4. 16~ Mobility of the joinl ' ho uld
be ...... ored .. soon as pos<ibk' 10 .....,i~ .....-m.>l
function and ~h,
M.lndibko ~Ihism i< one rIi UX' Il>05l tommon;l1 dcfonnitie< (Fl&- 4. I1A~ Unli~ .... ny rongenir.1
defo nn" K-s. malocelusion. become app"renl during
postnJtal developme nt. Many e, planation, re~a rrli ng
lh. etiology of mandi bular prognal hlsm h.we I>cen
....v.ncOO. bill no sillile ~"pl.l""tion hJ ' p""",d to 1>1'
.odequale. Although some f.mi l~ seem to ~ """"

f ig, 4.15 An ... mple of A ~ l syndrome.

fog. 4, 16 II$Ir',-IO IN<<hM.!Ia,......, . ,.,



..-. bcioI lA)..-d

joOnl ho<~
(II ~

f;g.4.1 1""eumpIe"'_~~

....;uI ..... 'K tb~

Clin ica l Appllcation

Only aOOm bJlf ofyouni people in II><' Uniled Slm , hilve nor....Ip .. and denr.l rel.tions. The proponion of """y <eVere mal
ocrlu<ions I, I"'" <moe In African Amerk.... and ~"""",",,lI$,
ISs.. The type< of didwmonie<. '-"'ef. diffCf
wit h ~; Art-iu n American< ...... more likely dwn caucasion< 10
haw> ante rior open bite malocdusion.. and Gliucas iom ...... more
likely ,han African Ame-rica... 10 have severe Cro'.'IUng of ~h.



I Development Qnd Maturotlon of!!,e Cro~! ofo5ial Region

fi g. 4,19 A mandible bela... (uppet) Mid afte< (k>wet) pl en",nt of, , "ccodul bone graft

individuals . ff. cred lha" do other f.m ili. " lh. p. trem
of ge ~ eti< lr. nsmissio" h. s bee" uncle. r, . " d i" m. ~y
cases il is found to ocr ur si"JrJdicaliy. The mech,1nisms
of m<lndibul" r growrb h, ve been "' ph",' d in , ,, im,,1
experimenls, but the' e ,t udi., h. ve not progressed to
the poirn of providing a basis for dltering human growth,
ConsequeLltly, the most cffective treatment h.l' beon
sUl'g i,,1 reduclion of m" nail'u l", lenglh (Fig. 4.178).
Growth is a fdetor that must be co n s i d ~ re d in pldnning
lreat mern of fad al deformities. For example, ea dy surgic~ l ll'ealmenl of mandibular p l'O g n~t l l i, m i.> oflen
unsuccessful beca\lse fhe mandible continues to grow
abnormally. In areas in which growth mechaLl isms .lre
belter unde"'lOOa, howe"" r. growlh c~ n be used JdvJ nt~geously. One ,1rgUrl wnl in f~yor of e," ly tre,1tment
hoids that a primary defect Cduses second" ry deformities in adjJ"'nt tissues, For eX.lmple. IJck of appropl'i.lle
muscle funclion followed .l pJrt ial faei,ll nerve pJ I,y J nd
res ulled in . symmetries in fac i~ 1 form. incillding " "derdevelopmem of the mandible on the paralyzed side and
devialion of the n.lSa l lip (Fig. 4 ,18 ).
In more severe deformilies, tis' lle, thol ,Ire inili,111y
normal can be distorle-<l ev~ n more than those shown in
Figure 4 ,18, If proper reiations are achieved at all early
Jge. growth is more likely to proceed " long J nor m,i
vector, In the dev ~ i o p me nt of normal dentdl r~l dl i on s ,
normal lunCl ion of the iips, lip sea;' and nasai breat hing
~ ,. e thougllt 10 be impOrl.lnt. Funclion is .llso importJn l
d"ri ng remodeling of bone gr,l !t, inlO normal !:>one
str ucture dlter surgicai reconstr uo ion, A successful !:>one graft can be difficuit to detect on a
rJ d i og r~pl' , except 10 II' " ' l"llili, ing wire< tJU l rern,lin
(f ig. 4.19 ). A piece of i l i ~ , ere, t bone fron, the fhllienf '
hip was used to r~p ia ce the diseas~d h'if of lhe
mJnd ibie thJ l Included the condyk . Mler rcmo.d eling
had o,,<:" rred , not o" ly did the gr.1fl assllme " n .1PI"op ri"te , hdpe, but the bone trabk ulations hdd lhe "pp-earance of mJ Ll dibuiar rather th.ln iHac crest bOl1e.



to modify .>bno"",1 f.Ki.ol SUU<1ure< in

inhibillfOWlh. Surgic.ol ....lWir al
drl\s 01 tho lip.oo pooLol~ ~ 1l"SU1~ in extmsiw
forwMIIck .e1upolltill al lho mniJ
.... ~i.lllywbmolMr~.....,~US<'d (~
UMl Wolh ...., al l!>r's1r r.odlniqo.ln. ' dilJnml typeol
midf.IR dfJoo"lir:y is produa<l ~ Olhrr
<Ipn.lions to;dv.u'lC<' tho mid,..". 11 or.1 drft<
~.lO'd. ... .... oc:rurR'd in
~ vill4tS in 11Id ......,
l ho' ~ bil.>l ~ral ddt!;
in ~ults . ... no{ dCCOmpoonird by m.orW anteriol"_p"'I....,Of dism'p,ln<io>s (Fig.
4.208 aoo Cl ~.pi ....lho d eva. m i", lu nttiorwl . nd "",.
me lle ('ffn1S at lhe unu... l,"" 01"1<lril in I"" individu.l
....0 in f, gu....4.2 0B dnd C. j.w ",I.llio ns 'r~ qu ite good.
Allhough ma ny que stions Tl'll., rding grow lh mee...
nisms ....Illdin, som~ poinu th .lt ,eeognize lhe
iIllPO lt . n"e ul growth e" n he ,Idled. A pt<>gr~m aimed al
aehiey ing o r Illdil1 " ini ng no, mdl fa" I.1 ,'ruetur~ an d
funelion should : 1) remov~ inhibilions 0 1 nOl'm al
growth: 2) p romoI<' nocm.>l function : 3) ...-due.. iatro
$Cnl< dJ m.~ to
as SU'i\cal "", rs: and 4)
ron'i~r rll<' ~1fn1 of growth on llle final ..... ult wh~n
In........... nlion duli", rhe' vowth pe1iod i. O<'C'<'SSJI}'.
dtild~ IN)' .onu.olly


1i"""'. 'udI



1M princi~ of facial grow lh and d eve-Iopm<'IIt

dlscussed in Ihis ch.pter include s~ifie biologic
proc...... . ,i'e< of growlh. riming. herediWy facmrs. receptiviry of envlronm. nt .1 cues. an d v.ria fou nd in " bno rm.1 d ev. lollmen t Changes in
t he dcnt,,1 arches an d alveola r precesses dre coord in. led Wilh 1 g rowt h, l'llsln alal grow th of rhe
fa,... is comp lex and vd,ie, consider.bly among chi l
Growt h proce' .... . nd Iheir liming must be
,,~sse<I ca lully for indMdual PoIlients loach~
opf imal
uln. from d ink . l l....a tm.nL Knowledg<>
of If'OWI h COIlC<'\ll> is imporunl because. in some
ill$l'~ growth im~ I .... ' llYnl outoonY.
whtIl".. in or...... sjt u.ooons. sr-rb intnfeR's with
at tlinllYnt of SlKa'Ssful 1l"SU11.


riO , 4.2'0 AEMmple 0< mid!>ce ,,,,,'erdMop,,,rot resulting from ,.. t,k
bon of "">.iII.'"f ~rowrh ~
ocaml'>\l ofl..- oorty 5Uf(Ii< ~ rC?Jlr of
cleft tlp..-.d IWbte, B. C ~.ted bioi!"''' defl of ~p .nd p" btfo in '" idutI..
GtowIh of the ;-s 1m 001b<>en re'\.lf'dlod. ..-.d i"'" ......,;on ...., <!"iiO 900d.


Self-Evaluation R~vj~w
1. When d""s the face grow with respect to othe r
p.1rt< of th ~ body? During the pos tnatal per iod. w hich
are-os of the fa,,, grow pToportio nat~t y mor~ th~n
other areas ?
2, What facto rs may influence an individu al's specific
growth p .l!t ~rn ?
3, Distingu ish bNWee" biolugic age ~nd chronulogic
nge, Why is ma turity '0 important in determining
timing of treat ment ?
4. How do grow ing lx m es change position in re l~ ti o n
to other bones ?
S. Name area, of the maxilla and ma ndible thilt
change relatively liWe d uring growth.
6. Descr ibe re mudeling ch~ n ge s in the g rowing
maadible thilt crea te space for the pe rm . nent molars.
7. li st the carrilJglnous structure s of the face and
identi fy whe the r they ~ r e prima ry or 'ffondJ ly in
orig in,
8. How does scarring affect maxillary growth In
pa tien ts with cleft lip o r palat e?
9. Why is growth signific.,nt in the treatm ent of f~ci~1
10. How is the shill'" of !>ones infiucnced by functio n?

f; S " '~' 4." , 4.' " ,\ ,, ~ 4.20 we,e p ro v i ~ e d (OU"" y of Dr.
j O<epll M ",,,. f igure<4.16 , " d 4.17 were provided ( O\ IIWSY of
Dr. W,lter G"" lni, k,

Suggestod Readings

Bjork A, Tho fo<." in p"ur, It". Lu"" I, """ling, Ila'''ytk <.i<!:

Enlow DII. r"" i, 1 Growell. Phil, del phi" PA: WB s."undm Co:


Ilo rowitz Sl , Ilixo", m . The N>tllre of Onhooo nhc D;<tgnu, i,.

5<. loui" MO; CVMo,by; 19% ,
lo" , I""" 11 A. 1",,,,, 1goO , i c ~ I" , Ildh ll,,-, ,'g M . G,." l>", TM.
e ~" Orof,,;, 1Growth ,od l)evelopro,nt. Til< lI, gue:
Mou ton ~ub l ;, h m : 1977.
Mm h, 1l W A. Tan ner j M, Pubert y, In : DOI' is jA, DaDbing ) , e~s ,
Seiell' ific fo und. tio"" of I'<l<'<ll",k" l'hll.><lelp hi. I'A: W"
,.",10"; ' 974.
Moo"" W], Uvelle CUI. Growth ot' til< raei, 1 Skeleton io t il<
lIominoideo. lond on: M , dem i, Pcm : 19 74,
Moorees U A, Cron AM, Lebr<.'t LM L.Y('" I'K), fc.h<:h f).
Crowth " ",Il l" on tho denMo n: ,ov;("W. Am J o.thod
' % 9 ;14;60 0,
Tar,"", JM. Growth " M o lo"erlce. Oxtord ' mackwell
Scie" tjjje Pub lit",h om : 1962,

- - - - - - - - - - - - -- -- - -"

Development of the Teeth and Supporting Structures

5 Development Of Teeth: Crow n Formation

Nicholas P. Piesco a nd Jam es K. Avery

cha pte rOutline'

Introduction... 72
Overview01Oent,,1Tissue, ... 72
Introduction to Tooth D<'Vclopme nt.. 73
Obje<tive,.. 74
Origin of Dental Tissue, 74
Bud. Cap. nd Bell $t09", 75
Development of Ihe Dental Pulp 77
Induc tion In Tooth Development 78
Ro leof the Epitheli um and Me,e nchyme in Tooth Oevelop menl
at Ihe r " sue LeveL.. 78
Molecular Control of Tooth Development.. 80
Dentinogen.,i, ... 87
Odonto blast Ditferenti31;on.., 87
M3trixse cretion... 89
Miner31iz3tion of Dentin... 9 1
Org3n"3 lion of Other Component<of the Pulp.., 92
Histol ogic Events during Amelogene, i, ... 92
se cretion St"ge 01Amelogenesis.., 93
Concept of the Enamel Roo... 93
Relationship of Tom",' Process to the EMmel Rod. 94
Pomecretory T,. n,ition3151age of Amologene,". . 95
M3turauon 5tage 0/ AmeiogM e' i' ... 97
Phy, ic. 1and Bicx:hem ic.1 Event> during Amelogene'is... 99
Protein, of the Enamel M"lrIx... 99
Role of Proteolytic En>ymes in Enamel Development.__ 101
Mineral Ph" ", _nd Mechoni<m, 01En"melMatur. tion... 102
Crown GrowthandCompletio n... 103
Crown and Surrounding Tooth Crypt... 1(14
Summary... J(l4
Self-Evaluation Review... 106

Introd uctio n
Overview of De nta l Tissues
A5 an oid in est"b lish;ng developmentJI relationsh ips
during loolh development (odo n tog~ ll e' i < ) .; l is import" nt to br ieny review lhe slr ucture of a fllily develol"'d
loa th (Fig, 5.1). Del.,iled descL'iptiolls of toot h , n" tomy
arc found in texIS on denl31 ~ n.llomy J nd will not be
considered here. Under gross inspen ion the toot h CO Ilsists of lwo p"rts. the crown .1Ild rootls). The crown pro'
vides the chewing or bit;ng (occlu" ' 1or incisal) ,urface
of the tooth wh ile the root provides lIle I1 ece." <11)' supporting functiOE" . The ~".1tom ic crown is th ~ part of the
lOOl h covered with en.lm e!. .1<\d the clillical crown is the
parr of lhe too th ex po,~ d to the 0]',,1 cavity. In yOULlll
individual, the clinic,,1 crown may be ,ma iler Ill.'" lite
" nalomi, Crown {e, peci" lly true during eru ption ~ In
older individu. ls with gi" gival recess ion. IMrl of the
~n,, (om ic rool may be expo, ed to Ille 01'.,1 c,wity, Then
the clinical cmWL1 will be larger th" n the " ".\tomic
nown, , ince it would illd ude some " natomic root m uc
tme, For simplicity. Ih" term crow n".1S used hereafter
will refer to the an" tomic crown. Unlike tile crown thJ t
n. ed, .' d ur~ ble covoLing. the roots of teeth ore covere d
with cem~ntllm thJ t functio" , i"'lead as an " ltac hment
surfJce . Tho jUL1ction between cementum J nd enJ mcl.
the ,eme"toe""mel j unction, l i~s " I the ,'ervix (or neck)
of the tooth .md i< J I1 importolnt devclo p m~ntal l.n,l
ma rk wor lh Qoting,
ByeXJ l11i llillg a ground histofogi, ,,ction of.ll' eru pted tool h, one Coln sec that lhe enamel ," vcri" g the
crown consists of lightly pdcked enamel rods or pri, m"
One c" n also observe th,'! lile Ilulk of the mine ralized
lissue that u n d~rli~5 the ~n_ m el consists of dentiL1 ,
Dentin i, lubulJr in n.llu re. Unlike enamel, dentin is I""
me"b le and con t., in< li<su e nuid and cell processes,
EnJmel and denti n ( onta in mi,ro>copic.' lly visible I"ndm",k< th.ll indicate the inu~ me nl,, 1 n_l1J r(' of mJ t, i,
deposilion (apposition.\1 growlh). These " re th ~ inneIflO Lllal fines. Relliu, ' ' tri,' e in en" mel <1nd illcremcnlaf
lines of von Eb ner in dentin (described in del., il in
Chaple., 9 J nd 101. Tile ju nclion betwe~ n the en" m~1
" nd d~nti n (de nlin"" n''''' "1 junctiol1 [DEj]) is a nol h~l
imporlanl development. I I., ,,,hn.1rk.

______________-'S ~t9f Tth: Crowrl FOffl!ll_

""' _ n


Cemmtum """""i"llhe mol enc~"" IIw ~. of roll...

!CO r.r:lC'rs (Sh.uiXY'S r,bers)a nd tbforefore po-lMd'" fi,m
anc hor,lit' poin t< (de ntal .lltachmen t) for fibers of the
p<."nodn ntalliga I11enl. Additionally, thc' rom, of the teet h
",,,,,, in ;n <ocker< or alvcoli. TIle
",rf....... pro
vide bony at t.l('hmml . iICS for periodontal lignntnl
fiben (.lIso S/wfpey"s fi bc'n ~ T1l.II pori of 1.... lNndibk
and nwxilLo con .';nillll lbr rooIh """""" is
.lIvnI1.r J>I"OC"SS and ronsim ot.lYroI.or bont. Ikt-.m
the' roo! and . IYE'OLlr bone is me periodoma l sp.lce. It
contain, blood .....'..,1 .. !leN<'''' fibers, (ell., and ground
subst"""e, Deta il, or its stnLClU le and de vt'lnpmen t wi ll
be ron.h:I.....d in ChalXers 6 . nd 7.



n... elm"o DIm.-\OD(h endoooPs aImS> 01soft rtss..... 1M

- . . . pulp. In !he' o-n (he ...... l.OI pulp . - in I....

....... ,


pulp ch.lmbc'<. and in , .... RlOIl It nislS .as ~ of

1M pulp cha mber lnmed root (T.ldicul. r) can.lls.
Odonrohl.m, . .... the ou~rmo'" cds of II>e pulp and . rc

responsihle for formi <l g tho pmtein matrix of denti n

(mo<tly tYpe I rollal:\'n) and Its ' ....." IUdI mi " IiZdtlon.
8<"tweffI 1h ~

OOonlobl.1m.nd lho' ~.kir,c.:l

min is i

LIyl!'r of JRdentin m.OIra thit hi< oot yo:'f bHtt min~r.l

iud Tbe junction btl .. e. " the dentin .nd po-edenrin is
tt.. denlin mi_.llulioo I'ront or denlin--",ede'lIln

junction. AI. tho' opn of t ho' moIlhe", ;. on opmi.... t_

.pic. 1fo'. mo>n. w hich ol1ows l ho, po=~ of blood ves",1,. lymphat ic, . nd ne""" Ihto llg h the too( 'dRoll 10
.nd frm" th e pulp oh. mDeT,

Introdud ;on to Tooth Development

Tl'ffh onc! Ol:he'r OIJoOns lk'vrlop .. 0 InIlII of compln
$l'1ies 0( inter.lClions ~n ~pi''''''ium .nd undrrty_

ing mt'~nc hym ,,1 tissue. In the roorh 20 prim a'Y tooth
germ, develo p initidlly. w ith 12 .ddition" i toot h germ,
diff~rent i.ting to form the perm.nenl d~ntilion.
Allhough eochtooth i"'fn'I ~ " .lI1 . twlomioc. 11y
disti nrt unit. tt.. fundimenlil proms is
.uniloor lor teflh. EMf! ~ ..... Iops I~ sutn'Ssift bud. ,op. onc! btU $UglS {Figs. 52A-e~ Duri t"ll tho,
e. rly >t.l l('C'S, th~ looth llO'f"'S grow.OO tllPoInd. ;u>d lho,
,eli, l hal will form t h~ mine r.liz~d ,ompon~nt> of lbe
teet h different iat e, Once l h~ forma tive ~ . II, o f t he tool h
germ dlff......nti.te. fo<motioo and m,ian af th e
..... tin .00 .. ""mel m.tTi< t.l~ p~ (FlJ'. 52 D-n
SIlb""lutndy, the coml*ted tootlI C11Jpts into tt.. oril
(.Wily (fiI, 52G~"'" enrption octurs.the tooth roots surrounded blr l'rio:>donIillig.unent oDd <upp!lrting iMeoloor bone <k-Yriop (Figs. 5.2C .nd H ~ Root fortnil OOn pr0.ceeds until. fun ct i"""l tooth onc! i" ,upponing .ppo_
l u' are f"By d....eioped (Fig. 5.2H).

f ig. 5.1 ONog.... d olDngilldinol_ d


.. _

ill ..... _


iJnttlon. eEJ: ument".....mel ~tion




. 1I ~to{ rhe Tmft ond ~pportingJlJc!ures


T1lt (JVft".1I oII;ecti-n of this d\ lO",-,bIe tho
stu<ImI 10: 1)~, in ck'toil tho ""lin 0( the foml..
.mr mls 01 tho lOOIlI. 2 } ~ tlIO' rule d indooion
in _lorrrurion. )) Oncril>c> tho ~ oI_h for
.....ion. " I De10ihe fhe ~ 01 mirorr.oliution .nd
I'KM it dilf= in",-,-r.nd <lentin. Sl o...c. . tho formolion of tho liMun ttwl tUmlUnd .><h tooIlI.

Origin of Dent al Tissues

f Og. 5.3 ... Map of ......,.1 <rn< <ell mlQ'<ll1on Ina 4-week-old ombr l'"
f, o",.1"-"<l ion repre_t ioq tho pl,me of ""'t lon '.' in ...and IIlml'<ll 1ng
n"",01 ,,~.I mig" tioo,

Nour. 1cre"" cell, COn$lit UI. much ofl he m"",rx: hy_ of

t ho hd .nd neck Sinc. t h. se ce ll, . re ori gln. lly
derived from t he . n od e rm. l ge rm r t h.t for m, t he
ne rllous ' y'tem , t h<'jl ' ''' " I", te rmed ecrome",nchyme
or ne uroe ctod erm, Th ~", (.11, fo nn . 11 of t he conn1;"'~
tim ,", of Ih. f.>=, ioclu dlng t ho d .o t., 1't""tures (Figs.
S,lA . nd B ~ Tho rol. of the ne ur.1c=t In tho dr-wlopment oftttth .nd their SIlpponing ,tructu... i. nOl com_
plotoly unr:letood. ~ tl'U. ,rise from the neuf.l
fold.. As t hoso fold, do$o, neuf.1 CR'St mi. m'gr.t.
down ttle <XI... 01 the he.od .IDO!: ""thw"" undntying
tho ec10derm (Flgs.. 5.lA.nd B ~ It is inl......nllJ 10 IlOlO'
lb.ol in tho coph,olic rqion d tho o:mb<yo tho mls d tho
neural <.Tnt boJin I"'" migMion bof"", tho ~ 01
lbe neural wltilO' in tho ltunk tbel<' mls IO'~
11ightly iii..- de-.odop<uwul "'"ll'l'. 8oc,U$\' of lbolr
rxlmSiW' mig.tiom MId propmsity lO dilJo-rml .. t
1on3 nuny d dowloprnontol p"thwiy>. _
ilWO$lig.>rors ronsldor _f.1 <.Tnt mi. lO be i rourth
i"rm Iilyor. 01""" ~ tho ... lO bo a m."'ging or rwo
n>lltypes, n too.. " ..1 and m<'SO<lorm.ll. which ;0 Iurn
fonn <:ell. th.>1 rest'fflbl. bot h types.
Ollring fhe sixlh ~k In " rno tho n fC><ko1m covering
the or. 1c....ity i. composod of. n opit holi. I I.y<>r, tWO 10
th ree cells thick. In th . regio o or t he f",,,rt' . 1.... 01"
pr<xe" e" th. or.1 eplt h ~li "m pro life r,lte' ""d lon m t he
de nt. l I. m;n (FiS- 5.4~ The ... a.... ho".,hoesh ~l",d
binds th,u". t ho pe rime ters of the IoWl'r . " d
"pper p",", .nd give rise to t he <.'Ctodemully-derived
pon;on. of the t""th ( Fit. 5.5). Tho """'t.1 I. minae
ul>dc-rgo fun hr-r prolirff. tion at .io;,. Ulm">pond'ng 10
the poo;;t i""" 01 dO(' 20 primary tl'Cth. This ......In in lho
form.>lion m"ndnI Of ovoid lIn>CI""'" (pIicod...1tIwIl
protnI<Ir inlO ,be rnosoncl'lymfe (pri m irivt' embryoIlic
con"""",," tinuo). n..... pliIcod.-. lot.. d<wIop inlo
_ h buds Of lOOlh eenns (liS- 5."~ Tho rnWlluy ifld
ma ndi bu w den.... Wni ...........m ..11y giW' rise 10 52

.t .

Fig. U ... MJ<tion

of _

furttM.-o-dKlion 01 tI>t ..... me1



_ __ _ 5 Dey~!op~cnl Of Teeth:Crown Formatio,,_


such buds. 2lI for lhe pr i......ry tn-th.. w hich ~ri.., ~

lhe siXlh ~nd eighlh pren.ltal <ttl<. ~nd 11 for ~ per"",nenl 1H'fh.. w hich ~p"Nt ~t 1.01... pren.>tiIl periods
(~ 5.5 ~nd 5.6). 5uccrMoion.>l IOO(h buds of lbe permonenl denllli"" de>'doP lingllill/y to 1lIr toom bud;! or
lheir decldoous prt'dewIn (~ .5..4 ~nd 5.s~ Thi.
occurs in uU'ro ~t 5 monlhsoe. rorrt..."",tr'" incisors
~nd \0 monchs of
for l he premoI;Irs. The linswl
exlt'Mion oC the dt'ntiIll.lmi... tM givn """ 10 the sue
C"l"S$iOrWIlrll is therof_ WIed rt.. 5UCCe.sioo .... Ianin.I



PMN_ mo::>lMsdtw'k>p "","".iort) to rt.. decIduOUS mlIIMs.. Posterior ~ of rt.. dmW IMnin.lIi"n
~ \'0 the fonl: ~ nlOlW buds durinl; the founll
~l~l _ I I md ~ St'COnd perm.onmt """'rs ~l 4
ye~rs of . A ..."nd I.omillol, rt.. _ibuw- I.omillol,
~Iops loimul!<1n<'OU'/y ~nd in assoOotion willi rt..
denl~ll.lmillol, The Vl'Slibul.l.l.omina firs( formu ~
of epirbel;"1 cell. r.Ki~1 0.- lJu,;ol to tbr"..
(Fig. 5.s~ II will form tile or~1 ...-srlbule or rt.. ~
bet-.,n the ~ ~nd chl"eks 0.- lips (Fig. 5Ji ~ T~h
~Iop ~nleroposteriorly. wh ich me~n, thilt Ute ~ nleri
or teeth dl'velop slightly ~lIead. lempor~lIy ,peakin&- oC
the "",lerior ones. Ag.>i n. each toot h is of a different lype
(fig. 5.5). II is interesting th,lt most all org. n 'Y"lem s
, um as the d ill"'l ive sY"lem. cardiw.srular sysl~m. uri
nMy syste ms. etc. are function ally <ompleted withi n 9
mo nn" lat bin hJ. bnt Ihe deve lopmem of teel h cominues long after hirth. Thi. prolonged developmenl p..riod
", canSth at the de w l" I,,,," nral proxes",' (cdl d iffere nti~ I i on. m.urlx prod uction. m ineralil.tion, etc.) are susceptible 10 m~1llI d iffer elll environ me nIal stimuli (diseases. di~. drugs. ere, Chapter 8 ~

Bud , Cap. and Bell St ages

Tooth fonllo."ion is a continooos process ttu.t may be
ctwr.Kteriztd by ~ series of di<lingui.lwble "".... The
mzn all' cf,miflfll accon:tins 10 the stupe of l he tJlithe.
\;.,1 eomponenl of 1M lO(l{h ~nd ~ll' named .oonlift&Jy.
Four d,rkmlt stll" ~", """l"izftI. fur eu~ the
L.mi...... bud. ,.op. or ben " . CFif;s. S2 .nd 5.1 U~
The dmt~llMni ... stqr i s ~ by ~ lhickeninI '" me or~1 epi lhelium. AI this . . . IIle1'<' ~", no dis"nposlwble _ " siln. The bud SUI" is me iniWl stqr
of dtfinoliw _II de\elopon"'lL Ttoe bud ".". dniS...res ~ roundtd. Ioc.lliwl growth of llle "';theh.ll celb
of the dml<1l L.mi... (fi p.. S.1 A. ~nd B~ h is .. OIl defined
n fbe initi.olion or pn>lif...n;"'" suge bee... se il is lhe
~ in whICh the initi.ll prolif~~lion of or.1q>itheh~l
~ns ~nol
mesenclty m~l ails 0Ul'S.
Prolir~~lIon of or~ epillteli~1 ~lIs 1l'Sults in tbe rormation of ~ bud -sh.ped epil hel..1 ( e n ~mel) org.n.
Ptoliferaf;ns mesencllymol ~lIs ,,,rround llie bod .nd
fomt an ecromesenmy"",1 conden..tion. Cr~d ...lIy. fhe
ep;'heli"l bud goin, ~ rooc~'" ...rfaa.". ~nd the e""mel
org.In Is Ihen co,,~idercd 10 be in lhe <op suge (f ig<. S.IA
and 8~ Dem.1 mt'se "chyme thilt i. pa rtiolly , nrrou nded
by t he <ap-s hap<'d enamel orga n i, <ailed the demal

cIont.. ~ a

Future _


,~ 5.1 A H"""",-,>, of tooth d"""""""''' I.... bud st-oge. Diogr.m of
- " <IeveIopment" the bud ,,_ .

fig . 5.8 " Hi<lologyof tooth ~'" .t the <AI? , t.oge. 8 oo.g,;am of
tooth dMopment ot !tie CO? " "'Je.



.... <10 ..

I>'pill.l or ~mbr)'onic d~n,~1 pulp. (<ils .od~nt 10 tIM'

1>'p;11,1o ~nd thow nut Iii' out'iid~ ,hr f'II.lIl"Oel
QI"Boln tIMd~~ ... grow ~round me ~me1 orpn loom
lbe drnW folli<* ... !We.


All thrtt >IJUctutn. JIM' ~ cqan. dm,,"1 ","pi~

folln. '""' Rffl in lbe up <togt. ThnP ,hlft
sInoo:t""" consIiltM ,be IO<XtII"fTI' ~nd ~ m.: fO rt.
tooth ~nd i1$ ...ppooting Slrucnam; (Fip. 5 &A ~nd 8 ~
T1oI' epith~lul COnlpontlll. tIM' L"nJmcl <><zan, fomos
~namel ~ <lmlall>'P1ll.1 fonn. tM dentin ~nd pulp.
~ <Im ,,"1 follic~ form. ,he c~"""nrum.l""riOdonlaJli,a mc nt. and ;,djMent " IW'Ol.1. bone. Not" I"'" tho collag<'oou, matnc... (demin. ce me ntu m. periodo nldl lig.o"",nt. nd oone) a re lort1K'd from t~e ""urJI
enchy me J nd the non<,'ollagenou. man ix (e na" lel) i,
formed by , he e p ithe lium.
~nd dmtll

"CS, tlY,_



After ,he "MIM I "'-8" " . nd adjoe" nl denlJI pap illa

inc",....e further in Sileo t two ' 00111 gem, pn:J(ffd , from
t he cap SlJll" to me bell 0' d iff""",ti.ltion stogt', This
""'8'" hJ.. two dI.lrKleri1tics: I ) ~ stu. pe o f th" fUlU'"
IO<XtI crown is (l.,fiJ>f'd .nd OIJ,JiJ>f'd by lhe jUl1C'llon
brlwttn the inner e""mtt epi,lwIium .nd <lmtll ","pilIoL This process. dI.l~ from an undiff......nri.oM upSUll'l' tool" germ fO.11>In dilf=ti.lted .adull-loolting
bdl-stJgl' _ " C'!""'\. is c~l~ rootphodiff<o<en'>Mloo.
2)The inner .....mel epitheli.lllls l t""'-' l1s .......... 10
me p.>pin..) dorIsJ,e ...... ditJc=nn.'e inlO ~s.
the fu,u'" en.lInd_form.n, cells. Mj;>cenl to tIM'
."""IobIJSIS. ,1M' ,U.lum in,l!'tITIe<liurn is formed from
I.ayer of.pind le-sll.lped cells tballil' in ""
pnpm<!1cul~, to tbJt of the dirr.....,n'i"ring a"""IabLlSls. The s"....
rum intermed ium cell. a", thoughl to funct ioo witll
a meloblast. in ,he millef~li.alion of t he enamel. The
ou te r .....lln'" e pi'helial ceils beco me a<so<:i~tl w i, h a
, a pilla ry plexus. wh ich w ill fu<>Cl io n 10 br i...g n utrlt ion.;ol
,u bs' a... c a nd oxygl'n to a tn~l o bla sts a... d other . ,],\=1
org., n cells (fig. 5,9). TIlc sto llar.. (,tM<h<1pcdj cell, lying
betwee... the matum it\l~rmodi um ami o ute' e nam el
ep ith elium compl'jS('t l\(o .t~lIJt. I'e ticulu m,


fOg. 5,9 '" H~"""'-n' 01 toOth ~~ 01 tho b<II~. 8 [)I,>g,.... 01

'001 ~ _""""" .. the b<II ""9".

The enamel <><zan in ,1\(0 bell >lal!" (:<In. is,. of four dif
fe",nl1 ype> of 0:11" I ) 1'ho..- Ihat <J>\"<'r (1\(0 CO'IVI'X ~ur
f.ocr. w hich alt' the
enamel epithelial lis. 2)
'Ibos<' thJlli ,he rooc.wrty of ,two enamel 0'Joln, wlllch
m~1 ."lIhelUI ",U.. 3) Th_ forming ~
alt' the inner
~ ;od~1 to l hoP in............ me1 ,.felled
to ;r< the >lr"uom in!!1'mt(huom: 4 ) 'J1I<M- ltu., Iill ,hoP
......... indel of rt. ......... orpn, which '""' 0l'l'm0'd ,be
Mel""", Ol'licuItom. The ~ teticulum is SOII'ICIi","
CJI~ the nwntI pulp. ~ .lIN of the ..... mel ~
~ 1lIt inllef.nd OIJ,ft erumel epilbct.i.ll cO'lI>,joIn
one anolhec is c~11ed 1M t:nYkalloop. The cervlc.IIloop
is an a",. of JCtiYe II prnI.reralion a nd lies in a "'I:ion
,ha( will l>et:ooroe Ihe ceMX of ( 1\(0 ' OOIIt. f<>Ilowi"lIM
fOrn' Jlion of the crown. ,he cO'll> in the rvio<~1 loop w.n
p...., rise to the epi lhelial toO( . heat h and tpi,h~Ii...r
diaphragm (d iscuUl'd in Ch.'pler 6 ). OU ri"g Ito.. bell
'tage . t he , ell$ i... thc perlp h.ry or l he demal I'<'I>illa d if


_ _ 5 ~lopmentOfTeeth.' Crown Formotion


f~"",(i.lte info odonfobl. m

~Io~f~ .00 will Function

. As (hey diff~"'nti.f~. they

in th~ fonn.lion of <i<'min
Thr-I'fOCP"S of diffe"",ti.:lfion of tho v.rious 'lis of tho
eonomel orpn .nd dentll po~11.a is c.llm cytDdifferend.fH>n. Diff~fi.:ltion of It.. Vil riou< dentll d=es duri,."
tb<w Sl.l#'S is (~~ hisfDdilf<o,....ti.:lfion. III this time.
!be ........ l.nd 1.a~.1 "",,,f.1 l.amin"" betin to d~
Thr- tOOlh bud Ius di~ti.:ltm . nd is indeptlldtm
'" 'Ilt' or" epimtlillm. In this pnIC'tSS. "'" tpitlxfWl ceus
'" It.. tim.... lMnin.l . . . . . tys;s until ee WniN diJo
.ppts lAss- 5,6 .ond 5. I n Thr- gooner'" Lomi... is ~n
tloi....:l lllOR posl<'rio<ty in It.. n>ou'h. hownrr. ~
Olher lft'fh =1tss.,;Mnad indntl o;>'lotlll (f'ip. S.10
.nd S.11).


Developme nt of the Dental Pulp

Thr- \'00"1 tIm"l popilLo Is tnOI't densdy JWCktd with
cdls ,twn 'M tissut< surrounding ,hi: teeth (flp. S.8.
5.9. nd S. 12~ In .....'" 5.12. two prilJLl'Y lJLlxill. ry
'OOlh buds t Sft'n a~ lWO mJ ndibul." moI.1,., In 'Ilt'
"",,",.;.w. 80lh a", in . he Ix-Il or dtntinogen "agt.
The high (.11 density in ,hi: p4pill"" i, .n indication of
,II division in 'he p.piTIa. which will k....p p.>' with
growth of lhe ename l o.g.n.
As I"'.iphr,a l denIal pJ pill. cell' I, n, form inw
colum M._sh" I,ed odonlob l.1<t$ th ey develojl crll

' ..... ~. I O \<: ",inll <le<fron mOcrolJraph 01 tile """"" Lorn;n;a with>ed
....."'''1'''110"''' al l.. bud <ap . ..... bell "J9t o f ~. Epilt..lir.o'n
w;>< _
ate<! from dental n'.""",~ l>y enzyme IrN tmorrt..,d 'J'<'",I.
m<>< hJnir:" lor<.


a -I - _

fog. 5.12 ~ _ _ ot....;.... 01 ... ........,., "'flatinrj

do.. lopiogtmh.


" _ II De ~
_ _t of the...!l'l1th and Supporti!.'9jtfllCtur~






1'f1)(.....,. (f ;l- S_ ll ~ Odon1obl~<l< [h~n ~n 1M

proce;. or d....l1n ronn;otion, w h idl is !<"nI'>ed dC'Ollno~ (~5.9 ond S_1J~ During dmli~ l~
"..".... p.o.pilLl !>oI1M:S wrmu_ {='t')lI a m..puI
..... ) br denlj n ~ iI is l",", ~lhe-..upulp.n.
dmtol pu lp .nd den';n .... dosdy .....11:(1 lOmliIlllht

Mnlin-pulp compWx.;n-forming

midIe in !be pcri~ oll'" pulp and ~ .. llory
form tho:' d.... ' in m.llril<. T1l<'s<' (.11< main~in all
procl'<s,,, in""lluboJln.
On cl~ ....min.olion. mosl: of the ails oft denYI


pu lp are seen 10 be Flbl'obl.1sls ~n d

reficulum (Fig. 5,13 ~ A fl:'W" LllFr blood vessels 1r~verst'

the cen t,a l a",. of 'M I",lp: ",,,,ner OM'S . .... .... n in its
P<', ;phery. Allhc>ogh I~rll" n."", trunh " r~ I""o ll'd J>I',"
{he developi"g y'lUng teeth , only ~ few , mall ncr~
.,,,,,,i.ltcd w jth blood ve, sels em er de velo ]1 in~ young
pulps.. L"e r " th e 1N'l h eru pt J nd (o me into r" nr tlon,
the Jorger nlY<'lin~tcd nerve< become molt' Abundotll
rnroogoout the pulp organ.


Induction in Tooth Development

Role of t he Epith elium and

M~ In


l)eoyeIoprnent at tn,. fiswe lft'eI

Inili>l expmmmb dnoprd 10 <kmmi"" I'" ... lit
epithdium And

in I,," initiAtion lit IOOIh

deftlopmt'nl .nd cell difre",nliol'ion nude use lit

epitltdi.ol "", .. ,..1tynwI ft'COmbi... tions. In l~ exptfi"""nl< tl>e ."ithelium .nd m l..,e rtdJyrne of d",,",Iopi"$
....m ~ ... experi",""tally ~r.l"" (with It. .id of
mat rix-dill"Ofing ffilYJl'Il'S ~nd "",,,,,,, genlle mh.lni"l
force (Figs. 5. 10 . nd S, 14~ The ..".,r~ted 'imlf'S....ere
allowt-d to grow alone Of w.... ,,,,,om bilX'd aoo allowed
10 grow in CUIIU.... or as a g roft. The"" ex!X'. lmenlS
enabled i n~ <lig~I0 r1 10 discovor whet her the ceus were
. mbryonicJ lly dele rmined (able to , ecrele diffe", nli,lIed
prod ucts indel>e "dcntly ) Or whe ther tile i"l er aClion
between me",nct1y",e and epithelium is '>ece'<J-tY for
the fo rmalion of tiiwespecific products. fo. e mpken."",,1 0.- den ti n. Furthenn<:>..... i' e""bled lhe diirinc
rion """""""n in<ITUCtivl:- ~nd penni;"'" li<_ inlerae
When the ."ithelium.nd fltE'SCnctly""" of bud, up.
or wIer <14" looth ~,.,. f'd from one .nor.... and
JRlWfI i"d.... 'idtn.1y boch will proliftor.lle.. bulllO 1'eCOlniz..ablE' tOOlh surlu,,", .,.,. forme<f. 1""""""1. wlltfl
JRlWfI j,><Iependtndy. ~ ~ """'" I""" ..... pe
(up or bdI ).IS wril.lS lllieir . lily ... form dentin or AI. be<r.. I'" epithdiurn IIWY kt1'~tinizo! .,.j I,,"
~pil'" =y form ~ mi,,"aliud liu<' r<'Sf'IIIblins borw.
This d"""on<!Tale< l hal lhe inft'r.'Clion olll>e two de1l1al
lmlle< is n~ry for lOOlh form.orion. ~nd lh.ll neilher
Im~ CJn conlinue along. p.llh of diff=nli.lIKm indo'pt'tI<lenlly.

Fig. 5,13 A Di> 01<ooth ~ >0:><1 lniti.l _inogon",'"

B Light mkroocop/1 <Icmon,'r;>\Ong lh. hi, talogy '" l,.;u. 1<Iefl li""9O""'~
ond 1110 be gln rOog 01 t Oe a ppooit iDlMl , 1"11". C l ight microg.-apl, ~
" " ' ''9 1110 , t"'l" wtwo Of'PO"il ior1 l. n... <<>mp.jd it ion .

Sin", l he'" two d~ntal ll l'u"" must (IXlP"rale to (Otm a

loolh . one wo liid like 10 know wh ich I b tle i' pfO\l id in~

_ __ _ _ _ __ _ _ __ __ _ _ __ _~
5 ~ 9l Tf!f!I h: Crown Formotion

~ inSfructioftS ~nd whic:h "'""" is mpondins 10 ;ndu<1M cun. This qUMtlOfl is.ans_ by ..,..r.ting ch<de nl,l ti.. uO$. ,"COmbining tl>o:"m with <lmld! Ii""'"
from d HT~ re nt ,etll or nondental tl" "e' (t>l:'teml ypic
' ''''omhi,,,,, ion' J. ~ " d I)un ing t he", 111an environ ment in
wnieh th"Y can interact (u. tldlly. s .1 gra ft~ When c.pderivt'd d"".1 nu:~nchyme from moL.. looch i.
=ornbincd with epillldiurn from . 11 incisor moIH
loom will ....."11. Fun~ ....1Im p.>pill.l 1Ut$~ is rl'Combi_ witb ~tlMlium from 1M
d.... "'l.I ( . fOOtltlf'<s ~ in . hot j.Iw ) ocewn non-or.1
<"pitheli"'''. Ih<' =ull is tho:' lormnion oJ COIllJ>k'le
lOOl h t tld! h in morphol"l3' diCl. tc d by the de nlill
me, e nc hyme. Reco mbi.. ,'t ion of (ap- sla ge ,1'>111.11
epithe lium (en. ,,'cl org an) with no" de",.1 mesenchyme do<-<; nOC ult in th<'fonn.ltion of toOII'h SITu<:In .... {AI- s..14~ 111
nper\lll<'nll <how tlut the Ill<'S~... ,he bud SI'V ollkwloprnmt .nd ~
<Io1c'n'rb1le'S IUOIIh type (stwpe) .lflcl an ind~
dhelopmrnt (..-cTflioo of ..... mel) from I'IOndmtol
epit!ltlium. ln tIIis r.~ the ~"'" is 10 ~
. n in' ll'1J(li"" in~u~ nc~ <Nt I~ PJlilhelium bKause II
carr i.. "In' tru<:lion,' lhat can chan~. IIw fa\~ of IIw
<plthel""" (Imm the <>ri~ina l m .lt ifi od "lu. nwu' keratinililli or non-ker.tlni' ing epitlwlium to . n ~ nJ mel
aIVn Ihal S<'<TC1' cn.lm el ~ 0" me ot her har>d, Ihe
epithelium ""'-"ft< a prrmissie influence "" . ~ dental
~ l>t<o....... only ito;
is 1>t'Cl%Ol)' for
......... dt'.tl:J\"'''''' ~ ""0(.""""", is de!ftmi...,.j
sill' ilS faft is lIOl ch.Inar<I by I~ ~'hc1iwn.



Tbo a_
I'1"rombin.nion cxpen mt'nt' arc m.e for inter." in" , occurring during the morp!"'S. nc'i' And proliferat ive , tJ ges of 1<.~h dovelopm~ nt. A .Iiffe"~" t picture
emergt'. when e'Ai1,luing 'im e"perime nt< performed during th~ period in w hidl the p.1 ue ming: or
positioMii1l of t~h occu.....M i<., pOor to !he bud $l.>gC
of de"IOlp" ..... t. , hi' Llimirw "d#' in wbidl Ppit1lel i.ll Arc bq,nnin, 10 br<:om<' apfN rcnt.
Rambin.ltion< """" beo:'n maok bet'M'flI ptt'm,p'alOl)' Ci'C" Mid earty or.1 epilhtlium. fu.lllermore.
recombination, betw""n first-arch (lTl.1" ilIary) and second-. i"(h (hyoid) me, enrhymc . nd ~ p i t h d l " m h,we also
been mad~ ,n ' lOg<:' prior to th~ form. tlon of toot h
bud.. In Ih<-<e circum""""" tooth deV<'lop"lCn. wouid
only pl'O<W'd if oral (liN-..rrh) <'P'llu"lium w,lS ii1<ludt'd
in 1Ir rombiin.ltion. This ir>diroln lh.ll the epilhrlium
pl>ys .... Inseruction,tl
durilllllw t.mieu "d#' of
lOOIh fonn.lIion and the ra.~ of the ..... tal crnl all'
i, not predtl:<rn1int'd. It appea" l!wl these ...oprocal
cell int" "Clion, OctU, in tW<J <lAg.... In the fir"
the . ,'ithel ium ""' d fi,,, Ih. "dental of the me,e"ellyn"" ,,,, d In the sem nd ,I,'go tho nw't'l1chyme
'I"'rili~, the looth type the notu", of prodl.l<lS prodI.l<cd by the epithelium. By t~ lore-bod ot Nr1y..,ap
'UgIl' .u>d b<yond, ~ tlomilW"i' 0\It't the
~Ihelium is estoblislwd.



To dl>termi ..... he mccll.lni<m 01 indl.l<tion durin! the

diffemulation of tk'nl~l ,is'ues. dent al p.o pill ~ and




li9' 5,1. lodi.C liotl 01 toolh primor60 by ......'..Im'" , .... k In 1'rIe><'Il(!rytne,

A Tro",pIont<tion 01 enarlO'! orq.;tn from tho .ltt oft.. ~1YooI"
til<' lipo " h""k mc,,,,,,hy" ,,", T" ,,,,ult ~ 0 Iol<:k 01 {Onl;nut.'d .....LlC' ion 01
toolh p<imordio.
8'......."...."'1.,., 01....-.1 togonfrom theUp II< _ iTl<'>m<hynl<> to the
- . . _process.. Tho .........;.; the........tion of lnol;h pmu--d'"

1'' ''''''''


II Development of the Teeth ond 5upp,!,ting ~ructu res~

Fig. 5.15light mic'09"ph; depicting tileonorpoology of tl..,

e,,,,,,,, knot

,t tl>c <ap "age 01toothdevelopment ,nd , econdary"nomelkr""'; at the

ocll " age 01tooth development (A and 8)_Corre;pond ing microg rJph, ((
ood DJdcpkt;ng the I""ol;, ,,,;on of FGI4 by in _,iw hybridj",ion.

en.lmel orgJ [\ h, oe been cultured 0" 0PI,o,ite , ;,Ie, "I ~

pomu, membr.'"e. The", tr" rl>!il!," experiments test
tbe hypothesi, of wbether cell-cell coL1lan or diffusible
moiccules are involved in the sign.lllng process. (lo,e
cell_cell ro nl.let. W;lIlO ut the for nw iol1 01 -,pec;"lized
j" n( t;on,. t>etwee n preamelobah ts ami p,"('odontobiosts
hos been se e ~ with the ~ h:ctro n microscope in the differenliation stage of amdogenesis (see description of
amelogene' i' below). During lb;s period the b"-,,,I l,lIn i_
na, between preodontoiJlasts and pre, meloblasts, ;s
penet rated by epitheiiai proce<ses. It becomes discontinuous and ;s evcnt u,Hy elimin.lted aliowing [he tor_
mation of heterolypic conla", betwee l1 ~ p i t h e l i ll m and
m e s ~ n chy m e . Hiters tbat had pore sizes iess than 0,2
mm prevented differentiation, Porcs of tllis .,iie do not
prevem lhe diffu, ion 01 "' ol<"Cub ' bu( ,10 prevent cell
pr<Kesse, from ei t h~r the me s ~ n (hy n l e Dr ep ithei;um
from reaching one anothe r. This rliles olll the exiSlence
of a diffusible molecule as tile signJ I. Since ;nh il,ilor, of
m ~ lr ix synthesi, inhil,il tOOl h developmenl ,11,,1 proce,,es of dent,,1 m. ",n(1ryme have beel1 seen ""aching the
epitheliai hasement membrane, it has been concludcd
l h ~ t ro nlJet wilh the 1>.,,1 IJm in" , ,,,I its ,,,,,,,i,,,",1
m,, ,,i, is tbe lriggN for odont<>hl. sti,- ,Iifferenti. tion,
Th i, would be an example of d short-range, matr;xmediJ ted interaclion. (MJ tJ'ix-me<li.lted re,1Crion, J re
di<eu ed below.!

Molecular Co ntro l of Tooth De velo pm e nt

The 'e<llI e n t i ~1 dnd reeiproral inter.elion, governing
tooth deveiopment and p a tt ~ rn i n g are w mpicx,
Molecuie, dnd , ignaling pathwJy' responsible for providi[\g -instruction, ' th" r ~z " IJ l e ;niti,' lion. p" tterning.
and morphogenes is dre intrk ote and hove Ll Ot heen fuHy
elucidated, However, there are some fundamentJI prinCiples eJ n be u, ed to fJ cilil,lle lhe un<leN,' r1<li"g of
m ~ ( h d n i , m s involved with dentdl d evelop m~nt. In so
doing, one mllst keep in mind that tile fLnal producl
(hu mJ n dentition! i< J culm;n.lIion of J serie, of
proce"es or extracellular , ign.ling event, ;nvolving
mo[ph03enic movements, as well as ShO Lto mid. nd
iong-range cell- cd i and cell- tissue interactions. He
,.e<pon<e of cell, to slwrl, mid. ,HId I ()n g_r~r'ge <ign"I<
depend, upon tbeir development.1 hi, tory Dr line. ge,
Previous en(o unfers with other cell" the exposure to
signaling moiecules (or morphogen<J, and the nllmber of
prior cell Ji vi, ion, ,' re <o me of the other (riteri" inlluencjng cell competence (the aiJiljty to respond to positive and negative signai< )and ullimately cell differentiation
Short -range signaling involves direct cell- cell comact.
Such inlerJ ction< J~ mediated by "" II -,urf""" mole_
( ule' . AIII,ough lhi, type ()I ;nter.nion b. , not been
shown to be involved in the illdunion of epithelial .nd
mesenchymal tbues of the looth. interccii" iar j unction,
Jre cortainiy important for cell-eeli comm unicJlion "" d
fOr mJlion of diffe,.en ti,'ted ti" He I"yer> within the


m.orrrl "'JoIn.ond ......r... p.1piJl.o. Mid- r~

inlC'r. ,ions i~ thit'di " usion of sign.>li"l moIu1es
10re,ponding ""lis in III<' immedi~~ vicinity_StICh inter
iKlions h ~ve bl-t'n 'hown to r,. crud ,,1 during de nt,,1
develo pment. Th ~ ", I, of t h ~ e' lf.eellul, r m,uri, in
mid -range <ignaling c~ n r\Ol r,., """dooM . Cradient, of
m"'l'hollc'ns oon, ~ ioed wi thin me nw,rix
(~n di~ "'II mig.-4lioo 4nd inOutrla (.. II d '"~rmti.1
Don. n... int...-rion of lIlOIJIboIms with m.- nl r..mlular nwrrix m.>y ....... ~ ns.-nri.llfol" " ... p100p; /l ic .KtiYily. In contr~" to <lIoort ~nd mid-r4n# int...-oellons.longrong<' inl.".~ ai"", Iwvt 0 mOR' vn~r4l i l ed in n","""" 00
l he ~~>t'ment of body p1~n. ~~ inrer.oc:tion . coordin.lre developm ent of hnnes, " nd mu , cle into
fU n<: ti l>l l ~ 1 archirl"<"lu[(', ~ t so involved in rcguu ting tM sym m<"l:ry ~wccn tM ~l't ~rod righ t sid'" of
the body (or denri(iofl ).

n... p.11 ffflli l1ll of ltat lImYI ~ (positioni"ll 01 Irm.

.md """II I)'P"') is depmclffit upon Ioul COIICftllr.Kions
of sign.oli"8 moIecu.... ~nd posiliofl,al sign.>Js Ih~t m>y
inOuence 1M r~le of cell division . tM plone of divi>ion.
lh . tenM ocy of (ell, to migr.I., th. direction of migr~
tion, Ih. ,Iine,.c", i'lio n of cell" ~nd ,.11 dc~,h (a pOI)(O, i , ~ Jl Is I mporr ~nr to ....member thilt the heh""i", or
f~~ of ~ "ll i, det ~ r m illed by 1M sum mation of rcived
inrelCl'lIular signals. During th~ 1"0( ..." of indUCIioo
~nd di"",",'i..lIion rUin combinations Df II"'" rivity
m.>y be swiId1c'd 00 ot off. Thl ~ Df ~ cdl 10
ind l.l<riw stimuli (i f> <ompN'1K") is lIOI only ~ t
upon tM I'I'Spon~ to prt'St'lItly ~iV<"d sijnals. but
~ I ", upon iI, develop "",","] history {number of p~ious
" II division" , n,-oulltN Wilh p"",iou, ind uClive Stim llli,

AUhouglt tllerl' is shll much 10 he INmed ron"'m ing

dmul driclopmer>r. 11Jl"M'l41 pKture is <'lIX'fJing ron<=i"l II.. idenhty ollhr mid_ra..,. <ign.llins _ _
<UIe< MId I""'" ... pIl"S>l'(I.>< [/It' vmous "'"'" 0( ~
_ _ (sumnw riZl'd in Tabl. 5.1). Itcmly, III<' imporYn<:~ of the SCQ.... nti.1 ""I'fl"sioo ol ""ndin homcobox
frdns<riplioo fdr oolS dnd signali ng ""'Ie<u!c's has been
h ighl i~ hl~d in ,ootl) devolopme lll. Tr<1n" riprlon 1.(tolS
bind 10 specific siteS On DN.". to foleil if<1re go". exprcs
<ioll. A sing!<' trans<riprio n fol(lOr nw y ol(tivote the
n prC'Uion of ~ c~o;cadc of getIol"S. CQllCCrted IC"'" nprl"<<ion .. ImpC nl ror mlI1Y bioI<>&it ~ indudi"l
1+,... ,,_~iooo ol m.- immunl >y>tern. and hormon.;oI respon~ Additionally. siJnaling nlOlccul~ (dnd Iheir rlJlIOrs) ~ nd , w lSCriprion
fxwrs may "" expressed alt"",,,tcly in ,h ]litMli um
or m~>I'nehymc " t v", ious time' d uring lool h develo pme nl. This " '"<en tUdt~ s the " b",rv~li"n thJ t Ihe r~<ipro.
(.>1inl" ol(lion, firsl obs~rv<'d ", Ihe ti"'ut level ~"" "UW >Ubstanfia'td ~l m.- mol ul.... k'vcL Our undrr'ilandins of IIISfOlogjc Ii...... inl<'facrion<ocrurri"8 durin& lOOIh devrioj>rncnl .and Ihr rno:> ~
do'saibcd Ilerl' rome from Sfudiots ol [/It' murine lImlilion. Allhouglt l hO' human lImlilioo diffn1; in nu mb...(16 l'I h pn ~rdl ..... <'ighl fot tM mou ...; no lalcr~1 ind-


T" b l ~ ,

JI Development

of the Teeth ond Supporting ~trtl~tures

5,1 Mo,""u"r ,n<! ti" ue ;ntCfacbo nin toot h developmenl





Wnl h"

roo" Impfk. te<l ln neur,1 Wh' form.

tl",...nd """..I" ,,' m'1'''100

FGf-.(! n Om ' h. epi' h,lI"m ind" ", lh. me>end'Y"'" to " " bti,h an und.."""' ''Od tooI h
bud , M" OI>:!l.a,, e'l"cssloo (p<el'ltt"'" og '"
'00'" Iypc ) "" y be , <t, l>Il>h,-d I" lhe m" ,
""" " " 1..1'1" ",,, to bud <t. oj
P" 9 "p,"", i"" in m. " ,", hy"", inil ial", twin

lol, . tloo


E p l '~el l ,1 mese",hym.1 iot""eli"", ellabF

i, h
bud. Indoction01' f><> "'''mel ~ not ill' ~ M ' 4 ~co
toolh,",pc. A~ l"" r
of the ,"" mel knot.
d ucod ill' themesenchyme I"e " the bud " , ge.


""<l;M;n9 01 """p/'I<Jg<tli' . TO< d""t.>1p. p;II. Thc pOrro'Y e OJ,"" koot ,',:I," , pUla"'" ' i<)" f" med " d "" "" " hyn,,1 dom'".n" ;, " ,111'9 cem", lndu<lfI<J QJ' p 10rm"l00 ' 1>rDU9"
"," bli, h<d,
lhe prod", lK", 01' '1l""I0'9 ",olt,," ,,, Ilk' SIiH.
~M P2. ~M "1. 'nd " GF-4 , The ' """'. of ' hc

,,,,,,I> i' _",,;noo ill' """ enchY"""



Deli"" i",
olt "" too' h i, "t'b",he d. Th.
P" rro'Y ""' mel >oot di,.pl'<"" , 00 >erondory
eromel ~ n Q " 'p!'<'" <we' tile ti~ of d"",lopifI<J
HI"odll!"'''''ti.>tiOil of<OO11""",n" of"'e
den,,1po"ill" ,,00 <r .. "",1",sa" 0<'"',


The ""ooda,y ,," nld knOl' ~ , od u"" m.,. 01

>i(I" ling mol,,";" .. U'" p<ima<}'
' not, Th. mo>t ' mpoi'"",
to be
' he memb"" of th, FGF ."d aMP family.





u~a<dl""', "'''"' "l<""CU~', e>pi> 1Iy

ed prul,,,,,!y<,", fooOO In tOe 1" ..,,,,,", n,,,n
1>0-" ",, may be
in f.,m" "n" gruwl l>
f""", "ti>ity (ot th;, ,nd ",hoe,
of d"",lopment).

i'" "".....



Sct.onda,y ,," nld k"" "

">;lny of"'o ,;...l d iffere nt;, , ;"" or "d"n' obl.,,, ,," d
'; 9n"llIn9 mol""I,, ",p", ,,,d by pM"" y ,m"obl"". $e<:c<t"," 01 d""li n , nd , "'mel
, ""mel' n"". A >'9'" Deoin"' fI<J '" ,he '''''''iv> mot"" ",,,,,"",,
I"i' '''" WiIV< "f ,W",,,,tiotion """
.~ I o,,,,,,"on Itow,,,d thoe c,, ~,, ' loop).
Oi!f"",n l" tloo of " ,, ~obI"l> ' nd ooo otoo"'"



"nd01000.-" ionofthe;"'>pedi", "",',it""'<>

, <'I> ~ m i" rIy.


cJ n i n~ ,. nr l,lL.,; in the mouse ), ,ln d in del1 lJ I

mO'1' holQgy (, b"pe <In,1,; 'e Qf ,"~ l ll) . m,Hly of fI'e enn_
c1l1Sions draw n from these sllldie, call m osl iikely be
applied ,1lso to the hum" n deLlliliol1, The process a,
descr;bed llel'e Is condensed ,lnd s;mplillcd. The referenCeS c;led;n Ihe bibl;" gr,'phy o rr~ r , d~la i l e d de<cr;p.
t;on and more complete discussion of lh e pro".." e, outI;ned here .
As ~'p"c ted. ma ny potom i,11 sigl1"Hng moiecules
(inductive o r morp bQgen;,' ,timuli) h,we been fQlln,110
be ex pres sed d uring too l h developme nt. Th ~ most
prom inent of these include sonic hedgehog (SHH) '"
well as mem bers of llw Wnt (verlellr,ll" hOllWlog of
Drosoph ila wlngie,, ), flbrobiast growl h f<lctoT(I'CF). and
traLl ,fo rm ing growt h f"n or bet.. (TGr--ll) fam ilies. The
I,' tler ,, 1m ;"dude the bo n~ m o r p h o g el1 ~ l i c p mt ~l n ,
(BMI" ) w hich, in additio n to l beir role In ' k ntal deve l
opmenl . " re import ant reglilato r.,; of bone growth and
regener" Hon posma t" lIy, Thc,e ,i gn" ling moiccuics
Inter ,"'l w; lh ' I",cillc reeept"''' 10 S ~ l up intl',lCellul.ll'
signal, th ,'t resu ll In ,per:; fte ge t1 " (xpre" lon. Among

_ __ _ _ _ _ _ __ _ _ _ _ __ _ - ,',_""'"

the ~ <Ktiv.lCed duri", ~.rly toorb dowl"l'ITK'IlI .....

al"" those coding for uan<eri plion lacl(lB. HolYlCOlJ<::
tran,nip tion factors .,re highly m" rvcd g<'ne~ thai.",
impon ant i ll controlling l h~ j)a tt ~rn ;,,~ of voriety of
d<-v('loping "r"'lure.. induding teeth. '"'" tra nscription
f~on implkat<'<l in connolllll8 ~ initi.>'ioo of IOOlh
dno' lop" .. ol IOOth """pho&o-o",S;' (lOOl!l ~). md
~W p.I.<ani0ll (pI;oo:t' iftll of tooth I)'PO'S .Of opKirlC
l.ri1. Pilx2 (0l1U). a..rxl.lhx6. lrna. and P.n9
a, ~II ., n....m btfs of ' l><' Mu and DL>c IfOU ~ (nOle tllat
by con""nt;" " geno, aTe ;t ~li ci ll"d and rllei, product' afO
cited ill conventiOl1al fo n l ~ All ho ligh t he location ,md
li ming of elK- ~ x p",,, jon of u...'" tran,niplion r. n ors
/uII(' bl'<'n doc'um~nt<'<l. ,toe numb<:rand id~ ntity of m..
~ rhty arf ~ I * for .Ktivari"ll ........ ncK bPton
fully rlud<Wtnt.

Mnnbon of ~ Wnl family of .i~lj", molewln ........

Iinkl"d indi{l'ly to tWO earl y ~m l>ryon i< p roc",..,,,
neural Ill"" formallon "n ,1 morphor.. netic movem. nL
Thi. '''!l&cm an in""lvemellt f'" Wllt In t~ e,,,1y ewnt,
of cr"niof.eidJ d~lop"'Cnt. including ll<'ur.1 erest
m;g,,,tion .OO those funrtiDn. "'ddins'" the ntdbli<hmmt or f.oN l ......,....... co...... ising the (Iomt" "rdlit'o.
foIkwring [he ~i$lln""l or ,"" flfSl br.n<h.... .lICb.
Pin:2. " n edrly home<>box t",nscription farl or i'
exp... ,scd in or,,1 cpHhclium during lhe iniri.lliOfl 'M#
(belo.. the apJX'ord"<."" of any "",,,gniuble tooIll ' Irue
ttir~ ), Its expression eXlend, broa,lIy imo non-demal
. "'. , . , ",..illi. expres sion "'.y be contro lled by me._
mchynulllO'i,I"""lsigtLIls. F.iJuJ'I' 10 exprcu thi, tarn><
r=tIt, in Rt1gIIr syndrome." condition dSSOCi.aled with
<Ienul Ilypop l.asioo . nd ~ n the .bscfl' or t_ 1t.
following the'ffidb!ishrnmt or cp;thtlidl (Iom... 1thidcning> (01 plaeod",,) the 'ign.ohng m....... ~_ FGF-8. i.
exp, ,,, ... d widely in "'dJ epill1l>lium Experim..m.1 d.ta
,ugj:cm th' t e' I,,,-,,,ion of fGF-8 is "'SIJO ttsible fu, the
initi. lion of budd ing. I'GF-8 n",y indlKe budd ing by
'timul.ting prolifct.t ioo (mescnctryn...J con<len"'tloo )
.00 me ""' ~ of the trolmOiption l'.oc101. pw. in
the fhCil, k h)'IN. Ani.... i:s .... ing 10 ""'prcu PdX91dd:
{Mh m titdy. Ac1...11y room lorm.llion is ~ in I""
e.rly bud SWg(' indic.t ing ltul u ~ or P;ox9 is 11"' ry for thC to<>lh . nl"g<> 10 dev..lop funlier.
Intere, tingly. r.,goxpre"ion in con ain dr C." is Inhibitod by cl'ltholidlly. prodlKcd HMP.4. At thl, c.rly .tago of
_ Iopment BM I>"4 is e ~p, .., SS<'d in ..... of the' """ta l
. rdl ~ t,,"1i will noI fonn. Tl.....rorc. it tu. bttn
spt'CU\Ml'd ltut production or 1M siJn.o~ng rnoImoIc
mq ,",M P~f"1"I'iooo~ rooth . . . k>pr,"',t 10
specifIC si~ in lhe <:\mt.>l uch. I\Ithoull:hthis mq be.n
~ simplification. it docs ouggesl how . xl'r.... ion or
~ycr.1 different f. , tors might , ite-.pecift<
ooontog"lle' i'
be ~ n

"'It"" bud stdgp. fGF-8 indlK'f'< the cxp""",,n of Lhdi

and Lhx7 in den"'l m~_ During ..... opt:lt'O II
cxpm.sioo or ' hew " . n<aiption l.oaon ouurs only in
the lomIrain.nd the first ptwyngc.1 arch. .... sl"tuly
thC'ir expres."",,~ ... rntrifll lO sites of


to{ Tef!th:Crown forrootion


tootlI fomwlion. iOOiutil1ll ~ ~ rom:Utian wit h woW dNelopmmt. Funhnmon:'. 10 .oddin"" to /'Cf4 the
tr~moiplioo f.ortoI' Uf1 is nJ'f"'S"'d firs! in dKo ~tlw
lium .00
in ce ~. '" ~ u~moiption
rxwr. Uf1 does not WOI't ~. II .oo;tiv.;I"", """" In col"'bourian with Ofhrr DNA-biOOioa; pmri... - ' Ny ~
......tina: in ccncnt with ...... Of ..-r~l of ,ho' oip,otins
p;lCtrw.>y< dulilll {his ,and ~, stogr< oflOOlh
droiopm~nl. Curiou<ly. Lri is ~I>o componeol of the
Wnt 'ign.olilll ""th....q. ltKombin.otion nl"'rilTlO'nt
.mOl tiue< from lri l-df.(l<i~n l ~od normal mir~ h.....
shown lh. t f. ilure of the ~ilho'hum ro ""pr\' Lefl
,""ull< in lota l ~bonc~ oftffi h. Aga in. t~ .re
. rre<t"'" Jttl><' bud ,t.g~. Ooc. l en i, ""pr~s..-d by the
~pil~l ium norm.1 dCY('lopme nl will occur "",en if tho'
mesenchyme is inCJI>J I,lc of l.dl synthe,i,. Expre" lons
of genes activi1 t.d by I.e n .md r,lx 9 ",e n~e<I"'" fol' pro
g.... <.<ion to the cap " as" or , lopm ent.


Whil~ Ih~ ~ p ; t lle l i . 1 oomponent J PI"'a... to iniriJlc the

1""""''' of odom ogr..... i. (m"'t l ik~ly by I'Cf-8 , is""l
i Ol~ the "instructi""," plOYiding r~ pat1C111 (pLo,...mmt
ohpnific P:>Oth morphologies al diSlina site<) probably
lit in ~ Ill<'S<'I>Chymf. In the rk-vdopi,,!: mou~ dc'ntilion il is inl~"I '" 001. t""l then- .Pl"'U'5 to M
p,onM11 or t.o<loeOOolllt'/lC< npno$5ied...."", the dmlal
~ prior '" the inic;"tion of ~ 11< .. 1 o;>"ottlt . AmoI1I
MSIl2, 0..:2 .00 1l-an.1. Of I..............
tramoil"-ion r.actDr.
is ~ 10 ,he ....,..,. firid
d lOOlh do",kIpo,ott.t Addirionally conl""ion dOlJrI
.lIll Dlx2
10 ~ restrictnl 10 rho' ~iW'
moLar region. Doul>W koodtow mi<t'("'eking boIh Dl~ 1
. od 01,,2 &C- j Lad ma"ilLory moLar 1tt1fL _
I~ moLars are normal Indicating ,hat ,he III<'<:haoism
101 p.m~ m in g diffnJ in tl><' UpD<'f J lId I""," Mnulions.
Ci~ the ~1opmt' nt.1 histori<>s of Ihese two .tche.
Ihi. obsel\lJtion i, nor Sl'rPl i, inS- Rememb<'r Ih.t th<'
lowor arch is formed Ill' fusion of left and right !\\Jndibu1.1' pro""' ., os a" d c. ch I"oct".' cJrries !>orh incisor ,1I1cl
molJ r field.,. In litOupper M,'h lh. rigltl J nd left m.. il
lary proc ~, ... , ", "'I fu>e Wlfh tlt~ in,'i",rbeJri,tg iltedi
I n IIJ<JI proc ess. Whil~ 01, 1 . ild 0 1,,2 alld IMr" I . Pl r
to b<: imporLlil' in mol.r p.otl~"'i il&- 1.1",1 is ~"pres d
in th~ inci"" r fields. U, C'llpr-es:sion m.ty be linked 10 l~
fOllllJn011 of incisors. H~r. 1TJ",~i( mire "'nil'll
M",I d"""lop no l...rh. This wggcsn 0 lOOR' ll""'r.l ....
for thi, &c"" in drontol rWYeloplncnL Od,.,- Mu,......
~ ~ .......... to ~ expressed in the """"""~
.and all m.y be' i!1'iOlwd ill somr woy in I>"I1",",i"l d tilt





Stili.. moo:p.....phir sipJlillllllOkruLo.. is ~

early. In f.Kl. it is n~ In the precbortl.ol pbt~ .lId
has ~ proposed to oK! .s midli"" PJl1<rnillJ ~
<ul~. In this reg..-d. SHH may ~ an ~. r ly PJltM11ing mol
uk- for the inri>Or n~lrb by .octing prior to the flUb-lishmcnt 01 the ."ilh~h.1 Ihic k~niOll'. U m.lY _rlc by
n'JIulJ ting tile e"~ion 01 r." tlJ ilscription foclO'" in
~ar ly f.ciol pIlXCSW'" Mulati on> in lilt 'iHH gellC resert
In Ielhality ~ . r l y in d. w lop=m, Therefore. il i<nO( pas-

_ _ _ 5 Demopm""tOf!ee~f!: Crown fomltltion_


sibIc' IU
d in:aly the ... of SliH usi ns ....
drirtion. ~, the ~ of SHH. iM Ihq>l<IO
(<Nd). ~ nd _
of m., gmc'S .octiv~1<"d by SHH(Gil l,
2, ~nd 1) lI.M.' bHn <il>t<'rminr<l ~nd d~mon.t"' l" Itwt
SHH h,IS im porta nl ........ dOlnnll hP inihatio n ~nd mor
phog~ nit stages of d..nt",r dewlOjlmO'Tll.
Interestingly, t h.. Sl",clfical ion of d..nt J I pa lt em il1g is
a pp", in ~uly In.ln d ibular ..p il heliOl m, UM I'4,
..xpres>e<! in .. p ilh~ l i Ol m ov."ly ing incisor, ind~ s
Mul ",hile fC t',8 i. ""110"<0'<1 OVO'I' molar fi<old. ~rJd
iooUC"O'S B.ln<l. 1lO'mov~1 or inh ibilion of tIl~ .. piIMl,~1
8M14 .igrwl .,....,- m., inrisor flO'ld l the ~ppropO.ltt'
Ii_ .....JlM in It. np<=ion of 8Mx I jnstO'.od of N sxl
in t"" n>lYnChyrne ~nd thO' """"':IW formation of ~
ltIOW in It. p&icO' of ~ inrisor. AdditionJlly. in I......
""lK'fimm~ a tooIh witll intt'nllNi.ltt' ctwr~io
(of ~ molar and indoor) wao ~Iso fontlO'd. It i< lJm1Il'Iins
10 .pecul a t~ ttwl Ihis n"'}' solIV" l hat ffiOIp hogl' nic
field , p lay a rol~ in <k-1..rmin ing Ihe ""'p ...." 'ion of (a nin..
Jnd pre mol,,, I~ ! h. Th.., .. <,xl",rlmcnt, ",bo ind icate th ..
iml>nfl,m ce of ...,rly ep ithelia l ,ig,,,,I. ill ,ped fi"..tio<l of
loot h type. a nd t h.11 ,pe.:;if"'Jtion of tOOlh ,ha pt' i, nol
pr~ d e tl" r m i ned prior 10 neu,..1Cresl mig r..tion

Durins ,"" Pf'O'U of morphogO'n,..;s (.acqui5ition of

IOOth !1lOfJ>holoIY. Lt . ~, nUJ1lbtf. and location of
cusps). thO'..... moi knol pUys .I U'fllr.ll . . . ;l< .I dO'\Iej.
~ rquLotor (ft&. 15.s~ ThO'momdbloOllw5bHn
Ii""""" '0 ot1lcr ~1I..Jrnowo <i1:R.llins nontl'f< <uch .IS
I"" ...........1 IlI!:le .md noo:>chord duli,,! .... rty dO'YO'lopm~nt. and thO' apICal tcro,lO'rm,d rid~ and ron.. of polari'ing ..ctivity d Uring limb dO'VO'lopmO'nl. A' prl"Viou,ly
m. n, ioned. t he e na"",1 knot is a IWlsitory smKtu ....
ma king it' Jil peara nc" <lu ri"l , he ea tly c.>p 't, ge of
develo pme nt. Its ini tiati on a nd d iffe ren tia l i,,,, a re
lh<>Ught 10 be lriWre<I by , lg ""lI ng molN:ul.-s in t hO'
~nd 'Y m ... The m<>'>' likely cand id. te is 8 MP ...
alt hough othO'r51gruling ~ a~ liUly to be n<:lO'd. This i. """"""'"' with ti...... 1KOrTIbi""tion .... pmIJInIU,. showins ltwl .I , thi< ~ of -.opmmt lhO'
mnmthymO' ~ its domi~ ~ , "" e,>irbtlium
.ond ..... id<s - imfruetion< - for the dO'tO'mlinalion of
.-h .lupt'.
h p r..,;sion of p21 (a lso cycHndep..ndent ki1l<lSO'
inhibitor or ( 1(1) I~ cells within Ihe enamel knot i' cor
r"I,tted w ith th withd r.lwdl from t he cell cytlO' .lId
l u b, eq llenl d itle rcmi",tion, Cell, w it hin t he e na mel knot
a", unrc'ponsi.... to the potenti..1.utocrine proliferal;y('
sigru ling beeau", they lack ~ppro p r i a t .. r<"pIGrs..
Among lhO' signalins molec ule< prodUCO'd by the .....mel
!mol an: SItH. QMP, I. 2. ... ~nd 7. fGFs" ~nd 9. aod Wm
10.. .uK! l Ob (ft&. 5 15 ~ ThO' proIirerniw ~1< .lfJ1
both epi.belium and ~ . <.ollSing ..-.01'1 01
(utu.... Cusp$. Ct'lIs01the.-....-wneI!mol thO'n undO'rJo .....
l'~rrunr<I a'll dNtIl (a""",<>'is) .lIld m., ...........1 bIoOl
di"" ppcars. L.JtO'r 'IKOnddry O'N...... I ItI1<n . ppcar .....r
rh.. ti ps of cusps of multiru, p id t...-th. t1x>se =ond.lry
e na,",,1 knot uc co nt rol tile 'II proliferation and di f
ferentiation ""currin~ arou nd , he form ing cusp ' , by pro



/I Df!Vf'lopment ofthe Teeth and Supporting StruetUre5

duci n ~

many of the same si~ na lin ~ molcrllies found In

tl'e primJ ry en" mel kno!. A gL'Jdlcnl of ' ignJ Ung molecule, pro<luced fmm the ocd ll", 1or in,",,,,1,,glon til the
apka l region Is responsible for the gradient of cell differentiation seen along the developing CllSP', during the
J PllOsition,ll stJ ge of tooth development.
A, ,i gn"ling mol<'cule\ "'t inoid, , ,.., "" "" ti,,1power_
ful mooul<lwrs of growth and development. However,
their role as signaling molecule, in tooth de"elopment is
no' well unders' ood. h ce" ive " pplic"tion of rell""ld,
. ffe, t, both 11mb and tooth <Ievelopment. St\ldle, in an i"
m. 1models demonstrate th. t ret inoid, can induce multiple Ilmh segments. SlmllJr ly. j rl vilm " pplic"tion of
retinoid, ind,.... , m"l tlple d. nt,,1 I.nllin" f"n n,tt lo".
indicating that they may play. role in initi"tion of teeth,
Excessive J pplic" tion or ingestion of rct inoid, can
"dvet<ely affect "Imo" any stJge of tootlt develol,ment,
iTld \l<llng th. pmce" . s of pmllfer.ttion. m.ltrix torm,,
tion. and minerali, ation, Ilowever, the mechani,m of
retinoid Jction in dental development remain, und ea,.
in IIMl studie, of J nlmals p-o"e"lng mut,,,,t rNlnoic
a( id re"eptors have failed to rewa l ,i g"ifi "ant <Iemal
defect' .
In Jddition to ~ ig r ,,\ l l ng n\Ole,'ules. ", ceptors, ,Hld Ir"n_
scription factors, the extrJceliulM matrix play, an
importJ nt role in development. The basement memhrane I' a unique extrJcelltJ lJr mJ lrix lying helWeeil the
two interacting ti" "e" Mol",ule, contained within it or
wlticlt diffuse through It are likely to play Imp-ortant
roles In regulating developmental pmce" es. This i,
especi,' lly true for memller<of tile FCFr"",l ly. Feh Il ,we
been shown to he s. qlle, tered hy hep,, ,., o , ulfate (onraining proteoglycan, found in ba,ement membranes,
Add ,tionJ lly,an J"oc iJ tlon of FCF<with heparan sulfJlC
a"wa lly appears to he re 4u ir~d for <lgnJ I tran" luction.
In addltloo ro fGf , Ignaling. , ulfated proteoglycao, are
important in Wnt slgL1.lliLlg. It has been propo, ed tltat
they may ~ e r W either to c ro ~ s link Wnl molecule, .' 11<1
induce clu' tering of receptors or "ct a, low affi nity (0 receptors that serve to incLN,e tlte 10c. 1concentration
of Wrl t , v" II.,I, le fo]' 1,lnding to Itlgll-JfJl nity cell <u"fJce
re,'eptors. Altllough not "" ILI lred. the Inter."" ion uf the
extr"cellular matrix molecule tenascin with a cell surface molcrllle, syndecao. secm, to facilitate meSeL1 cltymJ I CO l1de<l , J lion al the bud stage of development. In
I" ter st,'ge< of dew lol,me,ll , I,e extracellul.,r rlW rix
molecule" e,peciall y collageo,. play . n important role
In mJjnt,injng tooth ' hape and dentJ I development,
l o" of collage" ' ynlhesi' Uri vi!m ' PI,lical" ", M Idlhy.
rogens or tetra, yl'lin. to toolh organ ctLlw ....,) or inhibi
tion of glycosylat ion of matrix protein, profoundly distu pt> toolh <ttu ctu," d"d ' uh<eqllerl t development.
Therefore, the extr,,,,. II ,,IJr m.m ix i, n.~ I Ll l red for the
facilitat ion of epithellal- mesenchymal,ignaling and the
<I"bill,at lon of dontJ I morphology, I l1 t~ rJ clio ns and
everl l< during the SlOge< of tooth d ~velop l11 e l1 t J re
hriefiy su mmarized in T"hle 5.1 ,

OdontobL.ot Differe nl iatiOfl
OdontolUsts alld al'Mlol>l.Hn difTnmtwl.. in a """'PO"f~ spM..1 p.mern. This meolf\S tlul I~ <d is ~
hom prolif<'f.>ling c.U, ....... thr C<'n'M:al loop at<' t~
)'OU"Iffi <<'lis
u.lly. lis _
mo:-s in
oed.....l ....{"'1'oI1 dit<'<lion. _~ fmm t~ C<'IYiul \<lOp.
I~ d~lopm<>n t.<J ly okItJ 'lis .... d Mdins .nd
....g'n me p"""", of diffr nlwt ion . nd ""'tri>< se<Tffion.
Accordingly. lh . , rils ne tht tl"" 01 til<' alS"" o f d.....,l~
op lns t.... h in t he tal<' boll or . P\XI$itionol <Ygr.....
d........lopm. nt. lly olde. tl\;ln tIM:> n....... th e cervicol
lon p. The.efor<', in 0 ""..... Io ping tooth t il<' "que mlol
' loge, nf de velo pme nt .nd matrix , ,,,,, etio n can b. "i ,u,lllzc~ 01" " 8 llle , ide of J d..w lopillg ('U' p.



