Enamel

Chemical properties

- Mainly made of hydroxyapatite = calcium hydroxyapatite (Ca10(PO4)6(OH)2)

- Main mineral component of enamel = 88-90% by tissue volume and 95-

96% by tissue weight

- Rest is organic material and water

- Mineral content increases from EDJ outwards

- HA present in crystal form, each = 75nm x 25nm

- Crystallites for dentine, bone and cementum are much smaller than in
enamel.

- Crystallites when in cross section are in a hexagonal shape, but some

distortion does occur during development.

- Core of crystallite is different from its periphery. The core is richer in

magnesium

- The arrangement of molecules is shown below, however it is subject to

variation i.e. phosphate and calcium can be replaced by carbonate;
magnesium can replace calcium and any other ion; fluoride can substitute
hydroxyl groups = increases resistance to acid demineralisation. Fluoride
levels decline getting closer to the EDJ.

- Chloride, lad, zinc, sodium, strontium and aluminium ions can also sub in
to the places in the hydroxyapatite molecule

- Small quantities of non-apatitic minerals may also be present in mature

enamel e.g. octacalcium phosphate = possibly a HA precursor.

Water

- makes up 2% by weight of tooth and 5-10% by volume.

- Water present relates to the porosity of the tissue

- Water may lie between organic materials, some trapped in defect on the
crystalline structure and the remainder forms a hydration layer coating
the crystals.

- Ions such as fluoride travel through water = clinically important.

Organic matrix

- mature enamel = only 1-2% organic matrix

- organic component of regions where the prismatic and crystallite

arrangement is straight and regular = only 0.05% organic and where
 crystal arrangement is regular – 3% organic.

- Organic molecules = AA  large unique portion complexes

- Protein = amelogenin and non-amelogenin (enamelins)

- 50-90% of matrix is composed of small molecules = peptides and free AA

(including lots of glycine and glutamic acid)

- Larger molecules = components rich in carbohydrates

- Protein concentration is highest in enamel tufts at the EDJ

- Lipid content = same as protein content

Enamel Prisms

- basic structural unit of enamel is the enamel prisms+ millions of

hydroxyapatite crystallites packed in to a long thin rod = 5-6um =
diameter and 2.5mm length.

- Run from EDJ to surface

- Boundaries of prism = sudden changes in crystallite orientation

- Increased micro porosity at prism boundaries = slightly more organic

material can be accommodated

- In cross section, enamel prism can be in one of three patterns.

- All three are present in humans but the keyhole structure is more
predominant.

- Pattern I = near the EDJ, probably because enamel is formed slowly –

prisms appear circular.

- Enamel between prisms = interprismatic. Composition = similar to that of

inside the prisms but it has different optical effects.

- Pattern III = keyhole shape = clear and tail region. Tail of one prisms =
between two heads of another. There is an abrupt change in crystal
orientation, which is responsible for the refraction of light and the
appearance of the prism boundary.

In the head of the keyhole structure, the prisms are aligned longitudinally,
and in the tail there is a gradual change in the orientation so that the
prisms are about 60-70 degrees diverged from longitudinal prisms. It is
difficult to distinguish between the tail and the interprismatic structure.

- Polarise light identifies changes in crystallite orientation = useful feature

in enamel prisms.

- When viewed in enamel fracture or a section parallel to the long axis,

prisms appear to travel in a straight line from EDJ to the surface
 - Prisms meet surface at varying angles i.e. at cervical end, prisms meet
and a right angle from the EDJ but closer to the occlusal surface they meet
at an angle of 60 degrees.

- Fractured/sectioned longitudinally prisms follow a parallel sinusoidal path.

- About 10-13 blocks of prisms follow the same direction but blocks above
and below this follow a different direct: periodic changes in prism direction
= Hunter Schreger bands

- Parazones = bands of prisms cut longitudinally

- Diazones = bands of prisms cut more transversely

- Angle between parazones and diazones is 40 degrees.

- Complex pattern of prisms = resistance to fracture

- Outer quarter of enamel, prisms run in the same direction = no Hunter

Scherger bands.

- As prisms arranged in a spiral pattern, in some areas beneath the cusps

and incisal edges the changes in direction of the prisms appears more
marked and irregular. Groups of prisms seem to spiral around others,
giving the appearance of gnarled enamel.

Aprismatic Enamel

- outer 20-100um of deciduous and outer 20-70 of permanent teeth =

enamel is aprismatic = enamel crystals are aligned at right angles to the
surface and parallel to each other.

- Surface layer is more mineralized than the rest of the enamel due to the
absence of prism boundaries where most organic material is located.

- Variable thickness

- It is a result of there being no tomes process on the ameloblasts in the

final stages of enamel deposition.