Odo ntobl" t diff. rellt lat;on !><'gI ll. with the 0".1 o r
locoted ne.r t il<' b.o",l l. milla. ..p.>,.ting
the en .",..1org.>n from Ihe dt'nt/.I p.>pillo, The",
thO' preodontol>t.I<lS. Fnllowins ' fin ite num ber of divi
,ion> tlwy "".'" dividing. clnnpt., . lId lx-comr young
diff.......tiJli llg odontobt.>sts. Wi t h fun"" r elOll!lJlion
C'OIll<'S rte ru.b1i'ihmrnt 01 cdl' .nd thr fomwrion 01 .n .~.I pI'OC<'So (odontobLunc pt'OC<'So).
Clbo$rfW II><' 1'iN--fom>rd ~ti .... "",hill in ~
5.16O.nd f.. .... thr odon!oI:IWu rJons.I~ 11";1 nudri
O'\Ipy bJsal position in II><' 'II and tbtir org,ond....
bt<..,.. "",",...-;drnt lOW.rd tl><' .picJl
oIt,," c.lIo
(f!&. 5.160). Oaasionally .. sinV<' cil,um lL>:l<'Ilum
mJY arise from thr II body of lh<' odootobLo>l:. The
function 01 thO' ciliu m is u nknown. ~ ,. t,," . 1'1'<'.1.11 of ouch orpnelle< in orhrr 11. is oftrn r't'!Jt<'d to .
S<'lISOry function, It is .lso likely r""t t h is i nldimen_
t.ry " ""I",e related tn lhe d......lop"..."tol o rigin 01
th e.. cells from neu rocpi t hrll Uln J lld t hot it !l.l, no reol
Odontoill" m , ecrele "" ,t rix prott'in, exte rnally, " io
t ro",po'l "" . ide'. Jl t he opk olpo"l of t hO' <'1"11 " nd " long


' IQ, 5,, 6 Oiagco rn 01h i, t oM f"",nt i.olion within tl,.. d(".'('iop< "'l tout 11.
" tn o/ l"'ti, 1den tin .,>d """mel f""... tiM



II ENvelopment of the Teeth and ~I,JPPQf.!!I_19 _~~y~tl,Jre~

r'lJ.5-.1 6 1J-{) ~ W e.ljo uqs ol ~ ~ion

_"1Dn'rYbon. B.-l ~ lhI iIrnpoIt...c..stIqn
01""""'d"""'""-0011.... ..... m.!omIotIon 01-....4. _
H_ W



its process (Fig$. 5-.17 ~nd 5.18~ Thecol~ do1l1i...) is not mi.....-~Iin'd _n it is lil"Sl: deposited ud
is [11", termed prn:Imtin. - . full poLority ~nd fiiloil
dilferenli~tion """" been rlil"ved lhew noll, ~re
termed odontobLlstl. AI tM odontDbUsll ~ pre dentin trntril< nwtm~l .. ron'ilfing oi tol~ fibril,
~nd other orpni< m.ten.1I. t~ milr~te inwmlly
(row~nl tho cen,er of thl> pull ~nd .....~ from lhe ......1
l.min.I (figs. 5.16.\ ~nd D). It c~n ~I.., ~ ~ th,u
the Dij lier tho fon.....- junction ~n ee inner
en.amel ""ilhe lium .00 dent~1 m...encttyme 0' .ne of
the b<l..."""" membraIX'.
The deg..... of polariz.>tion distingu;>JleI a<\ontoblJ't'
from collJVn-pro, noU .. OdonlObl~Sf1 art'
the most I'OIJrized ronne<tive-ti..... 1>.-o<I"'in8 noll. in
the body. Unli ki" <><teol>IJSt' or ChondllXytes, odonlOo
bl.m.,.., n"""r surrou nded by. dense matrix (= 1'1
d uring p.1tholog ic situation,) ~nd Jre . lwJ Y' fou lld ~t
the pulpal surf.><;e of the dentin , Unlike fibtol:>l,," they
only rele.... their "",rewry produ<1. allheir apical end ,
In Ihe,e rI'~pects odontoblast! ...<emble >e<:retory
epith<-h.1 cell, lnore th." m",enchymal nW rix_l'roduc _
ing cell" Another indieat ion of rll<' lr J>Olarity is til<'
acquisition of spe<,.d jUilftions. The aplcallerm inal
I>.>r apparJ!u" consisting of. ","u l. a<l lll'r. ", ,1I1d l Oilu1.1 o<cluden,. become, .pp"r~nt at t he " pira l "lId of the

_ _ _ _ _ 5 L:kve/opmf'nt Of Te.?_, "_' Crown formotioo _

mol -.1Coo'ff fobtrs
(""" ruo brtwrm odontobWm ro ntf<'f IIv
prI'd... tin "",{rix "'I3"us !b.ot {lIP Ottluding junctions
~n,o nor romplclely ti!,hl. Expl'limenls us;ng Jow-m<:>leoc-

all The' f.Jc11~ 1 _

~ r~

.... 5.16

ul~r......, ;gh l Ir~Cef mol""" l~s demon.t r~le t h~l I""

I.~, is slightly ",. "nwa ble, Gap j unctiom
fo rmed , The~ com mun icat ing j Ul1ctlo n, al lClw
cell. wilhin (lie odontoblaslic I.y~ r to , hare cytopla, mic


.,'" .i,,,

compo ne nt'

,,,,:h as ions a nd

low -l1Io l~u l. r-......, i gh t


""da'Y me,....." mole<:u"". Thi. allow. tlw odon l<>~ic I.>yo!r ro function .. ~ IInil md 1J1)UP< of odonll)bLlsn to =pond 10 plJysioIogic lllmuli.

The JPI"'O'.""'" 01 1M JUanu,". ~ndopl.lSmic rc1iculum.

Colg; complex, and m itocho ndria ind ica' ", the pfllle;nsyn t he , izing nAlUre of 1h<>S<' cell . ( Fig<. 5.16D an d E),

Odontohl,,, r. immediately b~gin form ing t il e pre.:u rsors

of coll. ze n 0 11 t ile ribo so me, of t hp gra n ula r e" d op1 mi, n>l iculum. and tlw prolei" i. roncentw ed in tlw
Goigi co mp..... I~r. during diffcR'mi ation ~nd wiTh
lhe inili.lTion 0( mJ{rix S<'ITO'lion somr of lhe' f1ril
formoo<I col~ fibon IuYI' lK-m found To 1""0 ~n
Ill!' di~Ti.otilll odonlOllUsts iDd l'lttl'OO I.-m;! the'
~ Lomi.... wheft lbry ..00 in ~ fm-liR ~rr.'ote"lII!'lll.

T'hnoe rlbrn. 1CDrfr0 robin. (or __ Koo1T tibo'n) sum

wilh silrr ... Its (IMy ..... ~lDfOPhilicl mel luw boom
sbown wilh <he' ~Iln>n mi< ")S( ~ TO consi5l 01 borh
col~ ~nd pr()(rogI Y"~ n or gll'CO!>ro<rin compo" r nlo. Sinc~ Iht", fiix-rs ru n btlWft'n odontoblas" . ~nd


Fig, 5.11
<'Ie<1'on """OVophd .. ~ ... m......otion silnd
_ in.whKh_, .. smaoIl.....,....


Dcntall ubule


f ig, 5,18 T.., n, mi" ion olectron mi<rOgroph ol lho mi"cr" li, ationfronl,
dentin_preM"tin i "ncrion.

from the b,1Sal lamin' Into l he plI lp, it h,,, I",en concluded tllJ I they must originat e from (~I I , be neal h tlWodontoblast laY"'r o r rel h th,tl h.we m igrJt ed the'-e d uring the
lime w hen (e ll jun cti on, ~re fl Ol well est.l blished.
AddilionJ liy, d uring the stage of odont"bl.iStic d iffere nti~tio n ~ nd formJ tion of the early dentinol o"w ix. I h~
(ells secrete lype TTl in add ition to ty pe I collage n, in tinle
the lype I coll, gen become, lI,e pre dom inJ nt coll,,!:en
tYl'e (po.osibly the only l)' pe) prochKed by <T,,' ture od on_
to blam. Obse rve lite t1rst-formed pred entinai matrix ;n
Figure, 5.16 D and E. The co ll'geno us dent ina l ma tr ix i'
nDt m inerJHzed when ;t is first de ll(J, ited J nd is thus
te rmed preden tin.
TI,e fibers of the fim"fo rmed or mJl1lle dentinal matr ix
,lee o riented perpend icularly to the DE]. B,t>1"e of llli'
orient at ion the mJ mle deLltin is positively birefr;n<''ent
;n pol~r;led light in lhe mJ tUl'e toot h. The denti n fo rmed
b te r is circumpulp" l. [t lie' bene~t h ti,e m~ ntle dentin,
,IT,d the co llagen fil>crs h, ve " more r"ndo m OrielH,t io n
In the rom the first-for med coll"g~n fibers ,,,e p" r" lIei to
the lo ng ox;, of the t,," th . Therefore, no mant le dentin
exist< th ere,
ihe oo onto l, l,l st ic procc." plays all impo rt<lnt role in
mJ intaining the d istrihution of m,m i" proteins, the
, ecretion and rem oval of matrix co mp" nent>. J' well JS
the minerJ li, J [ion of dentin (s"", Chapter 10). The ~ 1J( 1)
olthe pr<><:e,,,,, m" jnt. in (heir posit ions (Fig, . 5,1 50 and
E) no", the DE] and the odonlohl,,,ic proce." len gt heL1 s
J , the ooo l1lOb la't retreats, During lite le l1g thening
prof ess , the <XIontobl,lStic process exhibit' m~ ny term inal br~n(h., '" ",..,11 ," Tl Umerous I~teral brJ nches. These
branche' in the m" ture tooth
,,, cognized as numerous CJn Jli culi exte ndi ng from t h ~ pr;m,lry de ntin,,1
tu bule, The extent nf ti,e <XIo l1toblastk process with;n
the denti nal tub\l l ~ ;, ,till $omew ll,1t controvers ial, It i'
intel'es tlng to nOle th"t the r"le",e of m,tlly m,lt ri, co mponents. ind uding co II,'gen from tlte odontobl" st, occu rs
at the W, ,, of the pnxe" or from tlte ,' picJI portion of
tho ",II body. H o wcv ~r. the rei. "", of pho$pll0 pmteins
",em$ to OCClLl' , t the j unctio n of miner" li' ed de nt in <lnd
predentin. These I'ho<pho pmteins must tr"vel from the
Golgi are" through lI' e OdOll tobl,lSl pmcesses to be
released at the m inerali"" tion front (den ti<\-predent in
jun, tioll Therefore, is not e nt i r~ ly correct to stole lb,lt
predentin i$ merely un mineralized d el1 tin,,1m" trix 5;n, e
it lock> som" of th e org,lnic , om ponettts found in minerJ lized de ntin. The preferent ial l'K" tion of pho' i,hoprotein$ at the m inel'Jl izJt ion front indicates th" t they may
piay a ro le in m,Wi, minerJlizJtion. The matr ix that
form.' J round the elongilted ( ell proces,es event uJ lly
m iTlerJ li, e, " " d the <XIont oblasti< process w;li lie with_
in " den t;nal t ubule

,'' e

_ _ _ _ _ _ _ _ __ _ _ _ _ _ __ _ _ _ _

~~Of Tth:

Crown F(lffil<Ition


Th~ n> i" ~r~ l il a{io"

of 1M fim forml"d pr..ocmi n i.

thought to ocr u, in on. of two w,'y" 1) Smoll m ineral
crysr. l, .PI",ar in ~. r,"f~ll ul JJ' "", irl e. matri x ",,<Ielos,
(f ig. 5.178: ..... OL>l'{er 1 0 ~ Minc raliution .p~ad , from
mo.... liltS rlu"ugoou{ thO' fim -fO<m<'d p<Ncnti n; 2 )
sm.11 ""......d CIyU.h ..... nuck'.,O'd In.PM<" llwl t'J<ist
wil hi n lhl' coIl>gm fibl'ils ( _ 10 thO' ~ ......ang<"mmc olll'llpOCOll.lgrn rtlOkrulC'S~ Dtmi""It~l oesis t.1b:'s
1Ila (~ in. two-ph_~."I'M tim is 1M rorm..r;on
Dl' t he orville roIl"8"n ",.m ix. ~ .sood is {h~ Mposition of calri"m p llosph.l~ ( hJld roxy. p~li le) cry,;tal.
lifter IIw initial (. Id fi<~{ io" , all nySlal, are . ""dated
within or on th ~ .u,f,l<'e of the rollogen fibril>. (I)" ' al.
~'" o~n lO'd ~lo"i I!lc' long of { ~fibrils_ n.e.c
min ule ~l.
lOO "P"'.ad t hroughout l.... ~
dm!;" wllil only thr rrwIy I<>l'TrItcI bond of collo&o'n
........ t ... ""Ip is """.ldronl. Thr _ . <T}'OUI.fUi",
<> <i2e' 01' 100 "m in
,>nd J nm in widl1l. I'!lx(.....,
of "",{,Ix fomw,ion l OO min".-.lJil~{ion. ,herefO!"<'. ~'"
do:sd)o ,due<!. M i "" r~ li,. tion proc=l, by ~ g r~dllol l
inc",,,(' in n,i,te,al d('n, ity of th(' ,Itntln. A' ~., h dJ ily
in<;reml'nl of prede ntin ( t h ~ .>mo unl I. ld dow n on the
p",,"x' Sllng , mf...-e each d.y, i.e. locremenwl growth )
fonm .1"", th l' pulp.ol bound.ry. thl' more p<'riphe ral
.od~nt pred<'nlill which flll'ln('(l du ri"" the ~,
d.1r, "';nrr~1iu's '""" bt<OOIIt'S dentin (Ag. S.l'~ N the
pmtmtin e.kiti<'s '""" IJeromM dmtin the ml.....-...iu-bon front or denti.... ~lin junction bo!<:omn <"<t. bii, hed. Following llle n t.bli,llI" lmt of the d\'nti n. prede otin ju nct ion. tho dl'm~ 1 p.l pi Jl~ b<'<ome, l hl' den l.>1
pulp. Preden tin Is '"<><" l" lLou, ly formed along t h ~ pulpal
borMr during crown formation and following pruptio n,
. nd i, cilei li.... along llle p'denlin-do-nhn junction (fl&5. 1 7 ~ Thi, "",ullS In i doecr\-..... in 1M OIulTl<' of the pulp


A " ..,"'



Dunna thot' period of u-.. dI"o'Il'lop,,,,,r .v>d don"l:

..-uplion, iPlJfUll;rnlttly .. .." of dmtin is L>id down in
r.Kh l .. hou r period {Fig. 5.11~ Attn" rhl' tfflh ",.rn
oeclu<ion IIIP r~tr drc...."" to ~ 1......1 of """ Ih.In 1 lJIll

per d.' y, In,,omemJ IIli1<''

Chopter \ 01 In den t;n


( ~ig.

5.\ and 5.19;

. Iso

l>o l;evt>d to result fru", he, ;t. ,

rion in n,. trlx (om,", ion .nd , u l>seq ucnrly altP",d mln..... liulion- This ntIY O('C'UJ" whrn Ihp b.J.",I lTlP1 aboli<m
is kJwE'sl r.rn <by. Or~ .... tio: eN1110'S in lllCYboli<m.
web .. O<rur ~ binh or durilll mnrss. mull In ~ n
mlL.oncmvm of thl'w 11...... tor n.amplr the nn>
li.....{_ C1Iopler IO~ 11'lCrn'l'll'Slt.lJ ~tion.nd m;......,
. 1~ liOfl o{ drolin llegin. ~ I thl' lips of!hl' pul p horns ~I
the DE) . 00 proem, by Ihe rhyth mic depo,iliOfl of con iCJ I IJyors in the cusps u ntil the cruw n, aro co mpletely
formOO (F ;~ . 5,19 ). Dcmi nogo" esls is com inued unli ithe
enti ", cro wn is ( omplete ~n d IOOS ~ ftcr thl' tooth !><'gins
to<rupl {F"' 8'- 5.1 ~nd S 2 ~ _
dPW'lopmmt ront;n"",
dun.., ~nd ~fter tOOfh n"UpOon nvse <k-<~lIs ~'"
de<cribfd In ln CIIlpR'l" 6. Dcuib of denlinil SlJUCWT1'.-l composition will boo <O'o'm'd in ~ 10.


- ~_


rig. 5.19 OW9"..... ~ tIv ~ "''' ' '' U cltpooiban d _ _

92_. 11 ~""Iopm~n_toj ih~Heth and Supf>O.r!fng StnKtu

! ' --

Organization of Other Co m po nents of t he Pulp

The organization of struct ural {'omponenlS wililin the
r ulp ch,lmber is a {omi nllinll process, The pulp "I' the
ecupfed lOot h ;<described as having . c~ l l- free " nd ceil
rich zone bene.lh the odO<\lol,I.1<ti, b yer. These iayers
only !Jecome appaR"nt foilow;ng erupt;O<\ .lnd their
;"'I "'I'I.lnCCwll i be con'idered in Chapler 10. P;" rl eel';ng
n ~tve fibers " ntet the toot h J t I n e.rly siage of deveioptocnl . nd s""m to "'treat. The eSIJI>Ii,lunent of a matu re
pJtl el'll of innerv. tion occurs I.l le in denlJ I developmenl. The " rrJ ngement of nelve fibers within the pulp is
al'o d~scribe-<l in Chapler 10. Tlte VJ,CUIM p.llel'll al'o
evolve,., the tooth eru pts.

Histologic Event s duri ng Amelogenesis

Fig. 5.20 ADiilgf.m depicting en,,,,," ' 00'. The . ,,<><10' reprosentthe rod ~
'h eoth', . rld. Ii,... COIln<'Cl;ng tho open end; e"do,e, .n """ mol roo : the
ro" is interrod"nanle! , The he'.go",,1profile represenl> the <e<<e lOl' ~ tOHi
tOf)' of one .melo bl" t, Note th. t It l. ko, louramelobl. st> to [om' the oulI;n<'d 'f~hol~ strLK ' ure, but ontyolle [orm, ." enamd roo. 0 Dia<J" moIl h.
Tom..' pcoce" of S('<T"'or~ amelobl.,t. Th. dim l p.l rt proj<ct< into lhe
onamel(<<0 , 1<0 FiQ, ';,24) " vi form' lhe en,mel roo. n ", pM;",,1 pm
ro'" on the enamel>u rl""e forming in' crmd en, mol.
CDi_gram d~p ;(t iog longilud;n. 1, e<l;"nthrough Tomes' proe",; , Not"
lhallhece are t\'lO growth , ite,. one Ic::.- the rod '''d on< for interrod em m'
eI, The , w x'ih f..., of lhe di' t.1 1Tome" proe"" , I;d., along lhoon" mel
m, trixa, tl", a"Wlob!'''l rctro. rs. line' repr",e,'t 11", orionW ion nf en,mol
crysl. llites, \'Ihichgrow ~p"n<li{u lar to lhe lorming mem",.n<'. Not~ lhe
' "," pi <hange in di' ocliooat Ih. tir of theTome" proce" (lee Fig5.21), 0
["won miorograph oftile di' tal portiol1 olTomo" proces,. Note lh" 'ecr~
ti"" gr"'lUh '>od lhe rod ,he.>lh' ", lh. en"md

DitYer" nti, lion of "m~ log e n e , i, . A, [he pre

. 01 eloh l., ,, d;fferenl l" te , to become ,1 '~"R"lOry
amelobl",t il ., 1'0 1",1<,,.i,.'" (F;g' . 5.1GD-F). I ntrd[~lIu l",
ChJ Llges involve . lengthening of f h ~ ( ell, prolif"l'.'t;on of
endopl,<tie rcliculum (ER ), and r~d istri blltioll of ,'ell" ""
org. nelles (1l.1<, 1 migr,1[ion of the nlicieliS ,md " pic,,1
migr.tion of Ihe Goigi "pp.",lI u~. i.e.. ,e l"' l"riZ" tjOn),
rrior 10 <ecre lion of th ~ endmel nlalrix the r r"
" mel"h l.,~1S h" g;n tile pro"''' of eliminating the h<1 ,.1
I. mina Ihdt Hes h e(w~e n them .lnd Ihe prcodontoblasts,
In the jniti. 1 phase of h<1sa l I"min. d imin.u ion mJ ny
amel"IJI, slie process~s " r~ sent thrO\lgh the b.l<.ll l.'llli _
nd. Ad,l;lion.llly, pJ'ocessc' from the odomobl" m ",e
now .ble to emer epitheti"1 terrilory J nd some m"y
insinuate them s~l ve, betwee n the d;fferen tiJling
., ,,,elobl,lSIS. The het~roly p ic ( oma n s {differ" nti,' tion of
. me)obl"SIS .l nd odonlOI,IJstsj have been thought 10
pl.y a role in ioollCl i"" proce"e, dur ing diffe,'enli.tjon,
HoweveL', this is not th ~ b<' :" " , e tile induCl i""
process l:>i>g;rl , l' I';or 10 the elimin. tion of I h~ b" , al l'L11
in. (w ith the formot ion of (he ,lem J I IJm in.l .ll1d c ~ith e
I;J I CJ p). Wh i l~ en" mel matrix i' d" I'0'; led, lite
dmel"hl." t migrJte.' in an outv,'ard direnion, A, enam,,1
matr ix synt hesis cOntinue, . Ihe lip, of the odol1 lOblastk
]11'O",,,e, thill enter<"d ep;theli" 1 territory become surrounded by en. mel matr ix. Th~ r<"'\l lt i, the for nl.ltiol1 of
" n en" mel spindle. Dur ing the d iff~ren l i .tio n process.
" meioblom , cquir" ,1 ' ''I of Jp ;cJI . nd ba>al termin"1
h<1rs as well . s a ,p O(';. li,<'d " pic"1 process. Tomes'
process. Tomes' proce" (" n be defined ., th." p" I't of
the " melobl.1St .1I,;c"1 (01' distal) to the " pical term inal
b. rs. It (om. in, n\l Ol eroU~ -,eC"'lion grJt\ulcs and is u,u" lly devoid of endop losmi{' r<"t iculum " " ,I mitocll0ndria.
Tomes' proc~,j CJ n h" divided into tw o portions, a proximal and dist,,1po, t. The pm xim,' l pMt ofTomc,' pl'O(~SS
contJct< adjacent . me loblast,. The dis l.,1 pJrl. J lso
,d )led th" ime rdig;t. ting port. " , unoun,led by (or
inter digit.le, wit h) " 'lam el {Fi gs, 5,20A . nd 0 ).
/lcq lli' ition of ro ~,",' I'm""" sign" I, [he beginning of
Ihe 'ecreto ry st. ge of .melogenej is.
TIle <uprJ nucleJ r cytop lasm of the " melohl., ,, con
tain, . cylin,lric.,1GOlgi app.ratus, Th ~ tr"n s (m. tu ring)


_ __ _ _--"""
Da !Iop._
rrtel_'_Of T~_
_ ""_ "
f"".... m"", c.. n"~lly 10Cdff'd. Mitoe hondriJ. aR' "'~I
[. red t hJOugholrt The cyto plasm . L.H. ' ally, ~melobla.r.
" ,e ,'on nec",d to one " ,," t he r by g~jl J' lOct iO]1', [Ight
June["''''' a nd ete-, mo >o"",,5. Tile pa " of [he ame lob la't
thaI I;" basa l 10 [Ile I..n ni nal ......tI is callnl l lle
bo<.>J ool~. N"","""" blunT ~
from illO
COIlIM:1 ll<'iShborill:l: S'lr~ lum in l~ium ails.
~ and all. of 1M malUm ,n~iurn a",
conn..,;I'" ro """ anolhN by ~ a nd SodP June
[ion,. Gap junc,ions be~ n ~m<" l obl ~ s t . a nd
" melohla. ' , ami Ihe celt, of ,he , tr;llum imerml ium
provide the ba , i, fo, cd l--<e ll com mun icatio n an d coo,
d i....IIOfl of <:t' lIul~r m ivili('s.



1- -..- -"

~- -..- B

s..<:relory amelobl.>sn. Iik<' lhe odonlobl~m. ~ re,ized ce ll, Wll h a sec,eta ry 0 ' a pical e nd a nd a no n-iIe<re
lory 0 ' hJ ' J I cnd. They mlg ,ale In " n omwJ L'd dire,'tion
dWay from the DE] ~ nd = reo .. L The product ion
and Ka'l"Iion of t ....mel m.ltrtx ~eins foll(IW tile ,ra-ditioNl C1'Ilul.-., p.alhway (m llNA
rEJI: .... Colgi ....
_lttilll, sr~nu"" .... lib.......... 411 the
<>1 C1'II~ )
as ..-~led by ,.lodio.lurosr~ph;c and immuoollistoelloemk al proc.-du ..... The ""rumul~lion of newly lihe,aled
.....m('I m.llrix prot<'in< can he v;, ..d by e l""l ron
m icror.copy ,1< "<tI ppled nld" i"l: TIle Inil i,, 1 or flrsTfo, med e na"",,1 i. ap ri<matic. As t he amelob la<t d........lop <
""d~cqui"-'" a To ........ pl'OCt'Sl. .....m..1rotlsCpri.m.) a...






-- --

.......... - " ,....-

Conupt of t he Enamel Rod

TIl e .,ructu,... of fu lly develo pe d e na me l will b e
explai,1C<! in (hall,e, 9. Howt'\lcr, a ge neral und ema nd
ing of Ih.. e....mel rod pnMdtoo ~ n imporra nt fou nda1ion
to.- the ulldnsundinsofil. dt...-lo~nLMal"'" ..fUm
e!, whnl...roon..l pnpmdicul.-.rty to if'S '"'" C lftTIaI l
surfaa is ...... 10 consist of ~<rl>- li k<' Kructu
sIIe~th$ or arcAdes th.>1 "''""' ... the boond.>rits of tt...
ff1Jmel rod. The alrema lt~rra ngeme nt o(,~~f(ades
in rowS roughly oud i"", ~ ktoyhol.. 0' paddl ..- Iil:e patte rn (fig. 5 . 2 0A ~ Tlii< patt e rn i, ,een hc, ne" , Iho
Of) nor neM Iho
These arN' rep rese nt
. ....... of prisml mam"l. TIle fufm,otion of ..... mcllnro
rods or pri""" is d.... ro It... ~ seCU'1"'y rronl
CI1'~1td br the ,,"",l~(ion of the di<al """ or the ~
rory ~ (T1InJO:$' proce_s. ''ISo 5208 ~nd D~
Whm I:'nolmel secretion OCCUrs . IOOS a nal secmOI)'
fronl. du ring (he ini(ial a nd r, '1J1 '(f(1ion of " ... me1
(.<oe be low ). [horo~ .... no pr ism , in (hO en~ me l. Wh.. n
eM 'c 1 S<'<,~,ion occu" by fully ~Ioped S<'cm ol)'
a"""lobLaSl< in It... p,,,,,,n<l' o f ~ Tomes' proccs5. ...... mcl
rods are formed.
Thtfl' ~ ... rwo dirr......" COIIa'P!' 01 a n f'I'WnfIl rod
One lk1inilio n hokI. IlI.ll I.... k<')'llolt-li~ or
p.-ldlol'~hk<' 'itT1.Ktu..... ...r..rm:l lU
enam..1 rod. If 111.. _
ory l..mlUl)' of an ~mo l ob l a Sl i.



Fig. 5.1 0 le9<r Kl "'0 Qppo,i lo pO<Jo.

d lnkal Application

proj~ l>m'" tIlI!'w ~stulX"d rods .",., can _

th.>t foor dirr.,l'I'nt alnl'klbl;l;$lscontribu.e to the S)'lltIlI!'-

[)unlll mm>d SftT<'rion in .1lI!' ;m~l'CU5INIalNS, ameloblasn

IRa)' bKomI' manpalatnl as their bonn ~ al>llOO'"'d (Fi. .
52 1 ~ In till!' folly fonnro<l C'-II thtw al'l'as ~ piu Mod
r~ Tbry al'l' "'-'1'I'Mdy difllculllO dtaa Pi, ....... ~ ..., """" 10 kftpbKm'lolouro( 'l1c'sc'arus.

>is 0( oow"",me1 rod Of ~ (Figs. S.2I:IA. 11. .......

Wittl this ...... I"",, an bt' no ;nl<'fTtld .....meI.


01..... ineStig.otoo bold tilt

-orr .....mel lOll. 01'0:'
.1'I'II!'IobIa<t" Wi<ll tllis view
rod is ck'/irwd ~
the ..... me1 boundol'd by tilt rod .Iltarhs (a".odn) .......a
li~ collDlina: rllt two """'" ollhl' .rc.ada This COI"I'I'spond< ro the Ilt.od 0(.1lt llsll or Ioeyholt .nd il is m.KIe
by _
.melobLlst. The "Iail" would .bm I'I']>I'I'... n.
i n~rrod ..... m~l. "",mtl.hal Ii.. l>ecI",-""n tilt tlldmel
rod.nd lnterrods (fi g. 520B~ Tht difftol'l'n<t
rod ~m,,1 i, not chemic.1 Ont bur is """''' On tile orit nt . tio n of Ille hy<1mxY.p.ltjlC nyst. l, {f ig,. 5.20 6 .m d
5.22 - 5.24). The in;t i. l t " ..",,, i is fo rmed wh en t he tMs. 1
1. min. is being el l", ln ~d and i, ,,,,,""ed prior 10 . 11~
forma tion of a fUlly d~velop ed To", e, ' process.
n.e",fo",. it lock, e" ..nwl rod, .nd is ..pris mAtic. The
final enamel i. prod ucftl w ilen tlw Tomes' processes '1'1'
",&,..,ssing.nd the'I' in tlw st.\g(' 0( pest><'CR'lOry Ir.nsdion a,Id ma.ura.ion. Orw may .lso hold
the vXw thar duri"8.he forma'ion 01 rhe initia l and tiRolI
"",mel laY""" that only.he pmxint.ll. or the non_inlef_
digiuting portion olTomes' ptO{O'SS i. pl'l'St'nl. Sil'la' .his
is the portion o(TIlOrIO'S' ptO{O'SS I'I'SIlO"sibIe for 1ann,"8
mri, .1lI!' !nili.1 .MId fiflOl .....me1 la)oefs
""OUId 'bU
one.mot'her bK.~oltllftr <imilarori&ilL Witll the -orr.1llI!'IollIasl. one rod"" vi<'w.lhe
ri rods can br r/>oushl 0( ~ bounckd by ;nl<'fTtld
mel on lIwit sid<'!; .nd c.pped by ..prisffi.llic Ini"" .nd
final "",mel The inilial. .nd final enomd would ee conl;inuou> wi.h inlen'Od eRollll<'l. nd coold br considefnl
int~rrod enam~l. Whilst lX'ith~r of these viM\OS is
"wrong." t he "one ameloblasr. ont rod" concept allows
!>nrer correlati on of t he form..rion of rhe e",,"'el rod
during developmen' ..ud w i.h other species Ih..r h.,ve ..
vel)' d iffere nt pr;smAri\' ..rr. ngeme nt .



fig. 5.11 Oiogf.......- ~ of lilt -...oon of<ry>tahin R>d


Relationsh ip ofTomes' Process to the Enamel Rod

FiJUI'I' 5..19 (8 .<ld C) Is. di.Jamma,ic represenl.llion of
Tomes' process Ih.l. might br =n in hum.. n t .... mel.
The inlCrdigital;illl (d i{al) portion of Tomes' ~ is
surroundrd by ..... meI. II h.H. sloping surface tll.I, f.l'S
the ntWIy formina:enamel rod (Ihe kJrmalive r..ct-) .md
ill opposing (l'Ion-forma.M ) ~ IyiIl1l .odjacen' to
int<'fTtld momri. '" un .... br """" in lhe diasr.m.
Tomn' ptO{O'SS h.H .....,....., irs baw_ The Int<'fTtld
.....me1 is fonnro<l iro lhis ~1'I'.l. The troug!I ~'''*
the '""" of !he pmxinwl portion ol T""",,' ptO{O'SS c.n
. 1"" br fhou&ht ol ~ a fonn.a.M f.>n". ~. il fonns
rtw inlefTnd "",mel whilt the fonna,i~ (,Itt ol .he
intndigil al;i1l1l portion of T"""", proc= forms rhe
enomcl rod .

f ig. 5.22 A ~ of on ...... ,1'1<'1 pit in ltI< nt.,,<"'P"! .,... olt~

to<>th. B Hil}hcr m>gnil k , tion Utowi"llt~ tod oIWKul.:rture and On
"I' It h<" 101 PI" rt In the d.......,.opi"'l pit.

W hm lhe Tom..' processes all' removed from develop

ing en . mel. tlto' ""posed ena mel ",tt. cr co nsim of

_ _ ______________-25 ~ ~_.9f r~th; ( r OW'll FomwHon _ "

"pi(>" in wI\idl ~ T."....... prott'<$f'$ ~ {fi:&. 52S ~

~ pi.. """" l'1,,~ !d.>'iwIy Rff'P ......~ns MId _
pndy sIopins '1Ioor." ~"f\oo(" 0/ 1M pit~ rs
tho- ..... mcl rod (and ;l'I blmdinS wIth lhr wall). and is
fonn.-.:l by Che .lopins formatiw' loKe of tht intmlig,w-

ing or dist.>l ponlon of Toml'" p~. The w~ll, "' 1M

pit ",present inl.rrod enamel formed by the form,llMf.\ ~ . of the pL"<< i"1<\1portion on o",e, ' process. Si,,,. the
noor is , Iol"'d. the e". m. 1of the noor blend, with the
",.11 or imerrod en. mel, It , hOllld also ~ obviou, 1M !
rhe ena",el forlTlO'd 'lthe "dttpt', rq:ion.- o f rho noor 01
the pit. rhe ......m.1 rod. i. dewlo~nully yoong. Ttwn
lhe.' Ml~ ~lJs or ;nlnTOd en;omeL
WhI'1I rumi"",,, in ...roan IN'''u.... profiles of lhe< M\' . - . in eM .... m>Undin:g mom (fi&.
5.2OCJ,. Thi< .ppeM~ is """'twlut dtaM"I in m..f
lho oucline of 1M T~ ~$ Is I'IC>t ,ri.:nlgUL.u but
~.lIy coosi>!. oil"" 'pro< of lhf INI1Ik'. .,.., side bei",
I"" formJrivt" and rhe ot!><'r the non-forma~ ra'" of
To"""" proeMS. and ~n e>;.ten,i on from 1"'-' side of an
~ dj3ce n t tri.ln ~ lc.

111. <1)1' 101' in enamell;t'nd to grow with their long ox;,

pcrlX"ndkul,,, to tM m ~ m bwK" lM I produ ~ , Ihe
""'UD<. It can bO' observed m.t tlK" on.. ntalion of tM
('I)'>Ial, dI.o"$S in ronjuoction with lMt of 1M- rnm>bra,.". SNrp dI.oll#'S b1 0)'SI0l1 d;~ can M '"'" al
t"" IJouncbry 01 1hI.' rod . .AIls. and ~ <ubIle
du..... ""cur from tM -<>pm ....... eliw liM joini". ee
mil, oIt"'" .mololko Of . .a lii ) oI1hI.' rod to inlftTOd
enamri (Fig,L 5208 .nd D and 5. :M~

Posh e cret ory iona l Stage of Ame logenesis

TIl<' ' tage of po,t ....,retory tr. n, ition OCCurs loward the

end of en'llK"l .......... ion and is m. ....Nl by t'Ml M ....lopmemal ......n",. a cll.1npo in lhe amelobL><r. morphol"IY
mel programmO'd ~11 de. th. FollowiflS [he deposition of
lhe majority dliw mamd m.olrix. .IlK"JobLosn loose
IhI-ir Tomes prottSS: IMy tou..,,,, short.... mel ""'''Y (up
10 25X) or the alllll'lollWslS d~_ " bIos.Illlrmi"" mel _ _
nnn! hemiclnmooonK"s. whic:h ~ attodunenl to
1M ,"",,1lK"1 surfaa. i. fortlll'd brtWft'll tho' e""nII!'l mel
There ..... also nmiceable clKlngt"S in the , tell.te retkulum. The, e cell, th.lI were once "e ll"te and , epar.ted by
cx tr. ( ~ lI u l ." 'I'-'C ~ '. il' nOW comp,lct. With the str. tum
imermedium ."d ou....r ~ "" m~1 epithelium the>e : 11.
will form a papillal)" la\'<'r of ~ Il, ben~ .t h the

-- ,, --/7 , '


fig . S.24 ... SC.nning ~1ec ttOn mlcl'09ropb of the forming "",mer

rod-.m"""," 01 ;"teriace. BOiAjj,. m ofthe ,.rat lo<1.~ lp of tl..

T"""",'proc." to the i nterl.<~ In Note that tJ>e <'dg<>oh~~ Tom...
POX"" ccw'.'PO'ld' to the md al!>.

96 _ II ~to{ the Tt't'th

QIld s..~ ing StnKlures'

_ _ _ _ _ _ _ _ _ _ _"5 Deveiopment .ofJl!<!th: Crown fonnotioo_

o...i"l': lbr pnxr<' 01 matur..cion ftWrnd b;Otlot$ fully

minrr~liZ<'d_ Tlw' OfIoIoic md w.t" contrnt 01 """mel
btcomrs reduroo ~nd the il\Of1000ic rnmp<Kl"nl (pri ncipolity hyd"",y~p.l{il e) i Jl(re.~ The proc:= of "",Im._
tion is rc~lIy an o "goi n ~ proce.. t hat begin, Nrly In t ~
,o',: rel ioo ,tage. 1'" "mel l11atrlx brtome, miner. ii, od a.
5oo n ", it i, fOJ'J1l<:'d aod it continue, to m.ll me. This f.d


u, ,,, distill.llu i, ""- it from dentin . " d bon... Unlike <k'nlin

.nd llo<>I'~,... i. no pr"""" ......I"
predent in or


unmi",..,..lilM .....trien in denlin .nd
~. =PK\1W'ly. During the *",(110" S1;>ge'. en.>rnd
......rf'Sl: lbr DE,L tw."l': d.-.dt ,."ully oldo'r. is _
mi",..,..l;u.d or ....._ . Tbe
ru ion I"'""C= is c0ntinuous. but .loCqUisition 01 full mi",..,..liuhon wiltl km
of almost alit,,", warn- and proIcin, occurs durins lbr
sUg<' of matur.toon. This $I~ is IirSl rrrogni.ed by tile

Ioon.bon 01. ruflloo<l apical border in d......loblolm (Figs.

5.16'00 5.2S).

During the ' tag<- of I1WlLrdtioT1, ,,,",Iobl,,!, h,M' bee n

found to mod "lale, M", lul'tion is , 1'f'Ve" lblc chdnge in
",II d<tivity .nd morphology. Two !yPt'> of . nle l obl.-,,~
u .....11 d' tr.n'ill...... l fonn.. hdw k<'n SffIl in this
SY#. They .rt' dl. rum~{RE1.nd ~
(SEl .mdobIms. Ilum..-<mded ~ their
...."'" <U:llll""l" possns JulJItd d isul ~. Rum.. . - .lI1ldobIuts pRdomi.... r. durins 1m SUXI', In lhe
l'Odmt iOO<Ol. ~ r. p;dly If''Wins .nd continuously
"",~ng , _ " of= u........ n"IOdel fo< $Iudyi"l .".,....
ogenesis. dDP"",im.lrriy 6l:n; of Ihmelobldst .Itt' !Ufn.-.nded . Only 20% of Ihe .melobl"Sl' dre ,moot he nded dnd the othe r 200: dre in v.,i",,, SldgC' of If. n.i_
lion [,..,,,''' "" t he t wo types (Fig. 5,15). TIle , piedl sp"'ridlll ,Hion of rtl lll.... " d."j , mel"hl" m resemb les lh,t of
intes, i....1 villi epitheli unl. bol i. mol? irn>gu ( mU'11M!
lerm milled in<teold of $IrUled~ 8."se o f t hei , ... per flci.ol rcsembLonce 10 resot]Jlive ('I'lls. these ('1'11$ mq be
reopon<ible for the of peplidn.nd .. mino.oriels
from the ......uilL The rum.. bor'1lC'r.ho ries in .ppe.r_
.IU durin:g In.r.. ,~rion. II initi.>lly .ppe
Io>o<Ied with
cLorkidense ".iRina m.unYl durint: e.rly nwI......ion
.nd ,hefl bo:>nW" me V.ocuol.olor<! .nd dil.ted lhe
e....mel ..... lu'eS {filo 52S~ The pH of lhe ext~elluLor
nuid in en.mel R'1.lfC<l to ru~nded .meIobl.S is
rh" "cleri Slir. lly mild ly acid ic (u low a, pH 5.8).
Am.-Iol>l" ' " IX' ,i"dk.1l1y lose lhei r rume oorde" (m<>dulat o) to [,..w,,,e smOOlhe nd ed . This un"r< very ,,, pi,l _
ly. U>u"lIy re, ,,lling in large ,pa<'t's "pi>Caring 1>e'W('Cn
the ('I'll, " nd their . pic. 1ju ne""n. ing mOl\' I ky
or di",pjJN'ing ....hile tlleir ...."'1 juncti<ln. become
Il1OR' tightly se.led. The a p;.,.1 .rN of t hese cdl< someIi....... <how< few $IIUC!U"" or it ca n appe.,- to be Io>o<Ied

widl YeSidI,>< ud t ubule< {fit. S2S~ n...... ,moofl,nokd . ~ al so :>J'I(M n ulOW'fOUS pinocytlllic
....ides (!'"lg. 525~ The pH of llle auallul.>, nuld In
rt'lator<! to lhese ' ''''''''h....ndC<l .melobLo<ls is
IlNrly nell" ,,1 (I'll 72~ In the ro<l<11t iOO<Ol ~n.mel
ol]loln am~l ublJ slS ... main "'tOOth_~nded for sOOM




Ii D<?yeiopment of the Teeth and SUppgilijl9JS.<""Q

" ", ,",",

_ tur"' Q ename l

lasin9 protein

_ Bo ny

crypt wei

f kj. 5,26 De v~ lop ;n g tooth with . n", r1y<om plotod crnwn re, idioqin ,

duration (20%of ,,,de) "nd then they begin the proce"

of ""' '''Jting the ",me border whieh lJ kes time to form
(20%of cycle lime l. Ameloblasts from the IN'l h of oll,.,
mamm al, un,lergo ~, mJ LlY as lhree full moolll.lI ion
cyel~ , per day ~s the e n~mel maturcs (RE --> Sf --> RE
e.ery 8 hours). Thc timing of lhe moo ulJtioLl cyclc in
hum.", ,eet h is prescntly unknow n. Ruffie-endcd
ameloblasts h.w e well-developed dist" l junn ion,,1 , omplexes bm lack pro xi m~1 junctions (Fig. 5.25).
Intere"lingly, during nMtlLrat ion amelo1JI,,,[S continue to
produc e low levels of enamel matr ix proteins.
The net result of the acti. ity of m'turJ tion Jmelol>lam
is ,1 g<, in in lhe mineral content (mostly Cdlcium and
phosph,l te) of lhe . 'l<lmel and d 10" of pro/fin <l"d
w. t.r, lCIss of protein from the mJ trix ,md " gain In minerai is eJsily vislIali , ed in de..alcilied hj, IOI0l:ic ,eclions,
The lip., of lhe eusps have Ie" matri x ,md mo re mineroll
content and exhibit poor sta ining or complete la,'k of
staining (en amel sp,lce), In CO!\lr,1Sl, the ccrvical area, ha. e a higher protein content st,lin inlc" scly {Fig,
5,26). SPJce, between eLl,mel cryslah diminish in size
with th ~ addition of more mi llcral to the matr ix, Th,
cry' tal, of young ~"a lTIel <Ire long Jnd slender, Dliring
m,' turJ lio n the crystals get th i..k" r ,1 nd wider. The
enamel rod (Ore or h e~ d of lhe rod apl"'ars to be mOSl
mineralized during maturation. The rod peripher y or rod
tJ il, (inlerrod enamel) still w n(;l in sufficient material to
be ",e n. A e ren, X- rJYHl ustr"t c, spaces bet"",. n roos.
which ;ndlcate, J lower mi" er,11conte l1 t (f igs, S.27Aand
B). Measurements of tb ~,e roos indicJ ' c thaI they are
Ie, s lhJ I11he 5 x 9 ~,m mature rod site. Therefo"". lile fj"a l
miner, 1 (9G%+) ;' prolMbly added to t h ~ rod p ~r i p1J e r y.
This final pro<ess of mineralization may occur sbortly
before eruption,
Fin, 1enJ mel lhickness (from 2 mm to 25 mm OWl'
the cusps) is ~tl" ined following complet;on of en;" " el
formation. The (~rv iC,11 region, of the crown dnd th ~
cenlr, 1 grooves are the last zoneS to mi'lerJ li" and
rarely re~ch the eX[e nl of the cusps. The ~m~loh l,,,,s in
thesc regions may Io<he functioLl<l1capacity before min
erJ li '-~tion is complete. l< of complele minerJ lization
~t sites. , uch ~s in pits and at the bil,e, of cusps , "
b e ljev~d to be , re~ s o n for the p r~ v<1 le n (~ of (-",ie' in
lhese area"
In sum mJ ry. en" mel mineralil ation f"l low, tile p" ttern
of matr ix form,llion from lbe DE) peripher<1 lly (Fig. 5.28).
The extent of m in~rdl i," l ion is indicJ ccd by the d"rk-tolighl , hJded zones proceeding from Ihe DE) peri phcrolly. The very d ~,.k zones are the mo' l highly rniner<liized
" " d the white area, lh~ least minerollized. The fin. 1stage
of minerali2.ltion of the enamel ro<l m.,y h. in ils peri phelY, . nd ,tl a lime just prior to eru ption of the (r own into
the or<11cavity,

~5J)evekJ~ntJ?l TretI>;


(roWll F~E!i<ln _ 99

Physical and Biochem ica l Events durinq

Proteins of t he E....mel Matri"
From t~ .\love MKri plion of the mOJ}>hologi, evCOlS
111.ll occur in the cells of the e,," mol o rgan ,1n<1 Ihe
"" .,,,, el m. t,i. irst'lf, we c." cond ,,,I. that the morp ho.
refie({ chan g'" in cell function . lId th at

._- ._---


these .I r.-ration, Ic,ad to diffe,illS molerul.r ~nd bio~mical ~l ... Sine.. tl>r procns of ...,lffion orrurs
duri'lll diff<"l't'l\li.1tion. _ion. ~ n "nsi
lion. .00 .... tur.tion lU&"'S ~ .~ .. il is.lPllO'G"


pNU to
Lor function in

in m.mix ~iurionand cdlulliI>d>o miul. Mod p/ll/'Ii"",opc

F;g. S.2 7


01 ..._-..,...." 01 fDnning...-.l

C1lI " ~ "_CfO<S_"


During tM proc.... of ' ITK"IOg<'ne';...mclobl.lsu secn'te

, 1., = of Illdtrix prof. ;nl . " d ..nzym.... The
("XJct ", I. of rrcsc pro,. in< in c'Y<r" 1n ude. tion, crystal
m ionla tion. cry' I,,1 ~ rowlh. and 11,J u " . tion is nut fully
u,Id.." toOO , 110""'....... it is intcre'ting to note thot
matrix protein. ap., tQ be 'Pi'tian y disuibuWd in Ii><'
~na"",L AddiliO<YIIy. Iii<' s.... lion of ,rt. in cL><<M 0(
mzymes aPlll'.n to be ' t.1V'-lt'LoINl. Purificmon Jnd
il:\tntif"'.lion of ""'mtI_m>1fu. ~n$ hwI> t>.nl d iffiC1l1L bc'<:_ I tqo J K <k-#~ soon . r..". l:hey ""'
mr,""",,- FunI . 1h O C. -COlll.milWlir'l(" porol:C'ins rrom
I~ 'Ift'lIm (~Ily .U>lllnin) ilio find their Ya'I inlo
lh~ "",mel. ThI' ""'..... 1m.llli>! is d complex miXlu", of
pro'in... Ti"u~-$P<'<'ific prol~ins ( prod uc~ d by
.m..loblastoj .Ild <..Jl ula. aC1ivill~' of J ..... lobl. SI$ d urillS m" , u' ''lion . ... (enl,al 10 th ~ d...... lop mem of l hi,
Ilni' ILl" m iL1.. r~li l~ d ti" Ll'. The p rot~i ns of l he en~ nl .1
nW riK.,e d,l,sified as b..lo f1gil1g 10 One of two mJjo r
glOOp'" ~melogt'" i t1 s 01 non --..m..I"8<'nin..." ..... Iog..nins .
... cL>ss. a", p...domi ,lJnl ......n' ..I ""'llix and
com~ Jbout 80S of lilt' y(IW'Jg ...... = 1mllrix. Due 10
.all... nativc splKi"l of
numbrr of a..... logmin;soforms tuw ..... lOund if! <'fWm<'l. Thty
dl'lt<l<'d in 'ft'IOIY dm<'lobbsU by immunocytoc..........



IGII <Yinilll .lnd J'" J ~spllk ..... ",'loo y prodIJCI... ""'.. IoIm,ns .... ~""I.11y hydrophobic poro(C'ins

wIth. hydrophilie "" ar Ilvil r.orlloxy lnmlrwl

Addilion.l lly lhey cont~in high Ievcls of
me am ino ~rids plolin.., g )u, ~ m in~. hi"idi..... and
leocine, They h,we a r..nd..ncy to J ggre~~ te in solulion
" "'I to form . u pl"lOnl. "ul" str UerlLl" 20 nm in d i"m.
( ~n iou>r)



tTtl l


f ig. S.2S s..."""",,ry 01 1"" " "9... 01_",-" min<r.liu\Ion. Initi. 1"""rod "
1om>o'd In .. and beaH'Il<'s """" m.tI\n (mO' coklfiood) In B ... firthrr
moIr'Dl ;, Iormt<1 C Further I n r _ .... fotnwd. 0 ~ _olil _ _
m;JI;rix ~ ~ ( nomoi ~ is bmrd on tII< ..... 0I1ho
""""" F FJnol_ is bmrdand 1"'OlI'<'S=<...... aIy.


_ a l n k ~" App l kation,

~ ~ I of 1M
rw;y.o~te during the


hyd..... yl .nion with nll<lridofo in

_ion .nd m.>tu,.rion ";qn ol

.". lop>,...... <ltouses lhe 5Olllllilil)" ollhe miJ>rr;oJ ph.o...

""*ins: "",mel m<IfO' ' cMio's rrsisum. This sub<fitution.

wlIiclI octur1 dlJCing m.omel formIlion .nd m.lI....-.,;,o", ptOdUCfl . noor.p.tIil~ l1u'oi.IJhouf lhe lllicknns ollhe m.omri.
Ourins: nllOri<k ~.fmC'nlS Oil tfUpte<! Ift'th ~ ol nuo~ for IIydmxyl ions octur1 in ... rf.oa 1.11'=' ooly. bce"i~
nuol'ld~ ",,"ulls in. condition known.os n",,=is. Tho ~n.mel
nwy he discDlote<l, IIypoJII...ic. Of boll',

f ill. Ut $l.llnmMy of 1Ir ..... of tI'of pt<JpO$O'd ..... of omeIogtnir"<> in-,,"
.. _oIuIion:
1,M' 1 _ ..,............bytfw ............... ..-d_......-..,.
1 .N ,. ' ) "iI,,,....,.........,. . " ' _. . ~ C 20 nm
.,.."...,.1 _ t.,<l>opl.C_
l aot-, "" ""'....
dl. _
_ oosP. " b
~ _ tI'of c".ul iooon



pQlellO tI'of ...,.;s (long _~ P""'""linlI~_

.... JCtiIIcj

.. 20.... --. ( ~ ~')p'uu ...... IIr~ UJbo>:y

,"""",Is _
prog""w.ty f'fducn their_
~ "- ""'~lIrrNlR<O>IlUiI'lino;)tI'of ""' ~

tin. _II ,.,....... to'PN'br ......ri'I..... __ """"""' _ _

. E......... _

proto=.,-lioo <109"""'" IIr trydros>/Jobi<"'~

(.~). lJOflC".. ingvnolle'r .. ' .......... iI ' II..,..._ ~

fr "!JITIO"'II and ",Mol p<ptldo fr;ogment ~ ~ by

5,R"n'l'''''' oI , ~......-.o<p/ltI.. from ,fir <'Y'\aI Ie

"",""1<,..d 1=
tI'of >I,lI"/.,-,

~nt 3).TIlic ....ow< II>< <fy>l'" 10 9'''''' in 'h ick.....,

Inl..lo< k. " '0 l"l"ibly IU>o,


lrnown m.ome l .... nosph~"'. ( Fig. S.29~ ~<pllerr
ol . n .~Icd "'"'" ol . 1'I'= irtwl<'ly 100 ",,~, ~n rnolKu les. "SI.ippled ....lll'ri.>l
lnmlbling "'" ~ is lJ'l'IIuud ~ secmory
.rnriolll.osn wd is round .ol m.omd growth Iron,s (fiI.



T ht cry<t>k ol ~ om.omt'I _ ~ 1M l!Io(' lFsr

oymls round in mi....... . i%illl lis>uo:s olille body. Tbtir
growth in Imgfh, thlCknns. .nd width is comrollo'd ~
tho:'i, wil h .melolJenins d uring ~nl.
In """""'ping
.me~in ....nosp/l<n'S ~lIro
....tically adh~ ... IG lhe devdGPing ~""md CTySI.lls. Th~
in,,;"'lIy Ihin ~~g"".1 '''''~ of th~ cryst.l. i. n,.,nlaiTl<'d by .dhHenl .ml~in ""nos~...... Cryl,"1
growth occllfS .1" '1I1 11e c-"" i. (Iongil\lu;n.l ""il ) of the
cry' t. l by prrr~ rr n l i .l del>o,itio n of mineral . 1 the end
of Ihe crySl"I. Growt h of en,ln1e1 cry't" I,. In widlll .nd
thickne . ;' prevenl('{l or con lrolled by the pre,~ ncr " I


_ --'5 Development Ofrt't'th; CroWl! Formolioo _ 10 1

~m~log<1l i ... ~nd

p"'rfwps ...... mpli...

on .~ <urf~

Boosi<ln dirKIing: growth, ~rnt'l<>tenins Il.tYe been propoosed 10 _

", ""lO nm 'PM'"f1"tO ~ . ~ t "'"
fusion of eTysl~" (Fig. UlI~

no. ~ olllOlhlilKlog"".ns in

v-th is Irs,
wdIlKldel$lOOd Thl' lIUjor rrwlrix pnlU'ins;n Ihis group
'""' luflelin, shc'.>t hlin (.at", tf1"rrwd ~n"n ).~nd ...... lII<"Iin. Tufu-Iin ~ppe~", 10 be ~
1O.lIl ~~a neorlhf' Df,j ( in ...... moi tu f",; _ Ch.>prer 9 )
.nd aPP"'a ", 10 be a produ Cl of boI h young: ~m~lobW ...
and ~lObl ..... Ou~ 10 ilS 1'l'S1rW;1<"d Io<~tion il h.l,
been propost'd 10 pl"}', in ind llC1ion. Illo inili.ltion
o f mineralilOf;"n. ,,,,d lm as a ju nrtion.1 maleri. l li n ~ing
e na mel and den tin. 5l>eat hlln, w hen iniliall y serref<'{]. i,
fo und t hroughoul rod J T1d intellotJ . M m ~ l . Howeve r,.s
iI' na m,' ",~ gests il is p refe re nl i.lIy localed in the rod
sheaths or orr,lll"s in de ep-er e" "",. 1 t. ye" . In d....elup
ing e n. me l t he rod sheal h .rc~ is pool'ly m incratiled,
Endnw lin is a n acidic, pho,phorylaled , ~nd glyrosoi' ted
procein. II is the la rge';! en al11C'l m.ll rix pro'in a nd i,
p rcrc~mi.llly .-..striet ed to t he p"",,,,,, I-rod a...... Its
phosphorylated ""fU.... a nd init;" l .KCUmul.lI ion ",,~rm.
vowina ~nds or cryst ~l. "'U"'I< 1M prwmoiin mJy ~, in ~I uowth or nudt~lion. Simil.>r 10
mIO'Ios<'nin. ...... l11C'lin ""',lI", bc<:1l ~ ....a f.ror
in limiling: aysuI gmwtlL


Role of ProIeoIyti<: Enzym6 in ENmel

In .oddilion 1<1 matrix proteins, hydrolytic pntymes hdw

bpcn found in t he ..... m.1 nwlrix. En.lmdysin i mJ lri x
1IiCI~lIopro'~"'. A< such. il. twity in lhe ...... mpl
""'lrix <.n be ....g ul.u . d byli..up inh ibito rs of lIiCIalll>prote~-",. , EJl.Imely, in is ""''''t.d with "",lrix p'<>Ieins
du ring t hp secretory slage of ~mt'loge n is. It i, prob.ll>ly
....' po "'lbl. for t he limited prot eo lysis tl' ,ll occ ur, at thi,
time. Matri, alte ral ion, , >ccu r r l n ~ /J llrlng ,eccetion
i"d uM ( Ieavage of t he ca rbo,y t",ml nu, uf t he omelo""n im, initial p.--oce,;" lng of endntelin, dnd procc-ssi ng of
,tlr-alhli" ....ull ing in 11< IlIol>illu rion tu ,~ ea th drca,.
Duri"g pust5CCfC10 1)" t rdn, lho n. prod tlC't ioct of e""l11clysin bf<:omes rrouced; the produa ioo of ITIOf<' ~
S~ SC1ine prot...."'" beg.i'" ~nd mnllnun th roughout
!hP "",.uration stilgl:' or a~nesis. SKine protc~
l'PIRO'W .mrlugenins from the InlCf' ~ ......... ~ll ow
ina v-t'll in 0)'Sl,ll width ~nd thidnns.

_ Cliniull Application,


........logtIK.i< imperfeo~ ' $ ~ ~ in

which lhe CBJIlIel i. poorly formpd or miner.llize<l.
Such ~c d i"urbJoces ( an he the resu lt or
dtfecti..., c""mel-- nwtrix . y nthesi., M fect ive pr!>,ea", formation (cndmclysin or '\Cl ine p ro'o"S).
or de f,.;t, in <>I he, ccllu la, fum'tin",;.

fog. 5.30 H~tion electron rni<rolI'aph ~ -.,ong ..........

0)Sl.... Iectroo micragr.p/I "-*'g 1 M ~of '\tippled ""'~
" at ~~ gmwtl> Irortt




Cllnl cal Appl kation


Mi no!Rl PhHe a nd Mecha nisms of E.....mel

Ma t urat ion


(~rt~ in .ntibi"' ic l ik ~ tetr.cycl ines, ha", an affinity for cald fi~d tiss ue, . Th<'Y
be<.-ome Incorporated with in the m iner_
ai pha~ during maturation and cau"" di>color~tion of enamel

The minoral ph."e of cnam~1 is co n' id. ....'1 to be c"oon_

ated hydmxyapatite. HOW('..... t. l he , mallesl f'{'pcat i~ g
u ~i[, til<' un it cdL is calcium hydroxyapa f i ~ Iwvi ~g tllr
formul.o Ca""PO.loI0tt ),. lA""ralion of H+ iorn dUrl"lf
INIu,ation mull:< in ;ncR'aW<l xidify within m.. malnx
(Flp. 5.25 .lIld 5.31 ~ This l~ acidity. if al~ 10

and ull<k'rlyin: denlin. Additionally. during .. ar1i...- ~Iop

.......1. tftTX)'Cl ines may int~ with m.. diffe..... ria rion of a
cohon of arnrioblasl> and ClIM hypopIa<tic moH of man...t
on m.. c.-m of _II.

CtlnllnU<'. could """,It in C1'y5U1 dis>olulion. Duri.... 11lr

'lMo<y plw... of am~l .......sis. m~ zwlntrions p"",,<J~ by en.ur>el INlrix prOl~"" or pepTide degradal ion

proollet ' could p ro v i d ~ the bllffer ing cffeCl need ed to

prevent a large d rop in pH. H owe v~r. <luring mMuration
1M pf'()(ein content of tM matrix <!<'<Tray, 'ignifKantly
and an<llhe< buff"";ng ')'5'111 muS( Llkl' 0W'r. The ~Ilet
al ion of bicartlono ~ anions by carboooc anhydT_ ....
'"""" IlfOIlO5'O'd H a buffniDll ....monism duri"lf mamcl
INlu ration, Itflb conc .... ITalions of carbonic anllyd r_
occu r in llle cyIoplasm of all maturalion a_lasts.
Hydr""~'ite t! r>ilo Cell


- ~ --. ....


H' ..... ..-.I pH 01 _

~ .-

P'"'ol . - _


- - . ... bof!enng ..,....."


..-,. _ _ pH ","",, _

_____ m





_ _ _ _ IDMIlp....,.


pH d rop ....,. ~ ogger _____ liOn to


_ _ _ lHCO,1 .....

.... _m ol

t 1-"",""","...,.
low calci"' lD

_pH """

>0); _

(H'.HCO,"'"" .. "' 0'0< 1I01onot.

~,; r ' n ln r

---- .
-- o 0
o 0 -"""""'- -L__'-_-'


5 Develop llllt 0{ r""tll: Crown Formolioo

CMboni< .,hydr_ is .....,..a;.lly .lilund.lllt in lhe .loPiUI

~ of rullk-mded ~rr.. ~ U..IS. ""'.....rnnmlS
of nwnd ....m ix pH durina: nulur.... ion dmIomIr."
.h~r rhe pH S1e~ ily do'dincs ~""'~lh ~nded
.mdobl_s ........ ur~ri"" prag~ lndic~ti nllh.l. i5
lh~", c ~lIs ~Cliv~ly pu m p c~lcium int o t i><' ""'lrix
(....member t hei r apic ~ 1 ju nct ion, ..... tlgh!) the buff~ r in g
m,d ,.,ni, m 1.1ils to k....p pace wit h tne ge Tle r~l io n of U_
io n, . Allhoogh tile exacl me<:h.Hti' m triggering J ChJnge
from ruff!<.'- end ..d 10 smooth~l\ded J meloblam is not
k_n. it ~ S" gge<led to ~Il''''ted to the d rnpof
pH (~k>w ~ ctiti<~1 level) oo:curTlna:
tnd~d ~",..Iobl .... durinl .K1iw crystal Jrowth.
foIlowitlJ the tr~nsil ion from ~ 10 srnoorit~ ~ is ~n ~bnJpt ...... in pH. The "'.oky ~pIc~
;unctiom ........ srnoor:t.-nJded ~fl'lIt'lotU ... ~11ow for
r~pid influx of fluods.nd buffninscomponron (c~rlJon.
~lt "td o;c,rum prot";n<) inlO the ......",..1. ~ .... blish _
menl of ~ "pH b.ll~n",," m.>y ee p..lrt of Ihe ".ritlJ
mech. ni,m lholl six",,!> th e mod"lal ion from 'mooChenM d to r"mee ndcd . melo hl. .... flddlt ion. lly. the
in<'re." c in crystal ,Iimen, iom (t hk kn" .' .lnd w i,itl1 )
occ" rri ng ,h,ring ....l urati" n J II<"""5 for int erlod<ing of
cry< t ~l ..


IZoMs01_ <SMsioo1

F;g. S.ll OwoiI.. m dep<;bng the g",..u, 0I m. d

in!en:...... ~ ...... come" sit<'I.


,.'~11 <mom.t cu;

Crown Growth a nd Completion

Crowm of the K'fltl irocruse in ~ by incnomenul ~
Olil ion of nwnd nutriJ< (fils- 5.28 ~nc1 532). 1be ftl'Sl
~ ....~ of the crown to com pletely form is the <u<p tip. .rod
th e 1.1.. is the """""~l l\"gion. Crowns '''''''''''' in helghl
Of lengt h by different i. tion of new ~",>lJ .. s. This is
101l""" d by en Jmel formal i" " ~t lhe cervi c~J ,l.' I>ects o f
t ho onamel " rg.ln (Fi~s , 5.28, 5,32. .lnd 5.33 ). Cr" wn s
al,o increa", in si,.. l>y cell divi, ion of Ihe inner en am..1
('J)iti><'liJl cells bcrwe<'n , he cu<p<. This r.-s" It< in ~ sUght
separation oflhe cusps w ith . 1l'S"lllnt slight inCfN <ein
crown siH-. Frmn I~ iOC<'ptlon of lWnlinogc n.... 10 l~
rompIet:ion of.l/l'l('~ the ~ ;rocre~<e in ~
~ t lour limes. This is prim,uily clue to "II division iI
ee cnviul rqion Md the deposiI_ of momelto I~
lhidlnrss of 1.5 mm. Whm t:Ite.melobI.>sI:s ditlnntl;."r.
(in ~ny ......l ). thcy Cl n no Iong\"' dMde. ThLo 1.t51l....... to
differentilte. them'or.-. l ....lhe interctlSjl;ll ~nd C'efVic~1
"~lS. ThLorefore. ~fl"" c~1l dilfe....nt ..lion. crown size i,
dope ndcnt u pon Inc... me ntal growlh (en. mcl de posi_
l ion ),
Enamel <urn plotion is ,Ig n. led nt>t o nly by lI t~ ln menl of crow n ' I' bUI also by m ine'll co nte nt. IV. Ih.
r.....1 , t.IgC of "'i '.li...tion. l ite fLltt<l ~lll<' lobl am
.nd thei r ~t membrlne .10<11 with the """"In
"" of the cell, of t he momel orpn (rtduced momel
O'pithelium) form l membr~ne on lhe ...rf..... of ~
~ (Mp. s. n lnd S34~ This is amne<I ~h '<
membr~ne Of the primory <UlQ.


Fig.S,l ] (""......
' """"""'iOn. _.olIaIiOn i, no< "".
pi'" at lhe cerviC.1""liOn, 11><
meI 0'9 '" ~ .-- In tl>< bill 01 .
red uce d

.,,,,me1 e pithelium ,

F;g. S,14 C<wnpI<Itd ,mom reolding in. crypt with I 'tiCicfpfonntd '"' II><
,LJrfoce ol l l>< enamel,


Crown and Surrou nding Tooth Crypt



. . o:b ....

S.1S). ~ foIlicul.lrctlls or rtlO""SO: iOO:IIymil 0rigin m.u..., .lldj,>ctrlllO IIlt)'OUng mmId orpn in ee
u p .mel IIdI S1-' (fi:Is. 5.9A ,nd Bl miu,tt ""I!I fnlm
rntir origin inlO tIw rollick' ,.mel indutt tllt form.olion or
[tit surrounding,l/ ....... ' nd pmodom.lllilol rntnt.
TM furu... pooriodonUlli&-lmtnl is , conllrttiw-- ti......
..,.,.. th.>tsurrounds the IOOfh,OO i, posilioned bo1wtflI
tM proIrttiw thin JhtU 01' ,Iveolar bon< ~nd Ihe dcYtlop;ng lOol h. wttr. ~s tM tooth trupts, rOOl fo",... tion
l~ k e ' plac. a nd tM I"',iodoolol liS.l",em matur..,

' .- I

ails Im J1'ol:'di..u tty surrounding 1M

... , upwIt Imowt1 ;os , tat dtnUi loUR


" .~


0 - . . ~u

f ig. S.3S (.11, "..' to< , uri, ce of t l><' ", M r d,otol<pit hclium ,tt l... Ix>II

,t"'). mi<J" te ""tward to ",oo<.t l.. f"''''' t'''' of ",rr oundl"ll perio<lont, 1



Oinlu l AppJiution


Tlll' I!'I\.lmcl cuneI<' "",y mn.>in .oclh.rml to !be !OOrtI ,f~r

truption. ~ppt,ring ~ , m:ldish 01bI-own sp<J{ on tM crown.
This IN)" c""se und"" COII<...... lor parmlS- HrfNNrr. th is l.Iytr
is soon sh<d or Nsity J't'Il'lOYt<l with I lOOlhbrush.

Su m mary - - - - - - - - - - - - - - "'1
T(lO{h dcYtloplTl<'nl is 1M rtSult 01' t hc indlK1i~
imffi1Clions thaI O<nIr l><>fwttn t l>< or~1 tpitMliurn a nd 1M ctlls of tM """"I
Tb< or,l
tpitlx-lium ~, dml~1 I.Imin.>.r o;yunn f",m
which 20 pri mary ,nd 32 p<'IlJWntnt tn.>.mtl
"'io'''' develop. All I!'I\.lmd 0IpIl' pa .. lhl'OUCb
ltat ~ bud. up,.mel IIdI ~ n.. prolifw,l i"ll ctlls diff......,l..t. inlO tI>t IOO[h lOrrrwtit lis
during 1M 1Id1~. ~ aris<' from lilt
in""" I!'I\.lmel tpillx-li.ll lis ~nd indU' lilt .lldjaC<'1lt ll' or 1M p,ipill.110 difftnnatt inlO
odontobLlSlS. w hich form d.nnn. n.. fornt>tion of
. n.>.mel ~nd <\tntin m~tris oem" "",ally simullan lU' ly. Follow ing Iht dtposition of a layrr of
apri smatic . na"",l. ~mdobJ",ls dtposi t eMm.1 in
lhe form of rod s or prisms that l>ecOlTl<' h ighly
mat ufal lon ,
a meloblast< funct ion to f orb much of th. water
a nd org~ n ic ma tri x from en am el to prov ide space
fOf th e growing e nam el cry't~I,_ Ena mel and d~nt l
nAl ma trlc ~, form by lhe ill(remenral deposit ion of
about 41"1' or n"'trix d~i ly.

Odontobla' t> first fonn ~n inc....m.nt of 0011.111'"""

nou< m.u ri", "lIrd pmkntin. tlwt is lat.... mi"""al_
iztd As d.>ily inrrtrn<nts of p~ennn loon. lilt
.adjactnt tarliotr-fonnt'd i'OO:lEllKm mi""",lizeos.tS
<\tntin. Tb< odonlobLlstic precess grows in Imsth
.tS mort "",trtr. Is dtposittd, ,00 Is illSU\n'J'H't\U1 in
cootrolli"ll tI>t tffl'i1'Ot\mmt ~r tI>t mi""'aliufioo
fron t I>rrwn'n dtnIin and ~tin. Dtmin coo,irn of 70S mi,.....a], lin: org.anic mat<'ri.ll, ~nd In:
Hyd roxyapatitt Cfy, " h in e""mel ;..,;n:,.ase in see.
which rtS uJts in "",mtl being 961; ml"",..1~nd '"
lXlI"nic materi.l l and ..ater. The arrang<me nl or
Jm.lobl"m .. it h ll><ir Tom.. process ,"Ju t" in
the formarion of ~na me l rods. Th~ PflX"tSJof am.l_

___ _ _ _ _ _ _ _ _ _ _ _ _ __

5_~opm"nt Of Teerh:

Crownfo rmotloo


An I' .." .



oetnt<iS is ~ sen es olsuaM<iw 't.lV' of proIif~r

~lion. dilf~nli.ltion, SC'O"ttion, ~nd maturAtion

(diogr. mnI m F". S.l6~ II four-fold ;nae~ in the

<iu of ttw rrowm octUl'l from initi.ltion until mecomp~ion of I\.lrdliSSlle """",irion. Th i'
illCl"l'.lSf is .KII1lplishnl by ct'Il division .1Id
incr<'lTlml.1 dtposition. ~ WOl:h follicle doeYel<IpS .round the IOOIh And .......,rually gM-; ~ 10
supponilll muetUlff.

Fog. 5-16 Swnm.ry'" <eII .. fi;ty

lion tI.-..., irnpartMll lD u.....

'. ,


1O Nriy >logoSoIIt><>th_
~ one! Iun<tion '"

le'Oth.~_ ~ic~ond",""tion....,...,.,

.... ~l\g'.U."'I"""" d< '. ,... t.t..-"" u..Irlt.