Incremental Lines

- enamel is formed incrementally = activity period followed by periods of

quiescence.

- There are two types = short period = cross striation and long period =
enamel striae.

Cross striations

- seen as lines transversing the enamel prisms at right angles along their
long axes.

- Cross striations represent diural rhythm.

 - Appearance relates to diurnal variation in the rate of secretion by
ameloblasts.

- Alternative theory = lines are a result of crystals within in the prisms

following a spiral path.

- At lower power, prisms appear 2.5 – 6 um apart = closer together at EDJ.

- Another theory = cross striations are the result of subtle changes in the
nature of the organic matrix and/or crystallite orientation and/ore
composition (especially in the carbonate component)

Enamel striae

- enamel cut on longitudinal axis = structural lines seen running obliquely

across the prisms from near the EDJ to the surface = incremental lines =
enamel striae (of Retzius)

- horizontal cut = striae appear as circumferential lines = like lines of a

tree.

- Routine demineralisation = all enamel structures lost because of low

content of organic material

- Ground section = many structural features retained = main = keyhole

pattern of prisms. This structure is known to lack organic sheath but level
of organic material and water is likely to be higher at the prisms
boundaries of the larger pores produced by abutment of hydroxyapatite
crystallites at this junction.

- Striae overlying cusps and incisal edges do not reach the surface because
of the way the enamel has been deposited. Can only been seen to reach
surface in enamel loss.

- Human teeth = 7-10 cross-striations between adjacent striae in any one

individual.

- Striae formed in weekly intervals

- Average distance between two cross striations = 4um = enamel striae in

middle portion of enamel = 25-35 um apart.

- Cervical enamel= enamel formed slowly = cross striations = 2um apart

and striae = 15-20um apart.

- Accentuated striae = metabolic disturbances occurring during the time of

mineralisation.

- Lateral enamel = enamel striae reach the surface in a series of fine

grooves = run circumferentially around crown = perikymata grooves
and are separated by perikymata ridges.

- Distance between perikymata = should be the same as ordinary enamel

striae = cervical = 15-20um and middle enamel – 25-30um. But from
 cervical region, as they reach the surface, they can may become up to
100um apart towards the cusp of the tooth.

- Deciduous teeth , enamel striae and perikymata only seen clearly in the
cervical enamel of deciduous second molars.

- Exaggeration of striae in different teeth forming at the same time =

possible common systemic influence. One hypothesis = may be a rhythm
with a 27 hour cycle in addition to a diurnal daily rhythm. The two rhythms
would coincide every seven or eight days producing fault in the developing
enamel

- In ground section, striae seen because of differential light scattering

effects at this fault line, possibly due to a slight change in prism
direction/thickness or slight differences in crystallite
composition/orientation and/or differences in organic content

- Partial view of striate in demineralised sections could be due to the fact

that there is a higher carbonate content, which causes greater solubility of
the crystals and greater porosity.

- Possible to use the incremental lines in enamel = cross-striations, enamel

striae and perikymata= to assess the time taken to form the crown of the
tooth + help age material. Assuming adjacent perikymata are separated
by 7-10 day intervals, the total number of perikymata on a crown indicates
the time taken for the crown to be formed. If about 6-9 months are added
for the 25-30 striae over the top of the crown that do not reach the
surface, a specimens age can be calculated from their first molars.

- Enamel striae are less pronounces or absent from enamel formed before
birth

- Neonatal line = marked striae formed at birth = metabolic changes at

birth. Prisms appear to change direction and thickness at the time of this
event

Surface enamel

- most clinically significant region

- tooth comes into contact with food here, caries is initiated here,
restorations are attached or abutted, orthodontic, toothpaste action,
bleaches and fluoride/remineralisation preparations applied.

- Surface enamel differs chemically and physically from subsurface enamel.

- It is harder, less porous, less soluble, and more radio-opaque than

subsurface enamel.

- Richer in some trace elements e.g. fluoride, contains less carbonate.

- Variable appearance, exhibiting features such as aprismatic enamel,

perikymata, prism-end markings, cracks, pits and elevations.
 - Unabraded outer enamel =very aprismatic = highly mineralised and
resisitant to caries and therefore acid etching may not always enhance
adhesion.

- Although surface enamel is aprismatic, the incremental lines of retzius

reach the surface and appear as perikymata grooves, wave like concentric
surface rings parallel to the CEJ. They are separated by wave like
perikymata ridges.

- Attrition and abrasion remove these surface features but may be present
in protected cervical enamel.

- In some areas, particularly cervically where the reduced enamel

epithelium persists for some time after eruption, small pits are seen within
the perikymata. These are the impressions of the ends of ameloblasts and
are 1-1.5um in depth

- Small cracks frequently found on surface, but it is difficult to know

whether many of these were present in vivo or were induced by the
procedures necessary to examine the tooth.