II D<>veIO(lment.i)[ the Teeth ond 5upportinq 5Iru~~UC""'~

Self-Evoluotioll Review
1. From whilt tissue does t he me.<e nchyme of t he
toot h originate? W hen doe, this tis, ue g~ i n it> spedfi"ily?
2. W h.t ~re l he SlolgeS of tooth deve lopment (m orphoiogic alld physiologic)?
3. What three compollents m. ke up the tooth germ?
Wh~t struClures do lhey form ?
4 , Wha t cell type, compr ise l he bell-sloge en omel
orga n?
5. Define l he ler ms morphoo ifferenti ation ~nd cytod ifferent iation ~s t hey relJt. 10 tootl, deve lopment.
6. What are l he roles of the or~ 1 ep ilhe lium and mesenchyme in t he ind uction of ooon!Ob'e nesis priot to
an d following lhe bud srage? Wha t is mea nt by t he
te rms inSlT1.lcl ive ~nd pe rmissive as they relate to
ep ithel ial- me,enchyma l im et~ c t ions?
7, WhJt role d oes lhe ena mel knot provide in t he
developmen t of th e crown', shilpe?
8. W hat (a"SeS th e ind uction of dentin-form ing cells?
9. De sc ri~ t he change, t hat our duri ng: odon tobl.ls_
lie d ifferen tiatio n.
10. COmP,l re .lnd cont rast th e role o f t hc ex tracellular
matrix in t he m iner~ liz~t ion o f en ,lmel .,nd dent in.
11. Describe the changes in t he inn er enamel ep ithelium duri ng l he process of amelobldstic differe ntiation.
Whdt is Tomes' process?
12. D e s cr i~ the d istrib ution of pr ism.lic ~ n d ~ p r i s _
nW ic endmcl in the crown. W hitt accou nts for the
a rr~ngement of enamel into prisms?
13, What dre t he tw o de finitio ns of ~ n ename l roo?
How m ~ny ameloblast, form ~ n en ~ m el rod ~cco"d i ng
to eJ,h definition?
14. Describe t he rel ~l i o ns h i p between Tomes' process
and t he deve loping ena mel rod,
IS. Wha t I, m e a~ t by the term " m odu l ~ t i o Tl " ? Al
w hich slage in ~melogene<i< d o amelob lasts modu late ? Whdt is happening to the en .,mel ma lr ix du ring:
lhis <tage? What arc t he roles of ptoteolytic enzyme<
in th is process?
16. How m uch does the crow n increase in size
~tw een early d evelopment ~nd complelion?
17. !<t he cervical regio n u,,,ally as hig hly mine ral i>ed
a, the cu<p lip"


,,, ,"or,

wo nld hko '0 ' hank Dr. Irm, The,l, fffor her ,uggo"ion, . nd the [ollowing person, who p ro " i ~ ("" r,~"n: ' r",
' hi, ch.lpter: Dr. P, ivi Ke"un"" , lIl'j>J" " ",n, of nnaromy . "d
Celt Biology, Uni""rsity o f Borgen. RO'lWn. Norway for l'i ~ u re
5,15; Dr.Toom" Piokwl,<h, Tox" MM Universi'y System.
B<ylor ((l II~ o of Dct1';"ry. [or Figures 5.200 .ln d 5,JO, At.,n
lloydo for r ll:ure 5.24,0,: Dr. Chocle, ESmith. McGill u n ,,,,,,, "~'
ond Antonio N,nd . Uni",'''ity o f MOll' '''At. fM F i~uro 5.25:
And AI, n Fincham, unlversi,y of <;0" ' 1,,,," C, lifo m;a, for
Figu'" 5,l 9 (wi".. po,mi i"" of Acade mic Pro,, ).


___ _ _______ ____________--"C-" """'o'p'm''''1t Of Teeth: Crown forrrw@:n

T. - . oIlo<fW'ion< on..,.n>t\ o;rysUIlorm.I"""

dun....................._ .......... """JIK
1996:24S:208-21S.......... SI'I. f<I. (lrtI.In', "'.. Hi><oIogy.ond EmII<ytou; SI.
LouiS ; r:v~; 19l16..
BaY* .... Tho... it . . . . . ol mm'Itl ~ I'nl<. __ 'lat.

__ 1957;l1U(91:9l1

c..-.:t. ...... _ 31;101 II I
_ " - _ r._k;p:iiioo--..atdo,,I;
-.. __ CiIIoo _ s,mp. 1!l!l'I:2!l5:IIS-])(L

1 " _ " ; ' _ " ' ,;, (lM ' t l - .'n.. ...........
~'w.,. ' :c ..... ~_J!ihuCl.
" ' - lAllJl.l:rn_ ~.~s.- ' -1 Tho. .
...-..", _ .....,
iot;<-'" aMP-41i11ol1cn


' .. " " . - -

_ l : n o I, ON. _:IZi(n161-169.
_q.0du0 ,'",lii.,,~.lur.J-(lr"!id.
I9J9:I06:(SI ~ 2-6.

K r _ 1 t Pool '" _ l ~ R.l.<f1 .... '

is .KI..... <"d bJ llMl4 olld "'P''''''' iJldtIrtM , _ illlff
""'""'" ion ,~.and _ _ lopmont.lO<n<'f; - .
1996:10'1112 -1)!l4.
.............. H. .....h"l: It. Mm ", <:a0l'ti0m btI_ K,f ,nil BMP"iV"lIin,; p.lthw"J$ : "
""""'''''''' (Of "",ihoni.... <be , d... o f _ Io:",,,,';OII.


'oll , 1 9'1l ~ 2 4 7 - 2 S S.
1lDb'"'"" c. Kilt"""' ). 5h<H<" ., <'<l <. De,," 1,,,",,,,,,:
IUn",'''''' 10 d... ru<t ;';', Hoc. R>too ; ( R( Pf<... 1995,
"""im"" C, - . . ~J , flo,..." W.... >ba.... Re. Ki rl:tl.lm 1F.n<",.; "",It,," ~." (ib.l Fou00. Symp. 1'197:l OS:1S6- 1m.
Iloh io,"" C. Bro" k<." , j , >no", RC Ki,'''''", J- Th< (kV<'101'n~
" "'....1'N " i"
><I f"n"' iOLl. EULJ. 0<, 1'iei.

""urf ..

l W1 : HJ&{ '" p p l l ) : l 8 ~ _ 2 9 1 .

$"".; T.10._,01 M. . ""gi"w, T,



,troc"',,' '''d ru",tNm of

om".,I>1.", ill '''''m,1f","", ion. Clb. f "," wl.

I!~ YI: ~ ~: )l -4 6.

S1m.,.,. JI', f,l>l"II_m M;. Mo."'u""



m"'~ >J\ i'm$ of 0<" '>1

crn. Rev, Or.. B'ol. M.... 19'1';,ti:

SmllII (l ( 0'1 1""" . " d <hom1"1 """'" duli.... ....",.1


(Ii, llr.Or.1 Bioi. loI<;1199S :9'.1~161.

'imid> CL N.loo A. Owervi<w d """,p""lop,,1 ""_ ill
...._ ....... lh ;oO[N,od Wll ~ ~ ...." ,n


I m : J9 : 1 ~J _ l ti l.

T... C..... M. Or" H........ II<.do;JI'~'... S<nKtu ........

.......... , h <'d. Sl- """" (V MosI>j: - .
~ l $hMpr


P. SIF>IIiI\I ...._

.,Iop.,,,- MlL






T1l< ..... " ' - " ,.... riFf pUa.). Do'<IL

_ .....It_S><1l71;an..Jl4
1), _
1. llyn....- _ _ .... tl>r
,uI", ' ...,
CtiL _ , 00..
.... _ _:t:Jli9-. .
_1lS><1l1l._ Z..... _ A . . - f . 9
~ _..-c_of-...
C Em-.~
000I1ri. _: I06~SI ~

_in "'-.,.. ." '. .




6 Development of the Teeth: Root and Supporting Structures

Nag;M M . EINeosr .. ocI ",meosK. Awry

Chap'.... Outli....


IntrodIKt ion. _ 108
~ . I08
RootShNth Dfo". .....
iI.._ 109
SinQIe-lloot Fomwt ion. I 10
Multiple- Root For mal lon II I

<bdopmenl is jnili.>led throuIh rn. romribufittM
of ttoe cells orlIIn.uina: fmm t he .....mel dtnt.ll
~pitl....nd ,,","til foIlidt. 1M rells of the Outer e~mel
epitbriium ront""t the inDl'f .....m.1 ."ithelium ot the
b.He ofthP e""mel o~n. the cervic..lloop (Fip. 6 ,1 .. nd
6.2A). l.l ter. with crow n , om pletion. the re ll, 01 the eervl, al loo p rontin ue 10 grow . w.y fm m t he crown ..nd
become root , t,.al h <:ell, (Figs. 5,28 and 5,3~ The i11lll"
I"O(ll . hea t h ceus cause roo{ formoltioo by inducing t""
,od~n' cells of t he denral ~pill.o to beco me odOfltobUsts. wlIi<h in 'urn will form roo! dentin. The t"OO(
.tle.. 'h will further di<tiUe wttet ...... ,hot tooth will how

Root Fomwtioo """

Fate of the Epithelial Root (Hertwig'.}... 113
Dent. 1ro llkle... 114
Development of (Intermedi.te) (ement um ... 116
Cellula, .nd "'.lIu[o, Cementum ... 116
Dewlopmen, of t~ Periodont; Ugament... 117
~nt of~""""'INPnI< ....... 119

s..nnwoy_. III


sinp: or multiple I"llOU.


The m...inder oIlhot retb of lhot .........1 p.apolLit will

then become the cells oIttoe mot pulP.1M tltird compo""" io mol forltutlon. the dent; follic.... is the tis<tol'
Ih.t surround< Ihe .....mel 0fi00n. ,hot dent..1p.>pilli. mod
the mol. It w ill give lise to r ell. tbat form the .uppo,till3
i1ructur", of the toot h_t ......1 Is. tM eemenlllm 'hat
form, on t he surface of t he root , till' periodo nta l liga.
menl, .nd Ille .I u,f aee iayer of !he "lwolJr bone. Th is
bone in itially e llclose, t he de vciop lll3 Crown of t he tooth
.nd lale r <urrou nds the root< (Fig. 6. 3~ It . ttaches to the
peti<xlont..l lig.ame<lt fibers. w hich .1.., .Uach the t"OO(
by me..", of the cementum




After <tudyilll thIs ctI..pter. deuils 01 the foIlowina: t0p-

fig. 6.1_oI,tnoi<"lDop.

ics .hould be undemood: root I""",,,ion indudl", an-

S ttaI"", ....


lmo, ono""

. ...., . .

~ p i lholium

,i t

'...s. '






oJ' . ~
..;= , J

."'.:-,_ .


... . . . . . '

... .




. ,

g in; fu nctions or Ihe '001 sM at h ill the in itiat;"n of root

d cn tin and inte, me ,liate cementum formotio n; develop",ent of cemO"lLi m and pe riod,,,, t., l ligame l1t ; format ion
of olve<:>l., oo" e.

Root Sheath Development

Nv:r m.- crown is romp~ t~ inner .rnd out<'r .... m
d t pith<ilum " I~ bJ"" ol'l~ tl'l'Vical loop (f'is. 6.2A)
pro lifer"l t m fonn a<'f of t'S'ilh~hal cell. talltd I ~
( tl~rtwig'.) I0OI sIlC'alh- Tho> first fO<me<l p;.rt ol 1M
~ p l l he l i .1 root , I"'at h !>e nd. upwa,d at a 'IS" a ngle 10
for m " d lsc- lik, ,lrlLcl ure. Th i. p"rt i. called th ~ . plth
li" l d ia ph L"Jgm (Fig. 6.3) t>ccJ u' e It rluee, t he sue of
t M primary Jpic JI o pen ing. w hich n",,11y b011X"O t he
apical fora""'n. Tho> e pithrllal dia pllr.ogm maln lai n, a
constant s iz<' durins roor: d<'YCIOJIrnoml btcause m.- COlItinuity 011"'" root Wath growS in Iffigth aI me...,r.t of
lilt diaphrasm (rrs- 6.'") a nd .... al its Cip. Tho>-'Y
fonne<I YMically <I........... part iii fhe O'pilbeli.ll $fw:oalh
(!'is- 6.48) indUCft tht adj.>o:enl ails of l ilt ~i.lI p.apiIIII m di"","",lwu- imo odonmbwu. whi<:h wi ll fomlillt
I0OI drnlin (Fig. 6,4C~ Wilh in<:n'a S<'<l 1OOl I~nglh. Ihe
n own ~n. 10 """'" Jway from , he b.>se of the CIYPI.
TIli, uplifti llJl of I.... lOOIh prOl'k1es 'p.lC' ".,oded for
'onli nlled root g row l h. As .. res" lt, th~ . pllh . lial
dia p hrilgm 11lol1 " t" In, its po, ll ion I" relation to t ho bJ""
of the c'yp!. Thr rwl therefotC IellJllh ~ ns al lhe <a m.
rm'as the lOOth move.ocdu",Uy (F~ 6. ~ and 8 ~

An , e ,


PI 't

f ig. 6. Formotion ()/ epithel. 1dr..phro>gm . " LvIy epi'hofi.ll d"p" aglo lot
"",too , Blot<'< epithelial>" Qm formahon. Cta ter root d~pm""I .


UDew!opment 0{lhe Ta>th and Supporti!19 Stroqum"'-

Single-Root Fonnatio n
Fl:wnWion 01 .;~ I_h 00CIIr5 "'rough 1M
JrOWIh of the roo( ~~"' li~ cuff or N .... around IIw
cdb of !he'~w pulp (fiI. 6.48~ 101_ bf ~
mm[ 01. the roo( lImt;n (F", .. 6.5A~ Crib; or!be ilW'l"
.... oIlbe roo( sMath Ind"'" .od~ cd.. oIllw denUI p,lpil'" 10 dj~i.lte iRlO odootobWB, which in

tumfoml dmtin. ~ odonrobl.1m ~ the droIiM

..... [rix;n COMU[ M ~B or ill<R'ftl<fln.. .... The /irK
01 denti nal ""lri~ m"ll'uliln. the- cpitlxiial roof


.heath re lls sep.lrare from [lor .urf.l or (be I'OOf dentin

and b"'''ks occur in it. (""Ilnuil)' (f;g. 6 .51\). l1>t' b.....b

. ... due to t he drgr ""'d1i01l of some c pithc lial ....lIs. The

6.' R<>Ol <>Io<KJ' l ioo (A) ...o toot~ "",pelon (B).

S<'"" ,, ' ed rOOl <hcath c~ ll, Ih<on t>egin 10 migrat. aWfiY

from the root , ,,, face, dcc por Into the fo llie ulM ar~a,
Me, enchyma l or euonw",nchymal ( ~ II, o f Ihe til' " lal
follicle lhen mi gra t~ belwt'l'n lh ~ remaining ~ p i l h ~ li al
'II group' to conla( t lh ~ rool , urfae<'. At t hi, "'rf....,
lh<'y diff~ ... "riate intO ce me n l<>bl. 51. J nd 'e<rere
'mentum marri . (<<,ment<>id). whk h ,ub.eq....nlly
mineralize< ro fann 'menlum. M ro(){ [l'm~nlum
fonns. rlx' ",maininl "lis of fh" rool shN[h in [hal asea
mi~are rartix'r _JY from fh" moo: surf""". They persiSI'
'" lhe d"""lopins penodonlailiga"""l as (Malusez'sl


epiiho'lial resl$ (f;&. fi5A ~ ll(l(ll ri<Ing.llion

~. >Mlh proliferation of I"" ~n;n;( moo:
......Ih <dis a l lhr baK- of the a nglie of , he q>ilhelial
d iaph<;>gnL Th;;, is ,,",compo_ by prolif".-ation of lhe
adjacnn <dis <II the <k'nul papilLa and .......tl1 foil_de
(fis. 6.6). f'o5 fh" rooo:lt'lSlbftlS fh"
......n' or ~rupcion pnMcIn spact' for furtix'r rool drvdopmoonl (F.g. 6.58 ).

""""""""'''''Y _

The fOOl ' heath is n<"\O\'1 seee .s a continuous i.lyl'r

beeause il breaks down ,a pid ly once fOOl d ~nlin b<ogins
ro form. The lOne of The ~p; r"" l ial diJphragm. hllW"""' ,
remai n' con'ta<l l J nd is the la, t p,1rt of t he root ' hea th
te) dege ne rate aft~r rool com p letio n. The pro ("~" o r roo
de vt'loll",e nt comlnues J rr~r t he to olh J,as crllpl.-.! into
the ora l cavity.

_ d inlcaI Application
Th~ prneoct of m., root .he~th in;tld' ''' d""",I<>pmo>nt 01 t!W:'
roof and detemli nes the . ize and ,tI.l ~ or (lor ro<X, ilS ~ ng t h.
w~ho:r ll>e root will b<o curwd or str aight. ~ro ... I'O<~
forma lio n occurs, t he '001 'heath m,,' l be pres" Ll!. Its inter_


ruption liMy res"lt in rOOI deformities.


_ _ _ _ _ __ _ _ _ _ _ 6 ~ o{ the Tth:~ondSuppoftinq5ltuct\Hl'S


Mu ltip le-Root Fo rmation

Hunwn n>ultirootf'd tN1h ~ in common. roo! trunk.
which is l~ ..... of common ItIOII boise 10<:.1...:1 bo1-...
1M =vic~ ~ and rbP . .... . 1 which fOOl diYKMm
oo:un (F;g,. 6.7 and 6. 10~ ~I"","""l or multi""".....


teeth pfO(ped s in 111 l1 ch t ho "'Ille m" nn.. .lS My clopme n! o f singl e-l'(lOIed { unti l 1M fur<. tion zonr is
compl"'r (Figs. 1i7 .nd 6.10~ DivI,ion or lhe' """ ,."'"
pWa I!'Ifough diffnnllWl In>Wl1l of [Ix" roof w.m. In
1M J<'lI,ion or 1M r pirlwl..1 tonJ:......lik<-

"" u.,." ions d"""lop (Fl&. 6.7) . 00 grow until rn nl.KI is

m"de w ilh 0" . or tWl] o p p o, in~ extension, th.ll fuse
....i th urn othH. Th t' di~ides the OligiMI $ingle ol'ffiing
of tbr- OUOI mmk inlO l\W or th ..... o~inzs. ~ ~l hr
hum Ibm conli",,", to proh fnMP.' on fllIUl II tbrpW""""" cA r.Kh '" 1M ~nss.nd lOrms epulll'li.ll
di. ph'''gnl' dod cuIT, to ..... ~ the ind,vid ....l root> .. they
r ln ngale, The .1~J< of (O rl l . " of t he long ll4.' likr len sion, form ep;llwli. 1 bridge, at the [u"alion W ilt' (Fig.
6J ~ A _
of. Stion lllrough t he fut,,", bifUln tioo
ZOO<' ~l ~ highrl" rNgni r,,~rion Is SO"flI in ftgu .... 6 .9. AI.


- @ -'~ :'~
n lJ.6.1_ipIo-r<Iotd..


....... ~_d~

""omiM, dM6ng lhr >inIII< roo! on lhr Icft ;,. "",.1 III tt.. ...... bor'"
mot> 10 be 101 mi'd on the , ~ .

1"00. 6,' o.-.Iop,,,,,~01 futulion~ . Bdu_l:rid<}e ( .,ow).

'Iii'; .,

~.. )

''lJ- 6.'~~otbilRol"",_.


Ii Develop'!!en!.-o[ the Teeth Q'!P_Supporting ,strucwres'-



-- Epi'ho!iol

e~ch brid ge. the inner cells of the epith elial root sh~dth
indLl("e fOr m<llion of odo L1tobl" ts. w hich ill turn will
P rodll [~ d "span" of M nlin be t_ en .'" d <
'round e,l{'h
root (Fig, 6.10) . Odo lltobh sts (O nt in u ~ to d i ff~r~ nti ,,!t'
, Iong the coro Llal pulpal floor. Domin form atio n will
l hen toilow the root "heath
produ ee m u t tl pl~ root,
(Fig, 6.11), Some root ' hea th (e ll, wili l be n dogener<tl e in
t be same manne r as in single-root form dtion (Fig, 6.11 ),
which will provide S for cemel1toblasts to deposit
<'~m~ntllm o n lh ~ rOOt ' urf,lee.


f ig 6.10 F<;>rmation 01 rooltrunk.

Root porrnat to n Anomalies


The continuity of tlto ep ithelial root sheath an d thc timing Of it, proliferatio n .lnd deg~ner.ll io l1 <lr~ believed to
be e,,~n tia i to nor m"i r("'t form~l ion. If tlte CO <l linuily
of the root sheath wcr e bro k~ n before <Ient in fo rmatio n,
lhe l'e"ui! co uld be missing or defect ive cpit belidl cclis,
O,lo nlobl,lsrs would tlle n not di fferent'J [c. And de ntin
wo uld not form op posl!t' th e d e f~ n ;n t be root , hhlth
(Fig. 6,12A). TI,C resoit wo uld be a smdil laterdl cdnal
(OlHte( li<lg tlte l", riodom J l ligJ ment with the mJ in roo t
canal. This s u pp l ~ m ~ n l a l ( anal is ("lied .' <l J(ce.sso ry
root canJ I aLld may occur aLlywhe r<' dlo ng t be root. pnfti( ul"rly in the ~p icJ I third (Figs. 6,12B and C). Defect'
also ar<' , <:en in the furr .lli o n "rea of mu llil'Oo ted teeth.
These a r~ d u ~ to incomplete fusion of l be to ng ue- like
exten, ions of the ep ithc lial diap brilgm d ivid ing the root
tr unk. Ac"","ory root ca'Mls arc therefo re s"" n at thi s
,I t~,

fi g.

- ,,-l


l ig. G,12 A Fo"''''tion of dol", ti,," "lOt , heath. BL:!ck of odontobiN dilfe<entiat;on"" d f"''''' tio'' of ~ . ,"i" C Ro," lting occ",wry com lin malu",

_ _ _ _ _ _ _ _ _ _-'6"~ 0{tho> TefflI: Root and Suf'PQ!

_ '_i!\9 5tructures __'_"

If..... tile Olhcr ~nd. lhr ..plbtlWl root wath ....... not
ck!<,or'lh! ~ 1M PfOIlO'r Ii"", MOd ~i ... .odhrrml: 10
tilt SUIU<l'clllw root dmlin (fis. !i l lAlll .".. nc!Iym.ll
crib of tht .... n'.1 foIlick" will II(lIl ~ ;nroronYCt wi th
1M dffitin. ~ would ,hen be no dilk1fl11i'llion imo
Wl"I<"Illobl~<" and no ~m~nlum fO'm.ltion. ""'ulTing in
arca, of fh~ root being devoid of c~ "",n lu m (Fig. 6.138),
II",.. of expo= 1
dentin may be round in ." 'y orca or
the rool , m fa"c. p.> rticu l,lrly in the cervical zone (Fig.
6 .nil). and "wy be t h., call'" of (l'rvk al sen<;li~iry later
in life when gingival ~ion t.lkes pliIcr.
TIle epithtl...1 root .hea,h also '''IT\iI in .odhrmll
10 m.. (\oon,;n in tile cnvi<:al .,... IINr 1M furc.rnon WfIot.
In lhis ~. tht ilMWf ""II. olllw I'0OI """'atll ~ di~
mh.U' inIo fullCliorW produce e<WJWI
droplH< mown .is ~ pr..... Erumd prark oft...
'" round lodgnl ~ n tht roots of tile ~ t
mol.", (Fig. 6. M ).

,. ,.,t

f''9- 6.13 A _ _ <... IuIHt<>_. _ d . . . . . . - c l _

If t he ep itl>o>lial root ,heath bNo",.. dislocated .r",

p,lrt ial mol m i t1~r. lil.lion , t he "'Illdining i>O'lion of th ..
rool m"y e""nlll" lly be bent or twl' ted "" ulliJlg ill a
("Ondilion (" lied dilaceration 0' roo! din on ion. Thi, con

dil lon i, .....n more in the p",ma"""t tknlitlon. Usually

II is (alZSed by. blow on. dedd ltOUS p~sso, resulli", in dl<pl.aet'n1Cnr of m.. unde'rtying. PM1IY mt........
Iz<od pnnwnrnl lOOlIt. A dilM'toralftl rool mq ~t
loodI nuprion.nd.also c....... orthodon tic...,.. exfl"Klion plObl......

Fate of th e Epithelia l Root Sheath

(Hertwig's Sheat h)

Aft~r <Ientin formation lhe epitheli,,1 root ,healh b",.lk,

clown, and its ",mn"n !, migfa!~ .ow. y from l h~!nal
,ulface. T1lt'' ",m""nl' COtlll' 10 lre so~ dlsunre from
1M mol. in Illc Pl'oiodonl~1 lildmtnt. and b<'co~
knt-n .. 1M epilhelial
MlLo""",- 1bo:'sc mls
pmist in lilt' pmodonLll lipmomts 'hroughout li~.
They '"'" of1m band lIN. !he ~pial ~ in Y'JUI'& indiridu.ak up 10 20 ~~...... ~. u
llww mls 1ftOd 10 J.
'"'" ""'"' in IhI' cnviul arr
lhl' lOOdL This could
be be<-aU' I"" ..pllhtli.>l mls hivO' ~n in~n( ""rKl<'risei( of movillllow.rd Ih~ sudolCO' ~n d "" fol i~ l i,,*" In
hum. n<. so",. of tho ~ith ~Ii~' , ..II rem""",, of th~ mol
sh~a t h m~y become t'dpp<'d in I>.,y- Iike dcp, .., ;" n,
bct~n th ~ dentin J l1d ccllul.. ,~ nw r\ l\lIn. for mlog
wllJ! i, knowo n ."" meloid or inl Nm cd iate cement um.


= ....

Oink.1 Applicltion

/Ittn.oofy root <. ""Is un ink<tion fl1lm """ sire 10

.nothn. Iflf<'ttion trUY lIur inilially in tht IODIn pulp.nd J.
IrdMmilt l'd to th~ ])I'OodoRI~lsPo''. ~ it may Sldn fl1lm inf~_
tion In 1M pniodontium dnd PiI" IOlht pulp Ii"....


..!!..p eVf!li'p_mellt of the Teeth olld Sl!"'p,po"""",""",,,""",,,",, ,,

Micro<copi, ally. epithelial rests appmr eitl1er ilS a network of epitheliJ I strand, along the n><lt , u ff~ce. as isolated island, of cell, surrounded by connective tiss ue
(Fig, 5.15 ), or a, i ,ol~te d cell< in close cont~et with the
ceme ntum. Three type, of epitheliJI rests develop, p roliferating, re<ling. J nd degenerating. This de:r iption is
delX'ndent on whether the ep itheliill rem Jre in the
pro""" of dividing, inactive. 0 1' undeff,oing cell l",i,.
Ull rJstrueturally, the epitheli,11( ells ., '" surrollnded
by b"sall,lm inJ J nd hemide, mosome" F~l(h cluster is
composed of a few irregul"\'ly shalX'd cells with ovoid.
oblong. or indented nuclei (Fig. 5.16). The cytopl" l11 i,
rather dens e with mjtochondri" , ribu, omes. J nd tonofilament, ap ~ earin g ' illgly Of in bundles. Th,'s" " re -,een
anchored to att" chment pl,lques .>t sites of de, ,,,o,om,',
and hemide.slfiosomes, Dense grJnule-, " re J lso seen in
the cytopl"Sll' . When singly present. the " l,itheIlJ I <ell
has a llniform , hJ I'" <url'Ounded by" baSil l lJ minJ with
J , mooth " nd rollnd nu( leu, outline. When chroni<
inn.l ntmJ ,ion or other pathologi< conditions occur, the
epithelial rest, lfiJy prollfer"te- into cy, ts or tumors.
Degenerated ~pi theliJ I cell<, however, m"y form J nidus
for CJlc i~ cd bodies contrii>uti1lZ 10 the formation of a
cemenlicle ill the pcrlodol1 tal lig" morll.
Currentiy, the phy<iologic role of epitheli,'1 fe<ls is
unknown. The beh"vior of these colis Is said to be
spe<:io, depeLldcnt In teeth of per<iste"t gfowth, such as
" r" t inci, or. wheL" coHagen llImove,- i$ fJp id. the
epitheiial rests are reported 1o degrilde coll"g~ o Ily
~ h"gocy tosis. In vitro ,w<lie, h.\Ve " Iso shown pTocine
epitheli,'1 rests to phagocytose coll,lge"

Denta l Fo llicle

<.t. ...

~-f "


Fig, 6,16 EIe<tron mic rog r"pI, ' 1\OW5the ultr" tructure <of , n epithol;,, 1"'st.
with de, lno;om. , between , dia<enl


Sac cells m;gr3<e

3W'y fro m til.
enamel organ 10

ini'i3la pa rlodotl'aI

Fig. 6.17 Dent, 1follitle in d('Vcloping tooth.

The dent,,1follicle (S,K ) is the ectomesenchym,l l conden<.\tion that initially " JrroLlIld<the cl1ilmel org.n " nd the
enclosed dental pilplll" (f ig, 6 ,17). w le,', it sur rounds the
crown " ml eve ntu"lIy tlto toot h root. C ~l l s of th ~ de mJ I
Sole initiate the d ~v"l ol'me n l of the suppon ing ti"uo$ of
the tooth (fig, 6.17) . They ,orise from the area near the
outer en~mel epithelium and migr,l te peri l'l, ef~lIy. Cells
of the SilCwill ,herefoL'e give ri, e to cells th.n p rod u""
cementum, the periodontJI ligameLll, and the " lveolJr
hone (erypt or aiveolus). Dent,ll follieuiJf cells thus control the fOfmJ lion of futllre periodoll,.ll , tfuelll"'s and
are first "1'1'"",nt in yery eariy developmenl"l <["gos,
At all stage, of development teeth " re proten<'d ,," d
'tJbili, ed by fo llicular tl"ue, Wh." the tooth germs of

Ih~ pnm.lncnl (."",,~naJ) ffflh lirs! ~pptar, lhey ~""

in I~ dental ........ Ihcir dtridoous p~'"
(I'",.. 6. llIA~ This rn.1Iions/lip is ""';nI~irWI until lhe
doriduous tftIh begin to ...-up!. TIlt P"flIWlIt'nt lOOIb
thotn'" 10+ ..".r_
wlll\irI St\W<'"'" crypn



(fiI. 6. lsa~ A OYPI is the ~ ("";1, t'IldI><inz ~ ".......

"";OlIlOO1b ond is formtod by I~ ..... we. E.octt <TYP


hH "" opming in its roof Ihrou:&b wflidl de1ltll .....

fibl'n ""I~nd for rummuniunon wllh 1he ....1 m~
1M fibrous ..,.l""sian oJ l he dtm~llM. which con nect s
lhe pcnn.In~nl lDOlh genn 10 fh~ or~1 mUCOSol. i. c~1 1t'd
Ih~ sU\:lcl'naculor cord ' (Fip. 6,19 ~nd 6.:ro~ Somr
~ulhoriri~. bt"1i<w dw ~rt~r lhe ~ruplion oJ fhe ""'=iduOIl' (('('Ih th~ gul>ema cU\.l r rord. lie' in bony ca nal.
known~. l u bt m.>cula r canals, wh ich ~"" e'ten , ion. of
(he bony crypts of Ihe , uITcss lona l t~t11. Alt hough thc
gubcrnan ,I,,, cord Is fo ml<'d of fibro ll' l i,sue (cxte ns;on
of II,c tooth ",e). ir may ro nt.,in ep l(heli,,1 cell,. poss ibly
",mnants of fhe <\e" rJl lamlna ( Fig, 6.20) , Some of the..




f;g , 6,18 ~t oibony crypt. " IttIa[ion</l;p 01 p<ima ry d pett1IO"""I toorh bods in <<Iffy d"""_
l. 8 Ile/.llioo,tMp of p<lma'Y d perm'.
"""tloo\h lxid, in Wer dl've1oj>m<'''1.



",m""nl< I'roljfetate . nd fo rm
ell ifhr lial
co mpose d of ke""lniled materi~1 ~nc1 known as epithe.
1i,,1 pc~r1 ~pil""Ii,,1 cell nMl' . or cysl.. Th~ dental....:
(follicle) ;ni' idlly "tnQUnds Ih~ younSIOOlh (Fi&- 6 Z1~
!Is lhe mol !om,.
tOOfh .rupl'S. lho follicular lis
s.... borne. tho' suplJOflM' liss .... of the t~: tho
a<nmIUnt, fhe periodorttlll~mml, ond the support.
inC i/WOlu boor. T1'lefrio>n'. tilt funclions 01. the ~l
1M ~; to protecl .ond subiliu lilt tooCh c:IuriOlI form;;l.
non ...., I,>,Cf ...-upliort: 10 providt n..riIion ~nc1 """'"'
supply 10 the drwloping looch: a nd 10 p..... rise '0 the
ct'll. lhat rom, the c",""",lum. Ihe 1*' iudoo,tlIlisamml
and lhe inllt'r wall of the bony <1YP! or alveolus.
It ha. been ~n fhal tilt funcliol'J or fit. follicular
-II. i. regul."ed by n!.l1lY autorrin. and""
ac'lion. orloc~1 f.lcrors such u prostaslandin<. opirle"""!
smwth faeror. " an,form illllSrowth factor. etc.


Also. it is now known that th" dent . 1follicle pl. ys. key
rolc In tooth etu l' tion . as irs ,."",ov.1 "use' eo mplde
C~ ",' 1
of er uptio n (,ce Cha p"" 7).


fill , 6,19 <ruption p" hw, y


Clinic... "PPlication
The <lonl,", folliclc i. imporun, M<;~'- il ron
moo'C'S to o.><:h of !be supponiOll fis.....-s 01 !be
IOOlh mol flte pt'I'iodonl. 1 ligamml cemenrum.
a nd . I..... olar bon e. The fonn. ti'le colis of these
, imponant in 1M ;n iti.ho n. fo"",,
tion, . nd m.inre,woce of the .. liS' OM.


.!.!6__1! DeVf!lopm_M ~of..!he Teeth andSupporting ~r,""",",,",,,

Development of (Intermediate)
Ceme ntum


Ju" hefore
degeneration of the e pithe lial root
sheath, root dentin is dellOsited Jdj,lCenllO it ,1S <1 th in,
amorp hous, structllrele". and highly m in~ ,"l i z e d secre
tion " ppeJ rs on the surface of the root denti n. This sub, t. nee is devoid of collJge n but contains tryptophan, an
amino acid, al,o found in the en,1"wl m,' lri<. U<co,,-,; ,teney i< similar to thilt of the thin layer of peripheral
en. mel. apri, nw ic en,lmeL Thi, , ecret;on Is more evident in the api,'al region of the root and aver,lgo.s some
10 to 20 ~m in thickness. The deposit is heli,'w,l to b ~
formed by the rool , Ileath cells.j llst before they b '-~ a k up
and begin migr. tion from the root surf,l ce, This cementum is deposited on the root ""r,lee and r" n,lion, In
J lt.leh the secondary ( e m~ ntl l m to its s" rf. ce (F;g. 6.22),
R&<'ntly. il been reporled lhat this substance m,y
cont" in O(c",ional epi' heli,lt ,ells. The root , he.lth cells
havc an odontobl. st-st;mul.tioz ability '" welt ,\< tlO" i.
bte secretory functions In producing the i nl e r m ~ , li J l e

Fig . 6.21 Tooth in crypt.

Cellular and Acellu lar Cementum

.~~! Inle'med"'le
S harl'''''~i'


Fig, 6,22 p.,V<lopmcm of intermediate cemenlum. POl: perOxloI1' al lig., .


rig. 0.23 Hi" ologyofearly <em""I, ""

an~ dcntinformotion

lifter root , cells begin m;gr,lli" n. the "" tomes,

e" chyme <ells from the dem . 1follicle then contan the
surf. "e of Ihe intermediate cementum .lnd begin the
formation of {'e m ~ n t u m . Cementum til"" covcrs Ille
roots .lnd functions to mat h t h ~ pe r i (~ IO ll, ,' 1 lig,lment
filler I>U l1dl" ' .
C~menloge nesi , pron'e,ls ,'t ' , lower pJce Ill,'" tl1.ll of
lhe development of adjacent root dentin (Figs. 6,2} and
6,24). The cemenlolll,1St' exlli bit fe.ltures
of cells cap. ble of prolei" syt\tl\esi' .lnd secretion, They
hJve J well-develo ped, co ugh-surfoc",1 f Tl dopl,1Smi,
reliculum. ~ nmJ I,te Gotgi Jp pJra lus. Llumerolls mitochondri. a large nu, leus ti,,,t comJ il1 , prom inent nucle-

f ig, 6.24 Developm"nt of

IILlI" CCmen'"m.

oIi..u>d l C)'Iop&i$tn (fill. 6.2S ~ The nrwIy dof~ti.l<c<l cmo.nt~ fim ~l.1bor~t~ t~ _nic
IDillTi~ or cemenroid. This motr;" romi su o f rol~
flb<1"s . nd g roo nd ' ''MIO'''''' wi th two COffiponl':l tS.
The flm is p rot, ,' gtYCdns. con,isting nl glycos.m inog ly_
with predo miT1"nee of tho ,,, If.ted ly!X' dm chod to
wre of p rolcin. Th~ ""cond is g lycoprot ~ i n s. Tho w ll. _
lI"n fib<ors prod """d by l~ cel"""tob!;l,ture co iled th ~
intrin<ic fib<ors. They run"" to t he a'mmtum surf.K<' in~" i~lar mon,,". Next. m. lIrJoInic nutrix is
mi" li
~ .... ttmmI.... is WeI down in <ucns~
i~i.,I.."lS unOI ~ pot:de-i"'illt'd 1hKblts's is
......:lIed. T1ltn'~frn-. II.. mr"1ll0bl~t".... t.... ~ rruX'<cmt
stiI~ nr~, t~ me ntum lTonl. "'ddy fO functio n =0Iding fO nPfll. w helMr for further growth or .... p.>ir.
Adja cenr fibroh l.SlS . labo rar. coll"en r,b<o,,,, wh ich
b<ocome . ", bodd od in th e ce me nt um n1oll , ix. to prov id ~
a!la(h"",n l of t ho lOOfh to the ,u rrou nding bo M. lh~
em bc<lMd po'h{lll> of l~ p<'ri<.>dontal lip",..nt fibers In
lhe cementum . .... known ds p<', ro,.tiJlJ; fl b<o~ Of
Sharpty's flben (fill. 6.22~ ~ .re the extrinsic flb<ors
of m. cnnmI.... and run all righl . . . . to II.. lOOl su r_
ratt {As. 62S ~
,""",,,um is do'scribnl ~ nlhn" celluL.. or """,llul.1,.
do'pmdH'S 00 wb<th...- il rontdins cell, in II, m .urix. The
Ix>havio , of cemen lDbl,urs du ring mJlrtx fonn. lion
<lo<e nnines the type {Ifcementu m to be> ro,med. ( ~lIul.,
c~me nl<Jm d ovelo p, w hen , o mo of t he (, ,,, o l1 t""I~'I'
el, bo,.t;ng th e mal rix I><-come emb~dll ~ d in it dS
ce me n t ocyr~, (Fi&- 6 28 ~ ....... lIu cenK"ntum, on the
oth<-r hand. ~ I'S wlicn .. lIl h~ umentobl.m l<'f..... t
inoo the periodontalligamml. le.MIlI no t,.pped cdb
behind. Ce1wr~lIy. .offl1\IIM mnmtum CC/Il'CflIhe fV\,.II ~ oi lhi' lOOI <lmitin ............. cdlulu mmnom is
found 00 tilt
I>.olf. ~,Ia)n-J of """'Ilular .....
ullul.1r ..........tum lIUY .Item.>te dl ~ny ~te (fill- Ii26~
In "'Ilul.u cemen tum. tr~PP<'d ",me ntobla,,,, devriop
cytopla,mic pn:><~ s.<e< (fig. 6,25) a nd reside in the
come n lUm Ilw rix to t>emm. ce montocyl ...

Ce,. _
CeIl . 'I"1


1> '



'.''' $


Development of the Periodontal

TIre prriodonullipmml ons;notcs from the follick ~nd is tilt speci.oJi'd. sdI, cannec'ti~...... lip-

menr lh.>1 PfO"ide< ttlt .ttarhmml for ttlt R'<1h 00 Ihe

.djacenl ~lwolar bo..... It' fiber> are embedded in Ih.
cementum OIl t he tooth', s" rf~ce dnd In the . J"""I.,
bo no altho Cll o,'r e nd
So",.. delk~te fibe, bundles of t he fo, ming pe riodo nl.1
ligJ mefll fir51 appe.r~, roo! fmm .nioo bclins. AI tbis
lime. ttlt foiliruL>. lis show i",",ned prulifn-~live
lI<riviry. The innermosf lis "".... m. forming lOOl dif_
fnenrialle ;nIO ttmmtobU>ts .and down """""tum.
The oulel'mOSl. rei!> diff~nli.Ue into osreobI,i;u .u>d
fumisJIltlt Uningofttlt bony S<l<Ut (Fi$- 6.27 ~ The ""'"'
' ....t"lI ly Ior~ted ",lis in I"" lig.lmefll diffe!1'fllia~ into
flbrnbla<ts. The se p rod"... con agen fibers th~l w ill


.:!""" 01 Nrly nmtoli.......

Fig. 6.25 Uhr"l".


' -- ri g. 6.26 C."'''''tal deposit ion polle rn.


!I ~~Lopme nt ofthe Teeth and Sup~gltru~lure


Fi,',I-locm. d I"""

........~ B ToolI1 l>OlOw


Tool l> above

Fig. 6,28 F()ffl1.1tionof periodonldllig"n""l. AR<-Iation of periodontalfiber>
0" ""e 'wt<'d "own. B Ref"rion of p. <ioo:Jontal rober> during intr, orafemp'
1'0 " . C 10;1'1100 of fiber, in theadult tooth. Nole II,e orl~nt"t;oo ofthe fir"
formod fibe" io A, B. and C.
. .....oIac

ligome n1 .-

F;g , 6,29 Di ff",. ,,';ation of pcnodon' aff;gam..'1fib.., .


beeome em b~dde d in bot h forming ,'e m{'ntllm ,1Tl,i

bone. Al first. JII the develop ing fibers of the periodontal
Iigilm~nt run ol, ti4ue ly ;l1 a coro" J I direct iol1 , from lOoth
to bone (f ig.5.281\). The " p i,'~ 1 fLhrol>l,l<tS J L" the ' lem
cells that p rolife rat~ and migrilte ",ie,llly to limn the
flrsl group of eoliagen fibers. As tooth eru plion p roce~ d"
the obliquity of the fibe,., gr~d u~lIy decreases and the
position of the cemento,m" n>el jm\Ction. which w~ s
or ig i l1 ~lIy apical to the crest of t h ~ nypt (Fig. 6.28Aj,
hecomes le.el J " d the" coron~l to the alveolar cr~st (f ig,
6.286 and C). This chJng<' I>etw""" Ih~ ceme ntoenamcl
jun<lion and alveolar crest may rel.lte to their funrt ion,11 rol. J ur ing tooth eruption. It also brings ahOll1 Ihe
final ~rrang"men ' of the prineip,ll fiber groups of the
m ~ lU rc p e r i od o n ta l l i g ,lm ~ n t (Fig<. 6.28A-CJTho pcriodo"tol lig<tment is i ~ ~ continuo" , SIO I. 01
r~mo<l~l i "g. both during developmet\! and throughout
Ihe l i fe ' I~'ln of lbe looth. The ligament persistently
mainta in, Sllpport of " n erupti ng or funCliOtti " g toot h
(Fig. 6.29), Remodeling i, achiev<'d by fibrobl,,, t, , I',' t
rJl'iJly 5y"t hc5ize a" d 5ecrete coHilg~ n. ~ ap id tm nover
of collagen IJk.. pl.lee tllroughout the whoie thickness
ofthe l igo m e ~t , from bone to {'e mentum. TUTJlO\'er i-,nol
restricted to the metobolically active midd le 'Olle, which
is sometimes referred to as the interme<:liate plexlI s,
There is a differential ", Ie of n , ll,lgen tumover in the iigJ mem , in an ap icocervica l diren i!)n. The highe>t
{LlInover ;s in the apicall'eglon, and the lowest in Ille
celv k ,,1region of the lig" menr. M~t ur,ltio l1 al1d thickening of the fiber bundle, of the pe riod''''l,ll lig.""en l
occur J Sthe teeth reach funniona l !)..e1 u, ion,

_ _ _ _ _ _ __ _ _ _ _ _ _ _-'5~Developmenf of the Teeth: Root and S~pporting Stru~l(1fe~

Development of the Alveolar Process

The llwol" bofw d"""lops d. lhe looth <irvc'lops..
In"i.oUy, Ihis boM rorm. l thin ewhell of wP",,",
r..rmO'd lhe IOOII'h crypt. lrouOO uell WOlh gJ1nn (f1&.
1i lO~ G,.od...IIy, .s tile IOOlS grow and ImltP>en, {til'
~ to::>nt "-Ps ~ with tht' <'Iong.otilll" . ... ..... pli... lOOUl vod a rNriool with exll tooth . (fip. 6.27MId 6.31~
Ik'\(lopmoonl '" 11It'.~ J'I"OC= bttin. in the
O'iPIh WftIt in ........ AI Ilwi rime.. wi Utin tile ....,.iI1.O
and lilt 1Nlldil* the lotmi"ll ~ ~do"'l:lops.
~,,"~. The bony~. ot URoIl. Is
fonne.:I ~ ~h 01 me focWl ...... lingu.ol .... rn <Ii llw
body of 1M """,ilw or m.ondiblc' and contains I'"
d......lopiflIlOOI II JIl'lll'$ lOVIher with tbe alvo:oLlr blood
~. and .......... (FIs. 6.3Q).. AI. rlffl.. the ~'"
lOOIh eerms liP rift in tbe 1">0"". Cr.>du.olly. bony ll!'\lU
,,"",lop ~ l~h. '" that e..m I;()(l{h Is lIYMll""lIy
conlain'" in sep.uar.. CTypf (Fig. 6.30).. The ;l(tu.ol ~

alar pro<e'lS d,......lops du rin! e ruplion of the tffih (Figs.

6.28 a nd 6,) 1).
Du' inS ule ri.... life, fho den tal .1....-01"' . like t he t't'<! of
lhe , kelet on. i, form<'d from ' n em hryonic typo' of lluo<'
comp<<"ll of IIny. oony , picules (fi g, . 6.) 0 . nd 6.31)..
Thi, embrY'lt1 ic bone Is of tWO ty iX" , woven boLW and
coal''I' bu n{lI~ l~lIlc, Both WI" " ( o nl"i n <o ll,g~n b\JIld ICS
in th . i,. m~ t,. l x , Th~ m.lin diffcrcn.... however, Is t h,ll in
wown bone lbe bun ~ I~, or mJlJgcn run in v>riou. dlrlio ns in lhe mal rix. w hilt in <OJr"" bu nd l~ b<m~. !II{' cOIIdgen bundl~' . ... lh id er and u\lJJlly follow . ""ra llel
course in III<' matrix. n,~ m.u rix of embryonic bone coo-

r.oin. more glyco",minoslyc. n,

~ n d gly<o"",l~itl.


th.>., of m.Ilu'" bo<I<::.1'hc' ......bryon i< bo"" i. however. of

It'nlporal}' o:-xi'l~tI("f' boing gr. d ual ly ..." I.K<'d by .... lu ...

....\;I_liar bone of 1M rootp.lCl or , pon gy IYP".
M.>IUfl' bone;' rornpoR'd of~... (L"n"I~) .rwlgf'd
in .on O<dotfly "",nnt<. II i. ~~ dl.r~ by if> lill<'
libr'r ......."gcommt. ill ~ <l'lls, . 00 histologi<.11y by
it< uniform dmfiry JOO by the f.ort th.1t if> ....trill SUins

md li&hIly.

Thr !looM belw<cn lilt fOOl' 01"'jmI ~ or

fnIllIinIoC.... Ift'tb is f<'nTIC'd lilt mtmlmt.1 ""PI""" Thr
bone bt'f\'UOl 1M nlOI1 or J "",lti""""",, tooIh is k.-n
.os ;nlffllicu\;lr bonr .... stpIUm (..-og. 6..3.2 ).
In iI. !Nl"'" form. the ~ bone;' rootpo1C'd 01
1M ~I""""'r bone """"",,.uxl tM supporti..,



tzo _

'I Development of!he Tee~h andJ upporting Structure,

Clinica l Applk at'o n


AI"""IJr oone resorption occurs more readily thdn p.rm~n enl

toot h TIJOt 10<>_Resorption of alveolar bone and primary tooth
rool' ' s n~<s" ry. however. before permanent loot h eruption
can take place,

AI.oo!ar bone prO!>'"

bone (Fig. 5,33). The alveolar bOlle proper is thin 'amelIJ of bone tlw line' the rool sockel. ,1Ild In
which the p"riodonta l tj b ~ emb'dded. II is known
radiogT"phkally as the J~m in" duro. He ,upporting
bone consists of bot h spongy and deme (comj}<lct) bone
' ltd functions in support of tile alvco lJL" bone propeL
', The
cort iC,,1 pl" ' e, Or covering of the m ~ ", l ih l ~ Or moxill .
fmn ishes the comp"e! poni oDof the '\lpporting alv""l"r
bone (Fig. 6.33),
Th~ , 1"" 01., . I}(me prope r i< " , peciJlized type of
dense bone <-o mpo,ed of b'mdle bone " nd H" versi<1n
bone th<1t <1ppears notlco<1 oly radlop<1quo on X- r"y and is
tl,el'efore c" lled tI,e I"m in" dur". TIle bun, lle bone is so
named bec" u'e il is p. n el ra'~d hy hundle" of perio<l ontal l igom o ~t fi bers (f ig, 6.34), The <1lveo lar bone proper is
formed by osteogenic cells in the outerm051 I"yer of the
dent.>1 follicle. The"e differeElli",e i",o o<[eol,I",[< "nd
l,ly down the I ~ mc m,w i x Or o,lcOi,1 in whiCh sume
osteoblasts become embe dded as osteocyte" The m" tn ,
then calcines to form matmc bone,




In " II Ix>ny tissue, <1 s}O'tem of cell-tv-cell communication exists between adji1cent Ix> nc cells, for ex" mple
oSleogenic cell,. oSleo[)I",IS, "n d osteocy,e5.TIlis coll-Iocell cornn'un ic,'tiOEl t.tkf< pl,lce by tllr<-e meJnS,
1. PrcS<'nce of junction"l complex (g"p) [)ctween the different cell,.
2. Presence of cyto,keleton at opposing point' of adj,,cent cells,
3. P,eS<'nce of sm,,11 nerve fi bers in the periostcum.

rhese may work together to pnxlure eff",tive (ell communication i1nd cooL'd ln<1tlon of cellular activity,
r; ~ _

6.n Ckmllie,tion of , Iveol. ,


P<lriodon' aI


Fig. 6,34 Histology or , Iwoldr bo'l< prop." H. w rsi, " " xl bunnle_



Roo! d~lopmt1l1 begins ~frer ell.lrntl form.>lion

ne~rs complelion ~nd 1>.0, reacbed lhe menlCle"! junction. An ex.len, ion of the """mel OIPn
!>.os In impo,unl ",Ie in roor: development by form
i", lhe epitheli.>1 fOOl she~lh. which consists of an
epithelial extmSion dlhe ~I loop (Fig. 6.3S~
The diaphr4Jl1 is me benl firsl-formC'd
pa" d lhe I0OI: $hNlh.
The inner lis dtlle sheath indoce me adjlnl
~hynul lis to differentiate into odontoblasts. whKhlOrm lhe roo! dentin. The cells dlhe
mol shead'lliso form l thin. struCIureless Layer of
cementum on the den,in lnd thm begin to degenerale. As a resull. thlff lYJ>e" of epi lhelial mrs
<levelop, proIif<o'lllng. =ring. l nd ~lling.
TlIno ~>tSl~ ~nt in the perio<!ontal ligamen l
llOJ'\llhe roo! surf.ace Ihroug hout life.

Developml'1'll of lhe supportin g lissues of the tooth

lnd ' 001 <levelopmenl ocrur simulla"""", ly. ~
mentum. periodontal ligament, and be"" of Ihe
in' iM Iini'" of 1M cryprs or alveoli ha"" a ",mmon
origin. , he cell, of Ihe Mntal follicle,
ROllI ."d cementu m dc""lopment milY be divided
into four phale s (Fig. 6.36 ). Phase I is the for mation
of root she" lh, In pha,. II. as Ihe dentin i' formed
inte rnal 10 the rool sheath. a layer of intermediate
ceme nl um is depo, ited. The function o f the roo!
'heath is then ",m plete and lh e 'heath break' up
into rt'Sl'S. In pha,e III, me, encllym,tl cell' appeat
and diff_nliate into ceme ntob lasts Il>.ot 1"lI dow n
m. first ~r of ceme ntu m. Periodolllli hg.lml'1'll
fibers. <~lIed perfoWing or Sharpcy', fibers.
l>eHnoe enmeshed in the cementum l iang the fOOl
surf.ace. Tbty will berome lhe mean, of lltaehrnenl
dlhe pnnciplco fibers of me periodontallipmenc.
In pn,S<' IV. !U"her llyers of ccmm'um ~~deposil'
...:I. f;n;olly. ,he epi'heIi.a1
rn<I'I'e fl l1bM from
me roo(, into rte periodon'allig.unent.

C om~ntLOm

F~ .


6,35 SUmmary of rOOl ~p, OC<>t.

.... ...

"",, . .f

.. ....

Fig. 6,36 '\u mma ry 01cementum fotm'llon,


II Dewlopmmt of the Teeth and Supporting"5.


Self-(lI(Iluotion Review
l. Describe the red uced en.lmel ep ithelium.
2. \ cells are respo nsible for initiJ tion of


de velo pment?
3. Define the root trunk.
4. Describe .lnd define the furc.ltion w ne.
5. Describe two d iffere nces between the cervic.lloop
and epit helial d idph rilgm ,
G. What is the origin of the Id)"" of Intel'mediJte
cem en tum ?
7. Define the demal follicle and nam e several of lIS
funct ions.
8. Describe the JrrJngemen t of the prin ciple fibe r
bund les.
9. Nil me a p-os, ible reason for the developme nt of an
accessory canal?
10. How doe s eru ptio n compen.' Jte for root growt h?
S"gg"'ted Re.d;ng,
o.vidsoo D, M, (u llooch (AG. Prolifer" tive b, h..viour 01'
periodon", l ligament ,e ll popul.1tions, ~ '''rmont. Res,
1 9 ~ 6 : 2 1: 4 4 4 .

Gomonnv W. IJi.<totogi,, 1c1\" , ctori" K<of ,110 , ~ ", of

M. t,,<e, i" , "" hum," pe,iodo,,';" m. Sr,om",ol0l')'.
1980:59 :9

Un<lskog >. fonmt ion or inter medi..t< ('e ment\lm I: e<fly

mi n-'r. Ii,.. i"" of ,pci'",.,", 0", 1",,1
intm n,'cH, ,,,
cemO" ' um i" mfillkoy. ~ ,,, ,,,of. , ,
I""'. Hiol.
198 2, 147_160.


Li ndskog S, form..,ion of inte rm, d"lt e c, mcn' um II: ,

".nning d ,mo n mi<ro"op<' "udy of ,ile eph heli"l
,hw h o f ~,,, w i g in tlw" lcoy,j,( r",iof",. Go"",- [)('v, Bioi.


19S2 :2: 16 1_169

Linct, kog 5. Fom""ion of in' ermed i.." m,", um III: JH

RTryploph.ln,oo 3H prQI;ne uptJ ke into ep;'''''li, 1root

, heat h of Henwig in vivo,]. ( r,1niof..", Cenet. De;',
198J ;J ; 17I- 177.
Mole"'" AH, "'>w<'o WH, ed" n ,, " i"logy of ,h('
Pe,;odon'ium. New York. NY: New YO I" Pre inc.: 1% 9.

Sim, MR. Ulrr,"ruc' ute of ' he mocrofibril components of

mouse "00 hum.," periodontal o:<yta l..n tibers. ( 0""""
Timl< Re" 19M : 13:59- 67.
"oen 'B, Cure',," '""({'J''' of ,h" d e nl o g , n ~ w..1
01';'11<1;'1' '' ~ conn"" ivo " " no " ,,,"mont ' " tl\O t"", l\, J.
Periodo"' . 1931:9:46.\ _47.\.
V,n dec Und, n FPCM. Du'etJoo li S. Development oft l\O
H\lman D, n,i'; " n. N('WYorK, NY: H.lTpe, ,,",I Rowe; 1976,
Wi,. G. M. ,k, S' ''<ly CJr., C. hill O. Il(l" lc; I', 01,,, ,,,,,,,,,,, 1
'""un" 01 ,"" de",..1 Inll;clo .. nd " ,..mol 0,." ," p,'i'" to
, ,,d du,;og toot h erupt ion. Z. D,w ;dnv;ch (ed). Biologi,, 1
mech, ni, m, of too' h m lption .ln d roo< r",o rpl io",
" icn,;"gh"" : t;WO M,<lia; W8B:24,-25 1.
V,m", ki fo., Ro<oCG. ,' ioom G, M. h,o CJ. Micm" I, ,,,,,,,,, in
hu"" " cc,,,,,n,obl,,,<, nd p", ;oonn...l r,hrohl' ''<. J
I'<riodOlll.1 9875 3:4O_45.


._ - - - - - - - - - - - - - - - - - - - - - - - -


7 Tooth Eruption and Shedding

l\I;>g.. t M. [IN_ ,,><I Jam6 K. A~

a pl ~

Outli n e

Eruplion i< lilt' _
""',,, of lbP do.<I'ping Ittfh rillin ..nd fhrougJl ~ bono .. nd lilt ~ns muco<.loftht
jiw< to
in tllt.,,-;01 c;o\/ily <100 R'.odl lht' occlus.ill


pUne. Erupciw nllM'lJ><'fln ~n wilh lbP onse'I of l'OOI

r"...",.,ior\. ~I btfor? the ~h .... '1ft" in rh~ or.l 'n
Il}'. n... ernergcnc~ of the ' '''''II til "",!" tile gingivA i,
",e",ly the firs, clinical 5;S" of e,upt;o n. FolI<>W lng
emergence, th. I ,h eru pt "I. maximum ra,e to r('a' lI
t~ occtu.<.ll plane : tlwy the" co ntin ue to c, u pot at ..
,Iow<.-r m . to conl ~ .. t. for).lw crowth,1nd occlusal


Mor1nmIslNdilll lO100(11 ~iofI '.n I><i' d ividtd Inm

pIwsIe. lbP pod"~

" "pl;"" ~ or nuptiw p1w"" IId tilt fun<1iotw1
mJlJriY<' or pom'I'UplM ~. All t il,", an ""lUlly ~
~ . ' [he unw Time in . he ".. rious _II in .. ~

Ihrtt ..........: 1M


1n1rOCkKtion.. IE
0bjKI:iws.._ 121
- ' ' ' ' ' ' ' ' I N<!ing to TOOIhEruplion... 11J
f'rNn4II...... PIwse._. I]J
Prriuncti<>">al Eru~ I'ha>e US
Functoooal lru~ (Posterup1ive) Pha;e.. 119
Th...,.ie1 01 TOOlh Eruplion... 130
ChronologyofTooth ErupHon... 132
Shedding of Primary Teeth... 134
( au.... of Shedding 01 Pnmary T""th.., 134
RooI .r>d BoneResorpUon ,.. 135
Resorplion Patlern of "ntMar Teeth.. lJ6
RnorpIion P.tlem o f Postl'rior Teeth... 137
AbnormaI8dlMor olPlimary Teeth... 137
~ Prmary T...m ... 137


~ryTeetIl. .. }J8
summary... 140
s.,1fEvaluoltion Review... 14 1

Thoo obje ctiV<' of this chApte r i. 10 I. millari,. yo u w nh
tooth ""plion by d<:'..:ribing its lh~ pluS<'s: prt'<i'ruplive. p",fuooiolUl, .nd fun CliONL You will o/)Ujn lnfor
"",lion on iniliol v-th of tI tooth rtLating 10 C'Ompto>$.Otion.lI ""'flIIl"S in the crypl and on the dowlop_
of l lot SUppomlll Ii"" S)"Iem. 1..11,". durilll funclioo.Il occlu:sion, minut~ cIwnp1 uti.., pLl ~piully
.>ncI ~I scw~ in lhe ,upport 'Y'!.m ~'" drscribnl.

Movements Leading to Tooth Erupti on

Pre e ru ptive Phue
The pree rupli"" pIw.., of tool" Jl>OVe11>mI is p"'l'o'r~fO
ry 10 lhe ""'~ P""""- Ir consisl. 0( Ih. """""""'1. 10
the ~piJ1i ~nd growing tOOl" ....... with in lhe

pn:nu ~ I0OI li:Wln.KloI1 (I'i&- 7_1 l 0.;..,

Ih.. pha<;<'.II-. sr-inc rttth ........ in vMious dorKtioI .S
10 m.>inl.tin t:hI'ir position in thc ap.lncli..,~ 11'1.. is
KCUnlplished by boIh bodily rTIO\/t'RW'RI ~nd <:'CanIne
growth. BodIly ~nl i, ~ ,hm: 0( the ('I1till' lOOIll
~rm. w hich c.u.... oone "'sorption in Ihr- dirtion of
lOOIh m "", m~ n l ~ nd oone apposition from brhind (Figs,


F"J. 7.1 Prt'e"JPliw """'" of rOO1~ .." phon

" '__I!.!?~,,!I0p.I1I.elltoflh<, Teeth and Supporting.g ':\'cture.5

7.21\- C). These movements occur con tin uoll sly dS t he

Fig. 7,3 ReI' t i,," pry;iti<;ln of prim, ry and peml<, nenl tedh in (A) p , ~ e , up t ; ""
and (B) erupt ive p ~ " , . "

jaws grow. Eccentr ic growt h re fers to relat i"" growth in

one I'.lrt of t he tWlh, w hile t he rest of t he too th remai",
con, t. nl. A5 a result, the , elller of the to<J th <;h,' nge,.
These movements relote to the adjustments thol
crown must ma ke in rclal ion to it' neighbo r, and to the
jJW, J' t hey inc"" , /, in widt h. heigh! , , nd le ngth. The
prj",-,ry tedh in tile ~ I ve ol "r p,ore therefore move in
a facial and occlm al direction or in th ~ di r~et i o n of the
gl'owth of the face. At the same time. there is 'o me
me, i,, 1a, well." distal movement. The I", rnlanent teeth
also m o v~ within the jaws to adjust their position in the
growing alveolar process.
F ly in the "l'eeruptive phase. 1110 ,,,ccessinnal per_
manent te ~ th d",,~ lo p ling"al to, and ne." tile i'Ki,,' 1Or
occlma l level of, their primary pred<xessors (Figs. 7,3A
and 7.41\), Al tile end of thi' ph.lSe, the developing ame-rior permanent teeth are pm i[ioned lingually "nd near
[he apical third of t h ~ primary " nterior tfeth (Fig 7.38J.
T h ~ premolars are located under the roots of the primary
mol" rs {Fig, 7.4B). n,~ change in po'ition of th ~ permanent tooth germs is maillly the re' ult of the el'uption of
the primary ~th and t h~ coincident increa'" in height
of the supporting ti>S lI es, " nd not of the apical movement of tile permane nt tooth germ" The pe rm~ nent
molars, having no prim" ry predete " oL'S, Mve lop with
out thi, kind of rel" tion.The upper molar' develop in the
tubero, ities of the m"xill", with tlleir occlll, ,,1 surf"c~,
51"mi ng di, t,llly (r ig . 7 ,5~ The lower mol"rs develop in
the i>dse of the m" ndibular rami, " nd th ~ir Decim al surslant me,i"lly (fig. 7.5), The permanent molars
undel'go consider,,!>le eccentric movement. , djU>ting
t h ~ ir po, ition, os the j"w, " nd the "Iwo [a, proce"e,
grow. Not<' that all movement, in thi' phase take pl"ce
within the crypts of the developing and gmwing crowm
before root fo, mation, The " reeruplive <tJld I'refull(tio,,
al pha",s overlap to some extent, but proceed in the following order: preem ptive. prcfuLletional. function"l,


B =,"""

Fig, 7,4 l'I. tiw po, it ion of prima ry mo laraoo perm, nffil pre molar teeth in

(Al ",,,erupt"'"

,,>1 (B) ent pt;w 1'!1'""

Fig. 7.5 Hum" " lOW' d uring m(>;ed d" " t itioo period, Perm" nen t m<1, HI",y
mol.r in l u""ro, ity_

,,",funct ional Erupt iw Pt.3se

Tl>t' prclun(li",,~1 ('tup' ..... ph.1st> btiins wi,h tne ini,ia_
tion of roof fo rm,llion ~ nd ~ n d , w h ~n t he tee,h ",. ch
occlu",1cont . ct. fivt', ev~ n ts t~ke place d u, ing t hi,

" ._"
Silo of


. pMl'IQliIJm

I. Tho' ~ phaR of ~~1le'Sis is comi>le''d
jIN ~ t.... """'" of roo( lofmMoon .mel p<riunction~ t'<UIlCion. ~ is a ~ !>etoile ii the assaOo:wI of
mirte',.liulion . ... aoctiYation of t.... ."il~lial c~ll.
beyond t"" enamd.fOlming . "'.
J , Tl>t' Intr.=oou, Sta8~ occurs w!>lm tbe rOOf formation be gil1 s . s a r. , ul! of t he p m li f~r.ti on of bofh t he
epit t>.lial roof ' ....dlh and t he me", nchymal ti " " . of r....
dent.>J ""pilLl and d~nlal follicle ( Fig. 7.6).
1. Tho' supraosseous SUP' begins 1N!>Im ,~ """,i"8
""'"' II'lO'ie'S omusally thftll4h ,
bone' or ,.... <typI
and the canne<tiwo ,issw olthe aI mucosa, SO lhaf the
il"du'd "",mel epitl~hum ~"II"" CJOW1l COI1>M
into COn,.K1 wi,h ,he Ofal ~1Ji'belium (Fig. 7.1 ). As Ihis
occurs, lhe l<'dnc<'d e""me1 ."ithciium or lhe crown
pro li f~'.tes and forms .
hmen f wit h l he 0,. 1
ep ithelium, A fused , dOll hi p i l h~ l i al l. ye, OWr l he
eru pting C'OWn is ,hen form ed (fig, 7.8~
4. Tho' tip ollhe crown l1'lters r.... oral CdVify t.,. b....aking throu&b the U'I"It('t
the ~ ~p;1'ho'1ia/
<dis. nus Inakthrvustl is oct<lfIII)Iish<'d tor the cusp tip




r"m.u... .

F"""'" 01 or1iI on<!

. _ _ ceducod ... moI




--. ----

Fig. 1 ,'

("",,",,I.nd I"""" of rNOXH..... meI ...."""''''_

"" I""",oy.




In infana. tooth ftUIlCion nuy be .KtOmp.onit'd by a ..igtIt

inm'a... mild irri, .,ion ol fhe gums, and ~aI
m;>l.;Iise, AfrJ .......e ~ner.1 symplom<. hll'WrW'r. should 1>01
be a, soc iated with t~lhing, .Ith ough so me 'y,temic d i'fUr,
1)J.nce .t the time of tooth eruption . hould be expe-<.t ed , An
. I.......d l im it $p.>cl1 or rompa n lTW'nt overlying the looth
IJtromts visib'" as an in~ fun ne l_shapl ' <N (Fig. 1.11~
In m. pmp/>rry ol , his 1Orte'. r foIlkle fibers direo:t them_
~ _ n l m. m
ddined "'''''~Iotrn .....OS ... ~ cord l Fip. 1.l 11 ..... 1.12). Some
author<. tM.1~ l ha t ,his <mXfure iUides 1M tooth in its nup.

I;"'" IIlOYf'tTI<'1It$.


II Development of the Teeth ond Supportinq'c',,,,"",,""""O'

CI,oicaI e,own



.;'hol":", \__\


f i9. 7.9 ( linie. 1. ppe" " 'K. olthe (rown.

Gubernac" 1um

fig . 7.10 Prirn<lry tOOl~ .t th< end of the eruptive

SQ '

in prceruptiveph. "',

f~ ,

7.11 Development 01,-",,,pl;VC p"thw,y

ph."" !'<rm,nent ,ucce,

()\", rIy i n ~ I~ ec r o wn ,

cau,ing degenera tion of tlte membrane. and is th e

begiL1 ning stage of [li nic~1 eru l" ion (Fig.7.91.The crown
eru pts furth er. and the laleral borde" of the or,, 1""loCO,",
beco me the dentogingival ju nction ( Fig,7,9 H). The
red uced enomel epitheliu m, now surrounding the crow n
like a cuff, become s known os the j" nctio L1JI or attachment epit helium. When the lip of the (rown ~ P l le Jr-, in
the or~1 c~vity. J [)out one- half 10two -third, of the roOIS
are formed (Fig. 7,9A).
5. The o["upting toot h cont im,es to move O<:1CluSJlly J t "
m.' xim u"" rJte. J nd there i, gr<l duol expo, ,,,,, " f more of
the cl;nicol Crown (Fig. 7.10). OCclusa l movement i, the
"e<ull of active eru ptiorr. As the (OO(h mooe, ocd uSJlly,
&r., {\"al eXi>"sure of the clinic<ll crow n i, ,lCcum l,!i' lled
Ihroug h ,;ep" "tio n or the attach menl epithelium frnm
the crown <l nd the ",,,, Iting "picJI -'hlft of the gingiva,
The clinic,, 1crown is the port of the tooth (cootm"1to th e
~llJc l l me nt ep ithelium ) exposed in the 0,-,,1 ( .WilY. and
differ, from the anJ lomic cm wn, the part of the ((l{lth
covered by enamel. The pref" " ctio" "1 orupt ive o r eruptive pha' e i, atso ch,raner;<ed by sign;l,c'''t ch" "gcs in
the li""e< ovel'lying the teet h, around Ihe leet h, J"d
lI nde rlying tlie 1<,<,lh.

Chang es ill t iss ue, o ve rlying te et h .

The initi, 1chongI' ",en in the ti ue< overlying the t""th
before er upt ion of the crown, is the ,,It.1'Jt ion of the
(on nective tis., ,,e of the denta l follicle to form a P<ltl'w,' y
for the erupti ng tooth. Usu,llly. this is more promin ent in
efllpting perman.,,, t~el h. Histologically, the coroLlal
port of the deLltal follide becomes he.,vily popu lJwd by
mHnerou, mo nocyre' in parallel with o>leo( I, >I<10 p" r_
ti,;p'te in !:>(me "e<Of!'tion aLld for mation oft he eruptio n
pathway. The m o n n cy t ~ i" nux is enh,1I1Ced by the
i"cre,,,ed -,cnetion of coloLly-stimul, ting fonor 1 recep_
ror protein (CSF_l ) ~"d by the che motactic "ctio n of the
tra nsforming g rowth f,let ot lletil-l (TGF-beta-I), The
fut,,". erupllon pa, hway appe, rs os <l lOne in wl,ich connenive ti'$Lle fillers hJve disappear ed, cells hove degenerated and d e(re~$e d in number. blood vessels hove
Decome fewer, and ter minol nerve S h,1ve I>ro~en up and
,Iegener,lted. These changes are probah ly Ihe p.>rtial
re'\llt of the loss of blood supply to this <lreo, a5 well os
the release of em.yrlWS th ~t ,lid in deg radJtiol1 of these
ti" uc" Clinically, tooth er uptio n m.,y lie Jcco mpJ rl ied
hy discomfort or pain, irrilO hililY. andio r.1 , Iighl temperat ure i,,("f('''''' .

_ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _'7J<Tooth frtp lion andShedding._ 12I

For ",,......,ful toolh ~rupl:ion.

~ion dille OYtflying bony

{h ~",

nlll k >0""..
7.U). which

cryp( (f;g.

i. in .l conSlln! 5l.~ of ",modeling . s ch<'!O<llh ~rm

~n~ .md t~ fola grows .nw-iorly .100

"".lIy. Tho:'


"""pi;"" proct'SS 'dn M consioo.-d I"rt of this ....model

illl Jl"WIIl. (hu'ocl",'s diIT<'R1ltiar.. a nd
portion 0( th<' bony aypl ownlyil>3' '''' c ruptilll lOOl h. Tbo:'
nuptioo p"'llt,....i)I. whictl .It lirsl i< <milt illClNSt'S In
di......,.;,on, Illowins ..-..romt of lho> room 10 m.. .....101
mllCO<ol (fis. 1,12 ~ Alttlough ,he nupOon 0( ITII)( ptr...._
l~ is "mil.. 10 II.., of primMy lC'<'Ih. (!lie
ownlyi", pnm.lfY I_ II .'" .......... ition.ll compliotiol'l.
Tbt ('IUpliw p"t hw~ of perm.1l1oCf1T i~ .ond C\1SI>ids
i> linsu.al1O .hot corrnpondin:z: pimo<y ~ This.un
shcow$.I pronouna<I ... Lo'gt"w:'" to .KrnmmocWlC' 1M
.odv.lnc,,,* ~.


Snlolll fordmi"" ,n I""

and m""ill. ,It!' cvidoo'n oC tlUplion p,ubw.oy> of th{ ,Interior I"""""neflt
l<ffh. ThHe' openings.. ,he gut..m.><uLlr f""im",., ....
[""lid l;n8....11O I"" ,In"""" pri ma ry t rella . Ild .orc 1M
_.i les 0( ,lip gol, curds (Fig. 7.1l). 1M pre n>ol.>rs
. '" loe. ,ed bcI'W't'n the loon o f I"'" prinuIY moLlrs.
Root IP\.OI"plioo in pr;""'ry [II p,oc O'<"ds in mud ' t h.
"',,}(' ma nM'.S bo ne '='>'111 ;011 (Fig. 7.14). When ,1I.
rooI'.I re (ully ",,,, ,, be d. 1m, .lta<;hment of lh ~ Wimary
crown is 1~'le!1<'d and !I,e crow n is she<!. 11\i' prod llC~'
.n er llpt''''' l"'ll,way for the premol. ,., MOSl rc>ots
re""'b ronlp l"t~ly ; 1l1e primMy pulps dege r"' ral~ oS
well. [)",Ill~ l h ~ ~riod of mixed d~l1 [ i t ion (."ouml 6 to
11 ~
elf . ge). whe n OOIh prim' r)I "Id i>Crm<1tK'nl
in lhe mo ut h , th ~ pheoo"...,n. of root rc;;orp
lio" alld looth forn~ll ion proc<'t'<l <ide b\I.iM (Fig. 7.14~
""'""" <h.lngcs OCtllr while t""tll 'till O\.linrain tlK'wing

WIlen lhe tooth ..... t> Ih~ oral mlKO~ lhe rcd ll'd
ron,,,,, into ronl.>ct wilh Ih~ .,.,..,.l)rS,mul l.lK'OUSly., he oral ~pithrii.ll
cells.nd mlll'd ~".mri epithdial <dl. pnlIifcr.U' .nd
f\tM, inlO_ 1Dl"It\br""", (F'1S- 7. 15~ Furt her IIIO<M'mffiI of
11K' 'ooth stn:1~ .nd (ftjns me 1Dl"It\br""'" .,.,..,. lhe
<;nIWtl lip
7_ IS~ AI. this ~ me mums.o ~omn
\lWIched b K _ d I ~ d blood supply 10 Iht ut'l.
nJption is ~ t ... -'I
n inlermiltm' . ~
Thr lOOIh will""l'l "~l)r
in .... tioIwy lOr_
timI'. MId!lwn ft1IPI 4i'in. In this
'he <lJPPII"'
inC tiuuf'J .... able 10 m.>1u: .>djustmmts 10 Iht""~
"_"lents. urn",,~.._ " Will =wts in_of
tIw <;nIWtl ~PPNrinI in lhe or.ol tmty ~nd runtwr ~.
r... ion d'he .1l~llmml ~lheliUJtt from ltoe I/'l\olmri
,u~ (Fip. 7,9 ~nd 7.10). Reanl """'...... i(lns of
hunwn prcrnol.l, Pnlplion moo:'.led Pnlplr." .K1Mty
ocrllrri"l mooily ~I niiht. wi'h mark<'<! Slowi"l or ~
..,tion duringlht day.

fOg, 7,13 Eruption ~te<'" ~<n[ \<'e<h ('J<Ib<-'mo<"'" !of........) Iing.laI

'0 the po-i.....ry<""""_Note I.... tip '" ' .... 101..... in<loo< '" 'ho fo<.~.

~".mel ~pil1lclillm
i"l muros.l (fiI. 7_7~



fOg. 7.14 N;,;r=opic: _ " " ' " '" lho rNIion of p<Wnory _

_ Cli nical Application

Eruption of tile leeth is more g" "'l ically ~m;n<'<l lh.n
t nviron mem ally ,usc~pI'ih le. Only Cal-"" of leW... m.ln utnlion. for "". mple, ca use ddayrd t rupl lo n.


:;:;;;;;::;mil "';,

"5 "'A '''"


Fig 7,' 5 $umma,y d;iI9,.m of f",i on " nd ruplure 01"'du<e<l e" ,mel
e p ~he' i um and mal epit"!; "m in tooth eruption.

Firts-formed "bere

Tootll beIOW. . . .. .' 'Mt1'l above

alveolar Cle,t
, lvWla, """,,I
r i<). 7.16 De""lopme'\l of iWf;ooontri lfiber< and modirKotion of , 1""01 , ,
bone d"ring loolh eruption, A Ea,lyfibe r formil!ion. BBone ( honge',
Cfurl l,,.,. fib.,,- do",,'opmenl. neilr occlusion. ";th fib.,,-,; morc dense..

Changes in usso es around teet h.

The tissucs ",ou nd t he teet h J iso un,lergo ch.l!\ge dur ing
tooth e' \Jpl ion. tniti, Hy, t he dent,,1 foHicl~ is co mpo,<0
of ,leh"J I:<' cO<Hl ~cl ive tissue, Grad llally, .s erllptive
movem ent s commence, collJge<t r.ber, ""co me prom inen t. ex tending betw ee n t h ~ forming m ,,' ,tnd the J ive
Ol,l t 110ne surface, The first no ticeab le prioclo ntJI ftbt' r
b\l ndl e~ ,'p peJr Jt tile cervical . rea of t he root ~nd
extend at I n J ngle coron,,1 10 the J lveol,tI' process (Fig,
7.16A). lit t he same time, t he alveo lar b,,,w of t he ( rypt
i5 rem odeled to "ccom modate t he form ing roo t. As t he
IJrge' crow n move, occlu, ,' lly, [he I>one fills in to ro nform to t he sma ller root diame ter (Fig" 7.16B " nd C). As
erup[ion proceed' . mher co llagen fiber bu ndle, hecom('
v isible J IOllg t he form ing root (Figs, 7,16B and C), The
area i>e<:o me, mo .... den sely il'-' jlul,tte d w it h fLbro blJs ts
(Fig. 7.17) , II sped , 1ty pe of fLh roblast. the myolll' '''hi' .'l.
is SJid 10 hJVC ront," <lile capa bilities, It hos bt'en r ('[J0 rt~d 10 be p"" ent in t he pe d odonta i lig"ment. if pre,ent.
t he myoflbroblast co uld ,l id in t he force need ed in toot h
eruptio n, 1111 Ii f,<l m ~ nt cells ond fi l><'", .,'" ( ur",nlly
helieved to be imp ortant in t he eru p tiv ~ proce" . Du ring
eruptive moveme111$. coll.lge n for mJ tLo n and fibe r
t Ul'llover are ve ry rap id (po" ibly 24 hOLlfS). ve ry eJ rly in
t he er upt ive p rocess , prforoting ftl, ers .1tIJ , h 10 t h ~
cement um On t he root , urfJce J nd 10 t he alveo iar bone,
Some n bers release os the tooth move, . tllen reJ tt,1Ch to
stJbHizc t he toot h. In th; , mJ nner. t h" ,oolh.., lJ t,iii,j,,&
prOcess is performed by t he same group, o f ftbt'rs
t hrOllg h"ut tool h e, upl ion. The fibrobiJ>ts are l he cel ls
activ~ in for matio n ,111,1d"ge"er't iO<\ 11f coliJgon fibers.
ll lveolar bone re modeling is com imlOl" d\lfi1lg emI'l ion.
As l he tooth move< ocd usa Hy, t he "ivcoiar bone inn eJ ' ~s in h,igh t and ch" nge, <llJp o to ,lc com mod' te passage
of t he crow n (f ig. 7.18 ), TI,. to<>th Cl'Ow l1 , JS seen ;n
Figure 7.18. h.lS migrated occlusaily, w hicb re,,,lts in
new oo ne heing d epo, iled J round t he root to red uce the
size of t he cry pt. Ahove " nd J"' und t he crow n, osteo c1,lStie J nd os teo i>l,stlc a<lio n OCClI rs, The, e ,1<tio", ," "
(()" r<lin,lt ed d ur ing the en tire eru ption process , as we ll
as t hfO Ug h o\l t l ; h~ .

_ _ _ _ _ _ _ _ _ _ lTooth ~rup tion (1fl( Shedding


Cha nges In t ln u," underiyt r>g t Hih.

au~ al"" orru, in th<'
~ping lOOl/l. Tbo>'

follicuUr t~ undft1yi.., I,",

~ 10 ,he ..,n

ch.lllSC'S ,......

l; ", ,,~ ..nd tile fund ic bane (bon~ surrou ndi",- th~ "pf~
of tit<' rool~ As ,h e fOOlh "'''pis, , pace is provi<k-d fur , h.
root to rengt l" ,,. primar ily ""c.l u,e 01t he crown movin8
<><:clu<J.lly and l h. ; 11C"~a l.e in he igl" of , h. a lveo lar
bo<1e. O\.llllM in the (und oc I<'gio n .. ~ bc li"""d to be
IaQ:l'ly romJX'ft"'lOry to lilt Icngthmi"8 of dK" rool.
Puring Ihe Pf""'UpliYe md .arty ..... pI~ pll.>ses. the
'oUi<ular rlbrobLom and fibft1; Iic' in a ~nt po~II.1 10
lhr baS<' of Ihr roo( (F'", .. 1, 19 ~ """" tooIh ~ ........
rapidly in thr oocur durins J'R"ftll'lClion,tl ""'l'Iion lIL,1n
l any Ollie', ptriod. fine bony fT"~ aPPN' in ltoe
fu ndi< ~~... They rompellSolte to.- tooth truplion . 00
provi~ ",m. '"PIlOn 10 r"" ..r 'i..'.... ( Fig,7. 19~
Some aUlho rs ,I..",ribe th is d, .. bony I.. dd. r. The l~d dc r

~"mo, mO L~ den, e ". ~Il.rn. t. layer, of bone pIJ I' ,

" od conr'c<liw ti"'... ..~ !.lid down (Fig, 7,20~
""" of t hl' p",ru nctionar crupliYe ply.... w twn rhe tooth
comes inm Octlu<ion mow one-tlIird of the """'mel



br l~ CinzM (Fig. 7.168l.lOd 1M 1001

is i,.. ""oplo', /lI. this Ii",... lilt bony

is U ..JlUlly

~ ....... pLJrt ~t ~

Ii",... to m.olet' ~ ror lbt'

dlPY\"lopilII root lip.. Roof romp ....ion conr;nut< ror ~
ron sidt'r~bk' li_ afl~r tne Ittth hiM' bttn in funClioo;
Ihi, pro<..... l.k", from I 10 I.S ye. ... in prifiJl)' t ~ h
.lrld from ;l 10 3 ye. ,. in ptrmaTlen t I'-"'Ih.


f'!l- 7.11 _ipalli> ..... '

'""il in ~ _ _ thecJwongt in
,ho ~'" IoAde fi><n.{ -D). 1mm

fl.J nctional Erup tive (Posle t upt ive) Phil",

Tht fin.>l function>l. tr'UpoM ph>sr belins when ,~
"",h ~.ldl occlusion. .ond conlitlut< lor .lS Ions ~ ~.ldl

room .......ons in Iht or,", ~M1y. Durin:s lhrt~rly p/wst

of fhis period. lilt ~I""""t J>flXt$S'" incl't~st in htighf
dncl ,he roolS con'in.... 10 grow. Tht l.-e,f! contin .... 10
mow ",,-chu.lly, whi ch ;lCco m m<>< j.lw Krowth ~nd
. lIows for roof ~lo "g.ljon. Th. mo, t markt d ch.lng<'S
",'cu, " o<clt"i" n i< e<,. bll, h.d, AlveolJ ' bon. M n' ity
in(l\"~""'. J nd Ih~ print ip\c nbc.. of the pcriodo ntdllii "
~ mm , ~ Sf ~lJl i,h lhem od-vn infO ",pardlt BrouPS ori~", "
~ ~bout fM B'''8iV.a.1ht ~lvtOlar =0;(. md Tht . IW'Ol.or

<wUcI> MOUnd !he 1001-

_ O iniull Application



f"}- 7. 19 ( "0 "11"" in

hn<ic bont dIin"ll =ptNt ~


~If in ti ppilll of .adjooceilt

"""h irllO lhe ~ ~.,~ br !his loss. I' ...
Ioos '" ~ prim.olY lootllR'Sullinll in lh is condition
nwy Pl'tWnI eruptioo or lhe ptnTWntnf tooth or
cau.... il1 imp.ction.

A misyn:s tooth mq

fi9- L IO form ahon 01bon< laddor in lhe lundk




A~ ~ ~




~r ~



. ~ F'

The diJ meter of the fiber bun d l~s inert. ' . from <leli c.lI e.
r.,," group' of m",,, to heavy, sCClI[OIy st. lJilil ed bu nd les (fig. 7.22 ). Arle ri .>a re e<IJb U, hed circumfc r"n tiallyand longinldina lfy, with re' J""t1 I" the (OOlh, in til"
cen t,,,1zo ne o f t he pe riooo m. l lig. nW11I . Fig ure 7.23 is 0\
pholomicl'OgL'Jp h of a developing root. 1n<lid i ~k o utline.'
e<1 ch o r t he h l()(lJ ve." el., in t he pUlp, as well as in the
pc riod ontdiliga me ill. Th ~ n t he tissue is cleJJ'cd la ' e vea l
t he vessel" Ol>se Lw t he nu mem " , w " el> O",t ~me r the
]ig.;rne nt fm Ol lI,e J lveal'" w ne. Ne rve' fo r ' ensing
p" in, heat , ( o ld. proprioceptio n, ,lI\d p L'essllfe o,ga nize i n
l he pe riodo nlal ligame nt ~11, 1 (ourse ., Iallgside t hese
blood vessels. FLom a pex to gingivd, bot h myeol indle,1~ n d
non myelin;lI.d ne rve' I' ,IVe rse t he ce nn . 1,egio ll of t he
Ilf,d m~m dlo ng w ilh Ihe l' I""d vess el, (Fig, 7.24 ). W hen
the fOot callal na L"fOWS, " S a "'s\llt o f rOol tip rlW LL' cil ion.
Jp ir" 1 fil,e L'S d eve lop to help (li shio n tile force' of
on ']" S<ll imp-let (Fig. 7.22 ). Lo ter In life, attri l lon indY
wear down t he o( d ll,,, 1' u, f,lee, of IIlC tee t h (Fig, 7,21 ).
TIle teeth e rupt slight ly to [Oo' pe ,,,,,te for
of tOOlh
str uct ure J nd to p LCvent OCdU'dl ove n-Io, ,,,,, (Fig. 72 S).
If t he ocdus<'] we.'r i-' excessive. cement um is de posited
on t he "pk al l ilird of l he root (Fig. 7.2 5) ; it i., d ep'1Sited in
tl,e fu,calion Legion of mo)"", to compe n"l le for hype"''''I '
ti011 of t he., e teeth. Some wne ap PDsitio n OCClI rs " t the
alveolar n ests, 111 "dd iti"n 10 , Iig]l l occlu" l move mel1l,
l ho te et h te nd to move an te riorly. Thi, is ' e rrll" d nles i,,]
drift ,\nd results in w ne resorption on t he me,i,,1 wall " f
t he ",..ket' .;r,,1bon e .' p ll<1<i rio Ll on t he dist,,1wail.


Fig. 7.J l ,om,,""nof t he I""cl "''''' epllI,.I,"m , A. B Pf<cru ptivc_

ph, ,,,. [)-F Fun.:!""'" ", <Iu, ;On.
C Prefu'K!;"n.1


- "=. 'PeriOOonlal

Theories of Tooth Eruption


00_ '

f ig 7.22 lnue osed den,ity of poriodonlal ligament fiber< J uring ~r" pt ; o" ,

Many f"n ors rd ue,] to ,oo, h e rupl ion hJ ve be en stlldled . a nd , e,wal ap pe" r to b. impo rt," " to li te e ru l' tive
pm( e \<. It W,l< OL1ce t hought t hat root growt h and p" lp,,1
press"", we r\, f"",I.ll nent~1 b elo!'" lI ntii case, of ~ru p
tio n o f rootless teet h we re reported . The ide ,l t hJ t IIle
fun d ic bDne J rea and wny iad de r formatio n w e,-e C"' , -

- -,,"

pe ' iOOonlai

fig. 7,23 V.",,, I. f;'''t iQn of pulp,n<! periodontal ;\ I'''' h'''~' dUring tooth
eru pt. ",.

fig . 7. 24 Ult r" t,",I,,", 01j"t"" tili, 1' I"' " j"
mont " Io n~ with nerves , nd bl ood ,.""" ,,

p,-,r;odo "t al l;~ a .

elO w.lS d i........n'ed ~, 0( me eruption

I"'lh....~ and ,he liming 01 jl< lppelrlnce ........l led tlw,

,hew loKI"'" l ... more likriy 10 ~ a ft'SU1t. r~lher Itwl l
c... ~ ol.""""ion. VlSCUllrily Iws Iont bem ron<iderf<l
lO pliy l . . in toolh eruprion. for rum11k'. .... . "0. 01
lilt S)'lllp.alhotic "'""" CO"'" \Il$Odilllioo lnd ft'SU1t>
in eoOl1on nuplion ol lfttlL Louliled ~ ... l
muI, 01 periocIontitis, llso Cl ...... i~.lSed v;CU\.arily
01pt'riodO","I,i""'>eS<>Ad increlW ertl pl ion ol ldjlcenl
teelh. OIher loKI<>n. such is hypopillJi'~ri'm. deere"",
vlSCullri'y ~nd ~Iso ~lrd erupilOn.
Impo,u""o l l1e d i"",,,ioon o f Cl Use'S ol 'OOlheruption i.
, 'a ~e . I, h.l. bee n ,hown
folli,'u l." ce lls migrat e lrom ""ar the . urf"". of lh e
. "amd orga n, .," d den tal I'-'pill"e 10 give rise to t he
, eme nt " m , pe riodo nt.l l ligame nt, a n ~ .,Iven la,- bone,
1lr".H "~ lI,e,", cel ls .fleel [lw reso rpt;un of bone in
ceee grow, h a nd bod iiy n",,,,,me nt of l h ~ I.el h,
Ihey p roba bly l role in 'OOlh e ru ptio n.The S<" celi.
tnoly cause enzymatic dege,l<'1"alion of , he Ii" "", overlyin. ,he tee th and may ron tribu ,e '0 me f,,""" tion ollissues surrounding a nd undtrtyill.l ' he ln1h. Rn:ent stud
in ..<>dies ha\oe shown the detlUlI follicle to !II' of pri me
;mpn'uoce in looth ertl plion. Jtemoyal of ,he den.... 101lio:~ u ......
tion of erupfion. TJw main role of lilt
dm.... JoIIide in 1000h ertlpfion is ,he fnrmation of the
ertlplion pathw~ l lle... 0( l ilt .Id~ _h. TJw lnl
Iide llso pooWks !be 0SInIbIlSts 'M tonn,"" bone tra_
becuIat *a1lO ,he lOOth. Abo, t hew reIll< al l taU
pia a, PRri>c' {iJD0,"5 duri..., lOOlh ertlplinR.


_ _ ,," ,," " ' 01



,he ' OOIh~, lhe cap and bell






\ f-Tl1l<:U<>od <:IImOn"'n

f;g. 7 15 P!Netupr.... ~ ...WiM _

compen;ol;,o, ~ol

= ...


8iochtmic~1 ~nalysts ........ alnl

{he dental follicle
reac!lts If!, 1Ildximum _ ight i t t he ,ime fiU pi ion
bog", Collagen ron"'''' incn'a'C, by 2$:1: ~nd prote<>g.Iyo:lns by 45:1: d uri ng e ruplion, Transf<>rming growth
f""or eeu I( ta I ) is a me",be rof a pro tein fam i
Iy w i, li div<-r.. bio logic .lCtivitie. , wl,ie h ,li muiates t h~
fib mhl," 1of th e d ent al follicle to secrete a11 e Xl racd iuiar
ma, rlx """d",1for its dcv~lo D n", ,,' inlo a i>Crido nt al lig.
l lllC'll. To d."', t he role <>f t l>c el'lM rmal ~rowlh lactor
lECF) d uri ng e rupt ion i, not cl~ar. It is, h",V<.'V~r. ",id i, sh mulates th~ d iff~....ntill ion of pe ri<>d"" tal ligamenl fibmbl~st'_

[)oo(n..w pr=u .... overIyil1l .I lOOlh . nd i ocr~.lSed

pressure ~round aDd under i, l .... nu,ior f.>cton in tOOlh
mlpfion. FiT51. the nuprion pathway Jlesjns develop",em when ItIOl [onn.llion COIT1mencPS (Fig. 1.26). In
CoK1. _.II i~lOn hive """"" ma l this palhway
wi ... .. Iop '"""'" whm the toolh is I'I'IfIdIaniully pR'from nuplioon. Snnd. i Hl....... I,III oltissue:s sur
roundi"ll!lt r=b ocnJf$ durir1;ll boIh pmUll('lion.lJ aDd
functi<lnoal nuplive pe riods. Iu ,lit periodontal fi~t
rtbers Incre_ in num her ~nd rna.... posilion. the a~
olar bone remod el. lnd ' hu s liml15 the so rt-tis' ''' ~
amund t l>c t""tb. III tb~ "'me l ime. tilt perindnntal
filnnbl.l.1S proll fcra t~ and tbe v~S( su pply incrl'''''''
IFig. 7.71). Alllbe.. change, b ring
in<T~a~ pres, u," ~ ro"nd ami " nde r the ", uprln g , ....,b,

fill, 7.U '0'11, ~ng """ r rh. ()IJt~r """".... <pithelium miwote iolO l~ luNI
d . .. ><1 ,id iO periodo""rd'-"'l'1opmt'n l .. ><I e,,'ptioo 01 the 100111 ,



f ig. 7,27 1I\(,.-.", ;n , ell activity iO p<'I'kldOrlfollg.a"""t during ~ r"l'l ion .

_ Q ink .,l App lication


~ "$ll<Jfour

ruk for pri rrwy IOOl'h ~ "'W I' t"'l

from birth lOur ltttb will ~ for ~d 6
Thus..6 _
... . 4 lnod.. 12 ..-1'" - 3 Iftth: 18..-l1>s
12 Ift'lh.: 24
16 ttl:'I:h; . nd )0 mond't< - 20 1C't'Ih.

~ ~ion stqUO'fI<l' ofl~ pri

ry &ntilion if pre...nled i .. Fil"<'e 7.2 3 .00 r.h 7_1: t~ eruplion
KqUm' ofl~ pe-rmantnt dt11filion i<'-" in FilUre
7.29 .rnd r. bIr 72, I.. tlot prinwy dt11rition, rf\IllIion
occurs ...lffon in boys lIwn i .. gim. In thr pnm.1nml
dtntition, _ e O'tl". cntpl'ion in gim """.1I1y pI(Cftloos
m.t in 00,.. T1'Ir<1' are no ditfnn=J in I~ eruPfion
~ of thr 1ftIh.
In #fIE'ra L tho:" m.ondib" I<'eIb Jlf"C"<le t~ m.o ~il
la'Y 10'<'11'1. i.. l be ~,,"", n~nl M ntition_ Only 1M
mJndibu lar cenlr.1 inci~or5 and, occo, ion .lly, 1M
m,ndibulJr second molo" pn>c<'de t be cor r",poIKIif18
",,"xillory teeth in tM prlm.1'Y dentitiun (TJb le 7,1 dnd
Fi ~ , 7,30). Under n< ln \ ,~ l cond itions. tee th (. ,,<1 to be
del~ ycd r~the r t hon e,uly in el'u ption. A d iffe renfe "f 1 Of
2 mo nth s on e it her ,Ide oflhe noted r~ng e (T, hle 7,1)
. hou kl not be ",nside~d ab no rrn,, 1. Homologous t('('t h
in me .. me .rdl .pl'<'a r In cl"", .pproxi m.1lin n 0( time.
Infant'S who . lUin the incisor teeth early u....lly erup!
t~ renuining tectll early. On t~ ot her hJnd. if the incl
JOr f('('{ h are d elayrd. l h ~ remaining t..-l h may 001Ml'M'
late. A tooth Un.....lly lakes from 1.510 2.5 months from
t~ bo'gi nning of clinic.1 """plion until it "".mn tM
O<dllJoll pl.lne_ (.,onine'J usually
Ioo'lgieU ti_ 10



68 me

7 ' 0 me

!HI "'"

~ 13mo


12 -16 "'"

12 -15 "'"

Chronology of Tooth Eruption

Prinwy Iftth """plion is ......-~11y clwract<1iad byi'~e. p,,:wmal or pbysiolopc spacing. This OOXUI'$ in
allouf 70l of inrantS: tlot mNIl1int 30% ' - 00 spar<"S
bmem lbe fft'I h. T1ltft is r'tIOR' spaci"ll betWftfl the


1&.1 9 mo

The"" iJ " " phys iologic sp,Kins a lief tho> ....... plion of Ih~
pri ma'Y {..-lh. An in r.nt hJs cither , sp;Ked or clOS<:'d
dentition_ The cb.oncc s of t h..,... b6ng no crowding w ith
peflThlnenl te<-lh JI'(' h igher in childr~n with 0 sp.>c~
pri ma'Y dentition th~11 in th<>se w ith , t l"se" d~Jltit lon.

25-28 me

2025 me

m.n tM!e'e1h.

fi<j , 7,28 Erupt ion time.,1d ""l"cnc. of t he pflmorydent it ion, S~

teelh"",pI ~~"" tIwn ~ <lKn'ljlMding tnoIl1 in Ihe O;>I"" "'II . rd1 (~
r_1, 1).

r.bIe. 1.1 ~ of "".clop,... ~ of~ prmor,dontition

......., "'......-



<C'Cr~ _

L...... ' ......

_ ...





" AMI..""",

--.., -"' -. .~

<0<,....... -




'H 6




.. ..."lJoooboglno



.,..m<oI,.....-..... '"" '""' "~

,,,. """"" '

,~ ....",,,,, time> IndI<_
v..ot lon,
<If , 01 mom'" on .;,.... ,;de or tI><
","","''' I, " hod"l.. ~ .bnmlYl. On~ _"""" ,,,,,_ >bly ", ~, ... 1M '''''90 >/IoYId '" <o<," ,"-,,'d .>boor""',



...,'" ".. . ,,...,..

_ _ _ __ _ _ _7'-"""'lt f ~ and~


'()'12 - "

11 _13 - "

Fig . 7.19 E",pl io<> limo , r<I scquen<. 01 the prrm>1>I1<l1 t . <th, ~N!
to<:'th ""UpI ... ,I;"'- Il>.Jn U,e ' ''''''spondlrlg teet h in t ho oWO,ing .", h
("'" T;oblr 7,2).

hl"",. ont le." ~

In o,d... <JI '''pllon

k lfl<.Uo.


C"""" wmplell


Apl"""n,oo In
"'up"on "m.

wm"'...... bmo


_ . -.. _


lo-T Zmo


' - ~mo


12 ~
2-3 .

lo""d ''' Pf'''Tlol.l'

""""' _ _ pn:.-moI>r
_ _ .......










11' 6
11_1 .




10_1 2
10-l Z
11 n

" -1\1



14-' 5
' ''''~

''''' ~

1'1-1 G
, ..25

'orum., " ondJ"',1J 0l <lUloo

MO.lJO ~~ 1 -IOOJ 4\00 1'\"wild . 411" uOlldJO<J J , """, jO,\5otOl<iH ;:"L ' btl

-~ I~ldU(o, ' .'P , 100J II" 'SJPo~ 9 11 0 :~Z.E~llI " SUA' OJ)
II~ " ,E",,1i li l t' ~ ~l" l dlUOJ J,," SUMO]) II? 'SJNII ~ l O

:uo prJ UP]rJ P~]rLl "lI """4 <UA,OJJ liP '~~P )0 s.lrClli
~ 1e :u oll P) iJfJlr J p ~l r f] ! U' ~~04 'i.l" IOW l<;" U J noj
'4 u ,q lll"(p~pnplEl lOU ' '"lOW P,IE' ll ) l u~ wdOI~""'P
4100 1 \U~ U e l Ul " d JOJ <J ilddp ..SJno). JO . !n, ~ <f.1.
1I0! 11 !ldd\l I ~~! 1I!1 )

'W' 05 1] 1001 jU, u, wJod oow.oJD~~I )O """

-, oJ(! !.q p;><"'" ' 4jOOl .(,.w~d JO uO<jdJOl'" lOOJ U! "' D01' hJJoJ

I f -L


f :ili

'~H ) ~lIoq "'IO~' lr pU" ql~", JO UO !ldJ OS~' SJ10WWd
pll " l Ll" 'Ur~!l lel"OpOFJd ~lP JO uo,,'''' dw OJ <J Uild Wp

Sl ' !l -' IlMO.LR " ~ l n _", \ W

)O l l n S ~j

r Mr lIlQ. l

P~U~1 "~M

~111 [[0 '~J'[OJ ' JO.)O_"""W p.>Se,,-" U[ :;),).[OJ p ~'''''JJUI -f

"(OH -~[; ) 1 1l.~1 IU~U "Wl",d J ~l JOlru!llO!l !'od ~ ~1 ' OJ
~.ll'd, 11l~PUJn< ~PI~O.ld Ol S.lnJXl ~:>"IM '~ uoq J"I"",,]e
~ l[l


~ ) M O" g

4100 ' '\ ' OllJlJd


Wl.WJ hq oSI' p J U O ~" ~Nl . , E ~ ' . ,mp,u),

'"IO,) hl e ~ ~l jO sU0!l" ) U! po", p El"
l in,,,, '~ SJ El)lO '1 1~"l hJPw p d J'Il

~ll!lJod<l ns '~ U"'I

uO 'l d-, os~J 100J J O

s~n" " ~ ", uoddn< J~l )O ~ U ! lI~~ 'JM ;~llO<I .I" " <>1 "Z
-w. lU " ~'I I "l " O pou"d " '1 ' jO <;'l Jq y 1UOW4) r u r JO " 01"
-SLWJ pllr <100,[ ~l[l "' " 1""1' uOljdJo' '' M'(U : L "~!J) <100'

"'D. " W'i


_""lOP P;" !LU5' ''Jnp ~l'''l lU,ueuIJJ<l 01 41001"J",u~d 10 UOIl"I'~ 0 [ ' L B'J


"-'"lUu d ~~ l jO UO!ldJos"" U! <lIn, . , ' P "IM '\JWI' ("" 'l<o

.10 " O' )\'L 1L j,)j ~1J I I' ~ 41 , o) n pu! (lE"L '~B ) I[H~l IU ~Ut'W
-.rod ~ ,, " d n,l . pll r ~[ L1MOJ ~ w OJ) ~j n SS J J d :lOOJ JO >S0l -I
'~l""l h.1r l " pd J 'II jO ~" ' P P"'I' )O , ,,sn eJ "~J ql "'" OlJ l[.i

4i31 . "" J \

4laiJ.i AJe WJJd j O DU!PP iJ4S jO SiJSnl!)

IU ~lI l,,,,,[.,1 ol[.i

'~Jr l d J!J l[l .1~1 ""4l ll'M " o,,~))ns

Jl~~l )O uO!ldJo ' J ,1 J!SOIO,," I,1 hq

' ' '()(lj

pJ <n>J ~1~", ~,"''''l) d . '1 ' JO u O l l el loJx~ " '1 ' <! lru ! P P ~ll S

'IOt 'L 'SU) sl l" P' jO<Mer J~~"" [ ~l[l Aq P,U"l d"J

"'l 01 pJl l'1I0JXO .E O 1'0'1 $ ;>q l SI1lU 1~, "-'elu p d "~1 1"~ 1
<MQIIOj 1] ' ~ Z ! ' U! J >r ~, ' J' " IOU U"" 'I,,,,"JOJ "J "O '~ l J ~l
~41 "' O")" H'IUrj U! ~'1 1 )0 SM? f ll""'" . ' 11 I!I {)\ ~"""J p ur
1-" hl " lUu d "~l JO 41J~1 J l[i "10' I\I~U "W,<><I "
pur lJ' ~,l" l\l '''! 0 :4 10") J O 'lOS OM) SS JSSod ""l[1 " T 10' 11
- <J" m r ",," ll'opOMhp "' " sut'wn~ " Iew wew ," ow ~1n

ilU! UUPld I UJ lUI~~"

II""" ",,'

4l a a.i AJeWPd jO DUJPP<J4S

~1l'J nJ.J" Ol l"l lU~SS" ' ! l ! ~,npx>q I lleJY' lI ~'s S' S' <f.1. ' 41~Jl lU~U
- w u 'Jd ~41 JO "U" " " I"o ~JOPj J41 p ur "U O'ldn,~ " ~ I <lJ~)j"
41~Jl "Je Wi, d J~ I JO "on<lnJ~ JO J}u~nb"" pu e 1"'~l10d ~41

UO!l~J!ldd\l I~.J!U!D

-----------~imlJniJSf;u.jJoi:ldn'n;uDlijJ;;T~1}D JU~wdoi;iloii(ji-'- ",

_ __ _ _ _ _ _ _ _ _ __ _ _ _ 7 Tooth Eruption o nd~djng

13 5

Root and Bone Rewrp t io n

The Pfll'l'5 of ......""roo is initiolPd by 0Sl~ or
odontocUsn. whidl ""'lin.Me from m..
01 <imllot;. blood 1JIOIlO()'I'" .flt'l' rlltir
from ,"" blood
-'so 0sliMd.><t:<...., ......... ly~. multi nucJe,ued
mls llI.Jt .WO''''' in nJp-Wpo<! drp<nsions of ' bI'
rnorlJi"l front of.ny h.>n1 m- (~ 7.12~ The cu ps/l.IpPd ~n, .'" <.11td H~hip's (fl&.


7.))~ Undtr IIJc,

-l-_ I '~"


light m ~ . 1bI' O<loodost "WO'ors

.os _1.UXt' ""II <U<lt.ining W< to 12 nU(Jo;. II ...., . v.ruoIalfll rytoptasm.1lId. sUi"tO'<! Of brush bonler .ldj.lcent
10 rte ",sorbing hard
microscOll<" ~.I ,


--- al oole< I d


(Fi&- 7.34). The elect ron

ru ffi O'(! bord... ronsisti ng of d..,p

inv,'s:i""' ion, of the <~Il

m" mbr.~

forming numerou,

Inte rmi ngled villus- like p roc..,,". Th<:,e diffe' in di" me te r L1 0 t on ly Im m one a nothe r but ,,1'0 .llong t he w ut'
of i n div i d\l~1 villi. The CytopldS'" elf the ruffled borMr is
.Imost dl"Klid of Org.lne lles. Bc!W<1en the ruffi"" bo rder
.nIl rh~ nuctei. the cytopl.,m i, cxt Jt"1m'1y m h in mitochondria (Fi&- 7_J4~ Still d""lX" .,Id do.." to
"",ny Golgi m<1<re Pf"'"nl surrounde1l by elffi:ron oknSO' lunule .and ,mOOlh ~nd ~1~ VlI'Sic\o>S- The
ek'c1ron"""'SO' lJ~nuk< ~ ... mnnbr~~boundlIT~nuk<
wilh ~ 'll1r~1 ~k'd~Cl:R sulT1llloded by ~ p;lle
h.J.1o. T1wy .....pecifK gr~nules dw~i<: of OSM.diosts MOd 1 _ pROlr5On. T1wy ~. ~ 01
~ .nd _
found in rnorIll<J1r< ;os ....... A6d
~ ~ bfton "'"l(lllW~tfd in Ihml. '" fur It'IO'
nuc!ri. . _ ultr...uu<1Ur.ll .oppNf~nc~ difkrs .KCOIdins:
to whHlW'r lhe ~S1 is )'<JUIIS 01 ok\. In youns:
~~ lhe nuclei .... """id.nd ~hl1l",,"li<:(~l
wl.h SOJOD{h nlJd<o~rJDl"lllhr~nt". ln oIdtr"',,oct. .... It'IO'
nurl~i boorome hMMU<hrorn.>lic (el.u l l .howing w rin kled OUllin.... "Id he pyknocic.
An oscroclasc is t he ,"",UJI 01 ' usion of celis ralh<1"
Th." lhe prod ucT of repc'lcd " "d~Jr div ision.
Monun u..I." os teoc lasts m,ly h. fully f"lKt;" n.]. rnult;" UCiCal ion is . ho p,,-,sibk for im l>roved pc rfo "'Mn,-e
a" d 1't'~ u]atlo l1 , Recontiy. ' Iud lcs con firmed t ile he mopoiet ic origin of u steoclam fr",\\ clrcu laling m onocyte, .
scmc in"",'ig,l.lors !\ave &-mOnSlrale<l e!\al odon locla<l
{l'n'Curwrs he"o me full y d lffel'l'1l1i'led and de ....lop
promillc1ll rumed b<lcder< only when l hey ro".,.. illro
di..-:t ",Ill.ocl with mi"..,-.lized d<'nlin ro he n-sor1>cd.
Thty nse _
d th.ol COfICOmI"nl with 1hC' rofflle<l



bo::>rdot'r form",tion. odonrocJ.sts nhibil eXT""';"'" S)'I1lhrsl. ,tid 5lOril:V'of ...:id ptoo<ph.Juse in ......ny v","'*'


infonn.uion indic..n 1....1 .... ttl-li .......

rnorpIion occur< in t-> ph.o$CS. ~ n lr.Kf'lhllar ph.o.w
invohllllw initial bR',kdown of ~ sm.I ll '"" of h.Ird lis-.
( U.-nUl

sue into p..1trtiollly dis<olw<l. fr.,.....,... In the inmo:dluIar ~. It'IO' O$leoc~ .ppc:'.m 10 ingnt _ rompk1e
lhe diuolulion of rt.. bn'.lJ<down produocu. ~""
01 .... reI lis..... occur< DN' .ht' rumed bon;I.... of Ill<'
ostrocl~S1, The cell ap pc,,, 10 "",round ehe fC'SO'Plion
slk WiTh ~ modified 0' cle~, ' 0,. of cyloplasm (FigS.
7.34 8 . Ild D~ w hich Sllgg<"SIS l ll.tttle .... 11,1l....."" th e
~ff..ltv"n." of i " hydra" lic enql1lc " As l he ,,'teocl."



7.34 o.t><b>t ..,_yln ~,Io<u

AOit.oclolols ln lac.......
M<oIl lnu<l<m,d 0 0 I _ .,.;n, bnnhbo
b "'.l >pi<uk', ( IluffIe<l
bo......01",te<:><\;I,1 with ".,;".".... 0'11'.. ollu!ottl' ..-.d <~ e.l'ac......."".
o '(IN, toM' of OSlcoc b><. ( ( ftu. of ruffled bor<lcr> du'irlQ the
fMr>I' ptlol' """"',.


.Il...,b tbe turd-Ii",,,. ""'Inx, lhecollqm mcshwod i.

Cly" " vi.ibI<! wll" n

", ~ I&d


disrupled and cryslal< ~'" ...... JS.Cd (fig. 7.J4C~ The

!>.l nd;ng pa ttern cha ract e ristic of cnlla ge n fIbrils a[ t his
' can be ....n w it h , I,el,on mk lO" :oPY. f,O'< cry'tal.
~ p p<'" to be ta ke n into cytopl asmic ."",,,o ", s of lhe
0,,"00;1..<1,. JIId .re S'.>dua lly d ill"'ted w; Ihin il (Fig.7.)5 ~
The disrupled roIL.1goon fibrils ~"" dl"strO)'l"d by fibrob~Nsn. ........ in ~ po!ridonuI l~rTIHlI c~plIbIe of
both degrMl.1lion ~nd <ynd ...sis 01 miLo,....
Ourin s lhe Il'O'=' oIl'eSOfllliall. ~ Pf"SUl'" 01 !be
, rupl lng ]l<'ffl\Inent tOO1h Is FtISl d i.-ected to the bone
se p.l,a t ing the c rypl of I"" p<'ftn.utem tOOlh from the
ai\'l'ol" . of t he p'im<1ry tooth (fi g. 7.36 ), Aft" r th i. a rN is
,eso, bed . Ihe cr u pli"" fn rce Is dire<:ted . t tit< r<J<Jt of t he
pri m.ry 1000h. w hich ,",ults;n resorpl iOO of the
lum.nd <lent;n.O<Ie'o<~l'MOt"b mi,......llzed but no!
unmi....-.lized ti>0Ufi-

'"' ' 1:'11-

F"l' 1.15 1Jpta1o:r of miner.. crrsuk in inI'oceIubr_..... A ery..r.k

_ _ ~-......0'~~
. O<."k+_ol

......... in _ _ ~

0<le0blaslK <?lis ~ My role in bone rnorpIion by

_ i n g .......Ir pmleJSn. indudi"l roIl.ogenase 10
deitade t l>< unm i,.....alized orga nic m.trix or "'tenid
th. I Ii,..., m""t bony , ,, rfJccs, Th i, p roces, bring, about
d ir.ct contacl o f osteoclam w ith bon e mine rai. w hicl1 i,
a Slim u lu s fo' t'f'SOrjXi\'l' M'livity. Wb<'1"", cementoid
ti",u, i. fil"Sl l'ImlOYl'd by sim n'cchan i,m i< IlOI


llftorpIion. Jiloe nuplion. is IlOI (l)/t tinllOU< ~

period< of a<1MIy .1tertlolte with periods 01 "'"". Ou,i..,
periods 01 rest. """,i r ITIolY lJk~ plil' by ~ppo<ition 01
bone aoo ~ntu m in limile<! arc.< 01 the
wh lctt
r~s" i" in p.>rfial .. aIWchJ11~nt of Ihe tOQf h, This explain,
why childre n e x pe r i ~ n<:e peri od s w hetl primary tee t h
.llerna te bttWffn loose...., and fi""t ion, IleSOf)ll ion
11$""11)' proceeds rast~r Ih.n ...p.oir . nd ultimately
,"ult< in ~ IOOI'h bring shed.



I.eM 01_ "'*'Y*"lI


Resorption p.. ttem of Ant erior Teeth

Resorption of t il. pri mary ,mter ior I....t h begin, al aoout
to 5 yea r< for th e ind <ors .,nd 6 to S yea rs fo r Ill.
canl~ depend ing on whel:it<r lhey al(' "", ndibuldr or
maxi1l~ l)" <:.>n;11('<. At thesc time.. Ihe crown. of lhe perm.lnmt SlJCIeDCII"< ~re rompleced ~nd situated in their
C1)'JII" llngu.ol lo the ~p;e'" lhird oI t he root< oI,he
lOm'<PCJI'Idilll primary IffI:h (F'1g. 136:.

d in ic.l lAppl ic.ltion


In in f~lIti,.lOO(h nuplion rrwy be .cwmpl~ by ~ oJiSbl ~

in lflnPtr~lu,,". milcl initonon 01 ~ JUIM, ~nd ~'"
m.ll.l~. Any - . . . ......".~I symploms. ""-vH. o;houlcl no!
be ~"",,,i. t l"d w ith =thing. alt hollih S<lIl\e S)">le mic dis tu,
!>.lnc~ .. t he t im<' of tOOlh . , ,,ptio n . hou ld be e xpe<;t"<l,

With th e _
01 er upti .... rt>OVI'11l<"IlI of the perm.nmt
ttll, w hich pnx"""" in an incisa l a nd "'bial direction.
pre" "", is first direct ed at t h, b(J[\~ se pa r" ring t hr
crypts of t il. pot'rma nen t ' UITeSSOlS a nd Ihe aiv"",I", " f
II>< primary roots. Wit h the Ios< of r.... sep.l rating bo lll'.
Pf6<u," is men d ire<:ted at the prim.ll)" TOOl< (fiJ.
7.37A~ TherefOR. resorptIOn of the primal)" ~merior
_II 6r<l: nIrs ~Ion& the ~"l:...r <tIIfaa 01 !he ~p;e",
third of~ tOOl. .. then plocee<l< JabiaJIy Ultlil lh< C1UW11
of t he eruptil1l pnnulll'm
(01"" 10 lie direo:t1y
~p;eal lO the primary tOOI h root (Fig. 7.378). Resorplion
t he " proceed s horil o ntally in an indsa l d i' '''lio n. ca " ...


illl l,,", pri rrLOf)' fOOl ro "",fol"'~ ~ I,,", ~ """

10 ftUpt in i15 pLKe (fiI. 7.l7'C~
Sometimes. JWrlkul. rty in I,,", rqion of I,,",
nundibul.or ilKi....... I,,", Lobl.ol ~nl 0( t!Ie pemune nl leel ll does not c.... se rom~ loss of lIIe primal)'
roots. This n", y resul l in llIe primdry incisors ",nuini ng
in Ihe jow, ~lt" c""d 10 l lIe 1.l>i. 1 ~Ivcol .r I"",e. Tllen,
whe n th e crown< of ti,e I"' rm."e " l Incl",,. , emerge
Ihrough th e gingiva. th ey apPCM lingual to Ihe jll'lmdry
ooe, tllat ~{(' ,Iill in plm , (Fig. 7. :MI~ Prompt {('mov.1 of
I,,", prim. 1Y crow n . "d ",maini.., root
UK' per
mo"""'l 0"'" in rottffling lhcir posifions.
In the ;.w. " ' - r. if the O'fnWlWnl
cMlines .ppo'.r in m;splnl JXKilion. lhey IISIYIly do
10 I.>bi.>l IO l he "",btilll prinwy CMlines. Ag.>in. prompt
~.. is bencflCLlL Il is "'", 10 see d ll\O.IlilLoIY perl'nInmt c.nine ffUptins li~1 10. primolY """. .os rtw
perm.nenl c.n'ne roukl 1bcn borrorne eml>cddcd in lhe
"". ")/ 00"" of Ih~ p.>1.'~,


rig. 7.l 7 IlNIM! pos;tion of, porn ....... nt ante<iof tooth to~ . j>fimMy pr<'d .
<"CO<"" during ~

pnx... of s/l<'d6"l1.

Resorpt ion Pattern of Post erior Teeth

Tile JIlIWing premol.r cro wn re IlIiti.lly ioc.lcd


~ n The roolS of The pri nwlY

tffih (1'"187.l9A ~ Th~firsl sips o( ~ion.rouncll hesr crowns

oo:ur in , "" <uPllOfli'lll in",..,..>dic\ilu bone. This is folIownl bl' ~ion of the .od;.cn.1 "'"""= 0(1"" prinwry 100tlt roots (1'"18- 739 B~ "",_hi". The bony .ohoPoL>r proc1'S<o:S inc",."" in hei&"t to (Offipen""'''' for t""
lenst""";ng fOOlS 0( tho pt'm"WIl'lIl fffIh (J't1'"II1')Jm~
As Ihis occurs 1M primary mol.lrs. emrlF occlu""'lly.
which p"'ilions I I~ l. r crowns more .pir.l fO 1M
prim.,ry molar re><>t' , The premol. " co nlln ue to eru pt
Ih ~ prin""y mol", root, [urtlteL' rew rb. and Ihe'. teeth
Ihe n ""foli. le (Fig, 7.] 9n The pl't'l1Io l. " then eru pl in
pl.Ice of t he llrin,.ry n,olJrs..

Abnormal Behavior of Primary Teeth


Primuy THth

The IIKISl: common c.u.... fur R'I.innl primary tffih .re

0( the perm.n""'l sue"""",. Th~
tffill m<><1 often . ff=r d are tbe upl'C!1.lIE'r.1 i'lCi,.",.:
IK'Xt aff.cted Me the I"""",r 5CCO "d mo lars; the
Ie. , ! ofte n . IT~ l"t ed ~ r c th e lower ce ntral inri,o,",
~<'1. ined pri mary I....tll often ,.nw in funcl ion.1 for
.mon i tll~ l"' nt !C<:'(h before lhey.rc
lOS! Throog/l t'PSO<p(io n of tho ir t'OCK1. Their loss il
bel,,",,,,,, 10 be con lri bul.... to by hNYy ma >l:ir.tory
Iiotnos or "'uillif~ 0/1 tho """,U I"OOtI .lnd bl' the conlinlJtd dCtir ""'ption mil ~ ~ eIonptjon o( lM
dinic.ol cmwn .... sudt tch at I'" .... pense of . -

Mg. J.lS

one..... of e<IOpfIon """ of ~ _1ngt.>.tI tl> pfI.


_d.. . .

.meocc or im.... lion



'--0;. J -" ....... positionaf. ptemolor ID . ptWnory _<lon>g "'"



II Deve/opmerlt oflheJeeth of!El.Jupportin g ~ru~ture,,>

Submerg ed PrimaryT"eth
Sometimes, primary teeth become anklosed. SLLch teN h
"re prevented from " tive erup tioLl and ",,<ome sub
merged in the alveolar bone '" J result of th" continlled
eruption of .ldjacent teeth and the iller"." e in height of
the alv",,"'r ridge (Fig. 7,40). Subn1erged prin",ry teet h
should be re moved ,l< soon as IX'ssil>le, parti<ul.1rly
when their !>"rm.nent successors " re pre,ent. The major
differenu, "" tween l'etained and ,u hn,,,>;ed prin",ry
teeth is th. t the lalter are fused to the alveol,,, bone
(.lnkylosed), whereas the former ~rc not. Deeply sul>merged teeth suggest th" t the .nkylosi, occurred eJ rly
dur ing ' hildlmnd.

f ig, 7 ,40 Diagrom <>f , ubn."rged primary tooth,

_ Clinical App lication

Ankylosis i, , hJrd-t i"ue llnion belween !xlne and tooth. It

prob.l>ly 'K( U,"." a result of disturwn,e in the inteL"a<tion
between normal resorption and hard-tissue rep" ir during
shedding. Primary molars are the teeth mostly affc<ted, where
ankylosis o<cur< mainly at the fllTcation " red.

Re mnants of Primary Teeth

Remn"nts of prlm. ry teeth J re part> of the root> of the
primary teeth: thes e p. rts e, c"l,e "esorption during the
proee", of shedding, Such root rem no<lts rem" in em bedded in the j. w" re most frequent ly seen in the inle rde n_
tal septJ in the region of tile lower second premol"l's, ore
u' ually Jsymptomati<, "nd, if " I>served on X-ray, should
not be diSt\l rl."d. Rootremn"n ts may exfo li" te ift hey ~re
neJ r the surf. ce of the jJ ws. 0[' they m. y under<.'O
resorption and become repl.1ted by bone. thus disappe. ring completely.

Preprimary Tee th
In very r" re eJ 'es. prepl'i m;rry teeth .p!>",,, in the ol'al
cavity of newhoDl of neonJ!al infants, They ore COmm("j[tly found on the alveolar ridge of the m,"'d ible. in
the int i",r region, and usually nllmb<' r twO or thre<'.
Because they po,.,"." no l'Oots, they "re not fi rmly
attJ chcd. Frequently, they ~re shed during the fLrst few
" ...eks of life. TIley should be removed .lS <oon J' possible. however, to pre,ent discomfort to !xlth th ~ molher
aLld the w by during S\" kling. Removal of the preprim.
ry teeth does not affen the pr;m"ry teeth. Sometimes,
hoWeVer,l l,e teeth seen in the mOllth of" nwhorn baby
are prem"turf pril""ry teeth. Therefore. they .lre not
replaced after they f" l1 out, ,lIld their place rem"ins
pate nt until the correspo nding perm" nel1 t teet h erllpt.

_ _ _ __ _7 Tooth Eruption ond SheddirJg


Eroplion is l~ ~n1 or ~ lfdh through llw

~ of 'Iw jaws ~Dd .h ~ ~'lying mucM.l, 'n
. """.r.Dd fuooinn in the or.l (.Mry. Tbe'" crupIiV<' m(M' ~n " con be dividt'<l into fhree p h.lses :
plffrupllve. pr~fu nCfio n "l erupti"". nd funclio".1

""live eruplion is lhe "'suit or ooclu,.l m"""menl

of fhe 100111. Aff'" ~rgenc~ nf lhe tOlllh Ihrough
lhe gingiv.l...,...., cruption is .KCOm~nil r,.",...>d
..... txpMu", or tlw c1ink.1 m>Wn by ..-piIr.ofioo or
I"" .llMhmen. q>ilhelium md IhLo .apir.ol shift or
,he gingjou.


(linic.>1 mJpl"ion ~ns with llw

of lhe
crown tiP in ,he or.1 (.wiry.Dd continues untilllw
fOO{h comes into or dosion. Dorlnli lh is pe riod , ''''''
toof h m""", f., ter Ih.n .1 ."y ofh.r lime, Figo '"
7.4 1 ind ie. tel m.ny o r t he chong", occurring.l Ihis
l ime. The "",lodo nl.1 fibers .l Ie org.l11iz lng to "obilile the erupting looth. the I'OOl d.",inogenesis IolIow< " the 00 ..... in the fund ic .-.-gion org.oni, es In
respon"", to the (1\;Inge< in r<Xlf ~hUke mll5t"",l" the is. diphyndont th.ot is. p"'<e5'ing twO sef< or teefh: pri.....ry mel P"""""""l The teefh or tbt pril!Wry 5ft
.., mwl1 .mol f<own-. to fit .he 111>.>11 j>ws '" tlw
;nf.n'. Ik<;.u... the teeth. Ofltt fomlt'd. ""nll(ll[
inc",.ISe in siu. t he pri"",ry 5ft of t=h must exfoli. le . OO he "'lllolCt'<l by t he 1.'Fr. mo.., nu mnous
teetlt of the pl'mI<lnenl ""'I 10 accommod . lI' th~
I.lrger j. w, of the . do lt.
Shedding of lhe primary teeth is lhe resulr of prog ressiv<' resorpfioo of their roolS l hroogh l he .octiv_
ity of the o<t<'OC1.o ,,, or odonloci.lm.. Hord lis<""
re<ofPIion occurs in two ph.a~: the exrr.eellu1.or.
du ring whictl tilt ""'lrUe fr.glT\t1lf$ .nd diOlUlion
~IIS, .nd lhe in..oIC<'lIuw. dorifll whidI compk1f
d~ion '" tilt prodUClS or rrsorpcion ocrun.. The
~ i< no( ronlin""",; periods
.rnv;ty .1<efNte wifh perinds of Il'$L Di<turb.oll'
of l he reso'l'lIon proce..s result. in .bnorm.l
beh .lvior of the prilTl.lry teef h: some ptim.u y teeth
m.y be retatned be'e of lh e .lbsence o r
impaa io n of l heir perma "ont successors. ol he rs
nlJy "" an kylo' ed dnd su bmergt'<l.



In "'''' cases. teetlt Illdy appl'dr in the ordl caviry of

ntwbom or ........tol inr.m... nd are c~lIt'<l pt\'pri

",,\ I-~-


self-fva!uotkm Review
The , " t lwr wi' he' ' 0 rffog ni" tile lollowing conlrlbutions;

1. W ha t is the p ur po se of cro wn move m e n rs during the

p reeru pl ive p ha se of toot h e rup t ion ?

2. What are t he charac teristic s of lhe intra oss e u s a nd

s upraoss eus stages of Ihe prefunClional p ha"" of tooth eru pt ion?
3. W hat is the rel ation oft he secretory ph~se of ~",elo ge nesis to
the beginn ing o f rool formati o n?
4 . W ha t is t he cause o f petiod \ of loose ne ss . nd fix.ti on d uring
lhe erupti o n a nd shedd ing of t he p rimary l""th?
5, Whal are three cau ses bel ie ved to t>e important in she ddi ng
ofth~ prima ry t""lh?
6. Describe t he two p hases o f bone re sorpti on. ind icat ing wh ich
cells .re be lieved to be responsible fo r Nch p hJse. W hJ t a re
t h ~ ir fun ctio ns ?
7. Expl ai n t he "si x/fo ur" ru le fo,-em e rgence of the pri mary te eth.
8. W hat a re som e of t he possible ," use s o f toot h eru pt ion?
9. Expl ain lhe rule of "fo u,," for develo pm e nt of t he pe rmanent

Dr D,wid C j ohnse n 01 the Uni"ersity of 10"" lor p"JV i d i ,,~

Figure 7,16; Dr ~<>g< r N,X)" ' '', 1'rO~ C. '" I)I,,-,.-ro, of t he
D<tM"',...,,,, oI l'cdim;, DentistIY, lyol, UniV<rsity. for pro
vld;nR lhe c1ini, , 1 .ppli' at ions 01 lhe rule 01 "Iours- " nd
", ;xifnm,": Dr Sol IIeTll ic ~ Idec">ed) or the Unive"il y of
Southern C, 'ilorni.l, for prov'''ing fig"",, 7.23.

Andre,son)O , OxI. ",, 1 ,ts o ~ " l o , ,, Its im" llc>tioJl in den" l

tr"" m'lOlogy, p<K"<IOOo" t"",or,!>ndontk<" nd eJl dod o n t i, ~
Int 10""" j.l:IRG, 67-70.
~ K ~ . MO<.1m ~j. Now,,", " liN. f'e no d on ~,1
lig, menl and phy, iologic tooth TOOveml'nt, In: ~K"
!lerJ<owirz . BJ Mox,la m, HN N..,,,,,,,, ,,, " I ~ TI", 1\ ' ,'IO(Ion" l
Ug,l menl i" He, I, h ",,11)1,",<(". Nc"'" YO" . NY: P, ,,,,,,,OI\
I'""" , ~JS UI5 _ l47.
Go",kiJP.M,,1<s SCJr. CU rrenl concepts or lhe biology of 'ooth
orup lion. ( rit. Rev, Or.,1 Bioi M" 1. 1991:J: W:;- l OE;,
Marks SC Jr, Gorski JI', C" hill DR, Wi",' CG, T(I<11h O" I',lon. ,
,y n'h " i, or " ' !X" 'lme," '" O I)", ,,, " l o ,, ~ In D,,;dovich Z.
od. Tho ~ io logi,, 1 M<'Ch'nism of Tooth Eruption ,nd
R"orpt ioll. Birmingh, m, AI,,: EBSCO Medi.; I9B3;
161_ 169.
Moxh" m BJ. Tho rule or tho p<.'oo<lon,, 1Vd ,,,;o d . r ", ~ ;n toorh
.,lIplio". In; l" vioJ"vi<h 1_cd. 11", ~ i o l og;,,<l M"'h" nism
ofToorh , '"pl;on , md Rool Re<orption. ~ i r m in g h " ", . AI."
fIlSCO Medi>: 1988: 107 _233
Pmfiu WR. The effect oj' intermiU, n' force' 0" eruption. In:
D.widovich Z, ed. Tho B;ologic. ' l'kc h, ,,I,,,,, ofl (o<), h
Elllpti"" , ,,J Kesorp,io", Blc," lng""'" , A'" m lco M<d i>:


19~ ~ : I S7- ' 9' ,

JR, Prom , WR.The p'ttern ,11ld control of the eru ptive

tooth ",ov<men l~ Am j Ortllodont. 193" S7;5(;-6{;,

The' Jeff I. Doe, opi,lerm,1g"'w 'h f, ,,,o c{O,\1m l ' oorh
e, up,ionl J. I)('nl. Chilo, '97: 84 :32 1_329.
'-oph.", ~T. (1,I, go OJ Jr.. ';", Itl, AJ. Ihlton DA, wtto"" Vii II,
Kle" , R. Elk , of epiderm,1groWlh foKtor on 'oolh dlff"
enti,tion ,'nd eruption. In: DolYi<l ovich 1_ ,,1. 1'h<' "1 "logl,-'1
M"'honi' m ofToolh Eruption "nd '"" "'1" 10<\
Birmingh. ,n, AI" , 1lS("O Medl. ; 19S5,117_ 131
Wi'e Go. Mork' $(; , C, il;11 DR. lIt""lructr"r> 1I;"" ure, of tho
dental folilclo ,<soc;ared in the eruplion I'llhw"y in til'
dog.1- Or..1P""ol. 1935;' 4;15-2 0,
Z,lj ick G. fih rolll"" cell ki not it~ in t he p<.'ri<xloll"l IiM ""'"' I"
lhe mou>e, Coil.Tim'O Ki"el, 1974;7;079-492.

8 Agents Affecting Tooth and Bone Deve lopment
James K. AYfl)'

Introd uction
C~in yjl~min ~n<1

""rmOll<' <k1J<ielldts, if """,",II

d uri ng lOOIh form . tion will a<lvt-rnoly arr<:,Cl fo rm. tiVl'
ce ll, <l nd Ih. mJu l, t h.t t hl')l produce. Mt'd ""ed org , nic
m' tr ix conto" t r<,u it' in production of nypo!,IJ'tic ti. _
we. Excc-ssl~ .......1' of I('{r""yd in", or noorid(, nidI'
b<:'tume l'lCorpor.ted ;nl0 mlner.lizing 1..,lh.lId Interrn.- wi th tM mine " li..., ion pr<>cI'''- Should boIh oi~
lions occur.' hypopI=ic _ri~ I"'" is <1Iso llypominer. li=llOUUld R'SU1r. Tht "~If of ,... de(<<t is ~
~ on 1M twl"'" of thor thor ~ of =n;s
or ddk w ncy. nd tn e d~loPffi"nt.1 ti"",
Vi ta mins A, C.~ n d D. p.ll.thyroid h ~.I<:'tT;ocydine.
aoo fluoride.", discu"o;ed in term, of lheir ",J. tion 10
nw,ix d......lol1tn cllt. nnd don lin J ild ~n<l m. 1 m ine rali, .
tion in d ev~lupi n g t""th. Mo.t . xpe rlmenl S II.lve !>e<.'n
roooucted on I h~ con [lnuoo,ly d<-><:loping to<k-nl inc;
"'~ which .ld C<l"" t~1y rerord. d~lopm .. nt.1 ~
TooIh devriopm<1lt nwy to. .fJNU<I ~ m.o.ny oul>Sl.>nc1'S. Tht n.>mpWs cited ~ ,hose _
st ud ied in .... m.o.l .ooI humin ........ n:ft.

lifter r~.d i"g rhi, cha pter you .,ho uld t>c . I>i.. to desc ribe
in de tail t n rred' o f vitamin. A. C. a nd D. par"t hyro id
hormone. <OdI um nuorlde, and 1<'t r.>cyClino on d<-><:lop _
i 1lll 1<'<'lh.

. "'"pt.. .


IntrodUCl i()Il.._141
Obje<;tiv...... 14 1
Vitamin ADefici..ncy 141
Vit. min C Oeficiel1<y 143
Vita min D Deficiency 143
P.rathyrold Hormon
T<>tracydin nd f1uo rid..... 145
Sum me<y 149
tion ... 150

' ' '_

Ii DevelOPlIl enf of the Teeth andSUPPIJ'!!ng.c?truCfures

Vit amin A Deficien cy

f i9. 8.1 Hi' toIOqy of vila m;n 1\ deficiency reve.lh e" am e!mO!rix deficien cy

"xI related den ti".1 dele m .l lho DE).

Prodemi n

OdOOt<AJI ,.

" c;''f,



Allhough tissues of ecwderm,, ] o rigirl _ lll,ll is. the ep id e rm i' _ ~I" primarily affected in vit,lln in A deliciency.
bones ,' rl d teet h ,,1 ' 0 record t his defi, iency_
Hypov ita m inosis A is eviden ced by morked metaplasi.
of the ena mel orgon. w hi,-h T~<"l l< il\ defective enamel
~ " d dent in format ion (Fig, 8.1 ). l.ih ",;, e, bone i s laid
dow n in "bnorm~ 1 lo c~tions , and its re mod el ing
, equences seem to be alleeted. Both ostco cl. ", dnd
osteoblasts hove been ' hown 10 be alletted by this d l, ea s~ prote,-,. Dentin. 1 irregular ities a" of i,11"d wilh
viu m in A d.fLd enf Yin de""l opi,, teeth . ppear . s . reos
ch. r. t te rizcd by eithe r exc"" i"" o<leoden lin deposition
(bo" elike, with cell inclusions) or ins" ffi ,j ent dentin
depositions (Fig, . Rl . nd 8.2 ), Alte rations of the differcnt iated odonto bl'lSt, aWear to be . ssociated with the,.
co nditions. 5om~ invest igators, how ever. JSeribe the prim,lry effet ts of vitamin " defLd en f Y to (>T"I el'illle liJ I
f~It" TIl i.' ,'iew originates from histo logif change, "" en
initially in the oral n 'uCO' . J " d cx tending to the d%'<'n"
el'Jtion of the epith ~l ia l-d e rive d " ",e lobIJs ts, w hich
,,"' \lltS in" l,ypopl,1Stic enamel matrix, If t h ~ vit, ,,,in A
d efLd~ nf Y i' ",""re. , ,,,"Iobtast cells will befom~ complet ely atro phied, wh ich [\", ,, It$ in JII J h' CLlCCof enamel
forma tion.
In Ie" , evere CJ se,. th e co lumnar dmelobl.m ~P l'<"
en tly ,hOlteD, and ,1dj.1cent enamel exhibits hypo pla, id.
An ex,1mple can be ,e~ n in Fig Llre 8.2. Seve L'.1 Juthoes de, cr ibe<! bonc defects d ,, ~ to v it~ m i n Adeticiency.
Most h"ve noled llW the de fects are a ltri hLLt~ l>le to
impaired ~ n d o{'hon,l r<\1 o." i r.CJ lion .nd faLi lty b o n ~
model ing. Figure 8.2 show, , ho rle,,",1 ,,, nelobl.m . nd
de feClive en. ",el . nd de nt in form ati" " . The no n11.11
apposit io nal rhyth m of dc nt in depo'it ion may b~
~]{e",d. V. sc" lar inclusio ns somet ime< Me .'een in the
de" lin {f igs. 8.1 and 8,2). If the vit. n,in A der.ciency is
reli{'Ved d uri"8 ''' I>seq uent tooth developm,nt, n orn,~ 1
dent in and e ~amcl "re prod" ced. J lth ough de fect ive tissue is not repaired (fi g, 8,2). Fig" ", 8.3 illum . to' cl1am~I hypopl,l<iJ ind uced by vit. min A M fi, i('[l('y,

riJ Kl lll um Jt ion of yit.,~ in A dof~i<ncy indk , tes s!lorteo'e<! ,11101001, <" .
" .mol matrixdeficiency. " "d """"I" inclu, ions in dent i" at th. DE].

Clini(al App lication

fig. 8.3 11I "' I" l io" 01, link,1 "",'" of defoctive enJrnei "" " lt i"9 from vit._
m ill A defici<ncy

Clini,ally, vitJ", in C deficiency is m.1 nifested o r.llly

by gingival bleeding ~ nd loosening of t h ~ teeth,
Weakness. a n ~mj" . Iwrw loss. ,lnd susceptibility to
hernor l'h. ge may also be a",)( i. ted with this dc fi<,en, y.

Vitamin C Defi ciency

ASCOIbic .Kid dt'f.. ;,,-,0()' h.ts bfEofl drsaibc.-d in ~i ...~
pip. ~ ~nd hulTWll.. 8...... """" 01 rt......
""""'" syn ll..-si... vitomin C. !My mUU depmd 011 ~
ditury suW/)' to m.lint.lin ~.,.th. Snmy. !he d;se.....
_ kitll
vi l~m in C 6rf~ C~ 00...,. dmri...
~nd Clmmlum ck'poo;ition to u ..... ~nd f""",,l~ cdls to
~lfOPhy. ,fWW1'1'. Vitomin Cis 1l'qUi~ lOrcol"" for"".nion. II i. ~ oy for , ~ h)'drtl:<)'\;loon 01 l ~
~mioo ~dd. proli"" and lyo;i...; an ~bwOlCl' o r d<-ficimcy
01 vOlamin C during dt-nli""l:".....i. mu ll> in d~f'-"Ctivt
den, i.....1 li...,c develo pme nt Dcnli ..... J lubu lc:\ ~
;r",gul.r ~ nd redllCcd in num ~r. vascular ind usion'
boIeo"'" ~pp.>ro nt. and lhose od""lOhl~m pre' ont arc
' ho rt. wit h ""no tJ kil1g on pirnllc., Il.,ped fiorol>1"'_llke . ppN r.lfKe. ( omp.' o'e [110 ' PI'oM. ncc of nOTm,,1
dcmln. In fi gure 8.4. with tb.t of de"'i" formed w bile
. ;t,lI,,;n ( w . . d ~ficlent. In Figu", 8,5, Figu r~ 8,6 is dn
illum. l;on of ch. o'' '''teristk , .'IOCi.u cd wilh .itam in (
dcficicllCY. Emhry<llogicall)'. vil.min C i. ...",nli. 1 foo'
proper d('V{-lopment Of .11 me se ncllyma lly derivc'd
>If!K1UlM. includ ing bo ne. demin. and ""me", ulIL
dink.II)'. vitamin C defitio!no:)' i> fNni~ by gingiv.1
bleNi,.".nd Ioo>ening 0I1~ lftIh due 10 bone te'>OfJ>"
tion. Yh.k........"""'... and >uscepl1bilil)' 10 hemorrf>IJIl' ."" m>y ~ <'Yidet>t Admlni>lrWon of vitom in (
mull> in r~ O'Iimi... lion oIll'le S)'lIlproms .-oo;i.o[ed
wi lh lhis 6rfodm<)'.



Vitamin D Deficiency
Vil.min 0 is ~ ...... tiaJ for depo.<ition 01 calcium and
pho.phoru. in h.lrd lisou.... lIS pre>CllCe inr;",.ses the
. b>orplion of dietaoy,.kium and Ill ~i nl ~;n . proper lev
els of cakiu m and phosphoru, in rile bl<>od. Primary
defi('i,t1("Y of vil~ mi n D re. ull> fm m i" , ullicient e, po' ure to th e . un and i" " ,fl]cient diOtM)' I nl~ ke, S""ondJ'Y
d~fi c ;" , ,,ie, ",suit from a bno rn , ~ 1 ; nt ~ s l i n . 1 re sorptio n,
S""Ol1 d"ry d~fici c l1ci~s may be overt'" m. b)' .It~ratio n of
diN' ry i"l . k~ of ~~lci um ' nd pho,pho" ,". A ........'" vit'min 0 dOficicoxy in <hild",n "'<ulls in li ct~u., , ,,,Kl i_
lion zcd b)' in",mC!enl depo<ifion of <akinm
..It. in bolt)' Hypo pla. ia 011"" ....."",1 . 150 may
be evidenl. Allbough vir..min 0 dcf"lCicncy is Ic5S rom-ftI(lQ JIl"IOlll.ldull>. if is onanife>'ll by dTNsed miner_
.Iliulion 0Il1X" bone mafrill. ltt>Ufrlcwmly mi".,-alizftl
......... cspo'<'i.Illy I"" ~l-be.rins Ion& !>one>. MI'
pn>n<' ro bendina: ~nd di<mrlion.

f1~ . a.5 Aw<or,,\( ~ 01dd ""tive ~t ln 1",,,,.(.,., '~ s" lti"l from ,"lor"i" C
""lki<or y, ,,;tll va""",, i'l<k" ioo, ' od dtq,""~.l.d ""onlool" "


rig. 8,6 nl"'IIIl"" ofw",""" ind"';",,...'" , It_

rmm ";1"",", C d<fid""y.

o<Iootobl.1", "," ~ i''9



--II DfwIopment of- th<! T",tl> 0116 SupP'!'P"9

\7itamin D Deficiency
Effects on Teeth

In Fig~ 8 .7 . nd 8 .1. _
tM .bnOl1Il.lIIy wiM nonmi.....-.lizE<l ZOtJC.' 01 ~'in .nd 'M intC'f'Pobu..,r
''''''''' in m. domino Figu~ g.s .Jso 5Jtows MUS of
.......... .offNtrd by Itypopt.o
nd hypomi.....-.h... tion,
-..~ of study of eftild
wiUt ricIIrIs indic.tod thot
.IS t1Wlll'.IS 25Snllibi,od m.J1JIC'I hypopI.ui.L II: .... bn
Itpottod rtwt hypocni...... liution of
is f~
'l""fltly found in ttww mld"",- No oUtn- w.rnin d..r,..
citoo<~ h.M' <uch notolbk" rifO'(l$ 00 !OOttI fonn.J.ion .IS
do vit.min A. c.,ond 0 dcl'lc;"nriI's.


Parat hyroid Hormo ne

increased width of predentin


_ "-- and dentin

cIinic.iol ;tppear.mee of 'ricl<et5'

_ _ _ _ _Ca -.e1lilarTWl 0 def"Cie:<~

fig. '.7 .... tr.. ion of 1nttJIDw- <ll'Ii... _ o f _ Odol'.do<.. , .

The pilr.thyroid lll. <ld. rcgu Ln e ca lcium boll" ",-" in t he

body _ A<l Im bollal1\'t . ~ it h"r de ficie L1CY or eX<'t i ' . o r
parathyroid ]lo rmooc (l'I'Il) "',ly olfeot 00" 0 , ,,d tooth
formation. h oe.. PTH (hypr11l. r. ,hyroidi.,m ) CauSCS
mobili Zilt;on of cokium from l ite ske leto n into t i><' blood
' t"'.m , calcium ion. m.y Ihen be e"""'tcd in u,illl',
f<s. .nd ,~t. f'11l mq inA Ul'OC<' ~II of lhese rn<'CI>;Ioi,ms. C.lcium t><Cf'!'lioo "",ull'S in hypo<:.l.lremi4l or
dKn'....-d ~I' of blood c.lcium. '"'" bonr, in tum.
mobilizes ~ cU;'ium. WMn Gllcium rMOrlfbon i,
..... t~, tllan c1eposillon, OSI<'<fI'<l"OS" inuits.
Osttoporos;s nwy tllm. lor rumpIr-, ti><' wp'
porting.-u bonr of tho _h.
As shawn in Fi&U~ 8-'. c.lcium mobiliution in bonr
rnult> in ~ bont dmI'ity ..,.,..;1 fW 100dl,
whidI is 'in'II.IS' thim"" of the ..,rni... du,.. I............
....r.U'ymM:l' (1rypop.I.'~thyn>id"m) ",,,,Irs in low blood
CO<Kl'nlr.l tians of ioniu'd ,~Iciunl, w hich uusn an
inCU'. ... in gLlnd .octivity. Bon~ d~n.ity inCR'o<'tS, w hich
.....ull'S in i llC~'sn1 th ickBCS5 of m~ I.lm i... du,~ ~nd an
i n",,~se<I d~n'ity of bone lr~ l>ec ul a~ (o"'""l""ro; i. ~

_ d ioiGIl Application

fOg. 8,' fli'lolOllY01 vit.m in D d ofl< ~n< y, _ till ;' iIldi<.tod by
~"'\l LJI" ,t.ini09 oflhe ""'tri rod bywid. po.d"nlo"


O>teo poro;is .....ults w htn c~ lcium 10" ~~" ... of

~ sotp1ion is g "'~t c r t han (a lcium de po'ilion. This
m ~y be evident o ,~ lIy w ith 1= of . Moola, 1><",. ~nd
loose ning of t ho "'.1 h.

._- -


calcium i< IlQ( ~ _ from nutu1'P IMh .. iI i$ from

boot; <0 lhe Mruct\I~ of -r. Is IlQ( alJtftl bV hypl'rp.irathyro;dism ~nd l'Iypopa.-alhyroidlsrn, 0'l<'Ill' dlll'in:l
MwIo prn~nl.


ParatliYiOid Hormone moaliinces'

Effects on Dentition

HYJ""fP" .at byroldis", wi ll ca u~ an inili.lJ IIypocak l'

of Ih~ fo.mi ng d...,t.llli.. ~, follow<'d IIy hypH_
calcificat;oo d llE' 10 ",,[=i~ blood ca"l "m. Calcium
cx"et io n by Ihe kid neys f<l llo ws. The ~ff.Cl of
hYPol>J..athyro;,Ii,,,, " nd hYP0rJM,.lhyro;d;sm on
Is illustraled il\ FlKU '" 8.9. II seclion of defl"(liw ucuun
de.1fy sh........ 1M cffl"<:t' of both hypop..1.athyroid isrn
and hyperp,ow hyroidism (fig. 8. IO~ Tbr horizonlally
stiioC'll b.ands ifilU....' .. 1M hypo(~lcifiNl ~ndlor
lIrI><'rralcif...., mnrs. /I SC'ri<'s of inJtttion' oJ poralhy_
hormonr i..o npnimmlaol anomm ......., &M'n 10
ictl_ thi< cfkon. T1w,.rore. boIh hypo1'p.Mathyro;dlsrn
ind hypop.>t.uhyroidism prod",," ukium i ~,
which ,,,,lIls in hypocaki r~ b.lods In lhe formln,
......Iin. /110" of in lhe SIlpponing bone ocrurs
with hyp<.'l"po.a, hy' oidis",. and ill(~aS<"d deposition of
mine.a l l" "'" placr with hypop.l.' alhyroidis"'.

Tet racycline and Fluoride

TO'I.)"'I;ne and n~, if ""allaN. during 1M m"'.....oliUlion ph.J'IC'. ""'Y Iw i,,,,,,, poIafO'd in ...... lin. """tIW'I.
amo:olwn. .and bonc'. Tbfy . . "'rlY dilferml compounds. ~ is i bi....ry cumpound of n..-irw, ~
fill .. ilII anlicmn T.....y<iirw. on lhe OIlier
h.ond. i, ""'<I "-! an .nlib.K!<'n.ol.,...,l. Ilo!h "'" d~posil_
~ aloog wil h mineral< in dcYt"lopiol bard lis~
Tet.dcydine i, dfrivl.'d from a Y\"lIow gold fung us wllose
color is m "i n," i ,, ~ d in Ihc pmi fi... 1.",libiotic . nd lr.m<-


rod D
oI ..........1ngbonds oflJypo<. l<Jf'.ed on<! I>n>o<c.l<.
foed <Ionrin. T...... bonds m>y dr:monor.alOthe clioical . P\>C....,CO of
trypoca"I~~ lOOf~ and b<>ne.
fig. 8., ,, """'--' of I"" ' -...

of PotIoId _

Di.><J<a~ oI .~ ind<N Mf......J "'-"PO't1ng bono!. C .


'lI .......,.



." " ",,,0<1

Olniu l Application

of I",y<iine> induck suinins or lMh.

hypopl"-!i.l, .and km of """ITJ<'I. Most of IiIC' suinillf;


is in Ihc lImlin. which is ....,n Ihrough tn., lran,lu< """ m ~ l .

Fog. 8.10 AIferNIing~""""'rod _10

I"',;rt ho,"""'" It ;.< ti<Jos- ' .. botIdo 01 ..... "'-.1 ond Inc,.......,.j m ..... ~
izali"" oIll>r 1Nlm.

l 46 _ II peveJapment at ~he Tee{~ andSUPPO'1ing ~"Cru~,"'"~=

Tetracycline-Induced Changes
in Enamel and Dentin

felTed to the hard tisslI e, in which it i, in,w pm_te,L On
prolonged exposure to light. tetracyd ine-'t<1i ned dental
ti"ue will eh.l nge color to J I>l'Own to grJy (the, e shade,
of discolor<1 tion are <'Yenl u.llly ,.,'n ill ,he leeth) (Fig,
RnA). Other effects of ' etracy, lin. , i n d \ " I ~ hypopl,l si.,
or absence of enJ mel. Staining is most observable in the
denti n, e' [l<', i,llly in the r.r<t, formed dentin at the deminoenJme l j un<tion (DEJ). N"t.ll,le , t.lining of tlte cm wn
is priLllarlly fmm discolored demi n b<-i l1g ,e en lltrollgh
the IT,i nslllce nt. lnd relJ tiwly ullaffccted. c l1 amel
(Fig,S,H H), Figllre 8,12 i< J11 ex.>m l,le of J pJt;ent to
given ,lur ing e,lrly i" r,Hlcy,
whom tetr acycline
St., ining is not visible in thc ccm ral incisors, <1S tile
frown , w,'re rorm~J aner ce<SJ[ion of treatmellt with
tetracycline, Th~ J iff,,* ,t,lining seen 0" tll~ eral illcl"or, J lld cl1Sp id, indicate, that tiley W<'re umlergoing
,Ievel" pme" t J t tile time, Tetracycline staining is more
noti,'e,lb le " " der ult rJviolet (UVj light (f ig. 8,l1B ). Thc
amount of i, dirfe [[y rel.,tfd to the mJgnitude
J <td dUI',lt ion of the dosage : any defects ,.<1",,'<1 by t h ~
tf tr.,cyeline may be com pounded by t h ~ effects of t h ~ ill
ness it, elf.
The preci, e mcchani, m of t~ t r<1('y di l1 e in,'or""r"t i" "
i<tto m;nerJliz;ng ti"uc is not yet known, bllt it is
!>e l i ~w<l l h,'t a cbel.lIe of cJ ld um alld tetracycline forms,
!It higher concent [atio"" "f ib m"y lx' " llel'e d. .1S i, ,e en
ill Figure 8.11C. In bot h "melobla, ts . Il d o<lontobl,1SI ' .
[he ci' tern.,e of the endoplasmic [et icul" m !>e,'onw
<l il. ted, . nd prolein ,y "tI'e'is i-, imp,' il'cd, Tlti" in turn,
will [cs" lt in hypoplasia of the en" "" '1 .lnd den ti"
T~ t r.lCyt;l i " e alld, to J limited extcnt, sodillm ~uo[ide
cro" the ploCt>nt,,1 h.' I'I'ier .lnd J '" ,w.,HJ ole to the
hllman fetus, If a pregnant fem.i l. ",,,,, ,,m.,, nuor idJ ted
WJteL' duriLlg mincraliza tion of the fetal teeth, the tel'th
will ;nt Orp'>r.i le tlli, ro mpouttd, Such teet h exhibit higher rcsistan{'e to dental <'<trie, . (oml',lred witl, tluoridc
blood levels in the m"tern<1 1 cirn llation, n\loride 01o<x1
lew h il1 Ihf feluSJ re ", ively low, If on the m he[ hand,
tetracycline . nt;bioti,s <1 re ~ d fll i n i "e, ,, d to the mot her
during the period of tom h m in ~ r . l i" , t i" n . t h ~ ,Ie<: iduous
leeth mJy IJter be ' tJ illed. Tetracyclinc ' t" ining of [{'eth
is perman" " t; <t ~i n i n g of onne is not permJ nent !>e, a" sc
bone i, remodele,1('(mtir"," u, I)',


,o)d"., """"""'" <1<8"""'''''''

oo'e"'"" c/ O!"

wit~ los, of~

FHj. 8.11 m e<lS of telw ydi ne in hum, n ' eeth result ill ' tdi"irIQ ."d
hy,",plasticen, n',,1. Sta;ni"9 I' ("V,ocm in first,formed denti", Botll
, moloblas[ , od OOontool" t .ndapl.,,,, i( 'oticul, arc . i[ocod

The period mJ rkcd by mine raliZJtior1 of crown, ex t ~ n ( h

from "W roxin""ely ') mon tilS in utero to 12 yea rs of age,
and i ncl lLd ~ tile n,irl('l',ll i".l tiol1 of bOIh pril11.ll'y and pcrmJ nellt den titions.

f iq. 8.' 2 11I u>t<otia" of tetrocy< lino" .lining in toolh inJic"te>th,,' II, I. " i"9
of the ," teeth developed wheotl", inj('{tion, were performed.

Th<o r....rh 'hown in Figure 8 ,I l .... hilJi l brown 'I~ining of

rbe inciSd I ...... Ihird of rhe "'ntr~l i",iso~ This suining
is due 10 relr~c)'di~ Ih~r~P'i It... t oceurm:l d uri.. rbe
inil;"1 plwoes of mi~~liulion of, ~ reet h: Ol~.
wi><o.'h~ tMh would ~ ,,",",n ,,~ine<l """'" ",M(~lly.
(crvk~1 SUlni"! is rn<lI'" ch.iIr.><misti< of t~r~iM
btulISt' rhis 011"" dtposits primarily in thO'lImlin. The'
101C'<.1l ~ indoon, (III the Olher Iwnd, ~n
mlllft~liutlOll ~hn drua; lher~Pl' ~nd ~ no( .d'fmed.
~ 8.14A is ~ phOlogr~ of monlrd ffWI1>tl<'ll by sodium f'luori* _ MotIIed enomd <lMnibn
thO' SC~l1<'n'd silt'S of ~ion ~nd ~
SocIium fIuoridoo w..... tlkm inoo [he body in ~Ir~
riOII of 5 ppm (whid1 OWl'S in some lIJ.tur.1l1y fllOOrid.or_
rei ~"'.." in rbe Unired Sl.I!o'5) is ~nl~, buI ~
c~""" moIrlord nwmd. The mon!c'<l ~"'as m>y or ~
not be mi~r~liZf'd (Ap. 8.l4C ~nd D~ The nr.ornrl rods
k>l1ow.lll Irn'lUlor <:ours<' through ~ ~ ..... s. DnpI1<'
tMir unsighrly ~~r~n'. 1"- ~lI.
~ of r~""" Fl"""d<> I. m051 b<-nriio,d to tM le('(lI. in
lfIo<C'n"~tions of .pproxi"w ely 0 .5 to I pp m of w~rer.
(Oll'lltrOllon ofo.s pp m m.y nOlpr"""nt " riM. Higtwr
{OfKrnrr.r iofll, sItCh . s 5 ppm. c~u"" mottling . nd
lIypop",sl. of Ihe ~n . , ""l . nd lIypomlnr,ali,ed den lin .
willi. lll<rr o"d Inlerg k,hui sp.lcrs.
As hy d' O>l y~ p.ltl tr crystals form . Ihey may ' ",o,po_
rale fluoride . it l,," by an exchange with lb. hyd L'o>cyl
group' O' by ,in ' I'I~ <1(I, o'l" ion. The hydroxyl ~ro u l'
" " han ge ts . I ow~ r a",1 I"", "",ersil>le tha Ll adsorpllo n,
In Ihe 1<1I le, process. the fluo,idr m,lY he ad"'l'bcd to th e
.urface of hyrll'Oxyapa tlte crysta b. Thi, . d,orj. ltlvr
process I nvol~, "",. k ~leell'O'latlc bonding. Ad",rl't'on
IS b<-Ioewd to be .~pid . though revers ible I Fig. lI.1 5~

II i. b<-li......d fluorid e found In innn eo.ontrl is

.lblfbrd mainly during lhe <ecrelory ,taV of ~mrlogO'
.....i. 01><1 rll.ll fluoride found in l~ oul... 30 lOSO llIIId
......rnrl O("{"I'" dun .. r~ m.otur.rivr ~. Brc~usr thO'
IoIW ~ lostllonur. I
is ti= for morr fluorid~ to
br drpositf<lln rllt' ool..mrL The' maru liYr hom 1 10 2 )'<'.rs in prim;",- ~h md from ~ 10 5
)'<'US in pomIoInrnt IMh. This may br lilt' ",oson for Ins
0"",* bcillllound in prilTW)' rttCh f1wnin prmwnrnr



Fluorosis of Enamel and Dentin


~ pi" ,,", """ """*"...", 01_

_ or _


- . . """"


lX1afftt"d ,'no""" ......

,urf.(~ r"


1".,. 8.14.......-.00.. cllI\toll'flt<fSd ......... lIuori*on dfwIoping tedII.

" Ch<.ol p;nu... ~ brown-'\t_ ~ oiIs.' ~ d
thew plts;n
d Ihf - . _ ill (A). C ~ "0:<..,.....
Ul ....... d It-.. _ifdrd ""'" iol t'~ D Hypocaldi<d _

d thr ",oOoded

_iIl (q."",>II~

Whm hisloIopr~illJ.tion is<t>OOU<1<'d on Ift(h from

.........01 hilh ~ con<ftUrailion. the ..... rnrl is found

10 br

~ltcml,ll.ln l he d<-nlin. Enamd rod fomulion is .lfKtf<l .nd ."""" of IIypopl.tsi.l .'" (OITImonly
found. FlIu", IL l&., . hows .n u of
~i.o ~nd suinin! in l he 'f1tr.1l flSsu",of. mol
moth: rhis u w.lS c~usnl by. Iligh co""""rrahon of
flootilk. ~ Ih.ll'h~ innn ......mrl isst.,nrd leu rll.lll
the ourer ..... m~1, Thi. is """,,"use the Inn rr nr.omrl I.
depos ited prrn~ r~lly. whtn less fluori<le i. .... ,loblr for
Inror pou llon.
T<1'at)"'I I"" w r." 1 di"'''''''red 10 he p....... nt in
h"m~ o ll'C"th .nd bo n.. whrn tr. c,,", we... drt<'<ted in
ilo,lO. vit'wrd under UV light Thi. oh",rv'lion provided
~v " ... Ibo<l of m. rking bone s and l""lh fo r follow ing



ll>tir d<'" "lopmmt _ All ('UrnI*' of this prO<T<1ure Is

shown in Figure 8.17. in whlcll tM slab of dmlln US
phorou.phed undr1" UV lip!. no. shows
1M. =-~i.... h.ld ~ inco<pOl~!<'d into.- dentin
' .... 1 _
mintf.olitirc. This ('fNled ~ W'fti<.ol .udle<I
lilllO$ rrwI<i"1l ~'lt' ioljt<:tiom 01 till' f<1r~~



compound ;nicwlJy is


in rt.

ptf'drotin . , if mlntfJJiffs into ...milL Evido'nc't oI lhis

nwTl<ing i.
in tM inrre"" illl di,wlCt'
~n n_ predentin fOfll>ed ' 00 tt.. . re.. of n..........
ce nt dont;n. Jl"USl' thl' l he '''p''ut ic dm.>ge levol'l .nd
vi'u.11 t i" ......labo-Ii"ll 1~ls roinOde. ,cnacy<linr
l>et-o widely ust'd to vi"", lIy r<"(ord growth in ""I'<'ri.


f ill. 8.16 Hhtology 01 fi uoro;;, 01 "", moIl00' ,.,,,, hypop!.lslM: p it< . ....

me nt,,1 ani",,, I<. The da ily de posit io n I,lte of denlin .0

., Il~ -.d brown-,l.i ",,~ """me l.

lhus be recordrd by m.", ,,rirlg the width of ocnnn

between CJch fiuoll' '''." l line, In Figu re 8,17, f1vt' di! cr~l ~ lines of tetr<lcyd itlo 5la;ning ill dentin at. ",'e 11 ,
One ;s more Widely lp ... ~ d l h~n the ",st. In thi! in51alK'. ,
lPl, ..,yd i"" injections ......'" ,n.>de on doY"
S; I(.
- . . . nine.dnd n. ExlX"rim~n'~lIy_ if ~ soxnnd dlUg wu
~minisl~red on ddy one. ee ~ff<oo:1 of thi.< compound
cou ld be m~~.ured on ~ntinog<'''''';s by rornp.>ring,~
b.anding p.mnm 'II the dtnhn with thos<' of ~ romrol
~ni"",,1 10 whim only 't:'fr~i~ w... ~m;nistrml.
~ U'mC)di~ is ~"".j in thc dlrnli~ ,ubult$..
.o<roUn~ roo- ,IK'
fl~, l i~
SIf't'I1 in F"1gIl'" a. J7. T",.~ li~ un be usnl ...... 10 tv.....
...tetl lO(J{h ~' bjr ftW~lins bo:>nf,.ond dmtin (or"",,000 (Fig.8.18 l This: di4'~m .oo.... lWO li~ in m.
cWJl{in of ~ a.-n. which indir~ln , ho' ti"", ~ n
injtioM. III mi. cae, ,ho' crown """ in tho' Nrly Sf4'f'S
of form.>'ion.. prior to ....plion. ~ , hJl ~ ill no
line in the n><J( <!o:'ntin. bu, IhJ, Ih~", ~'" two ~i.,.1
lin... in ch~ ~I~T 00"" on tM right of th<' ronIS ~JlII ;n
Ih ~ bifurr~tion l OM, Th~se Ii......,....,.., formed during ~
differ~m lime period, I>I'fo," tile roots we .... fo'med. The
tooth moved to the I~fl. ,HId , h~ .1vt'oIM !>one thdl
for med I>eh ind the " ,ov; n ~ roots WJ S cledrly 1.,I",lrd by



fig. 8.17 A ",,;e. oil..... 01101'..\'<1.... ll:oOininq In dellln m>rl< tho _
opla le. In ...."'I'llh""';, .... ' d"" OI. ' '''InI''9_Photoq,ap/l u....... UV


_ O inkal Application

HQ, 8.1B lJi>ojrom 01tetr><:),<lir>e l.obtlin<J Or,I"!I100lh ~Iopment .. d.

col.. h,,,,, in ~"9 <!on' in".,d ,.....,.. font>.d t><x>c. NrfHI i,ldka tMI "
dlrO< llo" 01 toot h m"""mO N.


B.-own <l:J.iniltll or d lief!: in tlte """m~1 of 1M

ioci",llhird of rmw ... indlcdtl"< the p"'leoc(, of ~
twcic subst.lJlcC in th~ body, dI th<' ,i n'll" of inil..r
m;neralild t;on or tile lfflh. I.ocJlion of Sl~i "i "g In
tl>e '~J'\'i<al J "'~ rel.ltes to inlrodu<tion of ~ tI,,,i ,
", h,t.ln<~ at d tim<' of final Crown mine'Jli.. tion.

8 Agenu- Affp(:ting Tooth and&me

. __ .

In f".,..... &.19. ~ IN pllolom icro&rap h of 11>0 lOOIh

rootsand tIlo' ptriodonl ium, lllie'R' Is hNYy O ~
In I~ roots mel ~ ahoroLlr bonoo. 1M lHracyctin<' was
~ by balh sit.. d hMd-eiSSU<" df.posil:ion. _
indical" Il\a( bortI !he roots ~ l he supportipt bonoo
~ 1il1dt-op>i'llI: dc .elopo"e"I.IIl I~ rimr R'U~~"",
w,lS 1njtcd.!15 can '" dnnonslrafftl. ~racydi"", IaJ>d-.
i"ll is a val.... bk prtlCftI Ult' for .cudyi"ll l~ _lop"""nt 0( lfflll and I:lontss um m.lry

A' nOled on I he left of Fig"... 8.20. th e secl ioned

toolh exhibil' -appeMing . mrlob las!,.
odomo hl.,ts, e n. me l, dentin , .nd pred e nt in,
Compa,e Ihi, p""el w ith Ihe neXI, wh ich illu'l, ate ,
Ihe degeneral ive change, in Ihe .melohl.a,ts .and
. ffeaed e"" mel dewlopment associated with vit.min A defi ciency, Observe 11>0 . Itered a wear. nee of
the adjacent lim -fonned de1l!;n.
In t~ .....XI panel viUomin C de fICiency i, =n to
p rl"..,rily affect con ne<1~ li...., forming ce ll"
sucll is t he odontobla'I., libmbla<cs. a n d
O5leoblHt$. !15 a f'l'Sllll I~ l issues fur whictl fhese
afls a... rn.ponsible will also'" ad'o'ft'Sriy affected.
Viumin 0 cleficietICy, _
is indlCatf'd in t he fo!1owI"ll panel is __ n alJectilll m ;ner~liut ion 0(
fftlll lll('fNS(d a...... of llobuiat dmtin .....,It with
rorlt'SJ'O"d;n~ inrerglobular spaas. n..... is al", an
iroo:n.ued widlh of predenl ilL
On lhe far ,.;ghl of Figu... &.20 . paralhormone <Im-

ciency tan be ohs el">'t'd having simi lar effects.

Hyperpa rat hyroid ism ...,,,11' ;n hypom iner. lizl'd
den ti n, whi te hypop.r.thyroid ism co nt ribu les to
hypenni "er. tiled denlin
If rt'I'I,lcement Ihe rapy i, provi,ie,l , nurm~t de nti n
d. posilion w ill resume In e"ch of t hese thyroid d elide n( ie,. Defective are .. in I he teelh are not
rt"SIOfI'd, hoWl"\l(c, as is the- ( . ... in bo lhal will be
....modeled. Allof the effect, d iscu\~
p rod ucl'd
on ly during 100111 d"""lop mcn l, IlOI: in fully <level
oped Iffl ll. Tffl'a<ydine a nd nuoride a.... a bsorbed
duriOlJ I"" minerai izoorion phaw o f
drnl;n formalion : bodt CAn p"net,a~ lhe "..,
b.orrie1' in ulero. Tetr.K)'C'line ca.n ~ 5tOining and
~ of
md bul wll h Ihera po1llic """"'
sui";.., is
lly mosl: evident in lhe r.r<t.1'<lrrned.
dentilL This antibiotic ~"(f'S a "..,rt on denrin
a nd bonoo, which is only visible undn IN light
~r,,",. il i, used fur """"""n"ll m",n ,iized. tisour JI'OWIh. Exce"i~ fillOrick' CA ~ brown suin_
illl And hypopl.l$ia in .""mel (Ags. 8 2 1A a nd 8~
bu l t~ enamd is
iSlam . The hypopla sia ' p pe. r a, pits 0( 1>0 in broad are ", of t he
crow n. One I"rt per m illion "fford s m.,imum
(.,i protOOlon ~ nd minim,,' h"rd tis.s"e .Iteration.


,.ries .....

Iioo ..oow. 1t'I r"y< ~ ..... fIuor=Ke In n>Ul. .,ld

.. """e (eros, "",tion). f'hoI"'J" ph.d urKk< lN lig ht.

f~, 8,19 H~toIugk _

Sogog<osltd Re.dm9'

( _ SCI- Tet.-y<1ine St~ oflH<ll.



~o. ~"'I'A.IMw.~ ~ _ """""""

pC i...



_Sund.j.D<tc._ "77;C'SICl

=K..~_of"""'~_ VorI<,

H't: Mao ' t t - '


- " __


enopt_ ...... ld[.cydliik _

kUd.J- Or..
PIIooJNcc>L 19li4, I;llia.
~ ItS, 1>truP A. Doio<tIII INS.GlotIo fa ~


(1IiId. l!l1lt :-48: mt,


rc. 1JkosIeff l L In .,[ro ,nhd.~"" of mouse

differ"" ,i>tion bjr ..... min A. Mh.Or<ll Bioi.

ll\'i ns /T. A"" """, moo ()/,ho ion""",. of hornIon... vit.mi",

" ,d .. "'" dl" , ')' foc""', on t~ o for"", U"" of 00n0, <\col!;"
, nd on,"",1. VilO m. flo ,m . 19 57 :24;:/91,
K, lIon l>o<n E. Mk,,,,,,,,P'I of te" ",:yd il1o i, ~ l u o e<i I..;on in rot
Inci"" en. mel org., n, Arch. Or, 1Hi,,1, \9110 :24:869.
1(.>w, .. ~ 1 K, f.mlJ<>dd I(W, On ,"" " la' ion, nip b<twe<n '"",
<)'<'11 "" , nd tllo I"",omenulll,... I" II"I-j. An.l.

1975, 11 9__ 49 .
iJ 005e d<1><nllen< ul"" '"",1uf.1 <ho '~ i" d OC<d by
ldfocydlne ~;n~ ,,",' " [i....... of ,he r... j. Oent.
Rn. 11l75:5<l"n.
Mol1eI1 )M. (""." IlO.0IserI NH. 11tf'.. " JJ. I'l't<h",,,,, of
I..rocydione indOC<d _
di_"ioILj. "'"- DenI .
. _:81:547.
....-.J.r.. ~of'Ilt~ ..... T........
s..ndo: 1970.
_.'l A" " ' _ of Or.. - . , . Mo' t ~lli ..



r" ""

n.,foI... A.,,~~IIit>IoP<.. _

............... _

'_ ' jDl'M. 00iW. 1911,41:100-_

_ ibut. . ol ..... _1OI1t1o plIionory

0... ( $ ." 197I:6:m.



F<jenI:<>JU" -..... I'Il ............. ill

(O""'''U'"1y llrnL o...l EpdmoioL 19l't:6:l15.

Isen"",,, l>it llIll'..tu<I""I_1'Il

_in "".....ion in ..[ inmon _

11I. _ tnplt

n.... id< injl ioJl ~ 1lrdL ("..1BioI. 197~: ""~.

~td 1 Nylen MI. 005e . nd
drpendrnt ...... ioJI,
in off, of '<IT>eyd i,,,,on ' 0'1'11<'1 1"''''''1''''' in [<>I. le,n<!

J. 00:"" Ill'">. 1915 :82 :209.


Self-f valllOtion Rwkw

I. Do tel'r~i"" .oo n llOri"" c ross,he p lace nu l


Fig. 8.21 ~ of the .tIl 01upt.... of telta<y<'" ' A' and ft_ (I ),

_ d ini<:..IAppliution


of wter ... ppt;es Ituoughaod the ~ted SUot.. is

dmtistry's _
~ pmomUlM prop.un. Wbm mottkd m.omri WdS ~ 110ft<! IIwn! "'.IS ~ .....a.lion with 1M
I.od< 01d",ul c.a~ Sodium f11101ide was round to .... !be UIISO'
of this phmomenon w hen ~ in !be _Iff supply ;>l , I~I
of 5 ppm or w. ln l.;tfef. it was found that 115 ppm ~fflI
carl.. a nd did nOi c.u"" mottled e namel.
R II(lr'idMion


2. When ."lI ln w h;o( form

t~r.<)'dine . nd/or fl.
oride depositrd in IImI fi>.sue's?
3. Do dinl,.1 ~ oftro~line'OO high ~ls of
n~ prod\ltt ,n elf..." on hun= Iet'lh? If so,
w!l.>t .... ,he d in;e,1sym p<oms?
4. Enumera te . dv.mages of II.lrd-ti'l<rue IabdiJlllwith
,clra<}Kli"" when one e'o'.IU'loe'! ' he effeer, Dl .~nts
on tooth and bone d evelopm ent.
5. Comp. t"\' differe nces be tween "ootide an d tetracycline by cont ra'ting: th e ill;mne r in which den tin and
enam el .ro' ' l, ined.
6. What li ,s~ in the body are prim.lriily affected by
d<oflCientie1 or vitamins A. C. .nd D1
7. How is ...., 11 of I~ ,ltfki"",its dinic.llly dl.>t.KtmlM in the ~h?
8. Describf ,Iw effe<ts of bodl do'ficitlKY ..nd n<rs:I

or ""r.. ~ 0Il10CJlh f""",,l ion.

9. Why "f~ tlww ~ffecn Umi~ to -top'''S t_h

. nd oon... '

In Wh..r are , h~ period,,"t. 1symptom, of vi"'m,n C



Structure and Function of the Teeth




9 Histology of Enamel
Nich ol... P. ~ .ond );1m" Sim m eoli....

Enamel is. hithl y mine1.Ji'd 'il$<r~1II the I(IO{h
crown, uniqo.>l' btca use it i. 10Ul11y "",J1ul ~r aoo i. pr0.duced .. .. r ult of boIh l he ~w o ry and n1'1Orpl i'l<'
activity of epithelial cell. Additionally, the enamel
""'tr ix consi sts of un ique IIalrix prolei'" .ond lilcks col_
14oM. 1 ~ "",in INtlix oonstiluoenl of mi,'enJiU'd tissues
"lisilll from ~ or ecto~lXhymo. A dentol
lXIYefing. ........... IS highly ..uplM [0 wi~ 1M
Ioo:n of ~..tion ..00 10 ~ _ . 11 is 961 miner,. by -;gill ~ two .. sinsut- (]'y!;QJI"... .cructu,", in
Ollmp;I[ison 10 allIer millO'f.. Jiz.-d ti~ E/LJ...... is
unique sin its hyd"""y.op.u ite crystals .., a tremely
I. ~. highly oOmtl"d. and p.lcked into rod-Iiu >tru<.
lU"". The <>rient..lion of lhe ename l rod. and the crystals
within roo and inlerrod enamel make. it I brittle ,,"d
provide. it with iI e..nain deglft of " e" ibilit)'. el1.lbling it
10 wilhsund sht..rinz foras. ( ""rod a ysu ls . ... romJlOllrd of hyd""'Y.""cil<', bu t ab o rontoin tr~ minerals
( n......""til<' .m(l c~Ud .p.;Iti teJ.nIl [<'I ~ts.
~ ~ CJysl" ~ un ""~ m.m>el
aysul:> ~ or 1M> suoaptiblt w .odd .1Ud<. Tht dismbution of fUln compo ~t! wrtIlin die CfY5UI also
~ I ~ift$ the pteuli.ilr rmn~r in which ~me1 cr}'SQIs
dlol~ in ~cidit: soIuti"" . The ori~nlilti"" of cryst.1s in
rod ilnd inr.-rrod en. met . loq co nlrihuto' to etching pdllern, in cariou s le.ions.
The muctur. J fUlU"" of ena.....l ..In "" do" ifted as
lhose ""soci.o\ed Wllh Ihe dmlin~ junction (DEI)
~r>d inil;.,t elU rn<'l fomulion, those ""soci.olN wilh
~ powrh. those ~llIONtN wittl d'I.Invs in
tI'Wnd rtd orwnurion,
those . ssoci.iII:td W1tt1 die
surfxe of die IOOth.. En.a l spindlts, rufU. uod ~nltIbe
..1st '" the Dj. Of these, spiodlts m. mtsenctJyowllyde'ri......J "rua um re rr~ling exlensions 01 """Iinal
lubul", imo (he ena mel m.tllll. Tun s ~nd 1. .....1Lae represent hypom tnetali"ed reg ion, In the enamel. and are
g!'lle'r. ny ""lieved to "" ' SSOClaled with sln1<:1uril t weak nesses. Tufts ' re ",gular stnJCrum ~nd exr.-nd lrom lhe
DE] th rough Olle'-thin:l lO oroe-h<ltf 01 the thidness 01
~mel Tbri r "'lUt.. 'we.u-mce ind iults l!wl !hoy
IN)' "" .n inleslll contponml linti", "",mel and
dmIin. l.Jmrilat ocrnr less frequently. ~ ffom !tie
DEj In !tie enmle'l sutfaa. re~ . re.>s of silJt iliulU
~il kness. .md ire SU>a'pCibte lO fRau",. Strunu....
",t..N to t he appositional growth of ~ nameJ ind ude

r 'O" 'p tN Outlin~---------------"1

IntmductIon... 151
Object........ 154

""yskal Char"teri<l~ of ENmeL. 155

Crystalline Compo nent of En. meL 156
Organ ic Matri, 01 Enamel... 157
Stnl cturat fNture<; of EnameL. 158
Enamet Rod: 8..i< StructUfilt Unit o!Enamel... 158
Dentinoen;lmelJuncoon ... 161
EnamelSPindle... I61
EnamelTufts._ 163
Enamellamellae >d Cril(ks. ~ 164
'itructIn'S RMN 10 the Appositional GrowttI of EnameI. . 16011


Additionat f eature<; of Enamel... 167

Gnilrled Enamelilnd Hunt SChrege< t>.lnd... 167
Surf.c e Co. tings 01 Teeth 168
Oemineratlutlon ol En. mol 168
Summary... 170
se tf-Ev.luation Review... 171


!II Structure andFunction o(the Teeth

cross Stri,'tions ~ nd Retzius' stri"e. tn ground sections of

teNh , cross striation' extend over the enomel rod with
regular frequency giving the enamel rod the appeara nce
of ~ IJdder with the cmss striJtion, repre",nting the
rung<. The "mo unt of en<,mel between cross 't riJtions is
believed to be formed in 1 day. Retli",' >tri"e are
hypomineraliled. occur less frequently. and display
varying degree' of prominence, They repre,e nt Incl'C'ment"l lines spaced 5 to 10 dJys apart: ~reJ S of e n~mel
rod constriction arrd irregular nystdl packing; ilnd <Ire
formed dS a result of difTerentidl deposition of rod and
inlerrod enamel. T11e mo,t pronounced mi~ i" lhe
neonal"lline, Where the striae meet the ,urf" ce of the
tooth they dre dssodaled with groove, called perikymato or imbri""lion lines of PickerilL Micro"copie features
assueiated with undul,u ions or the en"mel rod are
glld rlcd endmel dnd Hlinter-$chreger bonds, Gnarled
enamel is dssocialed with tbe highly twislcd endmel
rods that occu r in cu' p' an d i' helieved to hJve
increased re ,i 't a ~,e to , h e~ r i ~g forces. Hunter-S<h reger
bo~d, " re "lteIThlting lighl dnd d"rk bands obs~rved in
gl'Oulld section,. and represent pdtlernSof re~e<: te d light
from cross-sectioned and longit"din,1 11y sectioned
enamel roos. Surface , tructures on . n"mel con be developmental or dcquired, Devc!opmentdl struclures i~cl u de
the en~mel culicle. which is lhe I'roouct of celt, of the
.n"mel orgiln (prim"ry w tk le) or the cells them,elve,
(seco~ddry cuticle). Acq uired c""lings Include the 'dHvary pellicle (dcc u m u l~te d ,alivary protein, ). plaque
( aC\; u mu l ~ t i o n of b;l c t eri ~ in " soft M xtr,'n m,1trix), .,nd
e"lculu, or tarter ( mi ~ e ra liled ploqlle).
A thorollgh under<tJ nding of the developmenl. ,true
ture, ~ n d physic"l properlies of en"mel ,os outlined in
this ch"pt~r provides the cone~ptual b"'i s for the dent"l
lredtmenl of cariom lesion< ; for eXJ mple. preyenlive
me~ S ure S (fluoride tre"t ments. ",a l, nts, eK), the design
of Cilvity prepa Tatio~" choi'''' of re, w r" tive m"teri"h,
Furthermore. undemdnding the factors lhdt relate to the
deyelopmen t of 100lh color (aging. develop ment,1
defects, st"ining,etc ) i' important for f"n<1io~a l a5 weli
as aesthel ic co n<id e r~t ions ,

Alte r re~ di n g lhis chapter, \'<.lu should be Jille to de,c ribe
the physical feature, of enamel. which make it " n ide,,1
covering for the loe>rh's ' urface. d' well as lhe structure
or the enamel rod and it< relation, hip to Olherrod' within the en"mel i~ difTerent are", on the tooth (fwm cusp
tip, to celv ical areds). f urlhermore, you should l>c dble
to de.,cribe other struclural fealure, of endmel lhdt
make il resi5tant Or susceptible to carie, and/or fr"eture,

9 HistoJogyo{fJJame/


Phriical Charaderistio of Ename'

The p hysico] <h.>r~i.s.I,o of en amtl malce it.n ~~
"'n t ro W'll ng fnr th" lOOl~ ( tOW D.nd u . approprl"~ fur
itS pr i" " ry I" oction', to enable m~stlcati on.nd protect
me unde rlying de nt in and pu lp. It il t h. Ilarden and
mo<t mi_alizoo ti~ of the body. Inden tat io n te<U
tuve <bown th.>t the ~ Knoop twdne<s n ullUr
fur en.unel Is .pproxim n eiy lot3, tn.Il<ing cnvncI 1M
times "".... than ......1In. lbt ~ ~ MUI' in
t .... ~. Enall'll'l .KqUiff'S 1' - cnalarnri<tics b~
wil h tn.IlUrtry. it ga'n< in mineral ron~nl wh at it Im<'S in
both Ofgolni. mal. , i.ll .nd w,,~r. Matu re .na mel is.bIe
to wil~'tanding Jbrasion be cam e o f its eXI"' high
minerJl ronlc' nl (TJ ble 9, 1 ~ As a hatd. highly mln e,alIud malfl~, II coo ld be ass umed rhal.nam<'1is ('XI~
Iy brill'" .nd higbly SUSttJllibl< to fr~. Enamri".
ability to with<l.nd frKt Uf1' Is ~ in part. ~
of lhl' arr
".. "l of in eweptioo..lly ~ int<rlod;ing
I1e' cryn.11 Inro .....Inri rods . nd 'IS finn
wpport ~ th. u ndl!1'1ymg. more pl"nl dmrin. The
scarcity o f org.Ini<rnm ponen t. in mat u,," l'ndm<'J rna"".
il diffICult to study tllel' distri bu tion and fuoolonal
properties eW'n in .....fully pf1' pare<1, d" min..~liz" d
histologic iiIlon<. It appears lilat the organ ic com po........ of tn.Itu,," enamel play minor roles, if any. in COIlf<ni ng st ... ngth to enamtl. TheIr p rima ry fun<tioo


.. vol."",

OOj' nO;

10li ,,""'

- _90'"<

41\ , _ "
ll\ "'9"'''


t. ,,,,OJ

"" .., . . . . (_ _ ~dr

E.......-("'JtIlII' _toth< ........... <1'\'WkJ




_ _ '-"gIo)



Growth~ ,", " d

c.I<O,m~( ~_""' ) ~ Uy>,>f>


............_ ';00


Gtltlom ~ . (o.,d<oXY- "'.) ""'u"",,'ok



_ "."..'
n ..... bo<lf
streog' o 1><11'1.

- ,~

"''lle< tt- l>Ot>o ' nd co"""",""


or "'Mile 'nd rompr.,"'" " ""'9' 0 "',n

SptdI\< lI' - "

_ _ n'IOd~ oI < ~>tiCty",," """""" S21 gJml

Comp,.. ,tw "'eng'"

t<i1~ I.

.... >podic~l.8-l.1 gJml lrocr...

fNrrotI <tid _



bf Tome<' p<o<>. ""~


_ _ ",.,...,.,..",..,0<100



1 5~JI Structure and f un ctio n


app<~ .. to be to direct cry<t>Jgrowt h d uring"I d"",I~. Ntld will" n ""mel llaving a
higll org.anic: com,nt are ttflt!. lIy al-Wriotcd ";t h strnelUral ...... ~ furtbermolt. I"" low arsonic co nle nt
of """",I makes it btl"" .ld.lp(fll to withsGlnd add
attack by G1Jio1:<nic b.><ttn4
1M color of . IOOIlh Is due to ItIt thidnns.rnd op,xit}' of illt IMWTIl"I. Bluish etlimtlls - " whtn ttlt trw mtl ~ is m ick. EAarnft wim bluish Ii"'" GIll . Iso be
...... at eM io<iwl tdIn of ntwly nuplC(l tf:tth (w~
I;ghl pas.... tlmlouJh in .lbstn<t' of undftlyillll 6tntin~
The wh ile colot of di<Iuous IfttIIln comparisou !OpnltW>mt lrfl'b is dllt to tilt opKllY of tf>t;r IMOmtI (fN ering The )'tlk>wish ~ typiuI of _ondary U!tIh is
dllt to bot h Iht thinntSS and u.ansluct1XY of ~llYlld
wen as the color and thi<l<ntU of tllt undertying dmtin.

Erwmel is rrio tMiy imptl'lllotabl~ in COIIl]>Orison to

dentin. PoJl's. ... such. do not tldst in erwml"l. ~.
minute gilPS ""is! bel " .. n ttlt aysuls UUI m.>y ro nrain
OJllilnic ,""le rial ~ndiOl w. let. Surfaa- en~me1 i. more
mintralized.nd harde1 tllan d~r enallY l. II fool""""
that the i ncJl'~Sf in m'.....~l COnlenl 0<ClI... . 1 the
u p<'nse of the m;nutt lI"l'" btl~n 11l~ cry' l.h.
There fClfe. ,urf.." en.mel ls lt n p<'rmcab le than ;n n~ r
en<",,.,I. OCClusal or ind...1e n' n1~1 MS . Iso been said to
be harde r "n d I" s p<'rmeable th. n ctf\/iCOI en.mel,

CrysOlI ill . rode<!


IlIono ~ . c ..i. ( ')

and (rom thO inOlaO

IOwa'" ,~. IIdgO' (21

i 1


of the Teeth

Cryst alline Component of Ena mel


, ,
, l
- ~:: ......;
..... _., '
flo. ' .1 ~_~.., ....nwIcryrn.l TtwIN*d_~tIw

'""I tA_aobonoled--.

CIiI'lobl Appl iut ion


1M color of eswnd i> d ue to its !tIi<lmn$, ITinshK"'Q'. and

I~ I;OIor of the und~r1ying dmtin. ~l ~iSO bml"'f1S
Oil.intd. AIe'nts ~$I l* for eM mosl sicnifiunl SWmns of
~IM1~~. . >Udl i\S ~1e4 .rnd lobco prodUCU
(smoRd .rnd ~ ~ llrlore the ef<l of ho lM o:Iot'lIUI "'~
prodlXtl. in I .... 15th cem:ury.>rid' (sudl i\S nitric ~.Iso
"'lltd "l'" form) .......-~ <lpplied III whil.... t=h by ""Ibn sur8'!'0"" This i~b/y damaged the ~th. "'usll.., sillti6c<ln/
10 of ~namt'l. Den/ ifri"" wim high . br.. i~ ((Int~l\I etsc
whi t~n t("('tIl. oo t all"in Jl'mCNe , ignifK:. ntamou n" of t nam l"I. Loss of c~rvk.l m.rnel (d ue to its thinness) . nd " llYntum
on t xpose.:! root surf.." , wilh m e uS< of ab r. sivt's or Improper brushing l<dln ique, expo"'s dentin <lnd incJl" SfS den ral
S(' ns l t l ~ l ly ,

The mass of m.lure en. mt'I consist' of 96% ino rganic

m.leri;ll: lllis co mpone nt Is com prlse.:! alm osl emiJl'1y
of ltydro><yapatile crystals. The unit etlls of hydroxYilpillite crymls havt the formu la C .,( PO.JsC OH),. In
add ition !O ltydro><ya pali te. enamel .Iso contains C~r
bo rwres and ot hH Irace 1ntI.1s. Btuusc thtr< is no
!tIrDOY<J of 'naml"l. tract riPmenlS!O wllich the individual is exposed d uri", tM pertod of lOoth d",l~
becomt ';' lCOi porar.d mel rerl"IlIUl in the mincraUzcd
substanct of the lOOIh. Somt 01 U- U""" elt"",nts
IIave ariosUIi< pomnl.ll. tM _
notablt being fluo.
. . . Others minor. 1s witll suuesttd cariosto lic potmtWl art boron. bariIIm. lithium. rru.rncsilllll,. moIybdtnum. montium. mel ..-aNd\um. Clt:hH Ir""" elem<ntl
and moIKul.. make ee lOoth ~ susctptiblt !O
urits. n.... _ Id indudt c.ut> cad m,um cIJlo.
ride. iron.lNd. .....nganrst. ti n.linc. md magn< sium. 1t
is .also important 10 not< tha i dunn, tho- fornution of [lit
""ml"I "Y'L1l the lim-I'onned min....1 is a G1mon.:lfcd
apati te. FurthcrrnoR. t.... cort of the maru.., ..... m' l
crysLll i' thought ro ron"'in mo~ c.ut>on.ore Ilwt eM
peri p her'" regions. The Pll'KrtCt of carborwttd ;opalil.
in ItIt crystal ~ ""'kflt.... CIY'Ia1 more "",tptibl, !O
di osolution fro m the "n'ral rqions of it<t nd. and along
its co re than from lIS sides (fi.i. 9,

_ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ "ffi
"".sr.oJogy o{foomei



The hydr<Jl[)'~ti~ ayst.1> of etWrwI ~

WJnl: in
!tie body.oo _ fuil)' "".td in d.. ~ micro~ Their di..... n$lo.... ~ . ppro<i...., tety 30 nm In
width .lIld 90 nm In thid<nns. [)I,ttrmilwlion of l he'ir
~ ~I II. Iw been proble~t ioc.l First, it i. diffICUlt
to grt s1ion perfectly ""rol!o'll o tM long &Xi. of the
crystal and """ond ly. the cry5tal, fractu re re..dily wh en
>ecfioned. Some res rcher< believe that the cly>;lal.
Il1dY extend several m illi m e~ rs or throughout til.. enti",
fllleto"" of the cn.> mel. Di"",! mN,urement<, usinj
ground <OCtion . and th e teehtlique of Ion e; hi"$ to
!N~ the ~ meJ thin mough to v;e.,., wi tll the clrmon
m ~ . 11...... sllown m..t CI)'$'!;oIf ~n I<>ngl:hs of it
IN'll 100 Ilffi II'i ftf.l$t. Itoe O')'<tlols of deoo n .lIld bont
~ only :Hi ..... thict; .00 up 1060 nm Ioo:l:. This indoClItn dw.l the Ilydl'lll<}Qp.oritt ayJUls of enmd are
app"",imaldy 10 limn ~ and thicker ....... ""'"
t"""wOO {jJDr$ ~'I in IMlth th.1n ~ of bo~.
~tin,. and re llX'll1unl. Theil grea' Itngth is x hitw<:l
through the activity of . "",lobl";lo and the i nt.r~l ion
ohlle g rowing crystal. with enamel matr ix protein s ( 5~
ChJi>!er 5), The orientation of the cry, tals in rod and
lnterrod regions of marure
wos established dur _
ing me for""'tion 0( the ell.1l11<'l "", ' rill.. ReGlUing tNI
lhe aystal!i in the n~y formed erumel Imlrix lie
touIhly peq>endicuJu 10 th e ~mdob~ the
direroon of crysuls within thew ' e&ion s is e~1y
"p.Ined. It is ~ inr!i.... lion 01 ~ diSUJ portiofl 01
Tomes' """"" In Riuion 10 ~ prollimol portion. tNt
IM's ~ ~rUl_ of ttyst;lI dim:nons in rod ~ nd Inler_
rod erullX'l (_ FIgs. 5.19-521 ~nd fi&. 92 ).

fig. 9 .1 Oiogoa'n '" tho <haP'S ",-.n

rnd5 _ '"


<ods. Bolden'" ~_ ir6<ated by""" ~ ~ AmooI<'

pils.~*th<~;p"'Tomospma:$S ... thth< ......... rod.


Orga nic Mat rix of Enamel

Org.>nic ma lerial ls a minor com ponenl of the mal ure
eru mel Ii<.,ue ( less th an U:). The low abu..... nce of
organ ic IIWlerial in ITIJ.IUIe e"" mel, comp.ored 10 lhal of
dirveloping e""mel, h,gIIligJtll; the fact ttwI ee role of
o:qonic ~ are primarily 10 di>ect the ~
0( the ~ aysuh. The rmwinin&: oopnic .... ,eN!
app.ormdy Iw Ml ;mipificmt Ivle ill the stn>ctuJe of
t'niJTIeI ptr se. lla"._ . il Iw bttTI specul>ted tNt
lointt this ....te1ial alang wilh Witer. is distri buted
~ .'" hydrcli<Ya ""ti~ CIY'f~Is. ill; ni le may be m
cemml together lhe crystal< Of enamet,ods. As c'n be
.... " in th e !r;lIlsmlssion eleetron micrOll,a phs. Ihe space
betwe<lll the crystals I. small (Figs. 9.3 and 9.4~ but Is
greater In the arcade regions of th, t nam, 1 rod (prlsm)
w ath.. Indicating thJ.l more <><g. nic ""'trl" ' 5 pre~nt

.. ...

fig. 9.3 Tr .........-. eIoctron mIcrogr..,r. "' ..... mel crystJ./>.-. .. ;rn.g...
Ia.-~" CJ'OI,$ >edion (l( 150(00). _the $I'I\J.I1(>J.<eS bel_



9 .4

Enim<'I <rysl"

.t>e <ryslats

--.l 1onv ~ud in> lI)'. ",~ . t>e ~ ~


m Strudure and Function of th~ r~~th


in t h es~ areas (figs, 9 ,5 and 9 . 6 ~ Duri ng e namel d~wl

opm e m deg radJtion p roducts of a n en "m~1 protein ,
' hca lh lin, p r<'feren lially accu m ulate in t he a rcades or
pri, m bou ndar ies. lis a re' ult. th e J rea of t he pri sm
sheal h ha> wid er interrryslall ine d im ens ions Ih"n those
of correspond ing pri.smatk or interprismatic "reas .nd is
the I",t ~rea 10 mi nera lize. TI1erdor", the cry stals in
mat me e na me l a r<' not as close ly p.lcked in t he pri,m
she ,lth a, in Ihe 1'od or intcrrod a reas. f ollow ing de c~ lci
ficalion, I.,ger space, are a ppa rent in t hese a reas (f ig.
9 ,6). The role of the orga nic m.1tri x as -cementing materi.l- may de crease the te nde n"y of Ille cry $t" ls to fraclu r<' (w it hin t he rod or intorrod regions) or ,"te (p rimari ly along th~ rod She~{hs ) and st rengt he n Ihe en"m-

Rad shwth

f i9. 9,5 T," o"" i" ion elect ron mkrog"pt. ol lhe rocl , heath I" iorto decaleifrcal;"". Not e t he ;ncro. sed sp.>cing bet ween t he <""IAI, jo tho sh o" t h ' rea.

Prism "" ad she ath at


rod tlead - -

" The organ ic matr ix is prim arily ,,'o mpo,ed of pro "' i'"
a nd lipids. Compo nents of t he organ ic mal rix ofmalu ....
e na mel consist mo stly of p rod uct' liberaled by
ame ioblasts. How.ver, exoge nous (ompone nt' from t he
blood. ." Iiva. a nd oral flor" al so becom e irn;orpo ,a ted
w ith in the enamel. TIle mo st common exogenous com ponent is seru m albu mi n. which becomes incorporate d
into Ihe en ame l matri x d uring Ihe m.!ur~! iO n phase of
ena mel dev elop ment . Lip ids in Ihe ~ na mel ma t rix ma y
rep[{'s~nt mem br,l[\OUS remn ant, p in ched off from
Tom es' process d urin g Ihe secre tory stage o f ~melogen
esiS.ln add itio n to lipids " nd pro tei n' from or. 1b.1c!er ia.
sa livary secretion s appea r 10 become pa rt of the o rgan ic
matrix of e namel d llring: or following e ru ptio n.

Structural Features of Enam el

The struct llrdl featllres of e namel ca n be clJ ss ified as
th ose aSjoc iated wilh: t he DE] and initi"l enam~1 for mat io n. appositional growth. cha nges in ell" mel rod orierrrat ion , and t he ,urfa,,~ of Ihe to<>th. The SlI'uct ural fcatu res of e namel a Lld t heir d in ic"lsig nifica flce. if any, di,_
cussed below are summarize d in Tab le 9.2.
f i9. 9.6 Eleclron mkr<XJ raph 01m.ture " name! follnw;ng de",kifieation,
Note t he increa,ed organ;, mat",i. 1in the , ",0.

Clinical Application
Bleach ing agents approv ed by the Ame rica n Dental
Aoci,1t ion (ADA ) t hat reduce Sl<lining rely on t he oxid izing
power o f perox ides. Sca nning el ectron microgr.phs of
bleached te eth show that ble.ching increa"'" Ihe poro,ity o f
e nJmel. but t he"" a[{'as may [{'mine r. lize ra ther quickl y, It i'
possi Ne 10 overbleach (or ove rwh ile n) tee th and give th e m a n
lI n na n ,, "lIy brighl apl",aran ce. It i' nol possible ro quickly
rev e rse Ihe ov~rwh ite n ing process , Addit ion ally, oxygen
tra pp<>d in ena mel pores follow ing blea ch ing may affecI th e
se t of some co mpo site materials, f or th is re.SOn. th e u Se of
com posile restorati ve mat~rials on bleache<! t eet h should be
po,tpon.d (2 weeks to 1 mo nt h ),

Enamel Rod: Basic Structura l Un it of Enamel


C"lcifled sec tio ns o f teeth ca n he pre par ed wit h a d iamond s"w or car borundum d isk. a rl d grou nd and polished un t il Ihey a re t hin en ough to l ran, m it light. Such
und eca icified g roun d sec lio n' C"n be viewe d by rellee led or t ransmitted Iig hl. Sect ion s can he made either
alon g the long it udinal p iane o r ~ , ero " Se<:!jo ns (parJllei to the ocrlu",1 plan e, fig, 9 ,7). From Ihese lyp<>S of
pre parations , t he st n K!u re of en amel was sl ud ied a nd
d e., cr ibed ove r 150 ye a" ago by i n v e s ti g~ t or s like
Pur kynl!. f raenkel , Tom es. Ret, illS, a nd Ihe LinJ e rers.
However. inter p ret,l t ions o f how t hese str uctllres aro s~
" Old t he ir clinic,,1 ' ignifica nce have on ly been elucid" tcd
more rece ntly. Th is cam . ah out pr in Cipally fro m
im proved h i'lOlo gic t ec hn iq ues ( ~,g" ,,,a nn illg "nd
tran'mi" ion electron mic ro<eopy), improved b ioche mical tec hni ques (improved pre,er.ation " nd e xtraction
te chn iques), and devel op mems in molecul,, , biology.

_ _ __ __ _ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _

-- ............."'--

___-.of......_,t! .. _

.... _ . , . ...,






. . . . -_.. .....,1""1'



..",..I!>< _ _

No ......



.,...,-.,10..... 6t<p<f'-'>ol.........

<lo~ .".

_ -.ok.. ,

<11.".".._ ........",..

~ ,;gni _,...1o:ne in .... ,1nI<tu 01

....mcl"ld I. " ...".pl ,bIt ro m ckillg


{""' .............I ..... .....llEJ_

.... ol

"" mojOt _ ~. buI _

""'''''''''''.....-"ttfuol !T"'~"N<I """ rl<OOm<l ..,ondlng Itn .... DEI k>< <OM<!t._


bo',..,.., ....."..
,,, 10

""ur """"I~. ewe< ~11y In h,,,,,,,,"',,,al',..I " ...

, b< til< rewlt of l, ,,,,,,,",,;
dl>tlngui"'l Itn _

_,. . ., . _ !tl_
"" j



>Uri..,. and """"'"' >lllvory proI..

from "'" _

_ _ ol

S;g "~ ; " " ' """1<0..,,,





" ""' '''": prone to b , , ;o9' od



""""oI _ _ "' .......... .-oI

-..ongol_ <od>


pt<W<O ...... _
~oI. d
<b'Rg'" ' e

z. _'_ _ . .

"" "",0I 1oy 01

."""" " ....,01

""""" """"'Yd.'

! ,

...... _
"""'_-._ donIo;o ....... ... _
_oJ .......... t ........... _



, ___

... ~


' . '9 .. ""'
...... ~~"""9"'{lWlII..-.I~_
. .- l><o>y ht!<m>oJ_ ~ ",,~,;n,je_

- . . .. ""''"..

l . . -.. _ ..... .. _

, _ .~ . , '



1.- " _


...... 4 .... - . ,


""""' .... " ' -


_ -... ~

..... _bouno>oIyol_' .._

.......... du"inlltho l" "",,-, " ' _ """',,,. by tho _


No " _" ~
Thi> ..".,. m",l tc
Dy _ cernl"'l to , _
oro ' lnoo o", ~ .""h",~,



th l, loy"
," pl,,,,,.. .>tIer til< ..
r"'..... .,.,. 'Oe '''''''''"'' 01 t ho 'rd<Kl <r'''1'.,,1<pithoIiumon<! '" ""''<tOry Of"" ""iO' <l"'~" >iII, ffi"m",
_b 'Il'ld<IY "'"

~kM1 ~ ""~

i, th~"'"

_ _ ..... _~ ....... o..,~r:Kqkllrom_ond

_ .... 110<.

or OOnd;D(I .~""

....,.<OI"UOlIK""' _ _
bK_ tolootf1 ""'..".


1M u~ of rhO' >QntIing rimm IJIicroscopt' md ;1>

iI,,,,,_d ....ohnion 10riPw ground SI'Ctions 01 ~


wbsr~,,~<!d lhO'~~tionsof _eMly~il

ee SUMiIll MUot' ~ md
kJllowilll. brid' <ttbilll pniod wilh d i]u lO' .o<I.. ....m(I rocb un .... viewo'd in pound or fncluml ~b. TlMomm.ltlon of I.... rOIls .is seen I'oll'-;ng t his pro'(lu~
'Sde'pKtN in Figu.... 9.7-9.' . TlM- mamei rOIl ~reien l>
rhe "milWfalil <!d Irdil- I~ k ... by t he dm. loblast ~ nd it<
dista l (Tomes') proce<~ as it m igr"tes oU lW~rdly during
th~ pt",..., s of ~melogo n~sls, Sinc( "" i"itiJ l t hin Jay~r of
~p ri \mJtk cn" m~1 is fOtm r d at l ho DEl. t he enJ,nc-1 rods
only p. tpnd a p p ro .i m~tPly ftom rho DE) to tM , u rface of
thp pnan>el (Fig. 9 ,8~ Add;t ion~lly. t he JMlh taken by IIIP
arr,(lob!an during Ihe el.lbora non o f ....mel is flO( Enamel mds eross OIIP ~nothO'J ~nd lollow ~n
undulah"l COUt5<' <OS lh"y PfOI~ from lhO' DfJ tow:Inl
r:ll( 5Wf~ oJ lhO'~ . Tbrldooe. lhe length oJ lilt'
......-.d rOIl is ~'In Ilwn lhe lhic1mn.s oJ!hP momeIro
wtoidI il is rri.l.ted. 110", .... ils Imgth is dilWtly pn>portiona!ro !he lllrt..... oJ ee en.omei In Mt'iS ~
W (fUmei is Ih;n. such is nut lhe =Yil< oJ !hP lOOlh
.lPd .II m e b,),.,. of fi....'"- lhe rOIls ~'" e><~1y short.
The d,allX'fl>rof~ rOIl co,""ponds ro lhO' d i ~ mHw oI lhe
columnar ~melol>lm from w hich it w"'" foo....-<l.
E!lamiJ>oll ion of cmss-sectlon"" pnamel rods ........,aJs
a" J I~ mati ng "" i~s or JrCol<l", 0' tod , IIPJlh, in Ih.
biscokJIim..lJsj ~

Fig. 9. 7 Sla!tch showing ,ed io", of .... mol d<j>icted in FiQc.ts 9 .9 ond 9 .1O.


!II Structureand Function Qfth e Teeth

Fig, 9,8 SCanning eleclron mk r<>graph of..... ".,. 1W<t ioned Ioo g ~ u d i n a lly
followin<) an ackl.teh. Note: the enamel rod, are linea, WIJ,t...., .

En,..,-,el rod

enamel (Figs. 9 2 and 9.9-9.11: ca lled pa ttern 3 e n"mcl~

W hen t he a rcade s a re co nnect ed to on e a not he r. e na mel
rod, have t he a ppearance of keyhole s 0 1' padd le, (Fig, .
9.2 a nd 9.10 -9.12). with t he convex <ur face of t he
arcades (or h. ads of lhe keyho le, ) otie nted in a cuspald
or ind sal d irectio n. Alternatively, t he t hinne r nec k a nd
t ail of lhe keyhole is oriente d in an apical Or ce rvical
direaion (Fig. 9.13~ Allhough t his view he lps to ~xplain
t he rod patt~rns obse rve d in sectioned e na mel, it doe ,
no l acco ulll fo r t h e ex i s t en (~ of in le rrod e na me L
Investigator> now favor t he view t hat t he head of th e
keyhole corresponds 10 lhe e na mel 1'0 0 (formed by t he
d i<tal pon io n of Tomes' proc-"ss duri ng t he s",relory
sl<lge o f a me logen esis ) a nd th ~ neck a nd t all of the keyhoi. co rrespond 10 th e interrod en a mel.
In order to und erst and ena mel rod mo rphology. it i<
nece alY to brieny re-exam ine t he relotio <l , h ip of t he
ameloblaSI ~ nd Tome s' process to t he d evel oping e nam e L Th ~ rela t ionsh ip is described and de picled in Cha pler
5 (Figs. 5 , 19 -5 , 22~ Howe ver. in Fig. 9.2 the hexagonal
o UIl;nes re p rese nt t he boundaries of a m e lo b l ~sts in rela
t ion to the (ormi ng en a mel in t he sec retory st age of
a melogenesis . From t his pe rspe Cl ive il ea n be ob""rved
t ha t it t akes four ame lob last> to for m ti' e keyhol e mucture, one 10 form lhe head (the tr ue e n"m~1 rod ) a nd
t hree to form t he neck an d lail (inl e rro d enamel).
n ,e l'cfOl'e. each am~lob;oSI form s one en a mel 1'00 a nd
\Orne o f t he <urro und ing interroo ~nameL

Fig. 9 .9 Sc.! nning e1e<tron of cro,,seclioned enamel after on

Mid Ol,h. Note: t h< rods appear " P;l< .nd the lote rrnd ern mellonn< the
borde" oltho> pit>.

Crack in enam el

f ig. 9.10 Sa nning elect ron mk r",, <aph ol .n.mcl ,l>owing t he ,taY\l", ed
array of enamel rod, . Note . 1", the nod' IMt ruo betW<?en t Oe """mel rod"

Fi>J. 9.11 Diogram ' hovIOng the rol' t;on,hip 01cmmcl rod unils
(keyholes of rod ; nd underlyi!>;1 iot", rod onamel) t o ono
anoth",. Thi, relat ionship is lypical palle", 3 enaowl.

___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
An .l$pM of rod $l:rucru ~ th.Il should t>o, . PfRdated by
(!lot donicWl is [!wI ~ is I\"IOl\' susaptibl~ to fr;octu nns to" wp;Irmon .1onI rod boundults (tho . ~).
~ h;octu~ linn
drpictnl in 1M KiMins electrol'l
rnlcfoI:raph in Ms""" 9.10- Thr ....... lor tho pt klCllfi.J
Is Ml
~ in the Ofie'ntI!ion 01 <1)'5uh .ot 1M ~ botmdaries. _ I\"IOl\' S<lbde shift in
cryn.J orio'nt.>tion from tho ....rM1 rod 100 It> 'fYiu1Iy Ioc.lled intm'Od .... ~ (fip. 9.2 a nd 9 .14). This
"""""..ion has bttu U>C'd to -Idvinuar by d initi>M
wbHIlhoy m;fW cMty lJI~r.lions. ThI"OUJb 1M use of
nne cllisds. d ini<;i':lJl< ' .In .e~ JI'O'Ips of rods tIwt
may be un suppoll<'d by denlin.
Although 11>0 ry['k al patf<'rn Oft" in cross ...moo, of
humo n . "",mel is the altom.l1inS !let i... or ."'ild~. il S
pr..viously dlscu",d (p~lltrn 3), other p;luern, are r",quemly "b"'rvod, Th.s. alypical p. ttern '" due to
chong.. in lht 'hape of the To,nes' proct " from those
rypk ally ~scrihed in text books, Tlwoe vil li. t;on, usually occur whffllh. 1m" .., ' pro",:'$!is Inlti.lly formed and.
lh.",ro..., ", oI>s<1vo<I lIN' 1!Iot DEI. These rod (lUlli....


""!.r o{ En<J!lld
-----l ~ l


f;g. 9,12 Tramnmion elecln>n

micn>gr'" of_mel
... therod

1)Pf ] patUm. " " - {he crysUl ~

.......e ((1. tog$- 9 2 .... 9. 1 4 ~

~ the


. . . .

Clin iClII Applicati on

. . .


f.n.>rTIO'I rod' follow an uMu"ti ng Of t pi,.t rou =

runnilll ,,1I0O$I t he full ~ d IM ~namd.

nwy ue

more inclined in


~ cw.p$ ~nd

_~l ",,~r tho ct'I'Vi. d r ~ lOOIh. "Tbrir

dir~ is ~n import;lnt co'lSldo~ntion in
~~tion of resror;>lion<. EnmleI rods tll.1t ue
supponrd t". Iwd resror~~ m.mrUl nrhn t~
pl..n1 dmli n ...-~ """" hktfy Ql f r I =
Ft.llCMi'" dlllt$U~ ~ rocb in poorly


....1Ifd re.cor.otM

prep.>r~tions ~

m....... ...,uoo tho m~rgin, d

Joss or

tile IIUl"' .... !<'ria

Tllis m ulrs in m.ugin.ll Jr
nd "",,1= rn..
loorh mo... sU$(~p<ibl~ to c. ,ious ~tuek.
Add'liOflil[[Y. ir i, . tso important to ""'~ tlul th e
inclm,l liDfl of rods diffns in pmn.!""nl and p1i....ry ~h.nd mu,t be . ou nlfll for in the pr~p.1
nnc n of "', !nra,ions.

,, \
, I" ' I,'
I 'I,

oc- ~' II




-" ''/~~~
, ~~
'ry>'oI, In 'h. en.>m'" rod.

f ig. 9.14 Oi"9'";om ol lh< orienUtion 01


III Structure and function

of the Teeth
ta ke On many unusu,l form , ne", the DE]. includ ing cir_
cular (Fig. 9.15). Circular ena mel rod, (patte rn 1) ;)re
more lypi<.ll in ,ome animal 5 ~cies. The en dmel o lltside
the eireul;), rod, is te" nct! interrod or interpei,ma tic
en amel . A' the ;)melal>lasts move from the DE] th ey
became more oriente d, and the rod, they form may
exhibit' 'tacked pattern in w hich ,he ,,,,ades appror in
vellieal row, (patlern 2: Fig. 9. 1 6~ This p" rtern changes
imo the typ ical a ltern~ting pattern 3 (Fig, . 9.2, 9.10. and
9 .12)" the amd o blam retre.' t from ' he DE].
The ena mel rod, run nearly ail l he w;,y the surface
of the loath, stopp ing at the fi[]ill layer of ~p r i , m ati c
endmel. This prism le" layer is ~pp roxiLmtdy 20 to 40
mOl th ick and is thicker in ded duo u' teerh th" n in primary teeth (Fig. 9.17). The layer is formeu follow iLlg loss
of the d istal ponian olTo mes' process . Ail the cry,t~ls in
thi, layer are or iented with their loog CL'y stallographic caxis perpendicular to the ena mel su rf~ce.


Fig. 9.15 Irr"!jularrod pan",n. Some rod" an I>,,,een a, circul, rs truct ure,
(patt"'" I).

Denti noenam el Juncti on

The DE] represenlS th e inlerface l>etwe en twO very d iffere nt m inerali o:ed m"rices. one originating fmm ecla _
deon ~nd ' he athe r from ecrome senchyme. Its , calloped
natu re and result ing increased sarfa,e "rea enabte,
these two d issim ilar m~l rices to interlock. The pral eill-'
found at ti, . DE) (f ig. 9.17) are l>el ieved ' 0 provide n ud ea, ion cen' ers for mineralization, and possibly serve as a
cemen ting ,uhs" nce for dentin and ~ n. me L

Ena m el Sp in dle

Ename l spind les origin;)te from the DE) ond are formed
d u,ing th e d ifferelll iation stage of Jme tagenesis. At this
time. odo nlobla't processes cross the epitheli, 1 boundary fo rmerly occu pied by the lM, eme nt me mbr~ne , nd
their end, become insinuat ed belwee n inne r de nta l
epj,heliJ I cells (preamd oblasts). A, ti,e inirial enamei
iaycr is formed, the en,mel spind les become rep resen ted as lerminai exte nsions at' th e primary dentinal tu bule
into lhe en amd matr ix. In the ma tUL'e tooth en omel.

r;g. 9.16 Vertical ' 00 . Iignment l pattem .2 ) found ""ar the DEI.


I anamel

Fig. 9.17 l""", 01pri, ml= enamel , 20 to 40 mmthick. <een nM' tho DE).

_ __ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ --',""."._.




sp;ncllH ~rt bulbous 5frucru~ found .11 ~ DEI ( fi~

9.18). En.I~1 spinell... do lKII ""l\ib;t "11)' poef.''',,,li.lI
llip!llflll with ......mel rob nor do llvy .~ to be
pfflodiully opooced al"", ~ OfJ, ~ appe to be
mort nlll1lmlV> in ~ .usodo~ wilb l~ incis.lI
~ or cusps flInfth th.1n '101>I: (~slde1"nd R'lVil< 01
the tool'h. SpindlH ..... bmtr ~ In Ionsirudi.w
(<<IfOtI.ll Of s.l,;n"' j$tiOn< run in OO'$ of 1M


Sina spindlt'$ ..... !IlK ...rf..~ ~.turei,. (My . '" not

s,1et ~ Inifi.tion of dl>nLll <k;oy. _
. 0IlCf' 1M
incipiml Io!slon apprtlilches lbe DEl. decay m.>y pllIC"t d
mol\' '.pidly in art'" ' lwl h.w .. higlltr pormit)/ or
<lO'~n lc COOl""'. ,uch as enanY; q:>indlfl.

fl~ ,

Enamel Tuft.


E n. m~

>plndle, a", e><ten,ions of the pri""')' de nllnal t ubule into

tho .,llll ll/f'\Mllel matr ix.

()rigina[~ from the DE) lind .,.., so
I~ir similarity In .PllNr.~ to tufts

El1Jmcl (uft, "I""


bKllU,,", of

of ,,""~ Tun. ""WOO one-third ro one-Il.llf of the thicknt"U of l~ fflOmel .....lJix (~ 9.19~ ~
during the d<>wiopmenl of thf TomtS' ptOC"e>S ..nd dur-


ins l~ .... bor.. tioo of m.. init'"

elWlld of the' em"",1

rod. As sud\, they "'l'f"'tnr ~n-ridl ......, in m..
nw..... 11>., ";. that filled to
UnliR ..... mel spindlM.,
lufts ere i ~
~.~ pt'I'ioodick.n=clthe junctiorW lIN. They
appeM ill ~ ......""'. from the Ki~ ~ of tht
D.L.nd.", tftnltl ~ IOIIowin1 ld dnlIiner..~ulion oI
nwl (fi e- 9.20 ~ Tufu oppeir 10 Ik In the in~_
~ und"...tins: sho\ou
r nl wim me
sllNlt1s of tn.Imel rod group<.. Due 10 lbtir re"'1iIotly
high "'llallic "'nrenl, rum. h.rvt beffo viewed ... -ra"lls"


lhal tl<ist w ll hin lhe l

t ,;1, While Ibis ma y be
l rue , it is equa lly possible l r t lley l1I<ly fUOClion to
.,,,h,,, de mi n to e Tlil me l. Eviden ce for t his viotw is specu lati"", h ut i ' based on observat ion s tha t enamel t uft,
ap lle ar re gularly "l ong:the DE), Sill('e leet l> or. necessary
for feeding: and h"v e evo l""d from Im ea u men ta l d erivati.....' as high ly adopted ' trUClure s. it is unlikely l ha t such
"reiul . t ~akne<Se' or raul" " would b<! 'leleaed during
tJ>e process of evol ut ilHL lt Is plausible lhat t~ snucnut'S se........ SOI1>I: ....,rul pu1'plIS('. sudl u anchoril\i"
.... m.! to dentin or disl,;buting fOl''S IlWSlication to
prtYtnt <ncking or separation or tn.Imtl and dentin.

Fig. 9.19 Enamd t uft>

or. "",n .. 't"ft ' of g",,' exwndlng from the DE).


fill , 9.l O[.... meltlJft, .. """,.,..;t!I tho Komi "'} elect ron m lcros>pe 101lowing a brief'1l<h , Tult p<OIein .,. .dd r..i' to"'.


//I Structureand FU." e T!!th' -

Ena mel Lame llae an d Cracks

Fog. 9-21



0t90"C w...... ~-..el..,..e fol-

EMmel lamel lae we re first d e<crilX'd and Mme" by

lI6dcc ~ r almosl 100 yean ago. Lamell.e comi.! of t hin
sb~ of orga.n;c ""'lcrYl tholt ..xte nd th""'P>ouI I....
rnicknes. of the e""mel (Ms>. 9.21 and 9.22A and B) alld
ru n ""rtiea lly rrom inci....1 or Ctlspal a reas IOWai'd the
cetViX o r the IOOlh. They can be readily demonst ra red In
add decalctfte<l w oole mounlS .as lalmllar sheets on t he
DEJ (fig. 9.22B~ It is beliewd tha t lamell"" are lOnnt'd as
t he ....ult o r Ioc.lJ [oilu re of !be malu ralion process.
T1JeTrlore. water and elWmCl rtwt rix "'m....nt> mnain in
these: a~ It also bttn p rtlJl(lM'd thaI failure of tbe
m.u:uralion p~ may be d ... 10 seresses thai devdop
within the e""me1 matrill dun.... th e mineralization
may nap or Pl O'W1d Ihe Row of
process. These m =
wal er and elWmCl ..... trill and. the~~. Inh ibil l heir
"",""",aI by m>eIobl.asu.
Crild<s ~ lhe Solme -lpJINra"", as IameIlat In
vound section . a nd ohm appear ;os a nifacts dunn, !tie
prl>Ct'"SSing of IeedI. Orpnic material found in tt<1lCb
consiSU primarily of or.>I pn:>dueu 1ILaI did llOf onpnate
from the tissues of the dewlop"ll uuh. Thrir a>IllI""""
00n WOIIId """'" doody lnClllbie tlwil of the Jo>lMty
pellide and. .odd.lCionally. may lnetude bacteriil pliQUC
or food dobris.

Bt'-sides bei"i ..... '" prone to the initiation of "It>.

~ is some tW:Im IlLat WnetLae may also I~U"lf
an .....a of permeability by w hich bacteri.I may Io',n
a.oc= to the DQ. This may e>.pIain _
c...... of the
condition known a< Itiddm aries. In tI>lI condiOOn. the
~ may di~ "".ally r""" l he rond'llOll 01 lbe
denfin dcq> below.

Structures Related to the Appositional

Growth of Ena me l
Cross Slriations

Clinical Appllutlon


l1le <ltvelopment or crk. or rrattu.... Can be;l very ..,riou,

deIlt . l com plica tion l"e'quiri"i a crown.1td endodontic trUIImnt. II is impo rt;lnt 10 reI&niu rrKtu re' berore th ey
progress to a level be low the gl"8;';' or t hro ugh IhI' p ulp. l
floor. Should this occur, t he tooth would be unrestorable.
Sympto matically. pat ient. will expe rience pain upon b iting on
hml <>bjCCI$. Crack. Or lamell.e ca n o lie n be sec n in tile dellta l omce by transillumination with th e u"" of fiber oplics . It I,
also importanl to dlstingui .h cr;lCk. from cra zed e namel.
Crazed ena",.1 I, ", Inut. crack! mo.t oft en Seen In . nterior
teeth, which are
lillie conse q uence.


Cross suiation. run al rilhl a ngWi W Ihe .0><" of l he

.....mel rods and . th e refOre. can on ly be ~ In .....
lions running paralle l to the n i$ or the .....mel rod.
Cross <lrLalions ....... rKOgnilt'd in e""me{ 1000iliO and
~ lhen proposed to be reLaIKi to lhe 24- hour C)'dical
activity of a melobla st>. The o b"" ....ation. or lbe.., earl y
de nta l hlstolO/:isrs have <lDOd lbe te SI or time.
UI"aSlruc lu ra1 cYIden<e , ugge<lS IIl.lI ~ u l a Jly SPolcK!
undu lations OCt:ur in t he e""mel prism These c.<>IS .triation, are found to occur In hu man tcclh as rt'Jlt'al i"i
<lruetu .... 2 10 I> mm ap.lrt and are in ag rceme nl with
t he me asured dePO'Sit lon rat~ of tn.>mel. The regular
""riooicity o r th ese strurture:; ' I....s] l ods 1M
ap pearJJJee of a ladd er. w ith the ClOSS striations rcpre-

_________ _ _____________ _ _ ___ ~Hjs.!!!!..ogy of f"_omel


~nu n& l he ru n~ ( Fig. 92] ~ It lI.r:I ~l", Ix'en r-epoo1Cd

rhol in [hide grou oo SOO1l$ of_lI. ... pmmp:>ilio n of
IUin mu.-tUfft w ithin the .... ""'L aused ~ undul;a..
lions Of y icO$iI ~ of (he tnam<'! rod. might ~I<o etvt'
rbe ~ppe ~ 01 CfO$S an.tion<.
Cross SlN.ions INY ilso "'~ ;,r"n 01 <)diul
voriorion in ""Pnil: and/or mi....... (J)Il""" Of dcnsily or
lbt"",md rod. V.orutioM in UIboIw'" ~ sodium coo1m! """ bftn R'POf1rd 10oo:ur .IOfll lbt Imzth oIlbt
~ rod 01 rquW in~1s. The 'Po"'i"l 01 ~
vori.otionl: is in
Of'do!f at lbt dimna bH\'UR cross
ariMions. Cross Sll'i.>1iom m.IY a lso repo. ..... .lfNS
wilhin tho t'IWTltl rod 'I'l'ho:ft rhffl: is .(~ podli"lor
momcl )'lol.l1., 11'1.I.1 is w~ crysYb ~ one ~
wi'" ~~ ~ns and imnvmins orpnic ..... ~


Retzius' Strlile

Retzius' striae SC'Cllln ground cro:<, .....-rio", e .i miL>r ,n

appearance [0 the conct'fltlic growth rill&' found in c.....
sernOll$ of ' ...... (Fip . 9,24 and 925~ Li~ IhP l'(IWlh
ringS of trees and til<' cn.>$' Slri.n i"'" mem ioned aboe.
1M !let, iu, ' !.IliaC a l'" rt l'te$e nt lin.. <If inenme nl. 1
trnWlh, U............. r. simil.., 10 the Tings of .. tree, the ' lri.l.
ar. nOll ra lly ures at all but only ap ~ar as such in <-

f'li- 9.2] SonnirJIl tle<tn>n _mg"ph <:\emon<.lrabrI9 ....,.. <Ir1olions 0<

~i<'" irl<rernorJI.;lll. . in......-.d.

rions. The rings ola rree ,a n be Y;,u.ll;zed ,,, . sem , of

Sl](c r " ively larger ( y linMrs, on . in,IM l h. olh ~r.
or I I,~ l>ial ldyor prol if~ra le a nd d ifferentiale Ihro Ullho ul rhe le nglh of th e stem. Ilecau>e the
rhe TW h is limill.'d and t he dep<>5iT;QIl
~nam~ 1 Iwgins ea rlier in lh~ <uspal a nd lnd s.ol rrgi""..
tht Rcl lills Ilri .... c.on "" Ih<lUl:!lt o f as rhe s~es
belween I strits of ~wely Iargerrones .tad<ed OIlt
inside the OIhe t. Whtn CfOSS-st<:Iioned. ~ a pptlr lS
rinzs parallel 10 one anotlltr. In loogitudi.....1_ n s . il b
rtadily appartnl ,'''', Ihty art nOl par.olld al all a nd some
end at l he tn.lmtl surface. The d isYllC" b::1 .. N n $OCC'I!"I>M: $triM " mud! rrtale'r a nd nOl as consunl .. that of
emu str\ations.. Therri~ 1hry R'J'resent lint< ~
Ia)'tl"$ of tnaml't cItpos;ltd ....... a ~ period oI linlt.
in lilt oo:dtf 015 10 10 days. Dilftrl"llCn in minr.-a1 contmI oaur in lhew ;oreal.. and '"'" Ihoughl 10 lit d llt 10
mtUboIic d'''urblnrH that oaur ~ _




fop. 9.2<1l1ght of. QftU'd _ _ of.-" ~ RelDus'

The lIpptN<Ua of!llt 1letrius <!ria<' is crt.ted duriooa:

~ of alllt'logetl(sos ....... is mMl: likely
dllt 10 periodic dowing of tnaml't INtrix Jtm'tioo.
~. 1M rtlt.... of tn.lmtI mmix ;,; lKJI unifonnly
~ dowtl at .0 pointS of the Tomes' ~ &wmtl
INtrix >t<1t'Iion >lowsdown lim at ce d'>Ul portion of
Tomes' procts$, md conli""", at a f~ r.ole alo,,& lilt
Pl""i"",1 Of inrera meloblaW c 'U1f.>ces (Fig. 9.25). Ttw
ril"tO or Ih,s a tlMed rtlt. ... of enamel mmix is 10
~.... lhe .mount of im em><1 ..... meI in localiud

m. 0!'Cm0I)'

fill. 9,2$ Su ooing ~lro<l mi<rog"ph of Roll..,' "RH. 1'h< potlern i'
OCConl....tod due to t il< ~. of fe'Wer cry>.... In<l. chong<' in cry>tal
orlenlOllon lrl th. ", are.. ("row'),


11/ Structure and Function of the Teeth

Clinical Ap pricatio"'


Caries spreads more rapidly in denti n than enamel, The reason

for th is spread is not strictly the minerai content, because in
.ld d solutions enam el dem inera li7es more qu ickly than
den tin. The low org.lnic content of ename l does not provide a
nulr ient source for the growth of bdcreria or produClion of
acid. In de ntin, exposed and degraded coll'W'n can sefVl' this
purpo se, Addit ionally, in enamel the Rel2im ' mide (or line,)
are planar .muclure , of increased organic conten!. These striae have bee n proposed .ls preferential areas for lhe 5pre,ld of
caries within the enamel. However. the ch.lnge in crystal
di reClion at lhe, e siles may actua lly impede lhe progress of
"arie s.

area, The local incre, ,,, in the thickness of interrod

enamel in tu rn constr icts lhe base of the disUI port ion of
Tomes' proce;s. When secreti on speeds " p, the distal
porIion of Tomes' pro",,;s has 10 "squeeze th m" gh'" the
reSlricled ,rea" it fOl'm, lhe en.lmel rod. TIlerefore, the
ena mel rod is wnsukted at the Rerz ius Wiae (Fig. 9.26).
The alte red shape of the enamel rod may interfere with
the re moval of organic dement; (possibly shedthlin), and
the changing orient~l i on of the crystal< may "ffect Ihe
packing of crystais in this area,
A' seen with the sCdnning eiectron microscope, the
packing of hydroxyapatite cryst" ls i, .llso mo re Irregul,, ,
within the R.tliu, striae Ihan between them. Therefore,
fewer enam el crystitls are found within the Retzi", w ide
(Fig. 9.25 ). The greater the physiologic disturb ance, the
more pronounced the line. The neonalal line i-' one , och
pronounced Retziu, ' str ia, This is due to nut rition,,1,nd
hormonai changes that occur al birth, Fevers, vitdmin
deficiencies, metabolic disc.l,e s, etc. can al,o induce pronounced stri~e. No re~1 clin ic~1 <ignificanee has been
att ribute d to the R e t~i \l " st ri~ e . Howe" " il hd<been pro_
posed that they may im pede the progress ion of caries in
When the Ret,i " ,' sime reach the s"rface, Ihey form a
series of fine horizonlJ I ridges on Ihe en.lmc1 , urfaco
(Figs. 9.27 Jo d 9 ,28). $urf,ce manif.,l.llions are known as
perikymala or imbri"at;on lines of Pickerill. Pickerill WJ S
Ihe fim to correlate their dppeardnco with tho Rctzi"s'
. ti de. They are for med at Ihe boundary between one
group of ameloola<ts IhJI ' topped secrcting and another
that continued secreting more e n~ me l m,' tr ix.
Porikymilla are part icularly prominent on the fad dl side
of newly eropted leeth. They are especially prominent in
the middie to "e[Vical port ions of the crown, Bec, use of
the e!'Osion that OCCllIS with aging foliowing er uption,
lhey Jre less aPP.lrent in older teeth. When per ikyrnata
are properiy i lium in~le(1, they give the en.lmel ., urface a
finely corrugated appearance.



-,.Ji _U ~
fig. 9 .16 Propo<e<l formation <>f ~e tl i u ,' " ri,e. A Show, the Iypkill" rcade
structure 01 enamelwilhpig , imilar 10 It.o.OIn figuro 9.2. The dotted ijnes
Indi" ,c the p, ttern of formed enamel. ~od enarnel l' Indkated ingreon and
io,w rod enamelin pink. The image , !>ow, . ' '''l ilt arand coronal ,.<lion
Ihrough ,melOOlam and theirTomes' proce"es. En. melrod, ,,><i interrod
enomel , pp,w as alternating pinkand green band, . 8 , C Enamelforr"'tioo
in Relzi", ' ' I" ae, Note the iocrw , od depa, ilion of inlerrod enamel
(widon<d pinb reosore indic' ted by MroW' ), The 1ail, ofth eenamel rod
" nil' thi(~on. romtric~ng the oo,eol thedi' lal porl;Oll' ol lhoTom",,'
proc"" o, .. ,con in ",gitt,l,nd coron, 1""'tion; (8' aod C'). lotodificd, fter
~ i " ,. , (AO.l\. Re<:. 1990;226: 135).

_ _ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _"""Hi~()/foomtl_ 1 6 ?

Additional features of Enamel

Cna rl..... fnamel and Hunler-smreger binds
"meche, group of


fra tures of ",,,,mel = ,,11'

from the dlJ.nging co"r:;e' or Sllift' in the orienfation'

lh~ ~ n ~rneI rods f'~ a, m.oy pus th rough thoe eM me l
layer. In ~n B with our
10 """"<l enamri, ~.$O
shaws a "".. ;n p,lUem-" Most rods rotJow an
uoduL>t1"l Plllw., h om 1M Of,! to rnr llXlrtl '$ surf.oo:'_
In me, <lISP Iipo '" molH>. J1UoIP' of enomd rod> \wist
.obout onr _hier_ This "Ir~n pottem" is tnown os
JIIo'rlied """mel (As. 929~ Thtse drposirion
thoup1f t<> st rengthm .... . md ""'ki ng il ~ 1<'$i$Unl
lO f,actu,. durins tile m= of ",",,1;';.1100.
Hunt er-St hll'g<" b<nd< ~re ~t ..en in ",ne<tcd tight.
ThO)' c, n ea'i1y b<" = n in a ground section with Oilliquc
JIlumin.lliO<l with the uS<' of h.'nd len, . and 'Pl"'~r .. an
alt...... ting .., .... of ru""'" light and ""'" b.Jnds ~x ... nd
i", <>{ an ~ from the DEj 10 m,. ~[\;\md owf.o<T. This
m-;.ng p'Ulmi is <:iIUSed by ~ _ in whidl ""',
non..! .."...... rods rdIttt Ii&hl- The dolt. Nods (J)rl?tp>nd to ~ en.>md rods and .In! known ;os
d........... wltile f~ hJh'r b.ulds ~=mrinllongitudi.
nilly S1iolltd rods "'" known .. "" ,n ones (figs. 9.30
and 931 ~ Shills in rod Oflmtari"" corresponding to
H u n t e r-S< h r C ~ 1 b;lnd, ",n be clodrly demoT
m ratl'd with
tbe SC.ln.ting elect ron microscol'" (Fig. 9.32),



fig. 9,29 A -";'longlll><!lnol.nd ao. .. tion, of

Mam<I rods jHt'nlI/rSch ""l"'" l:>Md ..
'1'O'Ied (~e<I)
rods at
10(11'11 or <"'POI . "'.. of l!>o tooth,




fiO 91/ Perikymol.or 1mb''''''''''' ....... (of PO:keri~ on I"' t""'" su,I"".

. '" ",torn.>! m.nif",t, Uon, of Rotl ",, stri,e,


f9- 9.29 B Tho . h~;og IgIn (po,..........) Ind dill< (~) Nnds ill
.... .......--.1 .. _
In Mlecl<'d 1W)hl _ H...-.Ier.SC!I,".I"'" binds.


II! Structure andFunctiQll ofthe Teeth

Su rface Coati n g s of TH'th

ro.uings con lie doss,foN .oa:ording to thdr 0ri(O;Ilinp a~ r~ ~ a CIIlISl'quffla ollbe IIOI'TI\al ~I~ t of """h. The <"J'ilbelial 0M'rin1 or m:loced enamtl e~ljum. whidl is
SOJDt'ti...... colltd 1M wa>ndary <lmut <"UIiIr. i. lost
ooon ~ nuption clue to au.on.. II is the ... me u



tQs;myt1J's rnemllr_' 1rl~1)" WoIe<ina; on lbe lOOlh ..m.c..sen-! rtom the round .......
The <lmlal rutide. oomt'I,mn ullPd the primary acdh>I.l< dentol ~. Is the ~1JmaI attao:ho'le'" or !be
0fJMIic; mmill rflp<lRSIbIf lOr bindillC 1M .,,;mdium 10
tilt roodL It is ..-ntially !be lwo;;ol lamina malnial.
tbrtId by the cpilhelium. Coroo.aI ~tum is found
n;;>!Urally on lbe ocdus.ll su~ or tilt t=h of many
herbivoon.. If lhr "'<!oced elWlllt'l <'(lilhi:fium should
dtgmffiI~ prior '" O1'Uption. ctmmtum caD ~ dq>osited on t~ .....race of the crown by t ile <0'11. ohlle denut
Acquired (Oolring! are obtai ned in t he e nviron ment of l~

oraJ( avi ty. ll'"Y are briefly described in I"" order oflheir
appear. nee. Following. cte.nlnll l lte fLm e<Jill in! to form
i' the S<l1i~alY pell icle (Fig. 9.32~ II II t hin mOl of "'ganie m.le ridl consi'l ing of S<llivdry prot e ins (m ucoprote in<
and si .; lo p rot e i n < ~ Dcnldi plaq ue is a 5 0ft .dherent co~t
ing COnsisling of bacrerta e mbc d d ~d in ~ manix of ban....
I'idl a nd salivary prod uCl:' PI_que i' ed' ily rem oved by
bru'hing and flossing, If not rem~. pl'que {.n t>ecome
,"k illed as ",k u lu. or l attar. It ( ons im of 70- 80% c ~ lc i
urn phospllal o ... I ~ . Since cakul", becomes calcifiO'd. it i,
more iliff""l t to re~ Ilwn pI.>q"".

OemineralizatiOfl of Enamel
FIg.9.31 5aoInlngelKPon mi<m<j~ <>f -SCh'f9w boIndl.. bIdrIcJ
"_IO~"""""On<>f_moIm<k~thoyfoltJw .........1xing


,~ -



, ., . 9.32 \<:..,,,ln9 ele<lro<1 microg r.pl1

' Lllf....

of." or<J,,,i, i>dlid e <)rllheC'f1>m<1

The demi. -..iz.Itlon pUlem 01 en.omeL whether it is

through a 1"'1""!oI'e>i pnxeu or induced by "",,,"SUle '"
etdti"l: .... reri.II. ,"""Iif<! by lhr cbRicialn. is inl<'re<tinJ
and hu "'me impotWl[ ~ The
"O'tthing potlem" is due 10 lWO oItIIt Iratwn d """mol.
The li"t arises fion> lhe r.a tNt .. 0fWJId aysW is it is fonnfd a:sa ~ apolife. Willi ayst>I g.-th. !be mural /'fIiOn.$ oIl!If aystlI an- richer in
llIis ~ ~ This CIrtlorwl!'d apoOO: i s _

____ _ _ _ _ _ _ _ _ _ _ _ ______ _ _ _ _ _ _ _ _ _ --","",,,"".I"ogY.ofEnClrrl.c!__1 ~!l

susce pti ble to acid de mine rJ lir-"lion than hyroxyap atite
or fiuo'<'pat ite. and w he n exposed to acid s t he enamel
crysta ls preferentially d issolve at t heir ends. More specifically. the mine ral is re moved first in t he c.ntr~1 reg ion s
of t he e nds and t hen progre<ses . Iong t he core of t he
crystJ.1 (Figs . 9.3lA and Ba nd 9.34A a nd B). The cry5ta l
appears to dissol.e fro m the inside out. Tn sec t ioned car-

ious enamel or acid demi nera lized enamel , crosssec tio ne d crystals in the early p Mses of de mineralizat ion

have th<' a p pe~r., nC of doughnuts. In sections of obliquely

, ecrione<! cryst al. , they hdve t he a ppea ra nce of nJ irpins
~nd are called hair pin de fects (Fig. 9.338 ). S""ond ly, th e
crysta ls in en " mel a re h ighly orie nte d in t he rod ilnd
interrod f<'gion, . Crys t,l, w ith t hei r s. nsitive en ds"
point ing towa rd t h. su rt~ce w ill be t he first to be
alt, cked, When e na mei is e tched in order to create a
bond, t he a cid p re ferem ia lly a tta cks cry sta ls w ith
expose d e nds. Cryst,ts run ning at an ang le to the surfa ce
are more resista nt " nd d issolve much I"rer. Acid e tching
iocre, ses the 3urface " red "v" il"b ie for bond ing by cre"t ing
-. na m. l l"gs" due to t he d ifferent i,,1e tching of rod a nd
interrod . na m. 1 (Figs . 9. 35 and 9.36). Of cou rse, th e
initi, 1 , pri., ma t ic iaye r of e n, mel w ould have to be
removed first be cause ail t he crys ta ls ru n in t he sam e
direct ion " nd a re e tched UL1ifor mly,
Plaque a ccumu iate s in a reas tlw a rc nO! clea nsed
effective iy (mola r n"ures, inrerpr<:>xim.ll spaces, et c.),
and bacteria th a t unde rlie den till plaque p'oduce acid, as
prod uct s of t heir norma i me tabol ism. The f,lI ing pH
c'use , th e e na mel to dissolve a nd becom e porous.
Initially, the poro sity appears as a w hite Ie, ion or spot.
Demine rdlizat ion pro gre sse s be ne at h an intac t e na mel
, urface. Colla psing of t he surf. ce 3tructure or cavit. lion
occurs wit h p L"Ogressive demi neroli2J tion. Howe ver, the
remova l of pl. q ue (car bohydrate, food PJrt icles, and bacteria) and th e bufferin g c.1PJ d ty of sal iv"ry , ecretions ca n
p reve nt t he de m inera iiza tion p rocess. Addit ionall y,
reveN I o f t he process or rem; neralin tion can occu r.
Reminera ii"" tion mJy ta ke pla ce as mine rals from or al
se<;ret ions rel um to the pa rtiall y dem ine ralized . n" mel.
The frequency and iength of t he respe ctive stages in t his
cycle (de m ine ra liza tio n vs remine ,ali ".tion) and t he
com plex intc r"ct ioo s (b. cteria l metab olism, SJ livJ ry
( omposit ion, d iet , hygie ne, e tc.) w ill determ ine whether
Or not J carious lesion dev elop s. Fluoride also see m, 10
piay an importa nt role in t i,e re minera lit<lt ion p rocess.

fig. 9.33 ( ,=_,,,,t iooal ena mel ' <;'SIals. A Norm, 1, ro, o-,,,,';o o;] l c<;'St, I, .
B P, rti"t OOm;ne raliz.t ioo . long t~ . <-oxis of t ile<<;'St, 1. NOl e that , ome 01
the cry' t.l, e,hib;t ' he typ;c. 1'/l' irpin"l"' ttc rn when <e<t ion<d obliquely.
See ,Is o figure 9,1.

F;g. 9.34 A lotl\litudinal v;owof part ially oomine<.I;zed <<;'Sial>.

BDi.gra mm"';c re pr. , ent ation s/lowing , hortening of crysla l, due to
e ro;;oo at the ir e nd,.


!II Structull'ond Function of~<h"C"re.'~h


Since flooroa Piltite. nd hydr""yap.>t ite a... mo... , iotant

to dem lntralizat ion t ha n ca rbona ta:! a[>Ollle s. su rf""..
... min er. li,l'd with fluoride are prob.l~y m~ 'oslstant
to d,",ay. This is due 10 "'PlaC.", of mo re e.osily e u solva:l ca r1> wilh fluo tO- . nd hyd roxy. pat it .
Fluorid .>cro in two im~a nt ways: r, ,,,,. .... n inhi bitor
of crystal dissolu lloo du , il1l a carioul auack. . nd se<ond
by en hapcing lhe _ i rahza lioo procesl l hat prod","
a su, f"", ""nm of
i".nl n"""",,p.> tite mlteNI,
Fluoride. at sufficient concemrdl ions . ca n .Iso Inhi bil t he
forrnatioon at p i....... and .reid.


rog. u i ... Md.tdlod

Wucture _ _
of 0'II0n0d..-.1I*'fQd
-.lid bm
.". forln<rNSed .....
I;oa, _ bonding. Eldling poI\Itm IsdwlOea-of......... ~
a _ ""'" _.oIonlI ttwIr W.



Ena mel is higtlly mio... IIZa:! su bsta nce. thoroughly adaplnl m withstand lhe lors at ruslica
Don. Enamel cry<tal' a.... [he lafJ'C'll aysub found
in the body . nd .'" O'ift" one tbousand limn laf#'l'
that th<= of ~lill. bone. or ~IUm. The pri .
rrwy lttUCtU'al unit of mamel ilthe enamel rod.
Enamel rods . '" formed as a """II of ee Srt,ffi){ ~
activity of ame\OOlasls. AmolobIa'" play a n impor
G nt
in the matur.tion process "'IULali'" t~
mnov.>I of .lmost all of Iht maubllibtraU'd d~rilll
the """ eM y phase of mM'logtliUis. The oritntatioo of ay>l~1s a nd the dill:ribution of orpnic
matrix material. mnaini", in t!le enlmel malrix
l'MpOIIsib~ for lhe smKtu,~1 Piopelfiel of The lI1lICIUr.1 ~.1U"" of enamel C~ n be
c~tegoriznI as t~ .ssoti/.led witb tM Dij. the
appositional growth of enamei. enamolrod oritnta.
lion, Of the surf~ of enamel, The lltlKtural fe~tu r.-. of [he DEJ- illC1l'~S<'d surf~ ~~. d 1O.seal
loping. p~ of tuft> and spind ...beliewd
10 be im porunt injoining l .nd den fin. Initi ating mi.....-.liufioo during devol'p......t. Of conIriblJling m murnrral _~k ...... of tho ...........
Slruetu.... ....lated 10 a pposilional lfOWIh include
cross striafions (da ily growth Ii..... ) and ltetzi",'
~. n...... IOnn as ~ """" of cyclIcal .>crivity of
amelobLast. . and a~ ..,h.ll'd duri", Ii...... of
pbysiologic ,tn!Ss. Perikymal. surface
res ~~
"""ted 10 ~ppositio""l gmwIh.


r'9.9. 3IiT_
tron"*:J09r..... ~_d~ .......
...... Iizion( t.."'..-). ~bIKI<_'--' _I ~ _~

'1"""-""'- "'_ng . . . - l

a lm, ,,1Appllntlon



Acid mhil1l armIS all' UoN m imjlfO'o't' bonding of COlIljlOSite

mate rial , to enamel a nd dentin. The mhan ism of com pos ite
bonding d iffers in enamel and dentill. In ena"",1. l he e tdling
agents etch lhe ena mel nonun iform ly. creatl/li e na mel tags,
The bond s.t",ngIhs of so"", ce ment .. uS<'d to place orthodontic t>raclcet l on l<'et h. can be so s.trong t hat a sig nifica nt
amount of e name l is removed wlth the br.clcet. Etching is also
used pri or 10 the a pplieatw n o f sea lanls. seala nlS p rot,",t cav
ity pro ne . ....a. of the t()(}l h, especially the e na me l pits.

SIIrface features of ~"" ...... include l~ wh Ich

. rise during development. tbe p rima ry . nd second ary cuti cle . ~nd lhole t hat .'" .ocqui....d. the sal iv.ry
pellicle. p1aqu~. a nd t. rtet or cakulus, The efrecl of
ac id l on th e ena mel can be ""plained from knowl
edge of the formation of e n. mel cr ysta l'.lbei, cOm
position. a nd th~ir ori~nlation or dis.trit>ution In th e
e n.mel. Deminer.lization - ",mi neralizatio n cycles
play .n impo rtan t mle In the formation of ca rtes.
Removal of food parti cle'S . nd pl.que by cleani ng.
salivary buffering. and IOpi. al fluo ride te nd 10 favor
th e remineralization proce ss and inhib il e n. m. t




-- ---_ -

...............lftt>Dl.f<_'_.. J)B.~SM .

_cr._I<W.e- _ _ ...

1. lJ<oscr'iM the phys ial PropMit's of m.und

m.>ke il ~ tl< rovering lOr Ih. !OOIh.
2. Ot>cribt lhe OI'ientation of eryslO1s in rod


f. 1lif"'" S. SlnI<tuRoilho .....,.......

.c.rir<-' 1994.z:t:l .....

K<>c!.J1w T. 0Ut.1jimI

lW>................. ......_ _ IIOOIO_CMi<>1l=

. nd

inl~rrod ~""m.l.

3. How a re crystal com posit ion a nd ori~nlation ",Iar

td to palterns of d omineralization?
4. Desaibr- Ih ~ ~oUl';<" and types of increm en lal
l in ~s tha t a", foun d wit h in rhe eNmel. How a r~ t~
formed and ~ow d o d i.., ..,. di~t. Or orlx>r physiolog_
ic .~ ~ rlwir a~.r'IK'?
S. Dtscri bt the onmt-lihon of ..... me1 rods in differenr . "'~ ofrhe crown (ocdusil ~. cu,p tips, Ln
~.l ~ and neor me (MYix ~
6. How do ..... met rod pant.... expl.>in H" nl er_
Sc:hreger ha nd i",?
7. Wh.Ir is I~~ lelationship bt1~o lalIX'll.... . 1Id
cl acks? How might r~ be d i' llOgui shed from on.

8. Where is pri l m less e na mel fouo d on th~ t oolh ?

9. WhJt factors determine th e co lor of t he mot h?
Howea n t..,rh bt w~iten ed?
10. What i5 rlx< importlnce of me DEj? v.'b.l t types of
etI,1me-l fenures atise the re?
n. ..... m.1 pits fonntd mel bow are fhly

l"'OlN ctinic.o l1y7

_ ,:,190-296

MA. snun_ of wrfKt Wi"" on ,.... 1>.

"JrIHw. J _ n.... , lm :47:1J9-1.c7.
li N, Pool. DfG. Obs<rv. ' ioo, with oc, ""inA " ld

(j.... I1~


tr.n ' m''';'' 1<:",,,. mlcr<llrow on tho ' Ir"<1 m of

hum, " , ,,rf>co ...mol. "'tch. 0 ,.1Bioi. 1974:19:

11JS-1I4 l.
Nypotd VI(. Si""""lintJIN. UIo "' <Iud\' of ltlt ....,"


~kse=.crtk4: I~=-=:~"'=

SlnKturiII_XCOfI""'" at




_ _ S.

......'" ......n-...........I~"' .......



oto<;t"", IJliI:rnopy. /oIwt. ~ t'l9ll:ll6.o llS_

S. EnoI_ . pposiIion ,... _ lhr pri.... ~ ity in
h"""," .-II. x md. J. Dmt. 110>. 19l16;94:194--404.
~ i <nH S. "K, nni1'l3 oIO<l<on micrtl>Cop< I1ud1 01" ..

th" . d imen, ",,,,1"'''0' of ~ l'lt ; " ' li<>e' In hom." "" ",, I
0."""1. s<. nd.J Dent, Il.e ~ 1 9S $ : 9 l : 1 ~ S -1;2 ,

S, h_

HE. Dr. 1 xr",," ,,1aiol ogy. New VOft<, NY: Thiem..:

SdIout l PIl_ tIC. Ro~ 0( ~ ion of """mol . .....
"'",,"ofrKI or KuIC ~IlOfOtis. I\m.J.
DlI.- CWil 1937:'W:7!>1.716..
S<olt Da. _ J W.1tnoMd VI(. SUu<t............ of
DttIl. ks. _ ,~l=16S-ua.
...... ""..... of


19G :61:\0433-M9S,

tlD, 11011..... GR. Miharn Bj. C......I.. and

of or.1 _amy. bisloIQClI .nd ""hr)ooIoo. sr.
Lo<> ; Moob)'
"6<-<10 A, :>lruau'f ' "~ _ op""",, of ... mmoli, n
I'Io.D. TIl " I" Pej>l rt .... of Ao" n,"y, Lo n~ on Ho, pi" l
Med ic.ll Co li . ~ ., 1964,
Ilo)'<Io A. A 30 moctei of o""me l d'''"Io1>m. nt .. ,ho "" le of




""" ioc h '0 ,"" mk'rolo. AIl v. O<IIC. ,.." 1987; ',1 3s- 140

lloJdt .... Jol"........_", ..,.molln: 0<..." 1 E... "",1. CIM

lWnd,;ym,o. 1997:20S:1S---31.

..,.,.... _ . , JoI. Lnm-KS, _


IA _dtho

-. otoortr-.
..._ - . ...... """""'"""""""-~"
Oolnos; G. _
a llilf>..................... . . - ~


"lilly of _ _ crysuIbon:

Do. " ' - .mod

U1r."'".....,97ll:65'16J-I 12.
furnhead _ .$locl<


IN. - . T-'o ~ I ~ ...

C"""",,",ion. " ..... ,in. ..... Fund. .......1$lru, nuo_
Sri"... UX,J""" Wri(h' lit 5on S: 1!J71.
I'. .,nhead 1lW. Si.>l:. S, cd~ Toot h E,..",..

so.r.:., Pul>li,he,, : 19114.



r., mh.,d RW, ed. Tool h Fn. mel V. YokO"""h'. ).p" n:

flore""" l'olbH, I,.,, : 1989.

fi",,"' m AC, Hu Y. L-Iu . PM"". Z. Sl.wkin IIC. :><lead Me.

IooI.ltioo.1Id "'....1<1>0'""'0';""_ <II flu .......

_"'ftift f"",, , ,;"p: lOW dtnt,rlOll ""'" Hl'LC

1_ '.

fKh ........ c.;f"....,In~ 19!1O:."'1~1l~

FiII<rImo N:i. Mor-.oloW:


C , . 'I JoI. ' -. ,. _
J. . I
oIKtnHI. ldi<,_.... """" of

:li l .... ,. _ _

,,-,,""""n _

__""'II. Or.ollliol. m7;1iI:16S-7n


_~ ................. c.w._19G:16: 179-...

_'*JW.~n._DI.Tbooryfor .... ~
<II hum>n ,nod
d , _boo ~ ond and ~ lDTA ;

r" tn"'"

a COIm ..... SEJol anod TIM 'lUdy. Ardt. tIoI,

197ol: 19; 18J- 197.

Simm.. JP, Fir>ctlam N:.. MoIt'<UI" """,""ni, m. 01 <Ion" l

on" ''''1form>!ion.Cril. lIN. Or, I Bioi. Med.


Siocl< MV. fNrnbNod 1l:W, <'do, T_ h [ "...,.,1; Ii . C""'l'O'iti oo.

""'perlin . ..... Fun'L" ........ 1Sin'CIl.te. Bn,lOl U ~: Jolon

WIiJIo'. Snm: 19s5.

Tm UOe. ..... llr:II Him:>Io:osY Dc .<1<+....... SlnlcIu.........

~ ..... Id.

so. laoiI:: I.:Y. Mo<IIr. 1M.

A 11<1, - , .....010\_ Pi Colon. Dl. ~ MU

w" _.... JoUII """" .......

___/:a-. _.ns:9760-ma.

:"" a d _

~ ... _
w.n.oc. .... ....ki_ OF. - . MOIl. fftlo-.eI
101< of _

She>! ~

~ 1O:19-1l.

I,omdloo .. win ";,;ohon- _

_,.3' 110-11"'-

w.f><r Df.


PL._Df...r-.ure "'........ ~1IIIs

... .... _mel - . ..



.......... DI: . . _1Dpmrnt.

......, _...... JW.~\/l(.IMo ......

~tH _"'9>

~ I "" vl",

infol".,ion zonr in ocid _ _ bumm . ...... l AtdL o.-..

lIiI<Jl, ~ 3;II S I_ IISll.

NjolII!<l .... _
... )0,""'" _

. D<-nL J.

",nr'llu," iom in hu mon '''''1'''1 tMIllri. J

MOI']>IIOl. 1975; 141 :4 7 ~0400,

Wni" .k", Dl.. Kk~ .-.J. 0, SC. nniJl.l: elec,ron n,i,ms,, ,,,,, of
"'" n.<>,." al linc in hu""," o " , ~ , ... m., Orol Bioi,
1!l7B:2J:4S- SO.


II! structure andFunctjan af theTeeth

10 Histology of Dentin
Nicholas P. nesce

chapterOutlin e

Introduction... 172
Objective... 172
Dentinal Matrix Compo,ltlon: Inorganic and Organic
Con,tituen"... 173
Inorganic Matrix /73
O,qa ni( matrix 174
Rore of Matr ix Ve,icle. in the Mineralization of Dent in .. 176
Dentinal StfUeture and dassincatlon... 177
Cortlent. 01 the Denti",,1Tu bule... 183
Incremental Nature of Denti",,1 Depo. ltlon 185
Dentinal Fluid, Permeabillty.and Sen.itivity 186
Sum mary... 188
Soil-Evaluation... 188

H ,"-

Dentin i., prim"rily formed from the seCl'erory products
01 the odont oblasts and lheir processes. It is the h"rd t;, sue that consti tu te, the body of ~ a c h tooth. ,erving as
both a pmt cctive covering for the pllip and as a support
for the overlying enamel (Fig. 10.1). Unlike enamci,
dentin is ~ vitai tiss ue cont;>ining the cell proce.<ses of
odo ntoblast5 and neurons. Odontublasts perform a
,tructu ]'al role in the for mation of the denti nal ma tr ix,
and neurons con.ey sensory informatio n, The prima ry
component of th e denti nal matri x. co ll ~gen. imp<.rts the
re,i Hency necessa ry for t h ~ crown ( ~n a m. 1 a, well a.
denti n) to wit hstand the forces of m.lstic"tion. The color
of th. crown of th~ toot h is pa rti ~lly due 10 the color ,nd
thickness of the under lying dentin as well a. to the thinne." and tr"nslucency of the enam ei.
Although dentin re<em bles bone in composition, true
de nti n differs from bon e in th." con!.>ins no trapped
celis or blood vess~ls and also. unlike bone denti n. is not
continuo usly remod eled . TIlel'efore. dentin has a limited
cap;lcity for rep;lir. New physiologic or ]'ep<.rative denti n
can o nly b< addO'<! On its inn e' aspect so that as the tooth
age" th e bulk of de ntin increa ses as the ptlip cha mb<r
de<:reases in volume . AI<o. unlike bone. coro""l dentin is
covered with enamel and radicu iar de nt in is covered
with cementu m.


MMtia denl'"

De"" lracls

Fig, 10.1 ReI'lion, hlp between dentin. n,mel, .00 the pulp, DEI; denllno
en, n",l lu"etion.

After reading thi< chapter you shou ld be able to: recognize and classify lhe v~rlous lypeS of dentin: discuss the
developmental o rigin of the various ty pes of denti n;
describe the organic dnd mlne rdl components uf t h ~
denti nal ma tr ix: and explain the roles of the primary
orga nic c o mpon~ nt , of th e de ntin, 1 matri.
FUlthermol'e. you shou ld be able to describe th ~ eff~'l'
of natu ra i (enVironmen t"!. physiologic. or path ologic)
and c1i njeianinduce d (iatrogen ic) factors thai .liter
dentin compo. ition and permeability.


-",O"H!srologY2! CNntin


Dentinal Mat rix Composit ion: Ino rganic

and Orga nic Co nst it uents
MoIUR' elm,;"

i~ abolll


mi~aL 2CX\; ~ni<


a nd 1m; _ .... on. WO'ighI ""' is.and about SOX mi nnat

30S 0lIl"ic. mcl20S w~ on .. volume b.o<A Drorin
<Ioe's ..,. ~ .. uniform composition thfO\JlhOul tilt
1llCIdL It un vU)' in OIpJIk composition .. - ' I u
Iurdneu mel mi -..l tonlffll in different ;mil< III the
lOOIll. This m.lY bf mmd to anotomic Ioutiorl. ~ 01
dml.. sdmntI. or boctl. Unlilor mm>d tht higtI orpnic
(l)nlmI ' "

dtnIin ~ it


defonn ~ unrler

awnp.essiol. AnolIler ~<Urm1Julin&10lilt ~1iency

d tho cWnl' n nwy be thr ftuid wilhin tlle .......'M
rub<J~ n. nll .... wbu~_runcrion ..
"1Irmllc slIoct -ibsoo bt u" dissip.>ting the ~ of
_ iulioo- Oemi" thtrrioR' pn:Mdeo .. cumion" fof
Ihr ovnlyi n. bOnlt tn.lmci.

Inor ga nic Mat rix

Althou!:h tr ace amounts of ukium a rooo..te. n oor i~.
m.gne<iurn, zinc, and otoo miner. ls te.s. metal phosphatesand su l falC'l ) . ~ (ound In denti n. hydroxY' p.ll ile,
C',oC PO.lJOIl),. is the compon ent of
1M dent ln. 1 matrix. The

hy dro~ Y'p.1t ile crys tal< Me In

the form of n. Uelled plate' with the .wpro ximatc
diIll<'n, ions o f 60 1070 n m in lengt h. 20 to 30 n m 1n
width . And 3 to 4 nm in th ickne, <- The ca lcium: phosphAte ratio (by WC'lghtj v~ri ., in pe rit ubu la r (1:2,14) ~ n d
inte n ubu lAr (1:2,10) de nt in. but overall . ....r.g. ' 1:2.13.
.>".n. l.... ,de ,,,,,I. or depo<ition or p" ri ru bu l~r d.nI;n
(<<:Ief'osi,) tl\lIt (An occur wit h Aging 1lIAl<e. the d.ntln
briHk And I"" re1llient.
~ mi n" AI content of dentin mll<e:< it hMd . r th.on
cementum Of bone. Althoudl <o1ter th.on en.ameL In the
LoborA!Ofy. ...reln.,. CAn be meA'Um:! by the Knoop
Iwdne te<t in which A sm.>Il d IAmond point is dropped
from A known d IstAnce
A polished d"ntill.ll ... rf.Ke.
Thew indrnlAlion teSt< ~ .oown thAt the - . - .
lDoop "'rdnons te<! lK"""" h.mI....... n u mbnl is
~o:/y 68 loI' dentin AIld .appratimotriy 343 loI'
~ INtiI" etWrId fM time< IlArder th.>n denlill
(T.... IO. H B.nicA1ly. lhm! is little Dr no d iff<n'OCl! in
1M rAnI'" <II tMe Knoop Iwdnn< test ~n tttth <II



_ gloI:w.oloo_ .,.....'..


l><twoon montIt"'" drc"""P'Jll>ol _

cri11ound1o""..... _


g.......... Iqt< : h , pomo ~ I _ ...,..,. lnroot
_ : 'Imllor "'lnt",~_ ;n ' h<


Sd_ "don,I.:

"oml "'tho pul o :f~
hyporm,. ...... ,.d ,
Incrown o! ~ moo,,, <Io.. 1n ~ .. ...., O"l"',it<d. _ ,'",",."",- ,",.,, .. .
" '" -


- ,-

-...- -

p<IOt"'..... -.g




~poo ,.,"'iI'


.. _......,. .. ~.



IIJ Structure and functionofthe Teeth

different types or be[ween ro<)( and coron,,1dentin of the

,,, me IOOl h, V",ia[ianS m,y occur. however. under the
various env;ronmenl,,1 influences discussed previously,
Sclerolic denlin is harder, having a Knoop hardness rest
of ,l pproxim. tely 80. [a,ious denti n O[ dead tr acts are
p.rtially demine raii>:ed J nd hJve J reduced Knoop hardness lest of appmx im" lely 25.

Organ ic matrix


, ~

F'l. 10,2 Scanning ele<lmn mi(rog ra~ ofdec"k ifie{i dentin , howing col"'

g. nfil>cr< anddenti'1311utllle,.

T. bi<. 10.2 (omp",i'oo of lhe h" dnes; of.., m. 1,00 type, 01 denlin
nessnum 0'


Orthod ,ntio
Sd<O>I'( d"", 1n


eaoou' d"""n _ "

The bulk of the organic malrix of dentin (35- 90%) cansim of coll.gen (Fig. 10.2). Mo<[ of lhe coilagen is ljIpe I
w;l h minor " mounts of WI'" V .",d VI . Allhaugh lype III
collagen may be found in the pulp . nd in the inili. 1pre _
dentinal mJ lrix of deveioping teeth. it does not appe" r
to be a secret ory pnXhJCt of mal ure odonloblam.
The noncoll"genou, m.cromolecule<of den[in can be
CIJ<.sified into sever,,1 broad categories (T"ble 10.2):
phosphopro lei ns. r-CJrixlxyglul"m.te-containing (GI . j
proleins ,
misee ll.,neo ",
"i dlc glycoprotein"
growlh- relale d f" clOrs, serum-derived prote in, . lipids.
"nd proteoglycans. Among lhe noncoilagenous pro[eins,
denti n phospho protein (Dr r or phospho phoryn) is the
major contriblltor, com prising 50% of JII noncollJgcnou,
protei ns. I[ has been found to associ.te Wilh collagen J l
lhe miner, liLllion fronl bUl is nol fOllnd in the pred~nlin,, 1 m.trix. In vi,tO experiment.' hJve shown th" l
collagen [ffonstituted Wilh DPP re" dily minerali,"s. II
hos been ,uggested that Drp ""ides in "hole" regions of
coU"gen fi bers (belween lmpocollagen molecuies) and
serves "s" nucleator of miner~l iZJ [ion. The presence of
highly repetitive I\:;p-Ser-Ser (dss j molifs in Drr i., pr i_
m,rily re,ponsible for this fllnclion, In vivo most of lhe
,.rine residues exhibi[ing lhe", motif" in lhe region of
[he protein. " re phosphoryl.ted. n tte 10 i[S high electron eg. live charge and charge repllision. of pho,ph,' te
" nd c'rboxyl grouP-'. lhis region of lhe molecule exists in
on extended sl"le and also ,erveS'S.' -CJlionic sink- for
binding of colcium ions.
Dentin , iJlopro[oln (DSP) i, a phosphmyl"ted. highly
glycosylated prolein contJining high Jmount, of sialic
acid. Both Dr r and DSf> are IOOth-specif,e produ ClS.
Howevel', synlhes is of Dr l' has be-en dete cled lr,' nsie" lIy
in pre~me loblJm J"d odonloblasts. Recent genetic evi
dence indic"te, lh~t these lwo protein, (Dr r and DSr )
ale tra nscribed "s a bid stronie gene produ([ dnd ale
pdrt' of the same prolein, dentin sia[opha sphopro,ein
(DSPPj, However, lhey dre not pL'e, cnl in the denlin,,1
matrix in the eXl"'cted 1:1 r~lio . The ralio is clo",r 10
10,1 or 7,1 (DPr:DSI'). Ch"ng e, in the tatio m~y occur
during post-trJnslalional mod ificatio ns (phosphorylat;on and glyco,yl"l ion reactions) or furtber inn.cellular
or eXlracellular processing of lhe prote ins. It i<inte, e<[ing 10 note that ,oot or cemenltLm- associated dentin
only hils on. h, lf of lhe pho'phoprotei" content of lhe
coronal or en" mel-ilSWCi,1[ed den tin. The funclional signmcan", of lhis difference is not known ,


I Q tli~ ~Lo{pentin

TIw ....ults or N'Iy radio;lutograpllic npmments using

1M synrn...;. or "","un pllospllo:>proleins
<kmoll$l',;md lh.ll the phosp!wte Iblw.o. prrl<Rllti.ll1)1 dtposllfll II tho mi"",",w u lioon fronl. sugpsling ttI.ot
the .nu.K'tl...... u "ffi<kinI; or p/losptJoj>locei l'l$ d iffers
01 pmri... compri$i", the PR'lImtin.d pWrile
(~ coI1II"l~ n.. Lan... is rdr-.l by 1M odoorolUslie cd body or- nw- the ~ of tho odontobU:uic
II't'CflS ",hilt ~ n s .ppeM '" ee Glrrted
>10111 the odonlobl.ilstic prouss. " nd deposilfll n lht'
miner"l lz,lIion front.

"1'0, '"



G\;l prOCt,Il'l.~ so narnnllX'<.u.e they contain unique

"mlno add. l"C" rbox yia led glu tamic acid. ",. c.orboxy\;l-

lion reaction II vil.min_Kdependent. and 1M .>ddition 01

thlo... ca rboxyl gro llps e nab les mese plGIcill5 to bind calciu m, Cia pmte im are nol ' p<'Ciroc to de mi n. Bone Cia
prot~ln. or o,t~.l ci n . nd matr ix Cia prOld n have bot h
bee n found In d ent in. Gla protein. of t he a<tooc. lei"
lyp<' ha"" bc<-n tocalioe<l in odon toOl.l ,l k p ru<es= a nd
it has booen ,uU""{cd, benu .. or t"" i, anionk dla'.>eter
a nd calcium-bi ndin g ab ilitks. that they plq,1 s.ignifican t
rolr in minocr.liuOOo. Ma trix C\;l pf'O(cio h;lS ~n found
in lIMli n in 1Nel. sim il., to thow of bone. ll<'cenl evidtntt M"t'1l'IS to f.MlJ" ~ vXw tlwt ' My _ ~ . s
~tiw' R'fUl.lroo of m u-oJiulioll ,~ tlwn nuck.~

JI'rl:UoclYc_ ~" <Wm.lw!" dw>ndn>olin. .nd Uutin

...tOO conuinil1l ~mi~.ns ~ . 1<0 beftl
found ,n .....lin. DNorin. .....,1 Pi~.n _
~n'd . ,111 colI4"n !ibm; . nd biglyl:.ln.. proleO~n conuining t_
glycouminosl)'l'. n .i.... chain>.
'-e boIh bn found in denlin. Prol~.ns found in
\ftdenlln an ronoideolabfy larger tha n those found in
denlin . TIle ability of som. prnteogl~an. to a>SO<iate
.;tll collolgen , uggo:-sts IMt they ""'Y ploy a role in fib, illOlf"nelil (fii>er mo, plKJ lGl(Y and size ~ Proteog lycans.
' LI(h as chondroitin sulfate. ,"n inhibit mincral;""tion.
Olher proteog lyc. n, bind cak lum rel.tlvt'ly nnn' lX'dfiu lly and can Induce hydroxyapatl' e format inn in ~il rn.
Ad d ic gly('OptOtein, are carbohyd rate_rich and cont ain
acidic: groups 5uch a, acidic .mino acid. (e-&-. part ic
andl(lf~uumk acids) and .i..lJio; ac1d (DSP. oo DSl'P also
belong 10 ' hiS group~ TIle IWO most prominent proteins
In this P"O"P .... oSleonet n and OSleopontin.
~lltCti nISJ'ARC (<ecrI'I.... PI"'...n .acidoc and Iidt in
<ysIine) on,;INlIy found in bone.lIis since I>eft> found in
moM od ," miner.liznl ~ nnnm 'neroJiznl tissuoes. II
IIi'S ~ _ _ rated in PI~in and dentin. Jt binds
~ronatY 10 uJcium ;lrI(f surbcn of hydroxy~tite.
mhibitI"I miner.oliuoon. Jt . lso binch nonspecifiQlty to
coILopotL O>I",pontin, phosphofyl. ted etY<oprotein,
conuin n arJ inine.gly<:ineasp.o"ic .oriel integrin
reaptor-bindi"i~. Intepln. ate ,epfors foond
on the cell., . urfa"" dial ~ a' repron fOf """acel_
lula, mm;" molecules. TIle 95 k~ is in higl>er
amounlS In root (cementu m_Msocialed) dentl ll lh.J1I in
Crown (en.lme l- a" " d . tcdj <lentin .



IIIStructure and Function of the Teeth

Growth factors have the ability to stimulate the differentiation of undifferentiated cdls. Member' of the transforming growt h factor ~ ( TG F_~) have been observed in
bone, c"nilage. "nd denti n. In addition, insulin_like
growth factors and fibrobl"st growth fan ors (FG fs) have
al50 be~ n found in d~ntin. 1\ lL nl q u ~ bone mor phogenetic protein . ble to induce cartilolge for mJtion from fibmbl,l Sts h,l S,;Iso been discovered in de ntin. The-,e gmwlh
factors most likely play important roles in the response
to injury by inducing the formation of new odonto blast'
duri ng rep.>ir. Ir i< or p.>rticul"r imere' t that s m~lI
"mOllnts of canila ge-spe<:ific protein, Ii,; ve been fou nd
to be secrete d by "'p.>rative odonto blasts, Thi' trarrsient
aCliyity "'.,embles the formation of a cJr tiiaginous callus
formed duri ng lite he"ling of J fr~ctu red bone in
response to cartilage inducing fan ors present in the
matrix. TIli' i nd lcat~' a basic similarity of these two tis, ue types.
lJpids exist "' a minor component of the dent inal
matrix, Ther~ are no unique lipids a"odated with the
dentinal mJ trix. Phospholipids may pal'ticlpJ te in mlneraliation throogh form.ltion of c,llcium-pho, pholipid
com plexes.
Another minor component of lite org.l <l ic matrix " re the
serum proteins. Serum . lbumins and alHS-glycoprotein
hdve been found in d~nti n. The f" nctiondi signifLcance of
the.," protein.' in dentin is not cur rently known.
Role of Ma t rix Ves icles in t he M ine ra li~tion of

Clinical Applicatlon


Lilte rrt growth f"<tors within the dentinJ I mJt rix assume
iml>ortilnt mles in tissue repair, When a tooth is injured due to
infection or Ir" Uln. the res ulting rd ease of proteo lytic
enzymes and the acidic environmenl cau.>e dis.>olution of the
eXtl'aceliular matrix. Growth factors within the extracellular
mJ (rix .lnd within platelets from the blood exist in latent
forms. The conditions tile injured slte, such as proteo ly,is
arrd low pH, , erve to " , liyate some of these factors. eSl"'clally
TGF-K The activegrowth factors "'" able to induce growth and
differentiation of cell,.

Matrix vesicles are membranous st ructures that arise by

hudding form cell<. for eXJmple, fmm chondrocyte.'.
osteobla,ts, or odontobl",(s. In the,e tiSSUe< m ~t r ix Yes; d es serve as fIlKleation sites for c"ki um pho,ph"te. The
lnte,.",1 portion of the bilayered lipid me mbrane Is
enriched in phospilOtidyl"" ine. Ad dilionally, lhe vesicle
contairrs rr ud eorides "nct a number of proteins including
anncxin V and alkaline phosphatase. In t h ~ prese n c~ of
calcium, anne, in V bind, rapidly and with high affinity
to phosphotidyl,erine, for ming ion chJ nnel<.l\nnexin V
serves to mediate the flow of calcium into (lie vesicle.
P hosp hat~ ions recruited from phospholip ids and
nucleotides wlthin t h~ veslde are libe r a t~ d by th ~ action
of ~lk"line phosphatJ., e. The a<soci,ltion of pho'phate
ions with intravesicular calcium re, "lts in the formotion
of octac"lclum phosphate cryst" ls inside the vesicle n ~ar
lhe membrane. Besides it' role In the formJtion of lon
ch"nne ls, annexin Valso serve, "$ a collagen receptor. In
th l' ",gard annexin V serves to bind matrix yesldes to
the collagen and , equesters them in the predent inal


" 'H


Dentinal Structure and Classlftcation

01' hodnn;... lrut dmdn, is ukifiN liss.. lmt bdl.
edll. cont.l;ns tubuln. md is lKJoIniud by odontobWts
(~'3S- lo.l - 10.3~ n. mou prom i..... t ~~,u ..... of dmtin
~~ ,.... _tina] tubu!n. In ..... <:I't1'W n. the direction 01

<lrm ;na ll ubu!l'S 610OO5;n a n S-l hapl CUIW fro m

cten t iOO<'nam . 1junc t ion (DEj ) to t h. mine ralization

front or dentin_pl",l. ntin junctio n, Th. two bends, mak(n& UI' ,he S.hJ.pc. an' call<'<1 the prima ry cu rvatu res .
11k' f,w CUIV<' { ....."'" the DE]) w il d, towa rd thoocclu..l o r inci.. l . urf.ace of thr- tto:lfh a nd the stInd
tow.ord , .... a pel< oIlhe IUOII (Fil'. 10.1. IO.5 ~
1btst' <Uf"<'S ~ 1<'. . PJtI'IOUncftl in the ~I
repon ond II.. t ........ .,." m lln sn. t in dw: IUOII
(Ftp. 10 .1 And H).,"~ $m.Iller ~ryCUfVatum.,."
'o'isiblie m;c">5(opic~ly (Fit. 1 0_"' ~ I'IiITlOly nmralu,"
~ l ,.... p"llh lakftl durillJl ee ,nward migratiool or
, .... od on tobl.l"s. 50" d.u y <ulvaturn may .... r....

~og _

10.4 II "S' """,onn ", pr;m.y ~ oItho!


I S<a>nd>ry c............ repr~ od .. undubtion> 01 tho denri.....tubule.


Fog_ lll S lot>!"", . nd _ aI donIinOI tubuIr>.t tho DEI (AI andtho! pulp
(q R<I;rtiomhlp l>ot-en tuOOIn in ,.... <>Yity Ikxw (I 00<1 Dj . f>d pothw..,.
of '''~ th roug/1 dffil in,


II! Structureand function of the Teeth

Clinical Appllcatlon

The increas e in the number an d size of th e denti nal tubules a,

the pUlp chambe r is approach ed is impo rtant for se, eral rea wns. Firs t. w hen cutti ng into dent in. dee per cuts expose mo re
tu bules an d d~md&e more odontoblasts and their processes
th an shallower ru ts. Secondly, the ~ pplication of pote nt ially
harmfui substances to the denti n can damage the pUlp. Botb
the pro' im ity and increased diamete r of the tubu les make di f.
fusion of ba rmfu l mate rials such as bitcteria or bacterial prod ucts as wcli as clinically applied liners, bases. o r eucn puipal
obtu ndents mo re likely.

fig , 10 ,6 InterQ !OOur", ",a<o, I;., b<_ro tl>c m,n ,le dentin (aoo",) . 00 d rcumpulpoldentin (belc>w) ill the crown.

result of sma ll spiraling undulati ons of the odont oblilstic

proces., d uring: matrix fo rma tion and m ineralization.
Tu bules, like the odontoblastic processes. are tape red
and bra nch<:<l. The na rrawc,t part and the most pronounced branching OCC llr near the DE]. lis the odont oblast< produce more denti nal matr ix. they migrate cen tr~lIy ond become more crowded. Therefore. de ntinal
tubu le, are more numerous and do, e, toge ther nearer
the pulp (40 OOO/mm' ) than In the oUler o r milntl~
de ntin (20 OOO/ mm' ).
Dent in can b ~ d a ss ifi ~d int o distinct types bosed on
location. matrix com position, str uctu re. and devc!opme nt. 1piltte rn (T~ b l e 1O .3 ~ Denlin nomenclature i., not
ne< ~ s ",ri ly ~xd u, iv e ond often i, self.descriptive. The
dem ln neares t the DE] of the crown i, for med first arrd I,
called ma ntle den ti n (Fig. 10,6) . At the DE). mantle
dentin , ,,d enamel interdigitate. g iving the DE) a scallop<'{! il p p ~aron,,, . M iln tl~ de nti n COHsiSIS of rel, tively
large collagen fibe rs that ru n to ughly pe rpe ndlc lililr to
the DE). The highly ordered structure of mant le dentin
m. kes it positi,ely birefringen l in po larized lig ht In the
roOl. unlike the ctown. t~ collage n fLb<-rs in the first
fo rmed delll in lie para llel o r ob lique to the DE].
There fnre. no l rue mantl e layer exists in radicular o r root
den tin, The bulk of t h~ denti n underlying the rn,lnt le
de ml n is called circumpulpa [dentin (figs, 10.6 and 10.7).
Collagen fibe rs thL'Oughou t thl, den tinal layer ar" smaller in diameter ~ n d more r.ndo nlly o rienle d l h ~ n in
lllilntle denti n. The region , eporoting the, e lwo I. ye rs
ha, a chara cterist ically high amount of int erglo bulilr
dentin (Fig 10.6). formed as the result of the Init ial rapid
m ine,ali,. tion of de" lin. Initially. denlin i, mine ralized
by t h ~ fu,io n of numerous cillco, pherites, Cok ospher ite<

Table. 10.3 Orgilllic <0""1'0",,"1> in dentin " Id thoi r po" ibl. funaiQn,


Maioro<gll"ic"""PO""" (';Il --,}2~1

Ty ~ I prfoolin" eswitI1 m;"", , mounts of ty~ y,
Ty ~ tit

P OO<p ~_ n>

round in tn< p" lp , 00 during ",rly dentl..1


...,. play' ",1< in io " ;at; ~ minor,liW;oo.

Prov;de, t ho ,tn.,t", 1I"m""""k foeden ' ;".
gll'lng tt st rength ond ", ~ I "' ", e.

'"' fo,-m oti(>(l

M'jDt non<ollag<ooos protdn ~ dep o>lte d " ' Ile

min"" I",t"" Im "t: not ft>ur>d "' P<"d. "t ;n. Den'in
, 00 " "", ;" pi>o>pho,.-ote;n....
been 10000 to t.. cIo""ll" pm<iuct< of
I.lrger prote in.

M,y play an Import'"' role ;" mioer" " 'k>n,

Oe<m,,,n, , hon<J",;t;". , 00 ""t;" ,u lf,t , ~




Prole<>g<yc, n,


, od big<yc, o"" "',,"'"

ioM' t m;..,,, li,.tioI1 . nO ot hor> bln<I ulclum

""n,,,. , ;6<o11y. P,.",,,,,o ""y """ con,roI the
J>roC">'. Tho"
(oII,g"" m, y ( ow ol fi I>n1 I o<J , n ,, ~ .

h '." _ ,,, wi'"

t;<,,,,,, ;,

<>1. ... ",;n... I ~c-<i

..-.:M,;" but ' h""u"
b;nd ook ;um ," g ~ "t ; "9 tl'latU"'y n"y ; M ~ '"
or wnt'QItile m;ne"I;,. ;n _ . w' y
by ""l"I, ting 1oc, 1cald "m le\'oI"

1"<, <I:>o>yglu" "",t""",," ;ning p<otcl<1" M. trix

(;1, ,nO t.."" Cia Io" , oca l<;") "",tein,




,,,,-,,,,ted ",'h

m ")' t..
' Ile <>d"nlObl"t ~
p<OS5,..",;ng os , l;ok bet we"" m.'';, ,00 cell
"",,,," ,,n, . Role, ol other ~ _ ..e "" "0"'" ,

Growth foetor,

T" "'Io",,;og gKlWtoIoetor ~ . wtll, ge- In<luclog

loe lO". ;n,";;oliloo gKlWth Iactor s. ,00
pl, teM-<1.. ;..0 growl l'lractor .
No "n;1"" I;pid, "

" found indontln,

M")' (o<1, roIthe ~ ", I;fer,, ;o<1 , n<I Mr.""",,,",," of

odO'1 ,,-,,, foi_"'l ;oj l'')' '" , P<"hoIogic
p""e<>, Stlrnl>l. te re pair.


P!1" spOOllplO, rrny be iOI'O",d; " "';M k>n of

mln"" I;"t k>n.

_____________ ____---'WHi tology o{ DenIiD__l ?J.

~nl Sllh<'rk~J foci al hydro>cy~~il~ formed from
uklu.... phospIw~ nudo~ inll: sila This mlntr~ l izAtion
Pi-mm ;s oft.... UliM dobuW mil'ltflilution. -n.e.e
<phfflc.d loci cl miMuJizina: d....t'n .an ..... !<'Jme'd
&Jobuln dtnrin. T1'oest' repons IM'I'lINIIy ru.. 10 form .. Ironl. The "",unc Mh>C tft l~ fi&n( c,,cosphtris is o/'u>n I!ypominerolllled ( undenniner.ol
iud ~ As.. ~l. =.os '" hwominn.liud dmrin t illed
inlE'fllobuLl.r d 'in pH'<i<1 in ~ .,~ bftwttn m ns
lnu,,~d .mou"l1 of inte~1ob<l1M
den,in ein be formed btGou ... olllUOftlSis Of m omin 0
dcral'lCY. The ju nclioon ~n ,,",lin .00 pfNlmtin
dUring globul.r tioJ'l of dmtin is ;m.gular.
<howina: lIumerouo; rounded plOlile' " ~ to the
smooth p rofile gf n","mal dentin, In t he sca nn ing oleetron microS(o~ the... profile. arc s~., round proje<:.


,xl(n d i n ~

from the mineralization fronl after


Fig_10.7 C ~<"mp.ap..l dentin com pr;<H most 01the den t in 01tho tooth.
Note tho ""otllltol ~ .._

dige st ion 01 the predentin (Fig 10,1 ).

The dentin surro unding . lId 11<'. ...'" to N ch rubu]e in

<lentin ;s hyj>ermi".. ,.lit ed and Ii'd, collagen as an
orpnK romp<><>ent of its JT\,l. rix. Hiswr k"lIy. this dentin
!Ws ~ le,..".,.j peritubu J.or de min b"u>e it =ms In
sumlUlld the l ubule- DeYl!loprnenlall)' ~king. th is
dmtin is ..,,,11y fo,..".,.j wilh in lhe I!'lCISlina tubule md
the '"'" inlr"lIWular .....tin is ~ "ppropriak (Figs.
10.9-10_11 ~ DO'position ot inttllfubular dmtin ~ns
""""I)' "twr formation 01
mantle ..... tin is~.
TIle cqani< malriJ: is ~ basopblbc. mrtad'ItorI'IllIic
with IOIuid;ne lInd ""'~ Ill"" (pH 2.6 lInd 1.6). md
su ins <Itt'pIy W'ith "kUn Ill"" (pH u;~ ind iulina: " h ish
conlenl or oddk gI}o:......"inoslynns. Inlr"lubuLu""1 maUill producu ""' synlheslm in 1M aU
bod)' of ~odontobl.asl. rr" """",to1I viol
net...:wk through 1M odo,uDblaSlk p<ocns."nd "'" lilr
....101l lalcr,,11y inro 1M denh""l IUbule. Int r" m bula.
denlin is found th ro ugbour tM <kntln.ll m.otrix excepf in
~re~! of lnlO''l!lo bu ld' <!<>nlin ..nd in "boul t he rtrst lOO\rn
or minera lized Mmin (man tle denli n). In IhoSl' drc a, l he
rub lile loKks d hy pc,mine,alil . d Idye" Upo n d om i". "a1izarlon Inl rdlu!>ul.., dcmin mo ,tly d lsdppc ars , I.aving
o" ly lrace s of orga n ic "'dleria l (Fiio 10.10B). n,e ,cmilin<lor of the <lentin..1 JllJlri ~, which lie s be lween lhe
ruoo,", i$ describe<! as int ortubu l.u denril\. The zOlle
be ~ lboe inrertubu lar denli n ..00 mt ,..Nbularden,in
is hypomin..... I~ a nd h.l< beflI ca ll01l llo<> s hoa r!> of
N.... ""'" (F'S 10.108). Although no tr'lII! shearh _ ms lO
l>ounIWy b::1 ...." l hew twO dlsdncl nutrices
is diSlinct (d ilTmng in minoRl lInd coIlagm <OIlrenr)
""" m.i)' man rho oure-r ...teM of
den!,.... tubulo. n
;1 Inu n.istO!d during in dt.(1 ,,-uetll. HisIcOc2Ily. tht
she.. h of - . . . . rriennllO ItIt spact' b::1 oeM fbi'
~ proct'SS.lnd tilt -n of ItIt dmlin.ol tu bule
bJ dmo,nero.1iz.uion. ~, if _ fOlnll'rIy ftIlL'.rO!d
with 1M ;nlr..rubuJ.or don n""l s~. WIth Illcn;l$O!d fo, maliOll ..nd mi ........liz.otion or inlr..l ubuLu d.nlin, tlll'
lubule may ~l1y ~ oludod and tht resuJri"l ....nrin is te-rmod sdemtk. lI.rnsp.>m>t . or " ..ns lu---



f;g, 10-8 5<'''''in9 oIK tron 01 tilt ~ .LIff",o 01 domn

depding g1ntlu~ dertt....





~ot""""i P01 intffiubullr >d 100talUbu i dentin .00 ' ...... ",,1

l>ctWHn tubulo._


III Structureand Functian ofthe Teeth

I"',a (or peri_)


o<>"' ln IbI",,)

cen' dentin (Fig, . 10.11 and 1O . 12 ~ W hen imme"ed in

w" te r, the high m ineral content of 'clerotic denfin gi""s
il a Iran<parent or gl.lssy J ppearance. This Iype of de m in
;, commo nly found ;n Ihe rool<. e<pecially neal' the apex
(f ig, 1O . 12 ~
Dentin depos; lion begins w;lh the format;o n of Ihe
pU lp chJmber Jnd con lin ue<as iong as the pulp rema ins
vil.l. Dent;n can be cla<sified as de veiopmenla l. when;t
is form ed during development as a resul! of em bryo ni,
int er"ctio ns. or physiologic. wh en it is formed as the
resull of respo nses to environment..l stim uli. Primary
dent;n ;, de velopmenl.1 dent;n th~1 is formed befMe
" nd d uring er uption, Se<:ondary and n-rtiary denti n may
be tho ught of " phy<iolog ic dentin. They are forme<! dS
the resu ll of norm ,,1phy, iolog;c Jn d p<1l110logic sti muli,
respe <tively, f ormatio n of seco ndary dentin norm,' lIy
begins wh en root development is completed and "fter
l he teeth come into occlu< ion. However, ,econd"ry
dentin deposition has been reported 10 occur in impJcted (unerupted ) th ird mo l~ rs , The r,' te of ,econdary
delll in deposition is gene r"Hy 'lower tha n the rate of
pr;mary denlin depo <ition, " nd the r"le depend < upo n
d;el and lhe occlusal fortes to w h;ch the crown ;s suh_
jeeted, Abrasive foods and gre" te r chew ing fort es provide stronger <timuli for seconddry dent; n depo, il;on,
There is an "brupl change in ll,e course of the dentin,,1
t ubuies in Ihe shift from depo, ition of prim"'" ' 0 >eCondary denti n. Ille t u bllies "re also more irreglliar in

fig. 10.10 Microscopicappear"" e of intr.."bui.:lrdentin. AGround ,ec lion

of ",I, Roenlgen-ray Maly;;' , ~owi ng ",<ro.,od minor"Iden' ityin t ~ e
introtuOOI. r zone. BElectron mic rog r , p ~ 01 d""'in<ralizcd ,c ction , ~ ow _
;ng ooththe los, of mineraland loworganicconte,,1of intra!u!:>uf" donI",
CS. conda,y {" rv"tu,""cprosentod .. " ndul,tion' oft hi' dentinal tubule,

Fig. 10,11 Stanni'", olo,"on micrograph ' !>owing th" closed

""ed dent i"" I llIt" i1e,.

.,><i, ot "'OJ-

Fig. 10.11 5clero' ;c dentin inlhi' ' picala",. of root dentinfrom

a ground ",clio nof a tooth. Tho, b",nce of tubule' (by fill ing
with S{ 1 ~ rot; ( dentin) " ,,,., 'h i' tran, p""'''' .'ppe,mnce.

_ _ _ __ _ _ _ _ __ _ _ __ _ _ __ _ _ _ _

SOJld.1.ry (\<onrin (Fig lO_n~ It shou ld ~ olMous th.>r

<onoWy dt:pos llion ".",.. lIOl: ocror un, fDflllly in ~II
...~.-s of ."" <TOWII ......,. . . . .bjtned ro me ITIO$I <limull
~ ~ w ... of ~ry denu.. deposition- ~
pulp clllombc'r. whidl ~
h..... I'" W"" oJ lht'
auwn dun", do d '9"lI!'Ol(
tile fomul:ion cI pri.....ry dfntin. =~ . d;~l sI'I.lpe dut l(Illlr ~
mctIi<: ~{ion of =ondMy dtoon. Tho junclion
between prinwry and 'IeCOndory ","""in GOn .1-10 ~ dis(i.."..,Mod by Iight ch;ol'# in I"" diR'dion of ~
dcn li""l MlIII O'S (Fig. 10.13). Will> incrf~ dc~.ion.

the pulp chamber Jxomml"l m1ur~ in Sizedand th<'re is

fun"". crowding ot odon'obl.><l's, ~ od<>ntobJasu
may di",p"".r (~ apoptmi$) and men robule< m.lY
bccc rre occluded (", ',, ,""ir). M "",nliot>ed pr",,;ousJy,
t ubu les a~ bo-lievcd to t>ecome scle rol ic by lhe p rog reso
, iltt' Mpo' ition of intrat ubulal' dentin, EI<:erro n microg.-ph. h.wc L'cvcalcd m iM"al i~alio n occu rring wi ti, in
th e ooontohla'lic process du rin g the form ation of ,;cle
rolle okntin . This is nOl a no."",1 PfO<?'l$ a nd is m()S1
liloly d.... .Ocell injuIY o. death.11k'caki um ItlJ.t ente rs
me dam~<"d p"""'" most likdy precipitates d ue to the
~ of phospl>,"e groops (~d e n os"... l rip hosplur..
.ad............ d iphosp!wre. pbospbopror..;l\S. or .any 0I:I>l'r
phOJph.o te-<om~ ining molu~ ) prnml in the cyro.-


Un l; ~ SOndary """'in. """idl ls Iom>l'd;os ~ result

01 .-mol physiologic sn"''''~ tnti.lry or r~p.~utiw
<ltnIin is Jormed <itS ~ mult 01~ patloloP: (lfOCl'SS sud!

urie's. ~ aries snmul.l.tet odonrobWn to fomI

<krII,n ~t ~ (;lp;d lOIre (fi&- lo. l4 ~ OpKoUiYe prt><:ftlul<'S,
... ltid! ~11' IIftd<"d to ~ ~ lOOth surf.oa>s. Giln
.lJso provi<k- ~ sti mulus or danw:ge to me underlying
odootobUsts. When the odootobLnlic I.,. h.1. beo:'n
destroytd. crib in t he undHlyinl pu lp migr~le to th is
sire ~ n d differentiate and r~ p;dty deposit a n ir11'guLlt or
d isOlllanlud d" "tin.l m~trix. Ofte .. ce lls beco"'''
t rdpped In this mdt rix duri ng Its e.,1y stdge, of formdtlon. Whe" t his OCC lirs. t he dentlu a ppears to .....' emb le
bone dnd b c. lIed o' te ode nt in. The bou ndary bet wee n
seronda ry Mid tertidry d e nt in is a brupt (cdlclorrau matic
line ), r dths o f Iii<' dontinal tu b;llcs usua lly ~ ..... im erru [>ted attlti , junClure d ".. to the death of old odon toblost'

d inlca l "PP1iClltion'
Sderotlc dmtin m;ly $<"I'VC 10 coofi.... c~ries 10 !he
DE). whil e de.od tr~ if> )'Ounttt <\tIltin would
~ ll_ ( ~Iies to ~ .. t""",.<dllle pu lp ~ easily. Similarly. Ihe p Ul p' of )'Oung teeth d,e more
,u.ccpli ble 10 toxit ,timull (.om de '""1 materials
t hd" olde , teeth with sclemsl'd tubules.


_ _l!11

O Hi!!~r ofDer1tin




Av- 10.1) GfOInI>e<:tion of derm - . g _

.... tubule< bend >horpIy


;os theJ_ .... ~deroJ... The --...

If<e9IIor """"""",,....-.m _ ildoso< 10 tht pulp.

RS d . ~_-\


. . . .011.. _

C ireumpu'\>QI ""nM

f ig. 10,14 ~,.m of root <Moe.< <I>owiIIg du d troct, ..,d ",..-otic ond
......rot;", d..... irl ,

III Structure and Fl!~~f~!!..9f5!'. e




i ne

Fig, 10.15 Rep.,. t ivo donbn OdentoNa,t, Gm be ",en unde<lying ' t hick
I;rye, of ..." t iO/1a'Y dent in. Be"""en tIlo ,eactin",,'Yand ",cond"y
denl;n llle... i" prot1OOnced ",kk,u aum.{it; line.

Fig . 10.16 A l<o,coo""'Ydentin. Nole , large w ne of dentinal m'lm

<po, lted t>y " "",,,,ng <>rigi",,1po 't m ~ob c odomobl.m that had been
;timul' led by. relatively mild ' t imulu" Thi, tubular fc.otiO/1ary dontinal
depo>ited immedlate ly beneat h the "'" 01 dent in submitt od
to the , timuIus. apI'"'' to exhibit cellul..-indu,iO/1' . A , tronq ' IimuIu;
lead to deoth of 'he o'igi",,1odontob la,t>. Con<equent ly, the rep..-ative
d....ti". 1mW lx w., depo, it<d by. ,",w go",," t iooof oOOntobl, ,' _like
cell, wI1ich havediff.......t i. ted from Pl,lf"ll p,""u"o r coll, a, a "'f"lrati",
moemmi,m for ti"ue rep>ir,


. lr. palO n'

~e "I'"

Ooad t<aot

Aopa,e live


CGround ""'liO/1 ' howingcervicalc,

Note Ihe t 'anspa'ont <kn' in
underlyingthe dead t,act, In<etare, ' howing<&l< tioo, ryde1l1in wilh spa""
tubules overlying atubul., reactioMryder>tin by poIari, ed mk to <>py, NOle
the d.1 ,k border between re, ctioo. ry, nd repar'tivedentin,

a nd t he d eve lopme nl an d differen t i. t ion of ne w 000 0 10b las ts , Wilh t he de at h of t he init ia l odom oblilm. il new
d isorga nized l ubular ma tr ix is fo rmed by ne w odomob la<t<. If tbe death ofthe ooont oblasts i, rap id. the den t i
na l tu bules as <oci,' ted w ith t he fo rn'er odo nto bl,,<tS
hilve linle cha nce of becomi ng sclerol ic ln gro und ,,"cl iom. Ihese l ubu les a re fllied Wil h air an d loo k bla ck In
l ra nsmiu ed light " nd w h ile in reflecled light. Th"",
areas a re cal led de.1d tractS (Figs. 10,15 an d 10.16).
Ter l iary d entin has numerou s synonym , . such as irreg uia r. irr ilat ion. reacl iona ry. a nd re parative denlln. The distinct ions be tween th e type , of tertiary denti n have been
Clilrjfied . ReactioIlilTY M mi n is teniilry de nt in , fo rmed
by pre ex isting or primary odomobla't' in response to
lhe pa t hologic ' ti mulat io n. On t he ot he r h"" d, rep ara_
tive den ti n is formed by newiy differen tiilled odo ntoblilsts fo ilow ing lh e d eillh of t he o riginal ce lls. Since t he

BRep>ral"", de ntin, Note the dy>lropl, k and 'tu bular derrtina; ""I';.
tIlat ' ppe;lrs 10 exhibtt cellular inclusion, (osteoo<nbn), Consequently,
the repa'ative dentin. 1matrix w" deposited bya nowgene'atiofl 01
odonto b ~<l -l ikc cell, wflit;h
d iff""'nt~ted from
<>Of cell, ",
, ",,,,,h, ni, m fo< tis, ue r;>p ' ~.


oeee tract

_ _ _ _ _ _ __ _ _ __ _ _ __ _ _ __ _ _ _-",
His~_o{ Dmtifl

ro".....i"" 0( ~.nv., odorKobWu c.nncIIl M



i n o:p;thtll;ll "~r. tlw indllCliw: 5timulu:s is I,kfoly to

.:ome from IfOWIh r..ctors fou nd wil hin tile CM'flying
dentina l matri~. Dlmlin.olma lr1x bol. be-ero shown to eon-l~ i n growth r~clor u(/, . < oon. morpOOsenk prolein.
(BMP. , "'ember. of the TCF ~ f<1mily). in,uHn- lik.
g rowth f. <tor, 11C F'~ and fCFs, These growth fa<tors are
of stimulat ing ce ll proli fe ration, dilf.~nli nion.
and m.>1riJ( secretion.
In tfxo I1lOtS 01 fE'<'ttl, /X'a' !tie ~.ntodocnrillOljunction. i. tlr Tomt'$' grmuL.u ~ (Figs. 10.17 MId Io. l'~
The 1Vmu1lr AmIt<' or (his ~. .. obsenooocI in JroUnd
Stions. is lbt rnuIt of ritbfr smoIl hypomineralized
...... ot Mntin or .m.all l/'fIlrawed <p>ces llI.ot fonn
around the denti""l lubules. ~ .p;:,,:es ~ tht
re>uTl of fbi' d iwrlmtatio n of odom obl. " k proc....,,,
tha t are bei ng fO L'l11od as the toot h er uiK'. 'rho re, ult. >r"
tubu le' in whic h th e te rminal p.>rt. are twi st!. The


twisted ..rods


_.pu.- ....
fig. 10.17 DiiIgr'" al tho . _...... . nd buIiondllor Tome<' gr_
,-"inllor root ckmi n~ IIor ~ jurw;OOn.

as .url< &T. n u~ in ground sec-


Content'S of the Dentinal Tubule

The.' odontobl.lstic pro<='<;, Ih. oo:cup.onr ol rh.
d.oti....1 rubu~, F,,"ot cytof'lammn ~~ tbe most mariK'
leOS!i<: fin di n~ In th e od""to bl.stic proce. s. ThMe may
~ th e on ly cytoplasmic , tr uct ure, fo und in the ' mall
br~ nches . nd terminal end$ of the proce$' _Microt ubule,
. '" a""rller common cyto<l<eletal feotu'" the odOftoo
b....tic pn>'55. Mitocloo.>dri.J and ....Ides (to.I ted ~
m.l)'>osoones.llnd !iPCR1ion ,r.nules) Me found dos6
10 the cd l body 1IU1 ;$ Dl'Mft' Ihe- mi,..".ll1iudoo froltl .It
Ihe- prnlmlinck'l'lt ;n junction. The _
or!he odontobIol$Iic p~s ,.;min tbe tubu~ of thr- INtll'" !OCIdI
has ben! ClIntnllo'Pl5ial In'ri.lIIy. transmiS$lon eledron
m,croscopy lew. le<l the pr~ of .n odo nrobliIMic
proces, Within the tu bule on ly In th e inner th ird of l he
dentin. This is now believed ttl Ix> du e 10 considerable
, hrinkage Ihol occu " d uring fix~t i on. d e hyd r~tio n , ond
embedding. With improved fTlP(hod, or filQtion. KlentiSf$ 11.:1"" . l\oWn th.t the odonlObldSflc JHOCUI PXtend$
furtheJ into tilt tllbule mel !lw ....... nuy ",M;b t.... DE]_
bnmune st.inina: of dentin with .nti-tububn .lI1tibodie<
.nd . nti~n .nt ibodito< illso indi<:.teel !h.ol rM
~ or many odor'Icobl.ll<n exR'nd to the DE).
SC.nni,,~ dearon mi<:",~nph< of <!eminen liH<! .nd
coll.1genase-tre.ted fN'l h ~ i1lso provicltd evidence
tll.:lt. few precesses m.lY e~ tend to rh. DE]. ~ver, in
tee th th" hJ"" Ix>en In occlu, ion for lo me time ir I,
un likely th" t m~ny, if any, of th e processe' reach lho DEJ-


rog. 10.18 Hkl'*'!;Ji< 'I'I'N~ 01tho Tornrs' ........ ~("""'~and


CiniUII Applluotion


The tI\idlness el l M denllnallllya" iIlaNses willi due fU

the deposit;oo of =oncIary . 00 lerNry dmtilL The!' culor of
the to<Kh is m..tn1 to thr- lr. mlucelXY of the l . nd the
th id ne<$ 01 the dentin. The increased thickness or me dentin
co ntribu'e s ro the "yellowing" of tile te(:th wil h age, I ncre ~$P d
rhicknes s of de m in alw se rve$ to in, ul. le ' he dent.1 pulp,
ma king vilOti ty le$lin g more diffLCulr.
The deposition of ~ I iud ~ . nd te m ,, ,y dentin nlK
only mluces the vollllTlP of me pu lp dwmber but ..... . 11ft'<
if< wpe. This ......... tlldodontir ~ more difl"1C1.I1t
.nd i~<lStS die possibililYelwlrOl/lllioC~ lor tumpie, perfo" rlons. Pulp SIOOt5 IOnn in colO""l " lid r.ldicuLlr
pulp d"" to Ir.uma . lId oge. Thi. pmce:lS further rnmpfio:.o"",
t hE' o""lOmy of the pulp chamber.


II! Structure ond function of the Teeth

fig. 10.19 A >c.nning oIectronmicrograph of an odol11c>bfa;ti< pr a<e>; witl'

; ;M brofi(he, lhot projo<l into " rnJ;culi.

Br.n_he, of the m ~ i n proces' exle nd b te" fly in sm , ller

tu bules (later. 1 br~nche s). The smaile, t branc hes lie in
cana liculi (fi gs. 10.3. 10.8. 10.19. and 10 ,20). ft ha,
recenlfy been "how n by several investlg,llor, tha t the
ooo n lob l~s t jc process h".' n umero us <ide bra nches l h~l
exist in the lateral branc hes of the dent in. l l ubule,
throughout denti n. This is be,t shown in the odontoblaslic process after the den tin has been cleared (Fig. 10.21 ).
Besides the odontobfastic process. the Ol her <:eflular
pro",,,e, found in the denti nal tub llies are nerve fibers.
Nel've endi ngs are a variable fcature of th e dentinal
tubufe (Fig 10,22). Wilen pre",nt. the"e fiher, ofle n PJ.rtia lly encircle the odo ntoblasllc prOfess, Nerve fibers do
not exte nd a, far as the odo ntobla'tlc pr(Ke" and fo rm
no discern ;bfe junct ions. gap junct ions o r syna p,es wit h
it Unmyelinate d ne rve fibe rs h,w e been ' how n 10 be
occasionally prese nt in the outer dentin ~ t th e DE] of
yo ung teeth. There appears to be a re lationship between
l he nerve endi ng, and the od onto blastic process in th o
de nlinaf l ubule in w hich the ne rve te rn,i",1 indent' l he
process. In thi, way, a great er ,urf,' ce ,1 re~ is "re~ te d
between the nerve ter m inal an d the odontob lasllc
process, In 'ddit ion. these t e r m i n~ l s u' ually exhibit a
cleft or spac e between lhe en d ing and the cell process.
abou t 20 0 to 250 A wide. This space Is (o m p"rable to a
,y n~ptic cfeft In th ickness. as found elsewhere in the
body. Howe_er other fe~ture< of , ,y nap"'. ' [>!'"CiafiLJtlons of the pre synap tic ~ n d postsyn.pti_ membr, ne,
and lhe pre, en<:e of synaptic vesicles. are either lacking
or are poorly deve loped. ft is not know n whN her this
<:effuf,r ref' tion; hip func tio n, a<a rud imentary <ynap., ".




Fig, 10.20 " >carm;ng eleclron mk rog r. p/1 of ." ooontobl, ,,k proce;s , t
th< DE). Ernm" i.. bo~.

ctrrscet Application


The deg ree of dent al sclerosis can inn uen"" the choice of den tal ,urface treatm en t technique, fo r a,lhesi ve m,'te rial;. Re<in
from composite materi als flow s into open (no n, c1eroli c)
l u bules mOte read ily and form, resin lag' , Forma tion of resin
tag' re,ults in bet ter "d hesion , In sclerosed de ntin there is fess
po tentia l for these tags to for m. On the com rary, intertubu lar
den tin m~y be etched m01'e read ily than int ratub ular dentin,
an d sclerotic "tubules" m~y ~clU;llfy project from the ,u rface
of the int ert ublliar dentin. Therefore, rete nt ion of ; o me com_
posite ma te rials may be adversely affected whe n ~ pp f ied 10
scle rotic denlin. Dentin ex posed to the o ral cavity has
increased resistance to acid ~ltack. possibly d ue 10 incor poration of n uoride and the minerafi lin g effect of safjv~ (el>urMlion).

, "'''''''' 'hM

Prooos, e,

Fig 10.11 " scanning electron micrograph of an odonlofil"tic

pnx o" decalcification ." d removofof the organiccomponen!>

of de"lin,Top, no. r O[j: <onter, , l middon' in, bouorn . , lon9
the pulp bOld...,

_ _ ________ _ ________ _ ____ ___ ...!''", '"

, .' .,.,,,
,, ofDrolin

18 5

~ ~ endi~ in lbe <Itno:in;ll !ubuIes ~ sinsuL.>r en ....genlt"rs while (l(hen ~ .I~tincdiloUons


COQSIria,ons wim me odonlObl asfic ~ Bofh

types ""hibi I similar ""'"'u"',..... ~.r.nce. <ontain.

few mitochondria, and


ct\ar.><le';Slic cleft SUf

",,, "d ing th em (Figs. 10.22 and 10.23).

Til<' ", her feaTu re of the <k'nfiM l tubu le is the pre ,
~ of an org.lnic {'Odting: or inn.., l;nins consisting
mMtly Dl ctYros.aminoglyc.ns. This co.otinc h;l$ the
.~"-.1'Ia' of mrmbrarw in lkukified lU'nrd
Dons rnd by liJbl ~. mel c;on NSiIy be ronr.-d with ~ .... ~...JI mtmbr_ d l b e ~
pnxtsS. This LilY'" represenes hypomi".,,,,liud
inn-arubul.. do<llin. a nd "". bft>n tnmo'd the 1m"",,,'


hypomin..,ah,," 1Jy.-r. 1M ,..."., "limiti"l nwmbrant"

or "lami"" Jimirans ha, been . ""Ti(o(I l<> this !.lye,.

Incre mental Nature of Dentinal

The d.>Ily deposition 0( de<ltIIl un be roe~ throu&b
~ """ of Wbo'l,n:g.,gma.. A L1brii"l~r iI. wb<un<:..
rtwr is visibly incorpor<llnl ;00\0 ,he "".. Ii.... m.lIri... Tbis
<Q<e"r is pn i"i,i,tlly. mel .lf~. spe<:ifled pfflod 01
tim, (J Wffk 10 10 days) the ~ss is ~.ted. n,..
toot h is ....mOW<! som.. days late r, ",clio nNl, 'OO mk roSl'opk ally ex.m ined. The distance belW<'en the l<1be led
bilodS di. idee! by the lillie rep....' ents the amoont of
m.lrix formed P<'1" unit time. usu.lly <1.015. Labds thill
commonly ufCll bind 10 hyd""'Y'lJ'olti~ .udI. .. f1....
lIrO"lCE1Il nurlum. hu u.u~;1leSor c.oldum st.ins like
pro6on.mel .aIlurin rN- Roodioao:tie prurIOfS tho t ....
IIlCUlpoi.~ inlO t he ""'lriJI " - .Iso bem
p..m to me~.ure ""'lriJI synthesis. Micror<Odiogr~phs.
rtItough rbelr demomtr.tion of .1~m.>r1~ dm.ities in

the rnioer.IiUllon l"'ltem of dentin. .1'0 ' odic" .. lhe

f'9- lO.n _

~ ber ,.,.....
0'lilud'I0nIti0 In the......., _

0. - - . . . tuboR. NoIethe pr_eel

WI the _obUstiC pores-.


III Sl:/lKtureand Fu!!.~tiOll91"'",


Fig. 10.2. loIIc

rl>(IhmIc ...""


KSogroph ..-~

I.... ;n _

tllM drpi<1 ~

~..-m..... ~l

IO.l5&<cu1ld _ _ ~ ~doilrin<~.....,...,.."

i ncn:m~nt~l n~tu re of dmtin~1 d<opo<;i tion (Fig. 10 .24 ~

8.I>cd o n th... mt....remcnts. dentin is to.liMoe'd to to.
dcpo<ited ~t ~ rare or ~bo"l 4 10 8 IIffi per d.o.y.
Dcnti"05"1~S is tholllln to occur in d rllythmic rrw>.....-. possibly d... 10 the cit(.adim rhythmic.Ktivity of
............ control ibc Ilow or nulTie'n... to odon{()bI.Ists.. The im!llic.ation llflfS or - . Ebner ~ d.lily
<mngc< in odonI~SI dCtMly (fis. 10.25 ~ ~ pmDOUJ><nl i' k , enlt Jll;ol 1inn. contow h..... of 0-... l!'P"~t ~ p/lysioIopc .lItcrnlons in !he p,on=. 01
mineriliution. whidl ooxur oK ..... f""'I""JII intenr....
(fis. 1026~ Euqn~tN conIOtIrhflfS INJ eeee ~It
of ~ sudden clwIp: or p,otholoclc IlfOttSS. The ........ tlI
~ ... "'1" . ... ,,1:< dn ~~ conrow Ii"" ofOwm mel
typi fies the ctunlfl in jltl),,'oIocY (nutrillOrUl. ho....""_
~ l etc.) thn occur ~t birth (fis. 10.7 ). TlJtoseo ncorwl~ 1
Ii..... ~"' ...... in the prl""'lY teeth end !he fim IIt'fIIWnen l moI.1r:s. The dmtln distel to ihis line (""...... lhe
DEJ ) w.os formed prior 10 bin'" ~nd lhe ""'tin proxim.>1
to it (JIt"~= "' the pulp) ...... formo:od .h... birth.
n..... d'" no TC'V'<fSdlllnes bcc~u>c dmtin does not
",model 'n the "",nnet ~. bone. For odooloc la<t;c
;K\iv'ly 10 our. the odonlOl>I.>$liC ldyer would have 10
be di"" pt<'<l . Bone ",so' plio " I. 1JIt"d1...d by
o' lrobldS!<. f aclor< Itwt cause bone ",,,,,rpl ion.uch ~,
p~,"l h yroid hormo".. ~ od inlerle". I,,_1 b. do so indirect_
ly by binding to ",replo rs on o.te<.>bl.,t. cd" , iog Ih~m
10 r",rdel from bo ne su rf~ ce s. Odon!obl~,,, h " v~
br.mched proce" es thdl exte nd for g reat di5tdnces into
the den ti" ~n d ~rc tightly jom<'<110 one ~ Ml he r by rerm i n~1 b ~r< ~nd m hor junctio". (S<'e Ch ~ pter 11 ~
Ther~for~. il i. not (,dSy fm them 10 "Pdr~re from the
pf"<lentl""l 'ud "" 10 ellow fo r denti....1 ",nH)d"ling.
fu rt herrno .... eese l is ""'y b< i"",,,,,ble of responding
"' these hormo..... d"' '''.1Kk of I'<'C<'ptors. H~r.
there i, evidence' of minim.ill remodeling by odonro-bl.3sts.. E" docytic .Ktivity Ius been demonSlr.l<'d . Iong
the odomobl..tK pnlC8S in d<nh.....1tubules is _lie'
~t !he mi""r.oUurion fronI. UltreSiructur.or 0'iidC1lC(' of coIl.1#'fl doeJred;nion ~lso sugge<1:< lh.ot
odomobl.>sls INJ ~nicip"te in pr<'doC1ltin.ll mnrix
IWnOYCJ to ~ mlnim.ll d<srw. The CXImt of =nod~ling
is lnsnifoant ~ 10 lh.ol ...... in t>o....


_ Cl i n k ~ .


., SIln<Ury dmti... l d~pooition rnull$ in dIoo"l'"S of

tlw pu lp ctumbH W"",, os wel l os clwIin In sIu' ~OO Ioc..lion or tlw ~pic~1 fo.-~m'~ During l!'Jldodontic Itwr~py Ih~
;llCl' SODdary d ~ nti ...r d ~pos; tion ~ in olckr
_ h .... ~ il moR' dJlf,cult 10 ~ C'M t ~ pu lp ctwmb ~ nd
Ioc~t~ the COfOIWI orifICes of th~ root c~",,1s du ~ to COflStricnon. Howe~r. In<r.~ d >ecolld ~ry de ntin~l deposition
cecressesme emount of i nmUmtnt~lion ~ d u. ing root' dndl t""r~py. Addlt ioodlly. incredsed >ond~1Y dent in at tn e
dpk~l fordmtn le ~d. to development of more defm ite dpkdl
stop s ~ nd dchle""mtnt of . hell er ~pi'd i . edl.

Demtnal Fluid, Permeability. and

Dentin i< com~ of lUbule1 end. unlike elWllel. i. "'1_
.tiwly ~ . Ruds ( en ~ad,1y flaw ..".".,. or
tIuougb !he dmti...l IUbule complex- from ih~ pu lp to
the DE] or. w hen the erwnet is d.lmaged. frnm the DlJ to
Ihe pu lp. Ruid drisin. from the cui surfdcc of the ""'ti_
...1",buies ~ ~ similn composition .. pW..... dlXl. in, i, forrnod .. ~ tre nsud.ltc or pl~.m .. f luid from th e
blood flows through the reneSlr~lions ~nd intercellulJt
clefts of pu lp;1 ,~ pi ll.l'iH (_ o...pter 11 ~ Once thi<
nuid l.av" tM CdpiH~ri es it pootJ<:t rate> throug h tM
odo ntoblastk pred ~nlindl Idyel, whe... il mdY be combined with the ,ecretory products of ooon!o bldSlS. The

___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

''OHb ~2fpentjn



Buid then fillers tile pniodootobl.>st ic 'flo>C" within t he

dcn ti""l tubu lc (Figs.. 10,3, 10.19.m d lo.22~ TM f1u~ is
alway, unM. " slight po<lli ve p"''''' ' .

/19, 10,26 c.rou"" _ lOon ' -"'1 ' "" IlOIO'd I"" ....' nr.l line<,
contour line<'" Owon.

Banerial product. (endotoxin,) can enter the pulp

thro llgh t he M nt;" . l l ubu le, a nd create an infl"m m" t.,.
ry "" ponse , As "
of i" Oam lll.rion , there I, an
inc",a<e In t he pc rmNb ility u f blood vesse l, In th e pu lp.
The i'K"'. ><'<1 p ulpal pJ'e" ure and product ion of den linal Buid le nds to dca" .. the t ubu les and h inde r b.1cte ri.l from entering ltoe pulp_ R1.'d uet;on in the , i... of
de nti ""l t ubulM. d..e to Kk'rosi' or res to<ali"" ",.neri-


"I.. rC'ducn Mntin penncability. The aIJP1;,;.,. ion of

"ot.os. ium ..,..Iate a nd ca lciu m Ity<lfOJ<idc ront. ining
res/oratr..e mareiUls.1t l he b;Ise of c.w ity prl'p.uarions
mlU'li 1M po'fm""bility of cu r dffi tiJJil tubuIeL Liners
rnd varni.1In al.., s,ul 1M dffItin.oI rubol.... Tho' IOI"I'I'I.JDon of dentiM Buid un~ cavity prl' pHWo ru ( an
~0ftWIy "ffect lilt bolldillll of resromn.e ~genlS 10 the

Furtl"'''...... e. lOOns ~fId boottHi>I products ~ p in
entJy 10 the pulp or peliodoiKoi ~ tbo'<>Ilcb ... ~ .
;aI or ...ussorycMwk found in the denti n of the fOOI: ln,.
I027}. Tbt puoIp.ol pel ;o<lo"ul rrlolion>hi p Itlloush
lhe<e c.vWs shows lh./ol pu l~ inr..ction< CMI ~tkl:t the
..... iocIool~ 1~1 ~nd ~ ~


Denlin is i S1msifie,
This is p.uticuWty lnIIe in
fOOl: denlin 1M mq ~ exposed wilh gingiv;al ~n.

CelTlO'nlum cownnt Ihis dentin m~ ~ ibsenl or

~lIlOYftl t"f vipous lOOlh brushing. Exposed denlin is
~"'IJy st'lISit...... ~. , ~ ~pplic.tion of COdtl"l
m.ll eri~ls or inc~. sN lk'posilion of int "',ubuJ", den lin
led uc.. hol h t~ perme~ l>il i ry ~ n d sen,i liviry of Ib,s
den lin. The thet>r~ exp l. ini!l8 """lin.l " ",itivilYwill
be discussed In Chaptft" 11.

fig . 1027 SlCIn ........ '""I ~""" """"" III _

_lNtlt>< ....Is_.....'..... ~ .............

Of "'" toOl.-.


III Structure and funct,i,'~""'"f".,ec","""h

Clinica l Appli catio n


The sme"r laye,.. debris from instrumented dentin, also effectively reduces the permea bility of dentin,,1 tubules. Some
debris enters the tub ules forming smeat plugs(Fig 10.28).The
en try of smear into the de ntinalru bules is dependen t on both
the size of the smear p"rti<les "nd the diameter of the denlinaltubules. Smear layers decrease dentinal permeability; they
CJnnot be removed by irrigation but can be removed by add
tte"tment. The removal of smeJr by acids can damage the

Sum ma ry - - - - - - - - - - - - - - 1
Dentin is a vital mineralized tubular ti"ue organized by odontoblasts. The dent inal tu bules pcovide
sjMce for the odontoblastic process. ti"ue nuid, and
sometimes nerve endings. The odontobl"stic
process plays an import.l.nt role in maint.ining the
qualitat ive .nd quantitative diff~re nces in the
dentinal and predentinal matrices, by controlling
the relNse of pho,ph oprotein, at the minerali",,tion front and the formJt ion of p~ritubular de min.
Dentin i' incrementally deposited throughout life as
circumpulpal d~ntin , unle" environment,,1 factors
stimu late a loc" Jj , ed pl'Oduction of repor~tive
dentin. This increment~1 deposition coupled with a
lack of inte rn~1 remodeling effectively reduces th~
size and architecture of the pulp chamber with
aging. Dentin types can be classifi ed "ccording to
their developmental pauern Jnd loc~tion , These
common typ~ s are called p r i m ~ ry, secondary. mantle, circumpuip.1, "'jMrative, interglobular, .nd the
Tomes' gr~nular layer in root dent in, as well oS
intertubular and intratu bul"r (perilubular) ro nes.
Dentin,,1 composition may b. altered by environmental and i"lrogenic innuences such as caries.
scl~rosis, dead tracts. and/or irreg"l ~r reparative

sel{-valuatlon Review

Fi9. to.:ulAs<annir>g . Iectron miCtQ9raph ,00wir>g' ,me" pllJQ oc,",d,n9

, d. ntin, ltubule, (S.P. ,me" plU<J; Sl ,meari;ry<lr)

1. Describe the course of the dentinal tubule in the

crown of the teeth. Include in your description primary and secondary curvatures. How do the diameter
and branching pattern of the tubule ch~nge from th~
DEl to the pulp?
2. What are inc[ement~l lines of von Ebner, contour
lines of Owen? What are neonatal lines? What i,
developmental denti n? What are the differences
between mantle and circumpulpal dentin? Do they
represent developmental dent in?
3. Compare th~ loc~tion and composition of inte,
tubuiar and intratubular dentin , What is the she"t h of
Neuman? What i' interglobular dentin? How is it
formed? Where is it char~cteri,lic~lIy loc~ted in the
crown And l'Oot7
4. What is sclerotic dentin? How is it formed? Whot
funclion docs it serve?
5. What are the structural differences between primary, secondary. and tertiary dentin? WhAl are
osteod entio , [eaction, irritation. ~nd reparative
dentin? How does the deposition of these types of
dentin ~ffect the anatomy of the pulp chamber?
6. What is responsible for th~ ~ppea rance of the
Tome" granular layer? Where is it found?
7. What are the contents of the dentinal tubule?
Wh~t role does the fldomoblastic process play in th ~
deposition of the perilU bul~r den tinal matrix ~nd

_ _ _ __ _ _ _ _ _ _ _ __ _ __ __

8. HOW can dentinal deposition llIi' mea<u~? 'Nhy is

it easier to me . s u ~ den tinal deposition over long
p<'ri<>d' tna " bone?
9. Wh.ot i. the m;lIMal and o rg.ani<: conlent of drolin
i>S contpire'd to ~. ,,,,,," (Urn, and ....m.l? How

docs dffili n


in h.lrdl\e'SS \tI eese tissues? Is

m. OfJoInK romponml of tho' pmkntil'lll m.1tri.1l ee

WDP .as UW of ,~ denlin.ol ""m ix? ~ lhr'" any

quollit.:o'i.., di~~?
10. ~""il>e the functi ons of so,"" of the organ ic
com [lOne nt' of de nt in. Wh ,ll characte ristics (fu ne.

tional group,)


them to provide these func-

11. Wh.:It fa<ton . ,.., ...,.pon";ble for limiting or
i"""'''5i,,! <lentirwl ~.olM hty? How i< denli... t
~uid fonne.d ? Whit inn ~ its r.>c. of formtlion?
""' ~_odg.m


Modiall\ob. Inc. lOr ~ 10.10: II<.

UIoiw , of t - . _ .....,._ - . Sl-

lO.11 l.. e.-~Or"IIBWIucI_


~ 1'.121):

Or. GrtJiI _lMI<Io<{ULiw'Iii, d.T~

I\OuOMJll _ """""_ - . Sl.1.oorio. rnr """.. 1O.12 1m
0r\>01l1 01.. Hi>lO~ . ... [n'Itw)oolocy, P. 109): Dr. ~,h Kdl)o
10< F,gu", 10.19; Ur. H " ~ i de "ufOgi lot f",u'" 10.20: Dr, I SCIoot
.00 M M I<r for f igu l~ 10,24 (J.A"' . O<nl. A,..... 2 J , 1946) ; D',
lUvid P "'Y 'or f'iu", 10.27 (Pro<. finn. 0."'. Soc. !l8("'ppl,


_ ~

_ _ ", .. ",,-<be

odotIlIOt>I.osI pro<ns. J. o.m. lin. l\1l14:G4('\i>l'<W

pulp .00 don' io to roo '' '' wi'h

fllli"g In. "' ri.>I" J. IlOn'. Re>. 1915;5-4; 133_1'l"1.
kfgmhol! (;, ( OJ< Cf.lotxh<! WJ. 5)'<'0 \A a..:'..... I I<.. ~
"""00-.01 ~..""" md ito t/kct "" ,lit <10,,"'1


poIp. J.
~ ....11ot"*aI " . . - ....

rixc",,_"',"" in

.. - . - .


""" .... ~.and poIp .. ...--otift_iSf<y. _
....... Put> lid: 1\ISl.
.... n""rom M. ...."""OlIIi" K.
u","" ' ol"'rfn i.>.1 "" i"'<l ""n, in, Sw.d, Den!. ). 1980 ;~'
'''' Cf. Il<yl. UK. G;b/>onl; I A",,-ry JX. Hey< RJ- TIIt<-ffoct "f
__ _i
. ft'<IO,,,1> "" 'ho
f t _.J.Dmt. _ 1980;59:109-115fi..... aM. s..u.. Po Tr...
iMo <Iec.- """""""" 01...
iplloc ....... - .



-.. ' I._.. .



t<y AI... Upds_ lOomI....-_.



eyCo<hnn. 1996;31 : 1_111.



Co" t; JP, l5.n bon. 'ho ..m.' Di"inniw

Prol"''' i. , oI_",,,II.,. noo. """'x pro,oin. In I, ,,,,,n.,
1>0<>0 imply t ho OX;' l<n of di tf<ron l "od<rlyi"l


""""&'In", ,...mumm<- eti t. .....

19911.'9::101_22 J.
Yn<> ~ Qwn.... [, _ SIrioitl ..,,' .... _

Co eo _[,~
: rot "':=-- ~.:t:i.. 0.:'::'-:;;";)1);7.k,


l'1li1 :lli:l9J-&97,

Lind< A. 0Ici0m0.....- . ...i

. ....... Ill; 110<_
o(QlcIo.., ill ......'" Sysrzono,Ilouo ~ I\: ( X
f'rno: l'1li2.
Undo A. Don"n ..0<1 o.n" "'N',..>i~ Vol<- 1 '002. Ik>c.I Koltll n,
FL: ell(



[j "<1< A, S1ruc' "T< 'I,d " lciH<3li"" of d.n Lin. 10: Ikm",,; E
l..... ~ CoIIctf_ ion '0 Bioloci<-oI 5rsttmo. Boa Rolon. FI.:


oj I I~.
_ I...,,)
. . cn<i<.lII


. ..

. ........ typf

typf IO<i. Eur.J- 0...

.... _




dn'o;., ........ Ot.l 8lol 1983:21'--......

_ . , . .........

sa. J990:I06lSooppl. l ~W -D1

J-I'ftI&J. Gu n

D.l<wI X. 10)


, _<I<..
PI Ctx!o<l .",

on h uman c h r omo ", ,,,,, ~' dOn tin pl,ooll/lOprein


""l""n d<lo""ill,l' '''o. ), Bi04 . c~. m. 1997:1n:Bn342,

101. z"ichnc'r-(Uvid.111.
tIC. l'rodU<lion ..-.t


_J,lt,_.. . _l_.. .h
chM~oI_ ....,""


""'.... _


M,..-IA. .......


A cuArYL

1974:11:481 -507_
P.,."ley DH, Pontin 1"'1"..... boll<y . 1Id <IoOOn

,e"."iYIty. 1'nlC,

fi n. Soc, 199 2:a&(,uppl. 1~) 1_ ] 8P.,hll'y 00. S"",,, I>)'<r: """MOW of Ol''''''tir. oK'd f" notlon.
Proc. FIn, [l<nl. Soc. 1992:88('"ppl 1 ):22,-;>,42P~ Ot .. Noloo<l .. P.. hley EI, 10I _lInid _ _ in et>< do&- ........
Iliol. l'1li';26:107-111).
, . ._ 0iIlia. _ _

'(S, _ _0.'"


_ sa.. .

_HH._Dl;, Wa<,.l-KSix _ _ d"LiL. I. ""

. 00 dom",

Avy JX. R<'l"' n" 01 t ~

Mol " I" BioloiY. l'1>.lr m>eo\osy. and Pa'hophy, 'o\osy,

london, o..p""," '<1411.>11 ; Iggo ,1l- 96 ,
II<lk!ylt 80
Go C"" Cf. Tho.... <nf 0( ,lit ......_ "
""""" iIl
'"':I' lau;_ ..........) -......l
" " . . - . ~ ~!lIdL<nI 8iCIl.

~n , E",. j. 01>1


1l<>I1.,... GIl, ""'Ie.,ret>< ...... tobl>$t pnx=. In: 1,..,_. II. Kudll
T. ~ n l (0:<1'.). O)'""m lo A, ,,,,,,,. of o.n", 1Pulp:

~ n.

""".and _



llonrin ~.,;"and dn'o;"

... prodLlCl' oxpr .. So:d from a "op,

W. tll.lnk ,,., 10110\"'. fCI< permilti"ll .'" of i" diviOlUl fll" "'''
o &o1<Ie.lilivorslty of"""'fip... 102, ilL MMlin


1loIIMdI;L 1b< _ _ pro<nS:, _ 1984;6oOlSlr. ess- S " .


~ of t;Je'llin~9


1991" 101>

(>nP I~ ' 1):211 - 22 D.

,,,hou' t. M",1<:' M.Th. ",,, ,,.. " 11100 In en.m.I.,1d dootin or

1In"", 0 dociduooo tN<h . 00 It.... "","",",,0' molar, J. A"'

D<nt. AI>oc.19J6;U:1946.
'idIour l l'<xl<ll<r HG. Tho _01 "'~ MM'" 01"1
..... _ '"' m, ICd "" ... ..n....01..,..... ...........
__ J. DI>. CIoiI<lI9J1:5001o=.
S<b:",,,,,Hf,Dc I l l k . _ ..
_101 Or.. _ _ BioIoo. _ YoI1<. /f't; Th_ oI ...


.. Pul>IWkrs. lno.; 1991,4- 1B4.
SUnloy Ii, l\'mr>jC, Splq<-1 E." >I.SCI<ro>M. <load ,,><ts..-.t
~"II"" de ntLn' I' 0 ,..1Pothnl. 198J; 12 '2~7_2li9,
s:>... be 1 TromM . , K. ... be I. The odon ",bt.Ol ;>me'" '"~ ;to
b..."d.... !lldL 00'. 1BioI. 198-4::l9:ll1 -ln.
80""'" ll. TIlt Donull'ulp; Ill~ Co",i(\<r_
.. IlenUIII"I: ' . o. ~ ' ~ IippiIIcon Go.: _
_ " - _ prnu;", ..
_ _ ill



kiM ...... II<: Do,."IdIZ l n l l ' " " ' V " - - '

ai _

II", Cklk_a.. '


e....' ..... Tho OlIO> s.... lII>iwroify; 19!1l:IIS-I:IO.

w.i_ "" IriIDnd CP. ~>phi< ,"""Ii..""" 01

' ll< dopoo~ioon of a phc>pOOprolc-in .. 'll< mi....-.Ii '.noo
fron. In tho do n'in of 'ho rot 'lKiIKK.J- e. H lll el.
1 9 7) ; 56 : B J 9 _ 114 ~ ,

W.w.._h DJ. ~ c.o.. l:uo 1M. .... "rd<><II C. tori)'

..... ,,~ .. CIlu "" '" Ko<Iffob<-t>a"" tfw;, """illl<
oipilIwltt. ....... ArYL 1'l86: 117:ISl_160:


I!I Stnxture and f unction of the Tu th

11 Histology of the Pulp

D. J. Chl~, Jr.

_ Ow p t ~

Out l i ne

InlnlductlD<L ~

~ .. I90
PuI~IAr~Mectu..e . 191
Cell. oft he Pulp. ~ 192
0d0nt0bLnts... 192
Fib..ot....m and Und&enti.oted MesendIymoI ( ...... 196
Vauloture of Pulp 198
Nerws In the Pulp 200
( lH l~"'1<xrI 01 Pulpal Nerv<"$... 200
Theo,les 01 Pain-tran,m", ,,,n thfOU<lh De<1tin .. 21J5
Hydrorly""mic Theory 205
Tra nwuction n eory 205
Oire<:ll nnervat ion Theory... 205
Pulp Respon,e to Environmental and Iatrogeni c 206

ea.. e'... 206

H....llng .fter ( ""ily Preparation... 206

Not", On How Modifies Pulp. 1Re, pon, e, ... 207

Immediate Plilp E<o, ure an d DI'''''I Pulp C.pping... 209
Summ.ry... 211
SeIlEva lu. tlo n Review... 21 I

The <lentil pulp consistS of ~ connt..... [issue

<leriYm fmm nnmll aMI ~11s O f ~ lcrils
.&nd is roofiDC'd witbin 1M pulp cNmlln".&nd roof
or rhe 1OOIb. The pulp contl;n. ~1s lb.>t provid~ ~
.......ture pulp willi odoo,*nlc. nutTit...... st'J1SQ1)'. ~r>d
de r.-nsiYr functions ~r>d .'low rot preservation of vil.;llity
during nor.......1 homeosl~llC "",;nICfl.ln", and during
wound rep.>i r .fter Injury. The IT\dlu re den tll pulp c~n II<
divided imo lWO comp,lnmentl: tile O<Ion~ic 20ne
~nd th ~ pulp prope r (Fig. 11.H The odo ntog. nic wn.
indudes lhe odont<)bla , rs. w hid.are lhe c. U, rc, ['Onsibl~ for the prodoction and m.imenar,<:e of pred. ntin
and de nlin, the <-..II-free . one. tile ce ll-riclllOne. and the
pari. ral plexus of nerv. The pulp pNlX'r include s the
m.1jor ity of the remaining .r of the pl1lp alld co nsists
pri marily of fibmbl a' ts . nd ECM, blood ~,sel<. and
nerve'. Before it is surrounded by ~ .nt in, the pu lp is
called the de nldl papi n. In the mature to(){h. the pulp
c.Jn be divid<'<l lnto ~ coro"". ~nd r<>diculor ctlami>efs
( roof c.""ls~ As tile pu lp ~ the volume decre a"",
wid! ~ connpondins: iocl'e'Sir In denti.....1thiclness.
The blood ........Is ~od ""......... of Ihe pulp en ter the
roor: c.J.... 1s thmugls the .pIc,,1 foI......... The neM' bund
composed or ~I;tut~ "00 unmyrlin.tted
""rmutllled by ~ con~tis'ur sheath. The
"""'" fiber< !low been lIIOfl>IIoioPc"lly ~nd plly<ioJolicall)" described "S SIrfISOC)I "tid ~ionic symp,lthetic netWS. ...,. tile .... bund16 of nenn "'.od1 IIIe
~ pulp,. bnnchins oman ;ond ~ prr>phrm ~al
ple>;us (sL>bodonrob/.loslic
pic.... , IS
Un~""t~ .........., IIIen tr~ IIIe cdl-ridl. all(1ft. odoncobIastic ~ Mol miff IIIe denti.....1 tubules
~ Iong witll tile odonlOblasric pn:oots>n. The densil)" or
inl1ef\/iUO."<l tubules depends (lII rile <pKirlC Ioc.ation
within tile pulp. witll tile pu lp horns tile JlIUSI denS1!iy
irInonIated ~nd the """ pulp tile ,"S densdy in""",;nd.

-f ig. 11,' Dlag"ln 0/1" o;,tology 0/ ~p .


Afl.... re<>ding tIIis cI\.Opt.r you should be . ble to d iscu""
the cells. eM. " nd v.scul.r . 00 neur t:lefnl,nl5 01" the
matur~ den tal pu lp. You will .Iso be ilble 10describe the
",,['OnS<' o r the d.mal pu lp to facto rs such as ilglng. tr.arna, ,,00 clinicill treilfment. Arter furt her 'tudy. you
'hould be able to di<CU <5 th e origin and func tion of the

_ __ _ __ _ _ _ _ _ ____'[ !!
l Hls_toIogyof!~Pulp_ ' "

....rws In l ~ pulp ~nd dc'scri~ the ...... rioon thr0-

ne. of INio tr~ ... m"'ion IIIrougtI me elUm.! a nd denlin.

Pulpal Ardlitecture
~ limY! pulp

nn "" ,,~

1010 ~.aI


ments bned on irs location wilhin 1M pulp ctwnbtn.

The " ' " . volunw of m. <Iema l pulp 11 lUI2 mL me
moW pulps hwing four li...... the vol""'" of inc;""
pulps (fi&. 1I .2~ ~ coro<lolll pul p extcOOs ocd"... I1)' iom
the pu lp horns of e.>ch crown. Aptcolly. fhe co""",l pu lp
el'fend1 into me rAd ieu"" or root pu lp. TM noor of the
coro na l pulp in mu lt i,ooo;ed le<"lh is llle (" ,eu ion UJne.
MCl'SIOry Or \,llcrJ lcdnal, ar e (ono Pet ive-liu U<' <onnee-

lion. bel~ n the pUlp and tli< p<:riodonul ligament

. 1Id arC fou nd predom inately all he _pk. llh lrd of perma nent fC'C th a nd in rhe fu rca t ion ZOMof p rima ry te e th ,
lh.y .... formed by" dc~ive rQOI , hN th, whkh h...a~,
down p~lu",ly .nd then ... fur m.. prew nring fhe
indlKlion of odontobl~' on the dfflral ...pill.l . ide of
the tJ'llho!li.ll roo< 'heath and ~m<."Il1ob/.;1SI' on the follicular ,Illo re'lOulling in a tubuLar drioKt. Fibrobl~
blood vessd$. and "'"'"'" GOn ..,mtI'imn be I'ound with," l he .ccnsory ("""Is. Ar. fbi' ~ forimm. l hie pul pal
lis.>w bfa>rne's "",linlJOus wit h lhie lissue of llr p:riodonw llpmmt. A< fbi' nul'rirll lOOlh ftUI'$ functior>.II oa:lus;on. llr <ril-f"'" mel nil-ndl ~ IlKon><
<lefi1Wd (I'"" . IU). lbt <dI-Od'I zone m.IY bo i~ in
oIdtf ~It. Tbr a1l-f""' ...... sq)I'''fllhie cdl-ridl i.-l
odonlobl,ufi< ~ Th~ all-rich zone is ftIousht ttl
tQfltf;n pl'OCC'flilOr odontoblist'5 filii can bo ind~ ttl
d;ffl,=fiil~ into malU... odontoblistS In .... pon~ to
wound in&- lbt ma<t pm~il upea: of llr rornn.>l
pulp Is lillf'd by lhe ro lumlWf-shiped odo nfoblasts, me or!ontob lil ' ts in f he r.ldicu lar pulp Jnd fur<ition ,oneS Me cuboid. l 0< exhibit a f1alt~nN1 morphology (Fig. 11.41_The pulp proper. or remf.! pulp, conIJ;n, the la rg~ blood "",, -'el' of the pulp ..nd nClVe


f ig. 11,2 Pulp orva',,,,r perm~

tn'th. Uppe<"""'.
....,...ry . rch; loll <rol'" if>( jso.-th ""'llh lhird ,,"",Lor. lowe<
""",,, m.r>dIh<Jl" arch: "ft ceW . 1i""i>f l!>rough third mo/.Y.


CeM-och " ,'..

'* __ ...... _AceI--Irft >nd...

fog. II.) DIogr.... olodo:w.......

rido ........ "., porift.aI~d:_

fig. 11.4 " Co/um....r odoo_", 1n <"""",1, ,,,,_BC'-"><Nd odontobla>U

rodl<Ulo r pouIp.


) 92_

'I! Structure 0ll<l'-"un~ti<>n g{ ~


IlUnks. The veins in Ihe pulp range from 100 co lSOjrn'rl

diaJD<."ter .nd .rteriole1 from 50 ,0 ISO IIITI in diamet....
M)"Iin.llN.OO unmyellnat<:'d
re noon.llly foun d
in ~ .-ociahon wilh ,Ilt blood
1. ( fig. 11.5).

Cells of the Pulp

. '., .




, .



odail<l!1".. ~in<kod"'l1... ,..hOUl~... -

The most prfdooTrinant cell lYJX' in !be <lentol pulp is lilt

fibn>bla:sl. but lilt pulp """'-'...i... ocI<>ntabUlU. blood


<~Il.. ,...ri....... lu II"

SChw.nn m'"
mdo::d .t1i.,tJ <<"I'.. .ond undiffem>lial:ed ~
mil. ( t11s invohoe<:I in lilt inftMn"""""'Y and immu""
suctt ~ lymphocyln, ~ ..... sr:
mli.l:ypP II ;ann,m prossilll cdb (drndri fic cdb) ,md
1;>...... mls can.11o lit found in lilt pulp during p"riods
of inn.m.....rion-


Odontobl.. . ts
Odontoblilsts are ' enn in. lly d ifferenli.~. I"'I.riud.
pulJMI cell, deri~ from ,Ilt <ro ni.1 ("l'h.llic j
whiCh are found in t><'riphtr.llal"" of the
pulp closely .,roct.o lod wilh the prc<!onti n (f ig. 11.6).
The ITldjor fun<t;on of CKlont<>bl.m i, the ,y nlhe, l, . nd
= "'tion of the fibers and extr. , ellul. r m. tri, (ECM) of
the predentin .nd biomlnel'a llution of the dentin (Fig.
The OO ontol,I." t ' ''0 n" int,;n, tb. EeM of predentin and dentin l~toug~oUl the lire of tile toot h.
[)entin. unlike bono. dGO. nc>! ,""""lei under norm.1.
nonp.>thologic, circum".nce,. l~e ,~11 body of tilt'
CKlonroblw o::ont~in, .11 of , lie org.>ne l~ Ihat .", ""ra-



Fig, 1 1.6 r",. ~'9/>'rN9"ioc.t;oo "'....... 9

miCtog<.p/l <Iemonwote<
1" , 1 ""man odooIoblam. r>d odontoblW;c pnx"'>f1 an hod CO the fr",,_
'" ~
of!tle ",~; n . r>d dent ",. Cut <>dontol>",,;c lubll", cont ain
i"9; pro<e..,,, <an be
tt.. c ~ I ,.




Fig. 11 .7 Thi, low-magn,A<lit....

miclQgr>p" sho<ws ~ odon l<lb"' tl< laye<, The"",jOOt, oI U,..<)(i.oo.
lobl-l<h d<>mon",..t~ . """,,",Id" ,rbJlion 01

proce''''' e'I_


'lIl lntOttl<' Jl'C"k't'lin..,d denlin. Tighl jooc-

lio..1comple,,", con "" ......, ot ttl<' ned<ott;., odonlobl"t . l

the level of lhe cell. od pre<l<!ntl",1""'lri, .

II His!

moun. If) the ails' rok in prooein synlhtsis (fis. ll"~

The IlUCkuo oflhtodonfObls is ~ 1oc.I~ with m.
"""" ~ Mi<uhlm (KElt) _ Cal8i
Ioc. ' <"d .upr.nuc~ . N Il",",ro" , mi tocho nd ria .nd
Iysosom"" .... found l hroughout tne cyro~.s . ...
varlov> (l(her ~ Il u l a r Indu.ions such dO cyt""ke let al
element' , <Hia, and ' l'C, elory ve, iel... The ""'jor prolein
pro<lucod by 'he ox!on toblast is 'ype I <oll' s en: which n
~ ct. t", 1 Inlo ,he ext race llular space a, ' he predentl n. 1
1m.rface , Type I trimer . nd type V co llagens ha"" al \O
been """,ITed
~ a m inor con~, o f t he ECM.
Non-col~u , components of t~ ECM of ~tln
mel dtntin. indudi", pnxeogIy<_ Jlycoomtinoglyc;lns.


'I I

j I


M ~ "'"r>iov
- p0>0' "

phosplxrprotci ns.~meI~ C"





COOlUini"l!: proo:tns. .... .>Iso synt!>estud

-...d ~
odonl<JtlWu. Otller soluble moI\I.... such as ........t>tn
of I~ TGF~ supfl'1amily~indud"'& 1M bone mor_
phogenic protei n. (eMP 2,4.7~ epid....m.:.. grtM'!h bcIor
.nd fillrobl"'" 11000 h f.>cIOr-ha~ been found in the
ox!ontoblast and .seq trred in l h. EeM of preden, in
a'ld d.ntln, Thi ,,!IlI
that 'he'" mo le< ule' cou ld
play an importan , mle du ring wOllnd healing, Other
molf(llle. ,."port ('{! '0 be fou nd In th e odontohlas'
, import ."t for ocg.Jnlza' ion
' nd mine",li...,io n of the ECM. ioclucling <leotin ~ _
phoprolrin (DPP) mel denh n si.IOllrolt'in (DSP~ dentin
ll"IlInix proleIlI$ (DM P's~ decori ... . nd biW.n. Since
IlW'Iy of these moI\Ilocs ~ specifIC functions. they
.... -...d ill di fffft'nl _
~ lMy un be the
. . - elJicil'nL Mo6l'Cuit's such .. biS/YC.n and type I
(oll.n .", ..-cm<"d at t he odomool,w-pl'l'dentin
inte rface where tugfyl:an has bttn re ported to playa
mle in Ih< organi ,ation of the col~ fibril . in the
ECM (Fig. lun Oorln .. ncl DPP . ... secreted at t he
mine ral ization fm nt where d",o rln orga nize, an d aid'
in til<> registration of ,he ro llagen fibri ls allowi ng DPP to
then bind Co" to initl.:He mine"li u tlon or the preden tin to dentin (fig. 1I. IO~ Olher <ubstan= ,e poOled 10
be In !tie ECM or predentin and dmti... and wbich therefore ...... bem ~ by !tie odontobta$l. Inclode a
warietJ or gtycmamilltllfyuns tee. Ilyll uroni< add>'


Fi<;J. 11.9 10 'hi' photomiUog roph, tho protroglyc;!n brgly<, " I, ",o n 1oc. 1
ized within the p<Nentin. 8~ ~an ls t!>uullhl to be moclolled wi'h ",~ i_
ialion qllho- ""Ira< .......
IS _
I ... the


mat"" _



Fig. 11. 10 n
pho!omO:'''II,aph the ~n de<orin i' locarlZed ...
the ~,. ...,., f,ont be1~ 'ho- prt<!onl ;n.nd t he m1ner. lizW dentin.
De",rin ISlhoughllO <O"g<lf1 i,. the colldllenof the predentlnale' l,,.;e1kJ 1.v
mot rix;ad . 1'0 m. lnb ln spacing b<t~n the ' ypol collagen prior di,placement hydenl ln v/1OSj)hop<otein, Derorin i' =~ " l he Ie"" oItl'"
_aliLlbon tront _ iJ.. 01.... ""'" bo tran sported ;,tr~~
through the coil bod)" <I thoodo,ulIblasl and up theodonIobIWi<: proco<s
IOtho m...... Iil_1ronl.


''i1 11,8 Thi< ~oIi<alioft elr< tron """"9'. . 1lI00000a ~ tionolI_ olthood<>rll:~ bjo<or. Ihr
~ ,conuin ~ lypil:.:II <I proce;n Sythofi< acliv_1, In< W ng ..... nd;lnt ~! ~ , 'Ibosome<. and ....



UI Strocture ondFunction 01<.""


.. ... --,. .


11.11 ';onlNtyol........,.oltt>e [QI

.... (lSI> dontin ....... olEi.

" ' ~_ _ - .

...~._.GK.;~"""!JIIcI ... ~ W: ....m. ~

_ . nw: Ii<wo inhbtorol_.lIIopi_...." IJl'I': _

nunix IMUllopl'<ll""',"

(~ coIl.>~),. ll~

inhibiton of, ~nd ~ (~.g..

osteoponlin ~nd osttooak:in~ " sumnwl)' d'4um of

nuny of th..e ECM oubu.onC\'Sc,onbr-.. in ~ 11.11
The ooOlllobloOSl obo h.>< 0 proce<s exwndilll from
th e cell body 10 the denlill<>tn<>mel junction (DQ ) eon13ined with in . den fi",, ' t" bule. The """nrolll. " .. h;l>j t'
multiple p.oce ' ses . t Ihe time 01 term i",,1 diff.~ nl i o_

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

' '''
Hi s ~_.!?f the Pu/p_' ''

l ion. By 1M U"", (h~ man tl~ d~nlin .. ~ has _n com.pIo1...t. lh~ ttli. norm.oUy ""hibit only one rrr.>;n process.
fbomo ~ multi~ "'~al odonlOblooSfic ~ ronI.>IIlIt'd witllIn ~ <lmtin INt art m.lintoiMd lItrough
tht ~Ie 01 tht odoolOtu.r. ~ odon_ic I'f'IIC":'<
....y ..... (omain mi{odlondl~ RCll"lOfJ' ~

micrllnobuIfs. .nd inl ~ ~ rdinle1lts.

Odorllobl.lm .'" intilILOtt/y ........ to<! w;1!I .oclj.>cent

odontQl:>Losts. a-Ils ofl~ a-lkich ro l"Oe"ld (<'lis in tho:'
pulp PfOIX't through of june""",,' rom,*,=
indudillJ dtSIllOSOfnl'''' and tig ht. ,nt01'TTlf'dldle. and g.op
ju rw;tio;>ns (fig. 1 112~ The tigh t aod ;mennC'di.lte j unelio""'( compl"".. are i m~.nt for ""'i" raining t~
integ rity 01 me odontc>blastic 10Yt' 1Id prwenling the
log...." of f"reign mater;al, for example toxins and bJc_
le'ial prod llrl'. from the or.1cav;,y (1'Ig, lL1J~ The tight
j llnctlons pTU\l ide ntech"n i""l .n,ocllmem bctwC'e" a dja"
cent odontobl. m. Inn-rm<"<liate junc:t]olls have been
shown to extend around the pt'.imcn-r of t he (ldOflIObl.." as narrow bJ.nds..
~ PI' j" nai<m$ . .... areas of redu~ clNtri<.t
resiSUnU l!wt al'" allow ... Itj~ ~.<d>.an. of <UbSf~ncn bO'l._ odonl ~ G.1p juoctions ~~~ac
cmad itS cimllnscn""" srroctures wiTh 2-nm rubuJ.r
~nntls surrouJ>dnl by rillp of proI~'" of odjattnt
pIanw nwmbr....... tII.ol tr~ t~ p p bO'l. .. een "'lis
~nd tink t~ illleMr of ....jacHlt odOllrobWe. Each /wl f
of the M> juncrionol CUffiI>6e1 ClIIlSius 011 oymmrui<<tIIy (QUIVlloeno: hrlt.on...- of ~pproxi""llPly 27 kD. ~ is
tenTIN I connnilL V~rinll'< medl.Jnisms ....... been pmpowd 10 expl.:lin bow g.op junctions I~ 1<'gUJ.te<l.
indudilll mlrJan in pH, ulci"", COf>(ftltr~tjons. .nd
voluge (ba..... O!>'ning of tho g.op JUnction .l~
""all m""""'le:< .nd 10m; I kD M.W.),. Sum 's ( _AMP
~nd C~. 10 diffllSe' ~n I"'" cens and Initiate ~ c.seeoc of evenes ~.d ing ro . n il>C~.w Or <1.... '" in cell
.)Clivily. Cap junn lons ~fWeen ooonlo!>ldSts. ooontobldsts . nd cell, of the cell_rich lone and cells of lhe pulp
proper have boon Mmonstr.t~d ililhe l i ~hl .nd e1e<: !ron
microscopic levols using speci.l sl. inin, techniqu es .nd
immunohi'tochc mlstty. nd by f=le ft>Cl u~. It ba,
been s~>,d lIl. ! junetiOO\s pidy an import. nt
roil' In the rqUldtion of cdl gnlWIh and diffcrmUatioo
itS well itS coordi tlolting celluJ. r ""tvtly ~n odnntoblasts-for ndmple. denti~s. As I~ toot h . ges.
tho odontobl.UI$ ~nge Wpe from cuboidal to <M>id
-:f bome quies'nl. S<>rnto odonUlbUsts I~ lost and
lkII ~. The functionin& odontoI:Il.tsu confl_ to
~ ~in tbroolghnul the h~ of the II>OIh.
altltottlh ~ II>d I I a tNucN we. OdontoblilSa
reuin ee .bitity to uprepJ.le pmmn l')'fIIhPtic activity
in .....,.,.... In I.......... . fter ~: ""-".lhLe ~
is initi ~ted sIowe'r_ The odontoblil$(ic ceil \dyft' bo:'comes
discontinuous..nd die "'lis v.ry ,n IhLe .mount of ECM
!lein* produre:l . nd . ubsequently mltlHal_ in !be
oIdo!r loot h.


f ig. 11. 12 t:liagf..... ofo<\ontnbld<ts.cell ..................... type<oIj_liQr>.

Mg. 11.

l 1 U1tr~ oI ;.. ncIDIOI c

..,opIt>e< oI0d00. _


~01 the nude<-

Clinic" Appl ic.ation

Pulp 5font5 ale . normoI ""idtnl of I~ .... tule dental pulp. In

moSf cases pulp """",.le dSymptOllldrlc un..... they impinge
on lhe pul"". blood supply or ~ lar bu ndle. H~.
if ~ !",liMl plesents with dinic~1 . ymplom s Ihal requ ire
endodon tic Illerapy. ' I"'lp .tone thai obstruc ts lhe rool <an. b
could cOm plic. le lre. l_nl.


IJI Structure and Function of the Teet'!h'--

Fibro blasts a nd Undiffe rent iated Mesenchym al

Fibroblasts are Ihe mo, t numerous ,'ells fOllnd in Ihe
de Lllal pulp. They "re ' tellale-shaped cells with long
cytop lasmic exten5ions Ih, t contact adjacent fLbrobiost,
or odon toblasts through gap_ju nClional proce " es.
Fibroblasts con synthesize and secrete ,e ver.,1 Iype' of
collagen. including ty pe III collagen. and olher ECM components of the pulp, including proteoglyc"ns and glyco"'minoglycans. The fL l>robla5t is also responsible fo]'
degr"d ing the ECM , and can simullaneou5ly ,ynthe.'i2e
and degrade the pulP'll ECM. Collagen Is th~ mo, t abund ~nt connective-tissue prote in " nd occur< in sever, 1specifLc isotypes. Each is rccogni""d as " spec ific genetic
product differing in amino-acid compo,ilion. In Ihe
pulp. type III is the moSt abundant type of collagen with
oth er types. such as IV "n d V, as minor co,,-,litueLlffi, As
the dent.,1pUlp ages. there is a red uction in ,he numbers
of fL l>roblosts and a concomitant Increase in the numher
and size ofthe colla,,'{'n fibrils, fLbers. and 1>1I ndies (fLbrosis~

Fi brobl"m or undifferenti.lled mesenchymal cells al'o

play an imjXIrt"n t role in wound_healing L11~c ha ni sms in
the pulp. The resident cell' of I h~ cell-rich zone are
tho ught to differentiate into odontoblasrs " fIe, Ihe right
stimulus- for example, grqwlh faclor' (e.g.. TGF-~). bone
morph ogenic proteins (e.g" BMP2, 4. or 7). cytokines (IlI.B), or iotlaOlmalory mediators ( pro'tagl~nd in E,. F",)
releosed during wounding from the exposed predentin
or den lln, or i nflamm~tory cell, Ihat have migrated to
Ihe wound site.
There are many other cells found in a vit"l dental pulp
and some are assoeialed with ~ di<eased plllp,
f'eriyo sculor cells ,re found in the denta l pulp d o., ely

associated with the v~sculature. These cell' h"ve been

reported to be imjXIrtant in wOll n d he~ l ing mechanisms
associaled with pulpal repai r mechan ism', Periv.' >cular
cells have al'o been shown to prollfeL'Ote in response to
~ n iatrog enic exposure of the dentJ! pulp, and are
thoughl to poss ibly provide repla,..,menl cell, for the
odo ntoblJSlic layer in wounds where Ihe cell_rich loyer
has been de,troyed.
Peri<:yles are " noth~r Iype of cell Iltdt ore intimately

a,sociJted wilh I' lood vessel, In the pulp, They hove

cytoplasmic processes in contact with ti, e b",ement
membrane of the blood vessels. Pericyte, are one type of
residenl cells of Ihe denta l pulp that h,we bee n sugge, ted as prownitor (el ls for replacement odontoblast,.
Endothelial cells line the lumen of the I' ulpal blood vessels and contribule to Ihe basal I"m ina by producing
ty pe IV coll"gen. an afibrill,r COll agen, They have bee n
shown 10 proliferate after a pulp exposure in " n "t tempt
to neoYJScularlze the wounded area during the pm""ss
of wound he,' ling.

______ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ "'1.'." ."",

,,lo.9J1 ofthe Pulp


Class II mltig!m proc,,",ing cells h~ve been demonstrated

by immu nohistochemical m,",hod, in OOth the normal
and lnfi,med pUlp (Fig. 11.14 ). Tbcse cells . '" w mmon ly
( "lied d endri t ic cells bec~u<e o f m Ultiple, long cyto plasmic p rocesses that bind ~Tltigen< a nd process t he m for
pres entat ion to ffiaCfophages and lymphocytes.
Dend ritic ce lls have ""en fou nd w ithin the walls of peri apic~l gra mllom.1 $ "fter p ulpal nec rosis.
Othor vasculilT-derlved cells fo und in t he pu lp during
. n infi<1m mato ry co ndit ion inclu de ffidSl celt" B and T-

lymphocytes. polymo rphonucle .lf neutrop hil" and

nldcrophage, (Fig" 11.1 5 .nd 11.1 61. The", blood cell,
are of unt importa nce in fight ing infe<:tio n in the
pulp b ec~use of the <ub'tances they contain, hisl"m ine,
seroton in. cyto kine s, grow lh faclO,.S, " nd OIhe r ce llu lar
medi "to rs.
SchWll nn cells e nvelope ne rve processes w ith a myeli n
, hh' th, The n' yel in is " lipid -rich , ubst" nce,.ed
"nd se<ret. d by t he Schw. nn cell and cont" ined w ith in
t he cytoplasm. M"n y Schwa nn ce ll, ,1'" req uire d 10 cover
.n individ u" l "x on. " nd lhe refore o nly a ,mall po rtion of
each a xon is covered by one SChwa nn cell. The jo in!
wh ere t wo axons me.t i, called. Ranvie,'s node.
Myelin.n ed ne rves contain many w rap pings of myelin,
whereas u nmyelin.l led ne Lves a rc covered by a , ingle
w rap ping of t h e Schw ,'n n ce ll's cylOplos m in an
inn" med de nta l pu lp.

f ig. 11. 14Immu""hi'IO!Ni< 1000f;zolio n 01 deo lrilic cell, in lhe dp pulp

u<>d ec a pulp expo,ur< ,<>d at the odontobl.,t denlin inwl3C~ whr
se rie-; of de nd rilic cell; wa, al,o IOQI;'cd

Pulp slOn.s (de nt icles ) CJ.n be fou nd in t he denra l pu lp as

" normal consequence of aging (Fig. 1U n True p ulp
stones conta in dent inal n lbu les wit hin ~ m ioe" li2ed

Fig. 11. 15 Irnmu noh;<!och<m k;l lly.' !a;ned T. lymphocyle in an ;"ft,m.d

den t, 1pulp (8"""" cyl"P1" m).


F'J. 11. 16 B. lymphocyle, in an inflame d IM "'-"y fl'Jfp , IIxI. r_

lying. c''';ly prcpo rotion.

f ig. 11. 17 o;'g rom uf pulp <100.. (deo t leie';). A F, I, e attached den llel<', B
TrLle dent icle wit h l uoo l<', . C fa l,e, tree do lll;de. D Embedde d de nl;de.


//I ~ture andFunc fion


....trix .rId .'" sunounded by od"",obLa"- h~ ttlls.

Fol st pulp >fOnn.", tornpos<'d of . mi.....-~ ...t t<l ....trill
..,.,..nged in ~ 5C'ries of ~nu>c WnrlJ.... (FiJ. I U'~
Fl.I ~ ~ <pindlHh.>ped ....Is ~'" <>ec.o<lonolly SfffI
"" the ...-tOft oI lDe tlssut'. Pulp stOOlf'< ~ be found
mlI>Mdrd within II... dmri........
MUChr<lIO !be
~in md dffll:in. ~ Iytng r"", within IDe 51....... 01
lIu: pulp p<opft. PIlip sronn _ u<u.l.lly ~p{(lm..Oric
unk lhey impingt' upon ;I. 11<'0O' or blood vnstl PIlip


GIn C~ust p,nbIt".. during ~ndodonlic p~

du"", wh ~ n lhey I~ 0\It'l" ~ w,lhin IhI' .adieul.. pulp.
O<c;l.s;"""I1)'. difl'IM calcifK;niuns c~n be found in tne
cnronaJ or . adieul., porIi"" of lhe denta l pul p. ~1Id are
usually ~<sodated wilh lh ' V~<eulalu ", in Ii"".,
arrangemen l, These dy. tro phic <dlc;ficalion "
thought to be init;ollcd by mkrotrm mJ 10 i'ulp 10 the
, reas w h~ r. l h~y . ,. fOllnd,

vasculature of Pulp
Blood vessd< enter the pulp lh rough !be 'picoll for.ntO'Il
in Con....nMHissue oompartrlM'nr ~_ n the renIr<lf ~ (fl&. I l 19~ n...vmuks= I><'fworom 100 ro 150
IJITt ond ""'~;n~ . pprwi.... ~ 50 10 l00 .... il'r ...ct>es of SllNI",,"""""'" '"'" ~ off n the
I"...."d 1OW.utI IDe c...".... pulp mel pulp
hom< (rig. l UO~ '"'" _ i...1 copin.riM.nd .......1n
. ~ deep 10 the odonrobb<r:ic I.o)w. ~ , hey
prtlridc' n~ ~1Id o:o;ytm n<'<i'df:d lOrailuLu moub-

Oiniul AppIiution


nil- 11 20 T,;onsm;, ' ion oI<><t ,,,,, m ~ ""l 'oph 01 sm.>I l

in ptlil" with
'nd cyIO!>O<mI< ""~ .I",, 01. sm oot h mu10 ee l ,


TI>e- ~ of ~ 1IMd-~ rncturn-hy<Itlddecoor.oinina; ..........1....... tlftp avity _

~ Mter. pulp ~'" il: <tond.1rd cUnic.1 denl.1
prxti. How t ill' h. fd.-..... Wcium.~~
rontainill(l"",.....wIt function ro . Id pul pal ht~l ing
is 001 known. Roc..,l work suggeof5 l)wl pu lp-c~p..
ping nuU'ri.ol$ combining grnwrh f.>cro"l Wilh . n
c.ln be eq .... lly. If r'I<lt m""'. ~lfLc~ciolts
;n promol lng ho. ling,



~ roIogy~ PuIfl_' "

vli,m (F"rg. 1121) ~nd rt~ Ihe byprOOucr. of ~Ilu".

met. bali, m. The ,.pillary loop, are den, e in the coronal
.lId pulp born aSj)K1of the pulp .nd Ie., dense in the
r<> pulp. Continuou s .00 fffoMl r<>ted '.pill.1.....
<e ~ in tM odontobl.lSlioc ~. n.. fe'1lt>tJ"ued
upilblin ~ sm>l l 1'0"" r!\,>t cont.I;n only .. thin
membr",", awoenlll ~ of ~li.oJ ~II cyropi...... and .. ~mmt mem broM (Fig. 11.zz~ ~
po rtHow fur ,. pi<! ootw.rd tran sport of ' ub<fan<1:S
.nd 'ells Into the eMr. celiular space. s well os removal
of melabolic waSle durin g times of pul~l insult.
An~.nd .......... ~ munts """ ilso pre'$mt in lhe pulp lof ",pi(! tr.nsIeJ of blood (!'is- 11 23).
8<llII. tilt " rn:ri<Jom1ous shunc .-l tho rn-r~ upil1OIr;e, ~ been SlI~Sl:n1lo funcbon in .-Mudns inrerstiti.lJ pl"n'UIl' in the pulp during inflamm.'ion. Arrtt ..
dent.lI uperative procedure, the ".pill. rie5 un derlying "
cavity p.... p.1ralion will beeo"", I... ky. "Howing p1. , m
nd vlScuJ.r cell. into ,.... nlr.cellular spac.....
Lymph.otioc wsw ,...... <>Iso been ,epol lt'd1O ~ Ioc.~
in ltw *"t.oI pulp. The lymph;Jcioc ..., lllin
w"''''<!. tubuLlt SlrurnJm fhat """,lly do not (l)(It.li1l
<d lu~r t lr mml.. Durilli I.... .>gllli Pf<n$S, ' ht blood
of Ihe pu lp r xhibit ch.nges , ;mllar to 100.. =n
;n t .... rest of Ihe body, Accumulatio n, of cholr , rerol can
be' srtfl in t ........11. 01 , .... vessel.. llIrsr dlolrstrrol
<lrposil, un causr Joclliu'd in~mmato<y mpotlM',
whidt in lnm u ...... lhe inrima! surfr 011.... pulp,ol
~ to !Joo'lO! adhrm1l. . llowilll rrytllrocytr$ to
adhrre 10 lIIr ....1.. 01 tIw _ I.. ~ rrdu'd di-lmrtr<
<>l' the ....",,1, dt( Il""" the blood flow 10 tho<e arras of
the pulp, resu lting in hYpollia, Eve nl u.lIy, throm hu,
formed by 1M accum ul. tion of rryl hrocyl e, nn d;'
Iodgt' and c."",.n nnbolm. wtticb will uu'" a localiud
puIp"..;msj, whm i' occtud.. a termiIW capilWy witJ>.
in ' he odouroblouic ~ .. pulp PI'OP"f'


Fog. 11. n T.........lonolect<"" mi<rog<op/>cI . _I,ated copI:;y in I....

ooontogli< """'.

Fog. 11. 21 Xonr1i<1gt'locbun ~ "' .

"'I pulp,

,,"",nl in 1hr<D<O-


1/1 Structure undFuoction r>'lf".~,"~,'"


_.- .- -~

T'.... '. ... lliII"llb'fCII_



Nerves In t he Pulp
lhe <ensory mel """tpns! ,on ,( t ymp.otbcti<: """"" nul
innerv<>le tho /knt.ol pu lp W.,. 1124) original.. in tho
mg.,minal .u>d $O ~1iof a Me.1p ngl, nd enter tho

temI Ibrough the' . pic.1 fof.mffi. From tho neur"

noaplOJ in tho pulp, the' ~tr" p<OCn' of. niuminaJ
~ Dl' uroo IT" " " " I"" t"Ji!1Tli.... I"ngtion 10<;01.-d in ne floor of 1M midd~ a;,n~1 fos.. I F;&,,1I 2S- 1I .28 ~ lhe em trol pnl(K$ m.n 'YNI"'" on. 0_-order """"'" loc.rM in tho _ ..,..... <audllio at
the ~ trigoeminoI com~ lhe ....;onty of...,ond-ord<-< M Urom tbe'n dus$<ote .nd . Knld to
~ on """"""'" <0'1 1 bod.e I"",ned in the ....,tro-~ n udeuJ atlhe' thobmld. lhe [Jtjrd-<>rde<
nnnuns oscrnd 10 the .m. of tho pclSID'IltT.1 tyr'U$ (onarM<! witb "'. ororociol ~ lhe m*"ty of """"""
'Y stimuli 10 tM _ h . '"
d by tho p.ltimt
p;;oin. oJl hough ~ ",porn susgt'l.[ thof o t..... .........y
modol itin IN)" .Iso "" d iso:emed. su<h .. ~ . nd'
{ffflpe-r.rur... The mondibul.1r tCfth .'" in "",,. ~ by
fhe inferior .~I.r n.~ origin.ling from th e third
divi.ion of the l rigem inal ganglion. The m . ~; II . ry teeth
are innervatl by l he . nterior. mi<ldle nd posteri"T
su perior al"""lar M~'. The post ganglionic sympathetic nerveS form ~ o n th e ~Xl<'rn~l c.ror id ~rteries
and sub , .quem ly follow the t<'rminal branche' of thi s
artery into th. pulps of th. m,l nd ibul" and ma~illary


p ~"", "

fiDe' ,



t .~t h.

oa rvlcal 9Onglioo


Electrophyslolog y o f Pulpallllerws
8iophY';(~t ...... r~'erizatlon of trigemin~t """uron.
innervati"l the drnt.1 pulp. usi ng d i..o<~ted trigemillli
<0'11 bodi'" ~u$ly I.~ with . ,," ul'IKIIl IrlCff.
mggesf thot ' he", .re mree types of neu TOllS ",Iat"'" 10
fhe type of .mon pote "I~1 ~r.ted afin rurtnlt
injection tm"l fhe lhn~ 01 whol. all patch clompilll- Th.... 1YJ'O" of "",ion pocmri.>b h.rYe """" round



Fig, 11. 2S l'etlpMi-ol ond<Of"(rol ifwIefvaliotllo _~ A

lo~ f>t(YO. TtIgomir>aI gaogIion (A~ otic 9""11"ion 19): wP<"K)r(1/rYi<>l
'ymp.llhti lc9""9 lon 1C): bf'"'l''''' t,~ nude.' complex,
BT,lgeml"'" OOngl" n1"1with m~oIlc n""lew; (. ) on<! br. in'l"'"
'ri gemlnal " ""I." C(>mpl (b). ( T,," , ""'<JiancoIIat",. 1in""",OlIor1 ,

Mg. 11.26 ThiI phAcx' .rogroph " ' - ' port cd l~ m,n;I l;wy
portiool 01 t~ t
gonglIon, ExhdYi>ion cdl~ lrio:jem~

noI nerve (oph tMlmlc

Lory, ..-.:Imondibu",) 1>0> """roooI
<ell 00di", located $I>INl(ll<>po:aIy within tl>< 9""!JIion.
Immutlohi' tochemi<....toIr>!d g. "ll iioo ,01, ' 0"''' ni n<j (Gf(P

.'" the br;ght.yclowfl uoreK..,\ ' ell' "l~"i>I"

gar>;J I"'"

>OO wi,r;n the


I H".',,*,,""IDy g{J~P>Jlp


. ,'" , ~ 0{ ~r'rins .uad ~Illl C\Il'-

rem il>jeaioorts.. SI>irp Ktion poc.... lW!s. ~ po{m(i.oh

"';';1'I;on intlrion on 1M clro;andi"ll hmb one! muh~
linns net1I'OfIS, in ~.>Iion willi dilftomll g.>nglion ~l
di.".....ters. .~ th,11 , "" neurons In........' ''ing tne
dem .1 ~Ip oonsist of a diveBe popu l.lIi on <>f neuronll.
AltheH/gb the Ii ter~w", . uggcm ' ''''ltM neurons inner_
"ling the dent. 11'"l p carry on ly t~ m<xI.Jity of M el, eplion, the djv~ rsl ty of these cell. , ugge, t, th.t other
funcfions could . 1.0 be , ub",,,,,,d , This " furm., ""p_
poon~ by the IarV YU i<1y 0( """ nxr.nsmit"'rs. neuromodulatOf'<. and "",,~icIe< tlIil I\.IY<' .Iso beffi
ft'llOlkd 1<1 bf .~ed with pul~1 neurons (Fip.
11 .29-1131).
Brmcbe'l Df!he l ~ <>nil <Uptriof.""=<lI.>r ~
ld S)'mp.>l'hftic llftWS ffl'I" It>t ~ tIl !he Ift'Ih ~
mydi kd A-~ . nd A..s rtbn'5 or unmydin,ued <-filion
The jority of tho lTl)'O'lin.l1ed fibo:rs a", .HOCi.o<ed wi t h

-so mv ~_..,

r'9- 1129 SIwp _ _ Thi> _lIl}piu1 d ... "'ll CitW>"""",,," TIw


........ botrbe..:l~_no~


no;o; and Ihe unmyeli... ted C liben with POOl:eangl,,," i' syml'-'lhctk ne""" and nocke plioo. Two or
three brooche' enter the premol. ... . nd mol'r<. and . in.
gle lrunks u' ually . ," .. the Inci' ors .nd c. nines. Som~


FOg. 112 1 This pMtoml::rogf..,n is . Dif.Qbo!lo<l lJigemi",1 ~

gionulithrtlYd the'_""", Oil ~ m... oxp<>sed lnt
.....a.y ........ pulp S"'" NrSor.


FOg. 11 .30 H........,.d """""" This "<'Uf'Ofl is typGI "" _l:"'ll'~. ~t

de<nonW...... n "",""tion on the'.-.-.l portion 01"'"

" " Of <.fb:r. It

lion pof..-.NI op;~.


V 00!lI


rog. 11.2l1 This "'.....,OtJO\Ii"Jlhdemo<tw_ ~

dlemi<oI -'OIgfo< the _~(GRP. This ~ ~
IP<"'Cb to the ,e1I,n
f;g.. ~_. Moo""'" w<th



m is th.w.:.-~ iRnorvatOlg the r." ......;fby moIiJr 11.,,101

r'\l.I I -l1 Iol.olliplr tunped _""" Thio ......... _

nUli'* oction pal>'!>tiffs........ . 1O--mV <SopoIori2ing ""'t'nt
;oje<led. The ac'", ~t'nt;.l,

...... _spjkH.


11/ Structurt> and functkm of !he



Clin ical Ap p HC:.1tion,

The dfnUl pu lp Iw ..n in ho'rom a p,llCiry b;J respond

10 o:'llVIronrntntal or i.Urogffik tr.Ium.l mullilll
~ in$uIl or """,..iM l'Ioc:rdures. Some
"'tho medI.lni>ms tho pulp h>5 ~ 10 ~
lhtwdullmfKind.... v.1riou>~~
tdIs sodI ~ md c:Ws n dendritic
cells. Jtntsttited apill......... mtrioYmous ..nd
wnaus.wnous shunI>., .. ~ 0tculID0n. md
on ~;'J~d'ri! ""K."Ul.1r SIJIlIl/y.


... ,


fiv. 11. n _ b<;U'lChes from lllo nerw trunks . '" g iven otf

wit hin t ~ r~ icuL>r pulp. but mosI oilh. ter_
mi llJ.te in the com""l pu lp ,n the pulp hom .. and within
the denti ll.ll rubukos. A$ the n""," l runn te.och lllo . ul>-odonlObl.ostk teZiOfI they form pl~"", in Ill<> coron.lI
pulp dC'op 10 lht ceU-fidl ZOllO. The myoli",,1<'d fIoO'rYeS
tbtn I.... th o myrlin ""Nth md, togedIor wi th tho sympathoDc nnws. outel lht ~I-fidl looyn. II"~ the,.1nd odonlObl.1stlc l.Iym.,.1Ind outer"", dmlin.ol
rubuIM "' the pmimlin and dmrin. /'OI:'rw tnmiTWh ......
found in ;ill PMt:> of II......... pulp. .... the mosI dmso
...... ofinnnv.t>on is in t he pulp horrts (F"'1 1 1.32~ The
pul p hom. ..... ee _
dinlully SU1ptibio:' .JrUS to<
mvironmmt.1l rr.1lJnw, whoctlnwy npL>in lht d.nsity of
inMt'v.1lion. AppmI<lmor./y""'""Y ll'llh d~nlin.ol rubulr
COOl.,;.... _
tennin.olln lht pulp horn ~on of !be
roron.1l pulp (FiJ. I U l ). 11w DOt'Wt atend n. ..o1y 200
1m jnto lho d.nnn.oltubu.... II\rOudI tho prnImtin and
denlin (F"lJ. 1134).
The m.>jorit:y of lhe IltfVfS low ed with in the odnnt",.
gonic ..,.,., of t he ""'tu re dental pu lp ..", unmyolin.lod
A~ or c fihon and .... Ihous hl tl> l\<> """kepi;"" fibon o r
postgangli onic <ympathetlc fil\<>n. Th .~ fibers au
located below . nd bet""ffn tM odont OOl.,t nd . re
also Joca rod in t he d e nt ina l tubules o f p ml. nt in j uxupo, ed to t he ooonroblASlIc proc ess_ Most o f tile termi-

'. ,

.. theodoo t,,9""ic:..,...,of tho pulp.

fig . 11. 31 Tranlmi<sioI'l o+ec:tron mic:rogr. p/1 c!emo."tr.1llng . _

of d""'lnol lub\Jlo. in pulp horn c:ontainir>g _w" .oo <>d<>nloblon ic proc. " .

fig _ 1'- :l4 Hig/1 -magrliflc. ,ion 1,,,,,,mi,,lon eloc:t ron _ ro_
9rop/1 , howing . n",ve ,,,, mlnol , t>d oOOl>lobl,,' ic: p"""'" in ,
dent;n, I, " bo il,,_

_ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ _ --",

l<<od.l~d w it h tilt
bLo"ic precess ccn ratn




and me odoRl<>-

variet y or ele<:lron-Mn...
li nd/or plKtron llKnll ~id<'s (Fig. 1U5~ AUboogh dK'
~i'Y of I>e~ ,""" ...11 located in m. COR>~ 01 rool
pulp olSSOCUl~ with the YllO<ll"'IIl'" drme ClI<t'
W'Sic1et I~I suln posifMoly for c>led>oLomi,,", "'''"
J.Ubsu1>Cf'J could
~ roIocll~=l within tilt ~
tnminol. for fllI,mpIP..... b<W>tt P and ~~ inl6tiN! ~ (VIP). ~ nerve Ifl'minoII:l; "'" ~ In
be ~ionM: syn>IYthrti< tnmiNls for tilt ~
tiooofpul~ blood lllMlf"1J. l tJ6~ Tll=ll'" '"""~
Ioult<l ifllllt odoI'Itopmic mM t1>.ol rontoin II hoornoae
popuLn_ 01 ~ ~ ftSidts and "'" ~wci
~ wifIIupi!Wiot$.{F,p. It:J7A and B~ ~. 11w1f
'4<culir SII:~OOn function is uncu si..... upilWry


fe$Ul.llt<l by local h umor.>! lKror$ ~ ~

br.odykinin. prosf..,I."'H.... "nd illtnio:'ukins ,,"'bor.ted
by celb j"",,'-:I ;n rho inll.unmaro<y ~. ~aJ
author's hoI\Oe repom'd ,"", , _ deost cor.-..con'"inins
tn m,...b \o(alE'd in the od ontobl;lstioc regi"" play .. . ~
in moduLotins II><' res"""... of the sensory nockep(QJ'S
by reguJa'lrli the YllK\lLlr su pply to t~ In m, ls.
Other i",,"'ig.Ilon $U~" tho' ll>e<e I>l'IW' ttrmi l.
play .. role in modll')'ing II><' rrsponse of t he nd oo l Dbia st
dilllTlftn is

to in, ult, in ~r"illl"Jf' n t of progenitor rell' afler pulp

01 d~p cavlly p",,,,,,.,lon, or in lilt r~gul~{ion


fig. 11. 3li l*f<l'5~ of a

_ll"l'jun<I.... ~


inV onodol>losti< """""".


Flo}, 11.37 Ultr.,fru<lur,1 m nsmiuion oItron rnl(r" of odont~'

(A) ,,"lh 'l4rge nerve term01.>I (6) <onto ini""
' I>...r>d {yp<'1of

memb,.",,bound ""';c.....





Roll< .'" theory

V""o le,,,


Sl-\:><l'kor sympathetic
00_01 g' 09IIoo

Fig, 11. 38 SC....,notl< of th""ry, Cellr"rIO'>'e mentor doforrrn OOn 01

th~ netveterminalmay' Iimulotc the ""n>orytermi,,,,1 holinergic) 10 con

duct on impulse to the "",in Wl"")' nud" u, in the cent" i ,...,.\<OOs sy,tem, A
de><ending p;llhway m<ly slimulate , ymp;llheti< " im u~ to the . lfectory
lodrenergk) 01' or"ffir the odOl'tobl"t, wt>i<h . If"'t> re>l'oo", ofdenl;"ogenes" .nd repo" ti". don~" form<ltion.

of odo ntol>la'lic melalx>lism (Fig. 11.381.

M"ny anJ tomic variations of nervt's and nerve termi,
nals have been repo rled to exist in the dental pulp a,
de, eril>ed morpho logic. lly. nelJ rohislochemicolly, and
immunohistochemically. These v.1ri'lions hJvt' raised
questions a, to the functional ,ignifLcanc't' of these find_
Ings. Neurotr,n<milt er< such as colcilOnin gene-related
pepli d~ (CG RP). e n keph~l in. neulOpeplide Y, 'vasoactivt'
inle,linallX' ptidc. , ubstance P, som'tosWti n. serotonin.
acetylcholine. ~ n d nore pinepherlLle ha"" been repor ted
to be associated with nerve.' innervating th ~ dental pulp.
Pre, umably, these putative n e u ro t r~ n , m i lt e r> are contained in the ve.sicle.s of the nelve terminal, adj. cent to
the odonlObl ~sts. However. thel'e are no lI IUilstl'Uctul'al
,rudies eha",eterizing the contents of the vesicles wit hin nerve ter mi"" ls juxtaposed to the o<lontohl,W< of the
de nt ~ l pulp or in the d e nti na llll b u l ~ s locoted within the
predentin Or denti n. in addition, there ore no 'tudies
demonstrotlng that the odontoh l ~st ic plasma me mbran~
cont~ in< receptor> for any of these pU!dtive n eu rotran<~
miUers. Do lhe<e different conformations of nerve ter
minals and diflerent neurotran< mitte rs function only
during the tr ansm ission or mod ul., tion of nociceptlye
me"h~noreceptio n, or do they have other roles. su ch ~,
modifying the responsiveness of the odontoblast, to
iatrogenic or environment al insu lt? The an<wer to these
que>tiom are unknown at pre'sent, heLl recent e. idence
suggeStS lhal ( CRP-containing nerves In the pt'rio, teum
and marrow of lx>nes con increase osteoblastic oetivit;'.
( CRP-containing nerves have al,o heen found in the
de ntal pUlp in close proximity to odonto hl,sts. which
were' in the proces< of forming reparotive d~ntin ,
Re[>Ort< of adrenerg ic symp athetic located in the
dent, i pulp of v.ll'lous species of an imals suggeSt th.u
the symPdthetic nerve supply to the deL1 tal pulp hos
multiple functions. One function lh't is well establi, hed
is the respom e of the vasculature of the dental pulp to
sympathetic stim ul,tio n. Many lnvest lgators have
shown that the adrenergic symp~theti c nerves function
to control in int ravascular and interst ili. 1 pressures
within the pul p~l ti.ssues. Electrical stimulation of the
supe rior sym pathetic trunk ,nd/or ganglion results In a
decrease in pulpal blood flow. but doe< not result In a
( h. ng<> in diameter of the blood "" ,,~ 1 5 located in the
dentol pulp. The U.<e of sympathomimet ic, decrease, the
flow rat~. Sever.1 investigalor< hJve re[>Orted changes in
the pulpal blood now rate after injection of <lX'cific
cholinergi( ~goni m. suggesting that there is a pop u l~
tlon of oUlOnomi( nerve, in the dental Dulp that use
acetylcholine as the postg.l.nglionlc neurotran,mitter.
These studies corrolx>l'ate light- microscopic studies in
which acetylcboline esrerase has I>een locollzed In the
odontogenic lO n ~ and o dj ~(ent subodontoblastic plexus
where the nerve supply Is most M n,e. These result,
Dr~se nt a perplexing problem that n""d s 10 be funh er
eltLcldilted. consi,lering lhere are vel'y few morphologic
report' in t h ~ literat llre of . p,r. sympathetic nerve SU Dply to the de ntal pulp.

_ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ - '11Hi_
5tol9ilyof thePlJI(!_ _2()~


1lM>orie$ol Pain Tra nsmission throug h Denlin


1lJ I'~nl there a~ thfff m.ojor lhMries that !uw' ~n

~ to"in how p.>1n is transmilled th~
tbe dentin ( Fis. l U'~ Confu>ion ,,""" a......ult of Sl'V...-ol fKlOl'S. indudinS lht ~ of >yn.>plic 'l'ffialiulions
l>ttvoftn nefVe'S and odonlObl~ m e mUltiplicity of
l\l"Urntr .....,llIen found ill lht dmt. l pulp. aDd lht
ted>nlal difflCUllies in rffOrdiTlg e Jectrophyo.iolot:iaJly
from an ~ pulp. C.......,rty. lht hydrodynmlic n-y
prNomin.olft. .oklloulb - " thtofy .... po<i~ n


The' m<wemt'OI: of tIw ndld romai,....t in l be <lmci~
rubul .... in .... pon~ to i.1lrogmic or ......i"""""'otol m ,u_
m.>. is ~ """01 of me hydro<tyn.unic dJ<ooTy. Whefllht
n",d ,n tbe dent"'''ltubu...... . derivatm of the blood
pW........ is Pl'IIu'hed. the ~ 'mIi",," w ith in the
<!enti""" ' ubu les aoo t he odontobJastlayer a re drI",,-.;l
a nd initiate an oKlion JlOfml i<1l Numeroos studies ~

demon'trated ,hal ,arid m"""ment or the dent inal " oid

will <au" p.lin whctoo the <timul.., is osmolic. d ....mi.
ca l,

[em~" lu ,." ...,lafed . o r

me<:ha n icaL

Tran sduction The ory

The t ransduc t ion th"ory I. 1S<"d on , ,,,,,,,a l ""rimen_

lal crireda wu..ring th.l I"" odontobl. ' l ,-on lta OSduu' . medl.lnkol shmulu, . lId ITonsfer IM t , ignol f() a
c1"'Cly ol'l"""t'd ~ !<'nnin. 1. Thi, thoofy i< <uppo~
by n>porlS lhowing odontobl.lSl< to be d~riW'd f ron\ ncu 1 ere eeus, to be do<ely .,soc'.:ued with JI<'fW tennl
n.ols. .nd 10 contain Io'P jun etioos th.t eleoetronic.olly
rou~ ""~1 odOOlObI.uK AQ:um~nlS . g:ain<l: the
odOO10bL/l~ u.n..:luetlon tbtory ~ ... th.ol l he> ~
bttn no I'!'POrts of <Yn.IptK ~Iiutlon< btfwHfl
odontobL..1S wd ~ _
...Is. .00 IhemOl\' no
mem< of d ...mlC.:IIT~Mmiss.ion. mel thot odontobLtslS
_ "'" ~ uII.. mel thnrlore _ un.olW to pro-

m.c. ;on tIKIrlc.:l ~ .

Dinod In~ltlon Theory

The di~ mne'rvalion hypolhe<i< is the oldfo<I tbtory of

dt'nu 1 in"",,,ltion md is b.><ed on the tM.lief ll\.Il
1 JI<'fW _ ,...15 ..aend 10 the DfJ. Wh<'n the
~nlin is pe"",,r.~ the ne"", _in.ol i< <lrlornwd
di...ct:1y .I7t ...........oic.1 pertur!l.Uion . 00 initlal<'S .n
.oction pot~la l. Prnrntly, the f:Vid<>ncr .uggest$ l""t
.......... _IMls exl<'nd Iwlv.=n 200 . nd 300,. m no
~ prf'dmlio-dcolin, which i< too clost to the pulp 10
w pport lhi'theory.

P'odo ntin
Fig. 11 n Surnm..y 01inform,tiM 00 f,",ctlon a<Cor<1 ing lul h_ theories
'" donlln. 1io"" "" t iM.

1I/ 5tructure and Functjan at/he Teeth



Pulp Response to Environm ental and

Iatrogenic Trauma

Roparative demin



fig, 11. 4l'I Di"grarnof dental""ie< in tubute> an<J i"llammatorypulp expo-


Dentin affected by a carious insult will init iate an
infi<1m matory re<pon<e from the den t,l pulp's ~ resul'
of invJ sion of the pulPJI tissue by b,Cl;eri.1 toxin$ (Fig.
11.40). Initial disrup tion of the odontoblasts due to
edema break< down the j unctional complexes between
odontobl,st< ..nd JllowS .1C"'% of the r ulPJI ti,sue by
the bacteria and other or"l contami n"nt ' (Fig. 11.41). The
capillarie< tHogin to leak plasma. and vascul,, cell< will
become extra Y's.>ted (Fig. 11.42). The acute inn"mm, to _
ry cells release V"Tious cbemot~xi< la<tors. cytokine"
and growt h factors. The inflamm atory respome consists
of a rapid Jccumul.ltion of neutrophil". hi< tiocytes. J nd
monocyte, . Prolonged inAJm mJt ion re<ult< in .. chronic
inAammatory response that includes B- " nd T-Iymphocytes and plasma cells. With the pre , cnce of c hro n i~
inflammation. focal necrotic leslon< develop thJt may
lead to total pulpal necrosis. possibly due to , nJ erobic
bacteria l invasion and the slibsequent release of
degradative enzyme, by the,e vil1Jlent bacteria.

He aling after Cavity Preparation

Fig, 11. 41 l-li' tot09y '" ,.,"" in dentin with undorljii"g "'p;lr"ivedo",in
, nd infl,mm"t""" pulp re<t>O"""',



.1 /
f ig. 11,42 A" tOtil(fiogropl1 l< domon"",io" of 'ho patlorn nl IotHoling of I'''
tibri"0gen 10 mi""te, alto< ' d" , V,avitypro!>"r" ",n w., completed.

Experi ment,,1evidence sugzests tha t wound he" ling in

the rat denta l pulp begins after m"" hanical or thermal
trauma caused by the cavity pre paration. injures the
CKIontobl.lst, ope ns the dentinJ I tubule, . J nd di<pIJce<
the nerves and nerve ter min, ls adjacent to the udontoblost, and odontobl" stic processes with in the dentinal
ruoule<. The distortion of the nerve tcr minals causes
them to rJpidly rele,se neurope ptides w nt, ined within
th ~ir ve,id~,. such '" subst"nce P and VIP, Disruption of
the odontoblastic layer and injury to the c~ll , as a result
of the c, vity prep,r,tion initiJ te chemo,"ctic sign.lIs
reCl1J iting infl" mm" tory cell, to th ~ "''',,. The infl"mmatory ceUs re,pond by relea, ing various cellular mediators-hi stamine, <erotonin. and pro<taglandil1'-i nto the
,u rrounding tissue. thus jX1tenti J ling the infi,mmatory
reS jX1n s~. The j unctional complexes between "djacent
odonto blasrs are disrupted. allowing an influx of ionic
caldum from the extrJceliular dentinJ I fluid into the
inju red CKIontobIJ <t. and po<"ibly from intr>cellu lar
seque,trilt ion t>e<-"use of inj ury, c"osing disruption of
gap-junctional com plexes. The int ercellu lar spaces
become r.Hod wit h fluid and proteins derived from the
plJsmJ le,' king from the penne" ole C" pill, ries. effectively
preventi ng intercellular communication, Concom itantly.
the clotti ng c.lsc" de i< initiat ed. de creJ<ing the
pe rm e,bii ity of the dentin .1nd preventin g fur thet
ingress of irr itants into the de nta l pulp. With in I day.
in shallow cavity pre!><'rations. the odontobl"sts reorganize
and re-e<tJb Hsh their pl" sma mom br.1Ile< that were
dJm.lged duri ng the operJtive proced ure . Thes e
odontoblast ' begin to secrete cojj age~ " nd ot her ECM
com ponents in an " ttemp t to re pa ir the da mage

_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ ____'[ ljlH!l to{ogy.ofrhe Pu!~_'"

~ff~ liYO'ly. H~rl 3 d.lys m.eir lIWI~bolk: funcli"""

.'" not synchronous ~ m.e tlsht-Juno;tion;lI ond
pp-j unctioAll com~ I\.JW' not teen 11! f lublis~
bd"un .ldjftll cdl<. 14. 5 <bys ....tft" lhe InitWJ IUurru..
tM JoIP juoctions """ liJhl:-junctiolwl ~JOI:S ~
nubIish. and ~'lM6enti~11;01 ",od>td ,he
poilll 'I'f!ltre 1M """"""I of I CM pnldUCfd by rbe odon10bl.un ~ to
8y 1<1 .s.ys. tM inn.rnm..>tory resp:>nSlt is rnolvN. fhe odonrobl2<l1C 'II \Iyn is",...
O'fUbliWd. ond """,,,,[jyo, lknli~and new colL>Fn fOlllWfion ..... diminished 10 tilt ~ of ,he ron-



Notl's o n How In flammation Mod ifie s Pulpa l

In n. mm.t lo n in the de nt a l pu lp i., o><:com p.lnied by the
",Ie.", of w ide v..ricty of chemical ml'<!iaror$. of which
highly o><i.wtive molrno les-known M ,...ClOve OXYF"
spKics [ ROS)-p1~ .. IJ\iIj ", role. A5 the I\ollme infe..... ROS
. , e .. nstoble a nd nK>re ..... dily re.KI w it h OChrr comp:>Unds thon their emund $l.>~ dcri.,ivn.

SP"dn 1M ~ mild lhnmodyn.Jmlc pr~ an

be lMd to me orpnism's bmdil M ~ moleCIllo's. For ~mple. m.. 11!.KOw ~ ~ nitric

o:Uk ( NO') and , oxiclt (o,~l plq Uy ........ in

in!'I"""",' ion- Nini< OIl;"" """ ~Ity ~ ~

10 be tilt O'IdoIIIdium-dt'riWd lNxi"ll IllCtOr (EllRF)
""J>OIUfJl ror rtlllluing ",,$04,IoLIrion. Supe1'(II<idt aids
nonllrophll m~t ion by ~~iofl of $Uperox~

dcpl!'l....nt cl>tcrINttractonc.

ROS a~ produ'd in ll"' at..r quan""" by xtivat<'d

in~a mm.tOf)' <"II, as .n . id in plugocyt"';,. Thi'
pltl<l'>$ i. u>cd by our defen,e cell' a, a meehani>'" to
neulralize ;nding organi,m . The ~,pi r. ,ory bu...t
found in stimuia1ed macrophages i~ the be,' known
~a m pl~ o( thi, p h~nomena. Ho~r. it n a1, 0 thought
/hal overprod uction of ~OS m<lY be h.lrm(ul to flOrm. ]
hoSl nssue a. well. ROS ha~ ~n ,hown 10 co"'" di,
ru ptn'f1 at multiple cellul.u ,il<'s. Rettn, ly tilt role of
ninic o,ude and SUperoxiM h.1Y<e bftn In''fftigoted ;n
inflamm.olion ind uced in <lem..1pulp via c.r.'il)' 1""lWr...
tiolL ~ SI"" '~ tu.~ >bown thai bolh nitric ""illt .. nd
SUl'f1'l'ltde IrwI> i """,as<' wd h in1\am""'tiolL Thf-><'
~ occurrnl not: only in i,,~ ..mmallXY crlls buI
....1 0 In ~ pulp ri5suIe .os ~ .. $UI1"OUTIdint
",*"IlelLal/V-..Lar >lI\I<I\mS

To cOlluoi. ROS con<mtratiofl.. an ~~ systnn 01

_ _idan, ....,...... ...... in place. 01 whidI ",permide

di>muuse (SOD) is a ~ OO1TlpOlllt'Ol. SOD c>tilly=

tilt dismut<tIiOfl (th" simultil_S w.idatlon ..nd redUClion of lWO ltke m""""'lM) of superw:ide roldie..l, to

fonn HA and 0,. In "",mm.llian cell. ttle~ ..... lWO

"""or forms of th<.' SOD "n<yl11 ~. which dlff...- by meir
intr'K..l1ulM localion' .nd ~ of metal used al the
enzym~" acti"" 'ite. CopJ"'r and ~i nc<ont.i n; ng SOD

III Siructure and furn::!!.~'!...of.!~e Tee"""-


p '.



l l... . ,.. . .



"" ',.' .
,' ,l .:""S

l' 1 . ,

~l;' .

"b~' ~

'.\' i) ,,:JI --:

-'''7 -'' \:;1...
,, ;-,,< ~:; .
~, .
.... . . ,
,',' , ',~ ,
" -

. . ....
. ~

. . ..v,':, "',

' f...~"

~ .....

' ' "1

r .... ,"'~
. .'

< ~', '. ' , .


~ ,

Fig. 11 .43 ( avily prep" "tioninIhe hrCuZnSOD-tre. ted grO<l p ro,ut" in

m; a~ on of the me, i. 1ptJ lp horn, . In the deperportio'" 01
the cavity prepar.tion, thoor;gin.1odontobtost> have been de<troyeJ.
Repl<lcement odontobla<" produccd n.tubularrep. rat;"" d. ntin
(Rp), In the ;l>; llower port;oll' 01thoprep'''at;Qn.the original<>dontobkl,t,
, urvi\le.d arK! produced a ",gular, tubula'. "'''''Iio""", dent;n (Re)



(Cul nSOD) is found prim.rily in the cytosol of the cell.

Jnd mJng~ nese-conlJi ning SOD (MnSOD) i, locJ ted
m" inly in the mitochondr ial m.trix . nd the nucleu' ,
Recentiy. CuZnSOD activity hils tx-en demonm" ted in
J nimal .nd hum"" dent,,1 pulp. In "d ditlon, ( ulnSOD
~ctivity incre" e, with innJ mmat ion in extirpJ led
hum. n pulp l i"ue. Both CuZnSOD .nd MnSOD
immunost" ining inu N ses dr"m ati"" lly with inUamm. lion in pUlp liue surrounding a leukocytic infiltrallon.
Indirect evidence Ih"t increased ROS f on<'t'ntr"tions . re
deleterious to the pulp comes from a re"ent study in
which the effects of j UI>erox ide radical sCJvenging WJ'
investigated on puip. 1inn"mm "t ion 5 d"ys . fle, ~ Sl~ n "
d"rd ized cavity preparation. lnfl.mmation "n d lep<lir
we,e compJred histomorphometricJ liy betwee n .nimals lre.ted with exogenou' J dm in i<t]'~tion of J human
r e co m b i n ~ nt CuZnSOD ,1ntioxid.n t e,, "yme verSuS
s. line-vehicie contro ls.There w., ,, sigrrificarrt reducllon
in J reJ of innammJtion involvement in those .mimais
treJted with h'(uZnSOD JS co "'p~re d 10 contro ls (Figs.
11.43 and 11.44). Pulp repair was measured by the
amounl of rep<lrative denlln (lhe dentin produced by
repl~ceme n l odonlol,lasl' J fler tll~ o' iginJ I odonto biasts have been dest royed) ,1nd reac ti on~ry dentin
(increa",d secondar y dent in deposillon produced by the
o'i ginal odontoblJsts in respon", 10 I n irrilant) pmdu<'t'd by the inn~med pulps. None of the innJm ed pulps
from lhe ",Hac control animais demonsl rated rep"r"t ive
de ntin formalion and only" small pcrcenl"l:" prod uccd
reactionary dentin. Re parative and reactionary denlln.
however, were observed in the m~jori ly of lhe SODtrealed "n im"l s, E, ogenou5 adm inlstr.t ion of
hl'CuZnSOD promoted .n environmen l within Ihe puip
in which repl~cement odonlol>l~s ts could dev~lop . Lld
deposit rep"r"t lve dent in with . minim. i"to ry
,"e'DOme compared to the saline-tre" tcd contro l,. The
dentin_like m~l rix produced in the SOD-trea ted "n lmols
cont" ined muitipie "el l body incl\l$ions and. lIterefore,
m. y be extremely perme" bie to orai irritants, Whether
SOD tre J t m ~nl of Ihese cavity-p re]>ilred rills would ultim~ te ly preyent pulp necrosis Jt longer lime iL11ervJls is
current iy under investigation.
c linicaIA pplicati on


The high density of nerves in the dent" l pulp h",

been "'rorted to function in the lransmission of
nociceptive stimuli (pain) and in regolaling the
response of lhe odontobl.,t Mld pulp to trJumJ .
Variou, investigarors have shown that milOti" ."ttvi
ty a<ld rep<ltalive denlinogene<;s can be altered
whea lhe sensory or po < tg~ j] g l i on ic $ym ; ~1 1 h e(jc
aelVCS arc resected. The nervolls , ystcm h., "Iso
ben reported 10 modulate immunologic ",spo n""
in v"riOUj tiSsues. The regul.llion of v~,cul<" lone by
the postg,lnglionic ,y mp,l thel;Cnerves is ~ l s o impor_
tanl in maiatalning interstitlai nllid pressure in the
pU lp JS well J' ill modulating the re, ponse of the
nociceptive nerve lerminJ l, within lile dcLltai puip.
Recent evidence de ",on st r~te, thaI J,on retlexe<
" Iso pl"y. key role during infl" mmation.

___________________________,"cH";",,!!Q!r>fj Yof the Pulp-----.1.Q9.

Im mediate Pulp Expo,ure and Dire ct Pulp
Cap pillg
Numerous studies have demonstrated that the


pulp has an inh erent capacilY to respond to wo u"ding in

the ~b<o L1 (e of ot her i nnamm~lOry insults (f ig. 11.45 ).
Experime ntJ I eviderrce has shown tn"t using c1inic,lIy

(r ileria, an uninnammed ~nd exposed den" l

pulp will for m a den ti n bridge by 2 weeks in a huma n

and by 9 days in the mo nkey.
W hen an expe riment al pUlp expos ure is completed in
a prev iomly he.' lt hy looth, porI ions of t he odo ntoblastic
laye r and unde rlying cell-free and cell-rich laye rs and
plilp proper are destroy ed. Nerve, ilnd blood ve"el, " ee
cut and ext rav" , alion of erythrocytes ilnd plasma causeS
tissue ed ema and increased inte rs titial pressu re in the
, urround ing pllip tissue. At 2 d.y, afte r pulp ( ,'pring
with. (Jlclum_hyd roxide.containlng medicdment ~nd
re' to ratlon to lhe , " rfdCe, lhe exposllre slle conta ins ~
d eX composed of ti brin, plat olets, and r.-d btood cells
(Fig, 11 .4 6). So me polymor pho nuctear leukocytes
mig rate fro m l he blood ves, els Into lhe reorga rrizing
puip pro lX'r sllrro und ing the exposure slle, Fibroblasts
begin to migrate inlO th e IX'riphery of lhe subjacent
Injured pu lp (Fig, 11.4 7). The clot begins to reorgan i, e,
The previously lerminally injured odorrtobl ~'l' have
completely dege nerale d w here" , the adjacent uninjured
pulp appeJ r, normal.
By 5 d. ys " fter pu ip expo,ure. the clot ha< been
ph"gocytosed ~nd <lellate-sha ped [[brobla, !> can be
seen migrJ tlng int o the inj ured arN Jto ng the ",i ~l wall,
of the cut denti " dnd in the J ,"ed b<'low the exposllre site

ClinkaI Appl1G1ti on
TodJy. iadivid\lJ IS retai rr their tee th for long pe riods
of time. t'er iodont,,1 di"ea<r is curre ntty prevalen t.
The gingivJ J nd epitheli., t3ttachment migrate down
the root surf~ce of the teet h, exposing the cementum and root <Ientin, resuiting in an Inc",,,,ed illeiden<e of root c"ries. Root odontobt" t' haw recent
ly been retlOrted to respond to r<>Ot cJ rie, In the
,' ging pllip in ~ manner ,imitar to coron" t odo ntDbl" S!<, except th,' t it takes longer to initiate reparati", dent inogen""is dlld to com plete the repa r,'tive

Fig. \1 .45 Diag ram01 cavity propar.bon aod O'J>OSure 01 pulp.

(fig, 11.4 8~ ~ngi ogent$i$ and. p m!om1na"c. of

fibroblasts d escri~ tM granulati<m liO$". occu pying tM
wourx! ' ite, Pull' ti"". can be see n adj.lnl to fh e <:Nt!:rlying medicamenl. ute in thi s m ge of 1'" 1,,,,1 healing,
tho fibro blilSfS become OI''''''t''' "" ra l~l to tM m"'icamenl interface .
At. 7 to 9 d~ lh o fibrobla.t$ bellin to cnlar,. a nd
po lari"" wi th lhei r IIUdo'u. o rionte<! basa lly (fig. 1I_4 9~
Tho"" odomoblaSl- liko ~lls lhen ~,.ni pt1"\H"IId;' 10 the pull> cal>l>ins mareria l.By I ~ d.ay$. tne ~II
......., dtposilod a nd m;.... ali~ I"" se<m:od ECM
.."..",ti ~ dentin (F'I. 11.50} As fC'p.lrali~ don ton bmation conti nues, the tissue bctin. to rnemblo nor mal
circum pul",,1 d ont; o and contain. odonlobl..uc
~ Tbis pmct'S1<

conlin.... umil "".Ii... 1Ia$ been

~_ .

1"'9- 11



PuIp..........,.e.9'- _

. .-.d puIp<Ji""l'l'lh into "POW"

Tho dinical

on .......a1


of dilffl pulp cappi"l depends

racror. Indudins: lft"ftloon of bKtorW iIld

~ produC1'< rrom m rcnns: tho pulp d"",,,* the

"""",ati... pn>ct<Iutu.. Suc:a'uful ~.'mmt indudf.l ttW
formation of a penna"""t dmtinal bfi<:IP' b!r ~
menl odontoblam that .act. aJonc widI ee rcsror.~
material to ~
oral con...... 'nanlS from
affffi:ins the pu lp. Tho forrrw6on of do'IIlinai bfi<:IP' is
simi lar to ",para~ dmlin fonnation IIndn U\'ity
~ion or in Ihe pulp horm ...wlint: rrom occlusal
amition or In umo.

loa'" or


11.50 Sit. of pulp . 'pc>!"' Owith n.... dont ln form.oliun an ,.,. I I day"

____ _ _ __ __ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _
Su m mary

o[tht ,l\<lp_21!


Tht cimroJ pulp OlnSilU 01 ~ ""'"" ~ ~

mctc..-d by riIid ~Iln .00 dmlin limns l ilt
(l;IrOO,I1 ~nd r.odicuW pUlp. The most pnip/lo1"~1
~ ol the (!fOUlt pu lp conuins lOur ~ of ails
,ncludinx ~ Ddonwbluuc Ioyrr. the' cell-fr't't ecne.
I"" c~l~rich ZOM, ~nd the ""rieral p l~us or 1lefV\'s.

within the<e four "'-yen is the pulp P~.

com p""'d of fibrob1.l. IS alld an ECM. ~ pu lp i.
den""ly inne Nated with ' ensory an d "",tganglionic
sympathetic neIVOS, Some neflles are assod.ted
with maint eMJlCe of vascular to ne. w hereas Olher
M"""" are associatrd with the conduction of noct~i ... <tim uli n... ""'" den ... inne rvation i. in (he
pulp horns. Of rrn, 1Il1ft l heofits of dentin.ol
lMty. me, hyd~ d=fy is fhe most viable.
ArtmoIts, vmuleo, aoo lymphatics ...sstb "rt llso
~ l_ 'I'M pulp las an ; n ~ { upooc;ty 10
Il'SPOOd to environmmUl D....,.I a< i.ltmemiC tr......
m.l ......1ti1l8 from l'ffiontM pn:uod~ by the
uprqul.ltion of odon!OlllNic activity and rht pr0duction. ~ion. and SU~I minl'faliwion of




~r.ot~"""tin {FIg. 1l.51 ~

s<>lfCva/ulltion Review


embryonic cen

Fi<}. 11,51 S<lmmary of di.><Jo'om of ,"""'y _

1.l:.-er give"; ri... to <:>donto-


and discus< the julX"liono.l romple,....

~t\.(l nodonl~
3. Discuss the puI~ fibfobWf

mel its function durIIlJ .... inttlWlC<' .nd ..,..,. of ~ dmuJ pull'4. W!l.Ir v;ascuLor in ml",,
illl inttntitUJ Pfl'SSlln dunlll pulp.ll injury?
5, Which pulp.oll>C'fVfl functi on in me mo;nttnonc.,
of v,o'iCUI., ron.,? Haw . tt pulpal c.pi ll.rioH ronnolJ.,d?
Ii Which rh><y of p.aln r,.nsm ission through (l.,nlin
is lhf most popular? Clw ' f aw n. to support you,

7. Discuss innammal lon in thf de nt al pulp. including
the ~s of cells and seq Uf""f of events I.,ad lng 10
pulp.ll he. ling.
8. OoHcribe ~ otgi"i proc= in Ih., d.,ntol pulp.
9. Nailli:' lll,-.,e ""Il l'tIt ro ns mi~ found in Ih., d.,nl.1
pulp.oo rho'i' functions.
10. Compo", and conn.n me ECM of pmSmrin.OO

dmtin. .

,"l ">o""h ","""",,y;og ~.

"'"'" """tin. Pulp """"" iziIt;oo with oclontoblWs. ~I_ff....nd c.I..-ld>

zonrs.. nd~'oI- .~.inat<"dnetvell'\.Olb_f

1he=*.. ..... .ond ~ _ "PJ>Nf "" ....stl . . .,



11/ srr~ture andFunction 0{ tfldeetfl


fIIJum 11..:1 mol

11... ....... ...,..-ou>Iy~"'\lr.KiJ1<

~ r......., I'tI. D.


12 Comparison of Primary and Permanent Teeth

D~vld C. John. "n

"comp.orison of It,.. mo rpboJosy ~rod himllogy of pri mary ~"" pto, ma""nt lefl h " \I,npoltimt, ~. I~ eli"," in
number of W~Y'. Clinicdl problem. in th~ deve loping
j.... o f (lie grow ing ch ild. a, com p.ored wllh til< jiIW in
tb<o ~UI L ~rf ... Loled toCtw-actniSfics of dewloping prj.
JnOf)I lind p<'fm;I""'" ~ mol th!'ir RJppootifIJ: strue!uta As dnatJtd in a..~ 1, theft _ diffe1n..., in
tho number of u:tth: !he
20 In thr <!tnti_
Don ~nd 32 in ' he pmno nl dcnri lion. As ~Iso discus$Cd previou. ly, lh. dnleri", 20 pt" ll"-' nem t.eth

ropl. "" {he pri mary dentiti"n and . '" thus defined as
, u('Cl'u ion. 1. le('lh ..., doscly rnar<'<l in Ihe timing of m.,ir exfo!ii1fion .nd in ,be dtwlllpmtm of {loP
SUCftUion.lI limtition. 11>t' renw<ni"l 12 pmno......,
lttdI <II: . clop JIO'U'lior 10 tho 20 pri ......ry lefttl .0< the
j.o..., contin .... to!JOW in length (As. 12.1). floIh primuy

Ch.opt.... Outline'


1nItoduction_. llJ
Ob;Ktives... ll3
TOOIh Num be r and
Toot h , ha pe... 214

SI~e ... 2 14

ToothDevdopmenL. 2 15
TOOIh Stru<:ture... 2 16
Pulp Sile ;ond SNpe._ 218
Acus<Ol')' Root


Atdl Shape a nd Tootll PosiOOn.. ll9

Root Re$<)I"ptlon and PlJlp Oeg e""ratlon... 221
Se<juela to Injurie.. 222
Su5ce pt ibllit y 10 Enamel Odeet ... l 22
Summary... 223
5eIl.v.-....c;on ~_ 224

dnll iX'Ima""nt tmh j>f0Cftd through lbe $<1_ "og..

ot de.c1 opm~ 1l1. Th is ,h~pl e r d" >cribe, d iffc ron ce, in
toolh si~. shlJW of crowns. rOOf! . ~od pulp cn..mbel'5,
tile micros<upic <l ru<lu", of en.omeJ ~nd timlin, .a< well
... ~ng. 1000h indin.lrion. a nd arm Wpe.

Object ives
Afr.., r...odinll 'his cll.Jpter you .hnuld be;oble 1<l d iscuss
{he slmilariries and d i ~ ~ Ill'i...... ry .lnd
~ ~h and 10 de$oibe how I~ dwlr.a..m..
tics rft.lle to d,nic.ol rrral'lnent.

rog. 12.1
_ 9 ~,., 0/ .

potIod .. seenlnthl"~>pimenof.<tIiId


IJI StructuFe and Functionof the Te"'t'hC-

Toot h Num ber and Size

Fig. 12.2 SI,e'od po' itional r~bt ion 01 prim.ryaod permaoe"lleeth,

Perhap< tile mo<t obvious difference b-etween primary

,lod permanent dentitio ns i' the number of teeth. There
a", 20 teeth in the primary denti tion. and the !",rm"n cnt
t""th replacing them a", called s u cceS$ ion ~ 1. There a]'e
32 teeth in the permanent dentition. " nd the 12 pe r m~ _
nent molal"$ tha t have no predccessol"$ " re c"lled a,,-essional. As the'e p erm~ n e nt mOIJ" are added. J rch
lengt b and tot al mastic" wry surface increaSe (Fig. 12.2) ,
Primary and permanent teet b differ in Sile and form.
Several of tilese differences innuence deci'ion> about
denta i trcat mcnt. Crowns of p r im~ ry te<'th ~ re sm ~lIer
than crown , of tildr SllCCeSSOrs. witil only . few key
exceptio n, . ( rown, of f"'r m.m ent ind ' ors " nd c" nines
are larger tilan their primary counterpd rts in all dimen, ions (Fig, 12,3). and although Crown, of l>erm"n ent
molars are larger tilan crowns of primary molars, the latter ilave " larger mesiodistal diameter tban crown s of .
tile succeeding pre molar, . The difference Detween the
cum ulat ive me'iodist,,1diameters of the prim"ry mol" l'<
~n d CJ nines and those of the premolars and permanent
canines i' colle<! the leew.1Yspa ce. Root< of the primary
teetil are silorter than those of per m~ n e m reeth

Toot h shape





f ig. 12,3 Compari;oo 01 ~,e 'od ' hape of perm. ownt .,><:1 prima rycaoines.

~ ,man. n l


Fig, 12.4 Comparisoe 01the proxim.1, url,e e, of

primary. OO permanent

crown" Primary"",Ia" hirw . fl, t , urface with . oontilct li ne; !>"'maO(lflt

mol. "

h" . a contact poi nt.

PrimJI'y teeth resemble perm " nent teetil in several

w.ys. Bolh pr imJry incisal" and tlleir respective perma nent successOrs"re single rooted and have inci' ed edge,.
Bot h prim"ry canines and their re, pective perm" nent
' uccessors have , ingle roots "nd a single w sp, Prim.,y
mol~rs, however. hear no "" emblance to the premo lars
tilat wiil succee<! them ; instead. the <econd pr imary
mola!' crown re'embles tile adjacent first perm. nent
mol"r crown. The flt'St primary moiars be, ,- iittle reoem"
blance w any other tOOth.
( rown< of pl'imal'Y teeril are silorter incisocervically
tilan mesiod ist~lly "nd have a <hart. th ick-'et appearance. Prim"ry teeth have g re~ter contou r than permanent teeth, especially at tile cervical portion of the
crown, Contact arcas differ for approxim"t ing molars.
The . pproxim"ting ' Ul'f.lces of the !"'rma ncnt moiars " re
mo re rounded than thuse Of the prim"y mol",!" , which
results in "contact point (Fig. 12.4 ). P'rim," y molars have
fiatlened appl'O ximal surfaces, wilich resuits in a fontact
line. This difference hJ, clinical significal1ce in caries
patterns on ilpproximal ,urf,lCes and in cavity de' ign for
carie< removal. Interproxim,,1carious lesions will b-e cer
vical to the eont"et ~reJ S and of similar SIM f"'. A second
difference in molar "ruwn Sh,l l'e involves cu' p height.
Pel'manent molars and premo lars have Steeper cusps
til"n their prima ry countel'pam. and interdigitation i'
more fiexihle with prim"ry mol,,]'< th.", with permanem
Root' of primary molars at-e mo re ,Iivergent than
root<of permanent molars. The fiat, curved roots of the
prim"ry mnl.'" l>ermit development of thc underlying

pmnWr5. bjiosr;ophS [1'"'8- 12..5J dcmol\SlTll~ th e positiOll$ or r~ premDLirs underlying lhe prim..ry IJlOWs.
The widely d~t prim~ mol.r n>ofJ.Jlaw !be premoW CfOWR$ to dewlop under tbern without "i'f'ladni
!be Jl'iln'ry !ftI:"- As !be Jl'f""'lOlu erupts,. the 1'OOC:S or
lhoe prill'lM)' lllOi.Jr wi. be ,esoo'bed Mons llle ~ is indiulftl in I rMlqup/l by


Root WIN' "ict;mos pulp WIN' .00 is cJosdy coee..,led w ,tIl two imporunt diniul ccn:sicIn.otions (fig.
12.6~ fi rsl. eu.......:ll'llO'! willi llIin wIlls mIke me<:h.lnica loK$$ to root c.l\;lls m"", <IiffoeuJr in prim.>ry moLars
Ilwn in pemwnenl mola rs. ~n". lhoe f.l. ribbon- hk..
rOOf c.nal of lhe prim~ry toOlh i. in ,h.o, p conlr." 10 tr>.
oval. t ube-like rOClI c.n.1 of th e ~rm. nenl lOOfh.
.SigJlil)c.m d ~""lopment~1 differenccs occulln t he ro Ol
"nal, of t he p rima ry mo lor>; Ihe rool cana l fills in
un""e nly wilh secondary de ntin, which Ivo. calcifte<!
1:>ridges, Extonsio ns of pulp.olti.,U<', are then she ltored
(ro m InstNrTK"nfdOOn ~lt empl $. FjlJing-ln of t he pulp usua lly OCCUrs at abootlM ",n e Ih. l l he firs( pe-r.
m..nent mol.:lrs In m.>nd ibul. r second pri m..ry
mollors IIlcre.", I1NO d im l canaol1. one bucc.1 and one
h"llual. whidll'" connected by ~ or pu l",,1 tissue

FiQ. 12,$ Rado;.g,.p-. oI thr [>O<iIHln 0( ptMIOU" u ~

~"'" p'On;l<y " - ,oot>.

(FiJ.1 2.'~

Tooth Developme nt
I'rimIty md pemwnent _II simi l.r pronou of
dieveloPlMnt. bur lhe rime ~f'd for de'velop~ or
1M p" mary ttttb is consid..... bly shorte-r tlu.n th.1t
lI(led rot de v.-Io pmenl of the perm..anen l t<>elll
(Fii-12,1 lln ilddition to form.>tive events, prim..ry leerh
unde'lO rooc "'sorpfiOll and pulp degcJleution. Prim;lry
tool h crowns begin min er.lization in Ill...... w ilh l he
crown ro mplrlt'd shortly alter l:>I"h. Perm.n'nt tOOfh
crowns beg in fo rm ation .1 or .ftcr birth, d e~nd ing on
the tOOf h, Ono di nical resull is t h~l p,.. n~t.ll system ic

In utero
3 rnorotn



! ,

' '9. 12.6 (ompcori"'" 0( ptOn;l<y ''''' pe'"",,,,~ pulp ""''''

I ,,
I, "I ill
, iI' bI




Fig. 12.1 (O<I1p"";"'" 0( t~ lile of pti.....,. and po-trNnml leelh in chi.,...,.

Iog>c ~.,." .


UlS/:nJctureand FullCrJoo o{theTel


d isturo.nceJ un ~nea millffilliu'ion <>f l he prim.lry

100m rnIWtIS who!1ni posm,n.ol d isruro.ll<O'S un ~Ilt
miner.oliz.ltiofl fA The ~nM1 tMllh <TOWIt$,
Prinw-y l-'l func1100 itt 'ht mouth ~pproxim.lT~1y
&.5 yo...... ..-d lhis IilTlt-Sj).ln ~. n be dMded infO mree
pe1io<k, ~~
roo{ m.ll"'.ol"'" .ond
I0OI fMOfltlion
shft!dins- The cn-th pmod ~
~boul ~ l'l"'. fOOl rn,uur~lion .>bou13.75 yoMS...... fOOl
rtSOfIllion ~ .....doli~txm ~ boul 3.5 yo'~rs. OIllhe ~r
""Ad. SOfIIt of The 32 pHmoInenl tttth m~ be in I""
nt(IUlh fm m Ute 5l h}'filr on. w"""'~ s others m~ be in
th~ mouth from I"" 201h 10 l be 25th ye.or. T"" Pftm.t"'-"'I lttIh <ould Ihu. fuocrion ~n to eighl limn
longer Ih~n lhe pri"",ry l<"el h; thi, l ime of funcli on
includes 12 yc~rs of d. ""k>pmenl, w hich is Ih tff times
lo nger in perm~""ntleelh thdn in p rimdry teeth.


F". 12.8 Eropt ioo of perman.." IN'th on<! <x ~ "li<m of prirno ry, ,h dIJ ~
1"9 m~ denblioo period.

M~ny se)Mrdt~ ~""nts "",eur w ithin the SPI{~ of . Few

millimeters during dentition develop,,,,,nt. Ftlr a sillil:
prim ory toOlh J nd il1 'lIC<nsor, two s;mult~neoui
"""nCSrould be t.... nuJllion (with moo: form.:uion}or the
primary tooth ~nd lhe crown m inerdliz.lrion ol the~
toOth. Anottlll'reumpl. rould be mol resorption
of che pri .... ry tOOl h. which is rotKtIlR'nl wi th I0OI for....lioo olrho:- """,,,nonl tooth. In ~ 6--yo... -old dlild. OM
Of ..-e fornt..ol~ Pf'OCO'SH'S <.n be ooxurri"ll in 28 of 32
~ 1ft'Ih. whole somo down' of I'OOf l'ftOI'\XiOll
un he ourtiIls in ...odl of 2(l priIrwy 1:<1h. TIm........
(O(IIdi.... lion of myNd "",IS "","",il contin~ function
of . nd .oo:ommod.ltion to ltlt' u-i"ll.i>- (FI,. I U ~


Tooth Structure
Primary ~ nd permanent leoih howe ~ s; m i l~ r e na mcl
prj,m mllClu,~. ~lU;~11t ~l l he tOOlh ou rf~ro . Prim.>ry
le<;!th .re mo~ Ilx:!y to h..... . pri, mle" ,urf;><;~ ton~
t han are penna ne'lt teeth. A. di ff" re n,~ in the surface
re~Clion to <ondil iulling ~gent' i' , u, peer..d befa u...
elch ing oa: urs on prim ory tooth enamel t hon o n ~rm._
"..nt tOOlh . namel du rlnl . "id co nd il ioning. Vorlability
in etc hing llIP<'rtif1 hal ~n found at d; ffe~n l sites on
a single prima ry lOOl h, SKtio", A throogfl C of Figure
12Jl .how difft'rl1l1 p"-u~m. (or primary I_h ~ (It'r a
50% pbospboric-.Idd een for 1 minu"'. Tbesc mlrnl&r'ph5 d.monstr~le v~Ji.lbiliTy in C'fdl,ng: p.lllerns.
whkh maUs rell1l1100 of"";n rnaTMial unpreodio:ull~
md ..... rel~ in pr;muy leech tlwl in per.... nonl



Etwnd i!I .oboul ~ ., dli<:k in 1'O'fllWDl1l1ltb .,

in prinwy - " - "'ic~,.,..m;n.oIionrt'W'ab fur

_ Cliniul ApptlCation

F". 12.9 Scao nirlg """,10"00 n';': ""l"i>/l< of th<' ..""'lion <>t .., hi"'l ""tt~'"
In Ih~ " "I""" cn,~ " I
prlmOlY 1..lh. A
C, 400, B'1000.




Inl m . ion of the p<imary IOOIh Cdn di'9lola the

crown or ttlt' iX'Tmanenl tooTh before """ (0I'mI.
tion. This di<plolamenl is d,,~ 10 Ih.l.od: of do:'ve!.
opment of lhp ~riodont.1 tigamenl whic h will r 'l~hiJi lP th~ 10000h. Th. petnl.l""nl tOOlh mot
then forms al an a ngl~ In the crown (d itl{~ra. lon ).

m .... d iff.....,nres in thP ~ 01 fM prim. ry .nd 1'"..... _

tHih. ' 'lUI"(" 12.10 ~mon<tr. l~ 1M mosl
PfOIlIinml ill(I~'''"'''' liM c1lt1:Wus in prinluy _"lIM! -...u1 hili'. Thi1 wSlillCl incrnnoenul liM is thP
......k 01 rnrubolk tr.u.... 10 tM ~pi", IOOIh.K or
nr., tM time 01 binh. A _
01 .m illCInlll'ntol ( 1"IO'<lNUl) 111M'.1 higho-r magnlflc.llion is SR in ~ 12.11.
ENmel forrrl<'d posl"'I.lIy is """" hig hly pigmmtC'd
Ih. n en. mcl fPrTlM'<l ~n"Jl ally. Ikspite t hi. p' gmenl..
(ion , the enamel of pri..... ry tmh il wh ile, than (hat o f
per ma non! te oth. This 1, l>elioNo<l to be because much o f
pr im.,ry lOoth enamel ;1 formed pre nata lly .1 nd is nof
su bjt 10 some env;'otunt"ntal f"IO r<.
Pri.....ry Mid penn.'It"'lf l~m have a simil<ir bask
~miiUl muau
Denlin is m ;nlM'T in 1M crown and
thP 1"0011 of p,; 'Y ~lh lhan ;n Ihe crown and rooIS 01
penn;I_ l_h- A comp'ri$Or1 of tM hardnou of
clmnn ~Is prii1'W)' clmtln to tit' Slightly soIIt"f m.n
pm'I'I.M'iODf clmnn (' 'I- Il.l n I't'riphoroJ and dmJmpuIpoI ........ Mt IimilH In Iurd...... in bodt dmI,t.......
but ee ant.. l ........011"00I ~ 00W1I clmnn is comideeallly harder in ~I ffIl thall ill primM)' ~
H.ard...... is bdit"vNlto tit' dw 10 thP <kg.-..t 01 m' ......oJiunon. On Ihis basi.. Il" nml denlin is more highly
mi....... liU'd. In boI h pti
ry and pe nn' '''''''l ttll. fM
ha.d""", gradient is u itical in an empriJIIIIO d ille. enfiale pati'IQ logicaUy sofr dontin d ue to ca rlo, fro m p hyl ioioglcally lOft den tin adjace nt to the pulp (Fig. 1 2. 1] ~
Dentin Immediat ely adjacen t to th o pulp is 'IOr..... lly
so ho, t han de nt in in Ihe internl<'<1 iate and oute, porrions. With a ''''''II canou, It"sion. differentia tion or ca,_
ious and sound dentin is oor d im",ll. Wim a Lu. .r
lesion do"" ro to tM pulp, however, d ia....en ti.tion of
patholosically soh ~ n l ;n from pbysiologk.Uy salt
dlm!:;n is im po'l$i1>le on thP t-is c1toodl or
m.onipuLotion alone. This pIlmommon has sipliflwlI
impl ICation. in nt. blishilllPOW<of for

--- F'9- IL IO-...i""-....the c~d~


and pcor;nouIy formed .......... - . . -...."'

......H and _
..... ddefe<_poMnoUI ..........

_.... _P,,,,,,,,.,-


deoep ca ries..

Rg. 12.11 Prft>OUI .............. be - ' .., theriglll in !hi>

fjgber Mqlifi<0b0n lI'Jioog,aph ~ from FiQure lL 1(/.


~~ &I_ ,

55 KWN

f;g. 12.12 C"", parison of rt>o ......_

n<!'r1f <l<ntin.

of f"imar~ ond penna-


Hl St~ondlilflction fJfrhe

Pulp Size and Shape

fog. 12.14 (~01 rd>t

mol.,.. Tl>of<> i'

reb! ~

pulp sw. in

pnnary ..... prrmanoonl:

poIp inlhe prm.ry mol tNn ;nthr PH-

n..n:- . n:- a num bn of difJmoncn boot_ ~ pulp of

pri"",ry lffih and Ih.>t of ~. n e nl led h. n.. mool
significan t d ifference Is ttl<t in re lation to the protective
enamel and dentin, there Is relatively more pu lp in lnima ry th.n pe ml.lnen . Becau.. the,.. is relat i""l y
mon:- COI"(II\,OI ptilp In pri......ry lhan penn.anent teet h
(FiJ.1 2. M~ c"';ry ~r.ti"" is.n intpOll.ilnt oon~r...
lion. PTi""'ry--tOOlh ptilp size IDd s1u~ ~.ry COllSIcWr
.obIy. 1be COtORolI pulp cNm!>en ol l~ ~ lffilt
~ t1'lIft to r.... pulp Iton>s ... lI'lOO"e sIurply
poinIN ttL.ln ~ OUl!'rCU'l' contour VIOUId indic.~. Tht
""i"Sf pulp !tom in primary mol.~ is 1M ml'Siobol:c. l:
tM second largo>sl;s tbe rnesiolingu.l (fit. 12.1SA~
B<!caulC.' Ihe pr i......ry mo la" are small and ha"" la~
pu lp5, the bul k and th e dep th of restoralio ns are limited.
TM maOO ibular fim primary mo lar Is di ffere nt in tMI
ee pulp cltam ber is momboidJ l with four pulp hom5
(~12. ISB~ /\gain, lbe me siolJuc:aJ is tItr l.l~-pulp
born and fthibits n dte CO<1Dt'<ti"l it 10 ~ mesioli".
The mesW are. is titus SlnCetltible IO~ . A
comp.uison of elm U ~tions in primary w a
pe nnanml fim moLar is shown in Fi:Jure 12.16. The pn.
mary moLar ~.Ii"" is ..........1 nmes ",,",lief, es~
ci.l1y in dt'prh. Ihan lite penna...."l one.
Primary and permanent pulps a, e sim ila' in IMs ic histologic architeet urt' (Fig. 12.17), and the vasculatu,e,
connectl "" liss ue. and odo ntoblastic aOO subodontobla stic ecees are 5imilar in .ppearaJ>1. Tltere Is some v.riJlnon in 1M n umbe r oI lK"1V6 in the two dentillOlll,
.ltItoush 1M nl pulps ,....,..lly have IIIol;In:nenres m.m lilt' prinwy pulp$. The pleKus oJ IWdltow
orlhe pIDml---nenl! plmJs is nor ~ in e<trly roorformation fUgeS in pnnwy~


fog 12.151'U1p ........ 01thrprimory......-..u-_on(l/M. " lingual _

1 ():<;Iul.ll- '

' ;g. 12.16 (~ 0I 1"',.;z" 01cIo. '~'Ior..ioo. in pri......,. (\</ll_


(righl) teet"-

f Og. 11.17 The odDr1togtnic lOne 01 tho prio'nMy ' oorh

to It>oI; oI tllq permanenl tool"-

i>_.. .

____ _ ___ _ _ _ _ _ _ ___ _ _ _ _ _

"". ()[f!imal)'_.Pf)d

Permanent Tl't'fh..-1!~

AcCt'5sory Root Can al s

Pnnury md pnmmml _h Il iff... ill l!w Ioc.oliDn 01
<lCC"'*Y can.lls. In poillW)' mob<:<. .. lo:w ~
aNlS ~~ round in l!w ;Ill''' of the bifunoolion ~ti n ,H:
the floor of rho' lOON1 pulp (h.1mbn-. Thie u~11 {in tJ..
....... ;11""8 the in~rior surtoa of tilt cororwl l"'lp <h.o....
btr. ~ cd""ls ... ~ mlX'h If'S<
in this lou-

''' '1'''''''

lion In p"nn;l nent teeth. According 10 one illVt5ll&o>l"'.

2O'l: of primory moT... ",,"ve acc",sory con. l, in thi,
location (Fig. 12.18). Ot~r aul hor< found d high I"'rc(nt.~, Some caM I, enter the cementum and denh o
.00 "'turn to til<' pt',iodnntum withoot . ntering the
~ ~I

loc.1.ion of a"~ caRll. in

roo( ~nlin

of I"'ll1'Wnmt f(h is rocat m ~ of th. tOOl. In Fliu....

12.19_ .. . . - of . l'"f1T1"nmt molar root ,,"""" . _ ~
50IY cm.ds an ~ ....... (OIlnoning tt1e lWO ..,. ...t1al rooII
c~ Soof, h.ow .abo ~ ~ in l!w fututJOft



F9- 12.1'

No........,. n>ot

~....,.. _;,,!tle ~

of ~ po;.

Arch Shape imd Toot h Po!iitio n

Fou r p rilKipal 1""101"1 influe nCl' tooth " Iign"",nl "lid
.djtlSllT>nlts in lh ...rcoo of pri m;uy and Pl'fm.lnenl
II.Dl ilion< : ;ntcrden,. 1sp.clng. tooth ind in. ! ;" n, siles of
'T~h growth. and tooth , i, e, The prim"ry Mn tilion has
more sp.1(ing than the permanent dent ilion. Primary
lnelson normaliy lI..>lIe 111lerdental spacing, whereas pormanen l ind >Of"S do oot (f'i:& , 12 .20~ The primary molan
frequ<'fllly halle intn'denf.1 ~ thaI dose du ring
!aiel prirrwy dentition. This ~I ""' ~ aolle<l
the early If>e'$i.>I
PriItwy anine. tIno' a _
upri&1lI on",l""ion Itwt do mcceedilll perrrw>enl1n:fh. mil per-



...... "

Fi9. 12.1' ""ceosory root canal, u<u.lly oP'f'Nr "" ar t he ' 00I0 pe. ln po<m.""", l oot~ ,



1 l-20 C~ of ;.-.IrftI " _ lng ol prima ry ond ~



III St:ructul?ond Functionof,"...


manmt ttIOfh

atlWtlllUW. ""'"' ..bial indi....tion (FII-

12.21 ) dwI do primoI}' IOOIh crowns. A common .m.

me>sun"menr is inll:'K. n" ... w;';Uh. whidl is _~
from !he <usp tips. Wilh 1M of iIll"Se 4 nd- n , 1M
intn-<.ni"", w;ddl is PUtrt in me, P"flIl'....... def>t,lion

ttwI in tht prill1M)' ..... 11..... n... il"l<:R." is ~I

mis'"'M1.i", b.uw di~! t_II .~ _~U~.

Cinxutum (b>s.ol- ~) posinons ..... ~tely tht



Fig. 12.21 ",""""rison of nd_





I ,s.....

fiV. 12.n n..1erooay."..., io IhoI



M" 01
and....... d ......"
_ _ .i513mm .. 1hoI
3.1 mm .. _mao .. ' .u.


_ Cllnk . IApplic:alion


TIle appearance of larger perm.nent iotisors ' ue<eedinz till'

prim.ary ioci""" is ~rmed incisor llilbilily. Co mpe nsation In
spa<;ing is gained by till' ,m. lI.r p",moi.l" tha t socceed the primary IlI<)I~rs: this i, ~rmed IffW' y ' 1'0'<0.

..."., ronill' twO &mtilions (fi3. 12 21).

Arch will' is simiLu in till' .nu.rior portion of till' twO
do:'n\itiQns, bul lIll' ptllI10intm denti tion exleno:" fun1ll'r
dimlly.This is due to lrowth of till' ."'''''''-lNinly in the
posterior .'l'NU. with little I rowIh ourrilll in the
_ .iU~ ry . m",iof . ~ a s .od pr;Kti<~lIy 00 growth ourting in the m.lIId ibuJ. , a o~ r ior . ~a, (Fig. 12.22).
Differen,-", in the <h ~racteristJc, if indivi<Jual t""th
~ re impor tan t in them selves ,," d '" a part of the enti re
de ntit ion. Tooth _Si te differ ence, ~re crit ical In the
. , ,...smc nt of poIenti al Sp.lce for perm..,...nt tertII to
crupt int o good . I;gnlllffit. Th<' ,U<:c",sion of ,,,,,, lIer
pri""'l)' iocison with larger Ill'rmar.,nt incisors hal
been uUed incisor liability. The si~ ralio of pri_1)' to
penna,...O! in<ison _~R5 lhat ,pacing is r.....,...oble io
dle prirrwy dmtinon if pennaneot indsors mil c.anines
Me It> IuYe eDOI.Ch ~ 10 erupt inlt> .an ;K'Ct'puble
;aJisnmem.. In !he postftior ~t>. th e size ratIO is
~ for primary and perI1Wll'1lt fN'th. Thisleoewar
<pace proWIM !be opponunily for IIIe prnnolars 10
~ ~ ~ othef fN'th. The ~ <pace
.-.-..... U rnminucll muilWyquadr.lnt and 1.1 mm
in .ad! "",ndibular ~rafll I f1&. 12.21 ~ The SJI;l<C'I
Ihen do.. ~ mesial ~ment o r lhe pernw"",nl
moL>rs. This is Cllled fl1e .. ~ mrsWl sh ift. The lower;om.
shifts ""'"' mt'Si.>lly than does the upper ardl. The twO
main ,,'sult , are a rn.ngr in the molar .....tion. with the
lowt'r mo1lrs more forward. and .. dlI"~'" io tile ardl
cirrum ference.

_____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


ofPrifJ'o'J'. andPermanent Tet'fL


Root Reso rptio n and Pulp Deg enerat io n

Anoch-rr m;>jor d,ffe.... ""t l>etwcen primary ~nd """ mi'
ncnr 1= 11 i. the
of primal}' teeth /lQrmatly
....sorb (Fig. 12.24). TIM. process occu" . imulta<">l'OUSly
vrill. \he ......plion of the p"rmanentltftb. In the aeeeece
of """,,,~nl tOOCh. prim.lry-looth I'l'$Ol'ption 'Iill
ocrurs, b UI if OCCUrs much mo.... slowly. Tile primary
looth I'OOC3 ~ hi~r suscl!1"ibjljly 10 ....$Ol'ptlon
than ~ntnIIMh. The prim.lry ~h h_ pi..........
from lh e "",rm ' ''''''1_ h ..Me<! on their TOOlS. but this
is no( the totol c.u~ of this suso::eptibilily 10 fe$Ol]lllon.
As " i tt'(! p~""'Iy. fW D when ,,"lNn~1 100111 is
mi...inz. rho' primary ..-. WIll V.ldlUlly
pr<>:I'<s ollnOrption Is accomp.onw "" grwlUl (~"'"
in lhie pu lp. ICliUM 1225 .nld 12.26 show the pulp durinz l'OOl rnoqltion The CorSI 'iVO Is i ~octi(lll in tho!

_ _ _ _ ,Primary _



nu~r of ....11$ in the pulp: _

Irunkl: ~f1t'U~
;nlO p.o.tehn of ~in. and ~ lib"'l11 CICl:Un. llIood
...s>els ~.m until ee toOlh Is nfol"'~
Ccllulo.r.ond libril1u d'wlJet 0Uf durilll rtw lhtft
~ws in tbe fOOl: liM. of primory fH'lh: ~ compktion. and ~plion- Dulilll l'OOl form.nioll. tile
YtlUns poi....." toot h pulp Is hiIhIY ailuIM. lis lhr r-.
..... complmod. ~ ce 11$ M>d...,.., rlben _ tvi<knt.
Tbt pm/;f<or.llion of fibm continues dun.. llw fOOl
R_ plM. ~. ~nd !ibn bund lts m.lY be -.. (fis.


f"og. 12.2<1 RebIion ~Ihe


primary _ _ ""4'l'''lI ptr.


n.. blood Y6oel, rtloit "'~ 1M pulp (~mbff

IhroustIllw bmi", fOOl1 ~~ Inltiilly ~O'd ...rll
llw odoorolll.ntic: ~. n.y
lim' fonn .. wbodonlobI.1'iric ~ As llw fOOl1
moo1lO'd. tIltw blood
vo:uel, a hibil _
dttImef~M c.......,. ~llhou&I>
mosr Me ......,nwlVd unlUIht IOOl1l Is 1osI.
~ fibfn gr.odlUlly orpn~ in 11"1 pulp cI'>.In>ber cI
llw prim.IJY tool h. As Iht roorh ~.ochts ocdu""", Iht
"""" fibrn form ~ pin.U'< u ndf11ying Iht odonlOOlulic:
~ (/I.. plr:<us Is IftII"I'd ~ p.oriol~1 IiyE1" 0( """"
fibo=. 11leoe ~ fibers om los! during rnorpIion of
. llw prim..".-lOOlh fOOl S. wh idl nvJ(es IftrtI insmsitle
Ul pulp.ol p.oin ~[ llw till"l cI ~d"Ii.llion.


..... .

fog. 1 2.l ~ Np ~ d.-ing prmary--to<>Ill fOOl ~ _

;S I
tNu<tion .. ~ ~. _ - " " ,_ _ ~ compoo

Tho po:riodontol "'pport of pl'lm.lry ~nd pomwnfnl

IftrtI i. sim il..r in ooic: ~r<:hileau~. }U,allhy Ii","''' of
perm.onem !ffdI h.I. bfm ot>oerwd 10 be redder ttwl
lIJe gingiva ~",und prim .ry ~h.

din iCilI Ap'plicatlon


Primo". . nd p"rm~ntn{ teeth differ in Iheir

"" poo "" to troum. Althou gh both similir
kind, of outcomes when, blow ;, ' fr uck. such n
tOO1h f,<>et ol'<'. tile perm, nent lOOIlI II.. an addi t ion al S<"<luela. Whe n rhe primary tooth i. dislodged . rhc permon. ntlOOtll may be d,mage d suf_
ficienrly to Cau,' ename l bypopl. , i. or whire , pols,

Ostx:lasls iii pulp

Fig. 1;'.l 6 Histologic "ppe.. o~ <>I ,oot = orpl ioo by o,I"",I. m .


III StnK:tu.-e and hI~~,,,,,

. ,,

Sequela t o Injuries
The difJ~= t>et:"( ( n ptrm.I.....nt.ond prinwry _h
e:<tend 1O!he.m" of cItntiI tmI/N.. PrimM}' IJld penNIImt tedtl d,fJ(f in lheir ~ 10trd""" in _
dlniully signi6wll d:Spt, AktlouJb bod> primM)' IJld Pft.....nem: tedtl (,Onluw "m,w kinds of outeornn wIwn
st rudl: (ft~ of ee tooth.. fractu'" of the ,rown, dislodgeme nt or !he lOOflI, ft<:.). the pennd~t lOOlh his
I.... ddditiorW ~ of rhI' indirta rife of blow 10
I IIf, prim.ory I<>Oth.. t,,,ty in ~mel fnrmation. the", un
be imerTupl'ion of the mdmel fonn<lhon in ,he form or "
mark on l~ tooth lI l.... poim wbere l~ moe " I' of the
",rf""" ,I'll d('Ytlopi"ll
primary tooth Ilri . .. lhe
perrn. ne"t looth crown. TIJ.e clinical ap!"'dfancc can be
a -whi", .pol" Or a frd nk cn. mel hypoplasia. Inlrusion of
the primary tooth c,m ,11' 0 di,p lace thl Mv. loping
crown of the ~rmanent looth before rool formation,
Th e reason for tIlc rclati'((' ea,~ of di'placeme nt of the
crown bc f",~ rool fnr.....tioo i, th ot the", is no l i~m e l1t
to stabilize th~ ""," ion or the permanent tooth CI'OWIl.
Once roof formAtion bt'gins. Ihe periodontal lipmenl
has. . otabilirins ef1ea on t~ Drimt;Jlion of rhI' lOOdL
Ooce the pemw.....,t _
crown is. rot. 1<'d in il. YC. IM
~nnanml tooth moe tonI in.... to develop in il1 .......1
OIim ,.rion. The 1'tSUI, is. disf'isumj ;)IIg.....lion (or diW:fta rion j betweetllhe nown and """ oJlM pemw>tnI
I<>Oth.. lftnlcnilion 01 Wdl di"'~ "",,1'1.,.. ' '''"'
onurna con kad to dt.~ pl.anni.. "" UNlmenl of lilt
. fkacd ro"....




f"J: 12:27 PuIp<h;Jnge<" die lie <)'do oldie p<mory tooth, A 00<..- ..
. . ......b<rof c..... B ~ ..... ,.. ,( "' ......... """""- C 0. ...... "..( .....
"'" of """""- On l be ltfl is 1M I<XII fotm.nOon >loge, ;~ tho: cent.. tbe I0OI
comp " Uo~

,1'9", . od 00 t.... rigPlltl>t root =<>< pljo" 'loge,


Susceptibility to Ena me l Defects

Enamels of pri .... ry dnd ~rma nont leeth differ in , heir
susceptibility to tooI'h c\(f""l~ The grc.rcr IUIC.pribHily
of lhe enamel from perlll.1 n ~nt 1~l h 10 hypomlneralluot;on i, . >socci. ted with th~ difforent environmenl for the
to<>th afler birth, I'orm,1nent teeth are more , "sr. l'lible
to hypomiller.lil allon or "while , pol" deft'( IS, "'llhough
t ~ teeth are nol at ;ncrN >ed ri. k for denIal caoes Or
dbra, ion, the", can hi' Jl"lthel ic c o n cc rn ~ l n f~ ...nce ha>
~ n Il1.Idl' to the apparent increaSNI prev. I~ JI('~ or
whil por lesions 01 inocisotl to I.... increaSNI ~ or nuori
from multiple fOU~ s. II is. in~(jns th..ll tllf,
dritcfS for tho pomu~ 1 tttth .m 1oc. 1<'d ill the outer
portioos of the IOOIh mdmei. Rell1O\tal or the oute1" ,.,.."
tions of the IOOIlI mamel. ei!be'r 1I'IOCIlarncaUy or
iJIorpnic .ad. can ,",,11 in mnov;oI of the "wh".....por"
Inion. !be ttdIniqUl' .... bftn de1cri"'d;os momwbr."
1ion.1'rimary _h. on III(, otheof h..lnd. fann for !he most
pm ~ birth and In rfta(M isoLorion from lilt room..... Primary _1'1. .'" llwrf:fol1' ies1likt!y to h_ dofoct1
u....... there Is a .ipo'fic.m .yw.mic insult afkocti"llthe
unborn child


O illiul ApplKatioll


w mel. of primM)'.ond ~~tl<fl h dilkr in tI.n r w:KI'plIbillly to tooth de{e<;U, The lX'f m.> n~~ l l<fl h a", mor~ ~
l1ble to hypominrrdhuolion or ........ hit~ 'POtS" tholl primary
tee n llKa use t~'" dtIM!"~ ill l~ ou", r enamelt!>eycan be
~moved mech.lnically or Wilh ioorganic acid. Thi, i. koown ds
microabra, ion,

___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ "'",""",
00 of Primaryand Per~a~t Teoeth


f ig,

12.2 8~~ nofp<im;")'-pomnonent

Enomel ltJk~



For the practit ioner, primary and pt",manent teet h

h"W' several significant gros, differe""". Primar y
l~th are fewer and smatle r in all di men'lon, th an
lh eir successors. with One exceptio n, prim ary
mola" have a g"'''I''' m...;odi' tdl dimension tha n
su~in;g P~f$. Prima'Y-f<IOlh crowns ha ~"

short .md thid~ .~" exhibit contour.

espUlly 11<"'" t ho ctmc.l rqion. Pri""''Y moll,,;
form ~"" mnc=.. ~ ~""nrrnolm fonn

po;nt mnl.>Ct1.

rtx. clw<..,~. W1~t

A11:!>ooJJh prirNJy and perll\ll1ffil

ffflb h...... simd,v PI'OC= of !issue fonNfioo.

primary ~h rakr Ins Ill'.... to fOnn l han pnmrnm! !eI'ttI. En.o= 1 and _ in ..... thinM' in pli_

rn,, ,y ~ h !It,]D in pt"lTTI,lntnlleeth. Primary tooth

t namel is more c pecue lha" ~""nt 100111
e na me l and h.. ;\ """, ,,,"loll lll" . Surf<l' enamel i

fOOl ",,"land fOOl aratJ.n. and1,,<0'

............ pUlp


5umm~ry ------------


mo re likely to b<' pri'm lt " in primary th an permantnt t th; howeve" mu( 1I variability occ" rs in pri .
mary t ..rh. from tooth to toot h .nd for diff~r~nl
siles on III<- ",me tOOfh. Tooth pulps of prim ary
molars .... rel.ti" large in the coronal ponion
. nd become ribbo n_li k ~ to .cmrn modal~!O I,," Rat
rcees (Fig. 1228~
Primary &nd pc.'rmanem dmtitiort> have ~ral
ditT~I~"(~' that inOuona tooth aJignmml in I,,"
arclL. Interden tal spacina is ,....Iet in lhe primary
lhan in tho poenn.Inem (k,ntition.P!imary .ntrrior
lffIh .... mo", upnght lIun !he mo", labially
il'l(lin~ penn.l nenl .nlmOi teedt. ""''' ..... pc.' in
primary.rId perma nenl I~" i$ similar in III<- anl~
riOi ponion, but tn e ptm\dn ~n l dentition ~~Imd<
furthe r [XIsteriorly.


11/ Stl]J_et!l.reand Fu "ct~on of!h


SelfEvoluotlon Review
l. What are the differences in the shal'" of the primary and permanent molar roots and whO! i< the
clinical significance?
2. What is the difference in the formation time ofthe
prim"ry and perm"nent reeth?
3. State the differences in enamel ~nd denti n thickness of primary and perma nent teet h?
4. What are the differences in the smf"ce, of the
enamel in primary and permanent teet h? What is the
clinical signifLCance of the", differences ?
5. Describe the potential effect on the permanent
reeth by trauma to the primary tooth,
6. Stare the differences in hardness of the dentin at
various depths of primary "nd permanent teeth?
7. Where are accessory an"l, locolted in the primary
and permolnent rooth rools?
8. Discuss the differencesin size and shape of the pulP.
chamber in the primary and permanent molar reeth.
9. Stolte four principill factor< t1l.ll innuence toot h
malalignment in the arches of the primolry and permanent dentitions.
10. Defi ne "incisor Ii,'hility" and "leeway ,p ace: ' and
St<lte the clinical significance of each.
Ackn owledgement.
Figure 12.6 wo. provide<1 <o" n",y of Jo< C~mp, OUS:
Figu",,12.7 am 12.21 w",", provided (ourte, y of l),vid S<;OU,
DO': fig" ,'o 12.11 I'M provided ''J\ 'C ''w ''''- >:od Dwell, DDS,

S"QQ.,tJ R.ading s
f'.V" y JK f'. possit>le me<h, ni, m of paill conduction in ," (th,

Act, Hi!toche," , 1 96 J : 1O ' .~9 _ 6 4 .

Croll TP. "n .lITle l " ,i<'ro,b,'a<ion tor removal of ' \I~rf" i a l
d,mincra li,,,r ion alld ~<'C, l ci fica t io" <Ick"" J. Am. Dent.
M"".1990: 120:411 4 15.
Enlow I)H. II,ndl>oo. of f"" ial Gr<>wt ll. PhiIOKIelphi" Pa: WB
Saullders, 1975,
Gut nl,1nn Jr. Prevale,"''"' Io<;" ,ioo ,"d p<trency of .1<,"" osoJ)'
caml, in the t" ,o.,joo r<gion of
1001"" . ~
l'eriodollr<>loWlI978:49:21- 2G.
Joimsen IX . John, 5. Qu.l ntltation of , \(' '''0 f,ber, in tbe
p<im,ry and p"ma",, '" ""i,,,, , nd in< i<OT te eth in man.
Arch, Or, 1Bioi. 197R:23:82S
Kraus ~ s , j<>r(i , " RE. The lIuman [lentili<", " Ofo", BirHI
l'h il, <1oll, hi" Po: W ~ s.," l\dm : 1 % ~ ,
l'i llkJR. P, di, tr ic Dentistr y. 1'h;I"do lphi, . ~, : Wll S, unders;
R, pp R. AveryJK 5"'01"0 OS. Di>trib" tjon of n,,,,,, in hUlmn
prinlMY,,,,thoAn, '. Rec, 1967: 1 5 ~ : ~ 9 -lOJ,
Wh,eler Rc A Toxtl>ook 01 Dental Ana",my , nd I'hysiology.
4th e~. Philaclelphia. Pa,: W ~ S..,,\dN" 1965
Yo, hid, II, Y.l ku, hij i"" Sugih"'. A. T, o, k, K. T.lg,,,,hi M,
M, chida Y. """"OIY <>n,ls >t fioo r of t he p" lp ,h.", I""
of primary n,ol,,,. Shikw, , nd Bu, " ho Vol 75 Soc,


197~ : 75 :S Bt)-S<lS

- -- - - -- - - - - - -- - - -- - ---'" ,


Structure and Function of Supporting Tissues of the



N.$truchJre and Functloo 0( ~pp!?!!ing ! imJeS of<E'h<'tiT~",,<h,-

13 Histology of the Periodontium: Alveolar Bone. Cementu m. a nd

Periodontal Ligament

C h ~ p t...-



Int roduct io n
Int ro ducti on... 226
Obje<li""' ... 226
AIve<>I.r Proc..., ... 227
Alveola r Bone Pro!"' r.., )]8
Co mpact Suppo rting Bone,., )]9
Cancello u, SUPiXlrti"ll Bone... )]9
PI1ysioloQkTooth M""""'"'Cnt._. ) 30
A,Q inq " 'Afo..oeoIar Bone.., 231
dentulous J3w$-- -13 1
Cementum_.]J I
~c..ment um. .. 232

~Iul <and AcelUaorcementum__ ]JJ

cementum S<riace Ch.>c'ristics-_]]4
~i"ll 01 Cl:rnent\m__ 235


~~ Ugament...
~ Fiboers. .. 236

c.n;.-.l GrooJp._1J6


Oft*.,.~Gnlup- .. 237
V. ,n,W r;on:jNeu-af S<Jpply 237
Clog.lniution 01 ~j,l lJ9arnerrI--. JJ9
l igament ~Is-.._ 240
pithriol Rests_. )4 1
Pe.-iodontal Di............ ] 41
Summery... 24 1
SeIfvakJation Review... 241

The pe riodontiu m Inc lud~ t he t h, ,,,, <u p iX'rt jn~ nrccru,e, of the te eth : th e bony . Iveol., proce ss, the root
covered ce men lu m, o"d the i"te rvc n;ng p<'riodonIJllig_
..menl, The g;ngiv. I11~ Y 01'0 be comidered port of th e
periodont ium and !s tks<:rill<"d in ChJ pte r 15. The aJIItO
hrr p ltl$ i. t he bony ~ x te n ,ion of the ffiJndibl~ dllC!
......xill.> tlwt provides Ih~ ne=s.u y , uPiXlrt for the
. nd "'",.,. ~s. fibrous " tUC!l ll"lffit for the J>l'fiodon'"l
li~,,,n~n1 fiben. By ft'SOrpiion .nd d~posilion II "Iso
compen.. res lor IOOCh mlM'mml. The pt'riocIonlOl is ;dso supportow. ... spending tbr- tooIh in "'"'
sod<er .and pn:wldilll" rushion "8o'insr \Wious occlusJI
fo01:..... In _
suwIY provides" dtlic.oo:e -.... 01 toudl
.nd pr<'SSIl'" I<> lhe _II. <and its blood .....m UIT)'
oxygen mel OUIlIirion 10 the 1iS"""""t ... wo:U ... 10 tht
pe' iQdoo,<iufn .mel "IWOI ~. C""""fum """'" tilt
n:>o(S of lhe Ift1Il "nd servn .. ~ n
lor lhe
periodont,,1 ligolmm l fibn'!. It provides compen,,"on
lOr ocdus.ol wl:"f by "pic,,1 do-position "nd. "I tile ........
lim~. prorectlon lOr l~ wuil~ dentin (Fog. 1l.1 ~


Objec t ives
!lftc r """d ing t his ..h" I)(O'you sh ou ld be ab l. to d., ..rilJe
t he h l' tologie <trlL"tu"', ~ n d funcrion of the perlodont~1
lis ' ues, t he rcct-ccverec ,"erne" l um. the alveal. , be ne .
a nd the inte rven ing pc riodontal ligament .

_ _ _ _ _


of ~ Perio4ontium: Alwoior 8orn", Ce~!!tum. andPeriodomal Ligament


Alveolar Process

no. .~ plon'l5O!'I .~ tho(' portio", of th~ mnill.l

-:llNJIdiJ:>k, rhol <Uppo<1 \be rooo 0( 1M ~ They

~ composoeod oJ !he ~ /Ioont pooptr md \be ...pp<l<tn., ..... Tbr ~r ~ I""P'" is ttle ~ !h.u
~ ..... 1M so<bt- In r<Odiogr.q>hic ~ it is i(k, .<1 !O ...
!be /oImI... dura_This ~ is lhe bony sift' cl mKI>_
of 1M pt'riodont.II~!MIlI rotwn.Tht supportins


borw ;~ ,"" rcnuinder 01 1M .~r pn><e<s.

specifICally tht' Comp.iCl rortic.d pl,":u on the' outer .....I'.lces of the .~Iu ~ and 1M spongy bon~
bftWttfl lh e cortical p1u ... ;md 1M .~I.r bo"" proptI'

(f iio 13.21

As dl:KuSSl in Chapter 7, l l>e Jlvrolar process deve lop, .\' ,e."lt of tooth roo! clon3om on . nd tooth eruption. AI""ol.1r bone nW ure, .. t he te et h So'in functio nal

occlu' inn; 1.1Ier, i f the teeth are lest. the . lve" I,, , pmces<
di",pP<'ars. Thu, . toe tee<:h arc impo rtant in the de w:l01'<>1.01 . nd maint. Ra I>C" of Ihr . 1~.r booc. The . 1",,alar bo"" prop<>r is .tt~d !O l he' sup porting <:.ancel -

k>ul;.rod romPM:I.llveolar bone, 80ne IN rrow contoi,,_

i,,& blood \'5S<i.. ........,.. and l<ll~ ti.. ~ Iills thrp!,orn and ,t. ~ bot>t

..,..e ~n lhe rortiul

I'"'P" (r 'l- 113 1 The rnmn..>l ~ of lht' al.........r

proctSS Is lfflnC'd m e alveolat ~ (Fig 1 1.2 ~ II i. !ocaiN .......I I 10 1.5 nun ~!be <e"""'I~ junrtion.and Is rouno:Ie<l in lbe "",erioo' ~ and IlNtIy fLol
In me moLv a~a. Ir t he lef'l!l are In buoca l or hnr;ual
position. lbe aMoiar pn:ass win be W'IY min or p,ortially ""mn,. The Mea of an ap;e.ol1tlOll pmeualinz: the
hone Is known ... afell<'Sllalioll. and iUQCl;u~ at the
corolW ItlOIll<lne Is u=nnC'd MItiscl'Il (fiI. 13.4).

r'9- 11,) I'tiStOIoyy d

proper. _
""'~Ii;"", ,.,..,...,....
ni..'ion _
tt... ligamerl. and SUl)pO<!jrog bone """"'.

r'\l. 13. 4 Diag,am ~ los' nI.Mdo, bono ~ 10 lOOI~. 1I<>ne m.

,' u ' 1001ap;c<1 i; lermed "1""",1,,,.,,,,' ."" b<>... 10" in til< "'!lion of IPlo


is !t.'m1ed dohi",_ ' "

Alveol ar ecne

Pro p~

On a histologic ba'il. the,.,.~ two typn of bofwo : a t>'110m (spo!lJYl.u>d COIl>J'"Ct. .... _ r t>or..- pmpt'r is.
modific.>tion of comPKt bone .l< it tontiolm pe1'foriling
~ (Sh.orpty"s J(fi&. n.s~ ~coI~fibns~


bone PI.... . t ",hI .ngn or obIi_to 1M

s", fx e of tne long 'lXiSof tM tooth. This is Ihe ~an. of
attachment fur t he per iodo"t. l liz;lnlen t to t he tOOl h.
Th., fiber bundle' onginJ.tlng from 1>0<1. a", m ud, lJ.rger
t h.n the fiber b u nd le. inse'rting in celll<'n tlfnl.

Pelfor.ling fibns occur ~= in ~ ~on. wheor

liIammf:> .nd lC'ndons inwrt. I'Ifr1'Iy dNioc ptrforati ng fibns J..., al.., found. but DOl in J.IoImlJ.r bone
proper. 8a" se' t"" 1:JoM of t ~ . Iveola, p roce<' is rqu--larty pc .... tr.!"" by coll. ge n bundl es. it has been .ppropriJ.tely n,mle d bund!., boo e or alv('<)IM bon. pro per
(F~ n.s .nd n i l When th" llooe i. vi.......-d r.odiOV.phic/;lly. i' i' rc~""" to as the IIImino dura (F,&an n.., .. mi.... dura ;q>pean more dense 'bln fh!, .
adjM'cn1 su pporti",lloIIf', but 1m r.><lioIr.pIIic dmsity
may r,., du., to m