- Cracks show possible areas of weakness.

- Small elevations, depressions (focal holes = from the loss of the cap and
underlying material by abrasion and attrition) are also found. Caps are
thought to result from enamel deposition on top of small deposits of non-
mineraliable debris late in development.

- Large surface elevations, enamel brochs 30-50um in diameter also occur

occasionally and consist of radiating groups of crystals. These are more
common in premolars.

Enamel dentine junction

- boundary between enamel and dentine has a scalloped pattern – areas

where shearing force would be high e.g. beneath cusps and incisal edge,
but it is smooth on lateral surfaces.

- Convex enamel and concave dentine.

- Dentine crystals are much smaller than enamel crystals and the transition
from one to the other at the junction of the tissues is generally clear.

- Aka amelodentinal junction

Features from EDJ to enamel surface

Enamel spindles

- narrow = 8um diameter, round, sometimes club-shaped tubules, extend

up to 25um in to the enamel.

- Not aligned with the prisms

 - Thought to be the result of some odontoblasts processed that, during early
stages of enamel development insinuated themselves between the
ameloblasts.

- Size of spindles may exceed ameloblasts

- May be dentinal collagen or remnants of dead odontoblasts

- Most common beneath cusps where most crowding of odontoblasts would

occur.

- Best seen in longitudinal sections of enamel.

Enamel tufts

- junctional structures in the inner third of the enamel that, in ground

section resembles tufts of grass

- appear to travel in the same direction as the prisms. They appear to

undulate with sheets of prisms.

- Hypomineralised and recur at approximately 100um intervals along the

junction

- Each tuft is several prisms wide

- Tufts are best visualised in transverse sections of enamel.

- Appearance results from proteins = residual matrix at the prism

boundaries of hypomineralised prisms.

- Tuft protein is not the highly abundant amelogenin but the minor non-
amelogenin.

Enamel lamellae

- are sheet-like apparent structural faults that run through the entire
thickness of enamel. They are hypomineralised and narrower, longer and
less common than enamel tufts, but like tufts there are best visualised in
transverse section.

- Can easily be mistaken for cracks but cracks will disappear in a

demineralised section

- Lamellae have developed due to incomplete maturation of groups of

prisms or after eruption cracks during function – contains saliva and
debris.

Microporosity of enamel

- in vivo = pores in enamel = water-filled spaces between crystallites

- enamel has porosity of about 3-5% by volume.

- In prisms most pores exist as very narrow gaps between closely packed
crystallites, some appear as elongated and tube-like
 - Most pores are accessible only to small molecules such as water

- Larger pores that can let through molecules bigger than water are located
at prism boundaries and those that let through smaller molecules than
water are located throughout the enamel.

- Therefore prism boundaries = main highway through enamel.

- The pathways for diffusion and, to a lesser extent, electrochemical effects

arising from the charge on the pore walls have an important influence on
the formation of a carious lesion.

Age changes in enamel

- wears away slowly, depending on diet and masticatory habits

- seem darker in colour = reduced translucency = secondary dentine forms

and reduced enamel, also partly due to change in surface enamel coatings
and stains

- fluoride can be incorporated in to enamel = reduces porosity and

susceptibility to caries

Clinical considerations

Defects in enamel

- present in 68-95% population

- may due to environment or genetic origin

- hypoplasia = disturbance in original enamel formation, manifests as pits

and grooves on enamel surface , induced by infectious disease in
childhood = measles.

- Hypomineralisation – disturbances in the maturation of enamel = surface

is generally intact but opaque rather than translucent, delay in the
removal of amelogenins during maturation

- Also caused by birthing difficulties and dietary deficiencies.

- Mottled-enamel = high levels of fluoride = fluorosis = opacity of enamel

and surfacing pitting occurs.

Enamel structures and dental caries

- tooth decay = acid by plaque bacteria = dissolve enamel mineral.

- Carious lesion seen in a ground section in polarised light.

- Before cavitations = surface shows little change =, but beneath = 20-50%

mineral is lost.

- Mineral is dissolved = loss begins at periphery of prism

- Mineral not totally lost as remineralisation can occur by saliva and

 fluoride.

- Prevent caries and treat it by promoting remineralisation more than

demineralisation = minimise plaque formation = starve plaque biofilm and
make enamel less soluble by adding fluoride to it.

Enamel structure and restorative dentistry

- Different acids at different concentrations can produce a variety of

patterns of partial prism dissolution to provide a roughened surface
suitable for adherence of restorative materials = reduces or eliminates the
need for mechanical retention cut in to sound tissue

- Agents mechanically binding to enamel = need microporistiy in the

surface by acid-etch technique = microscopic tags can be seen
invaginating in to the roughened surface.

- Preparing cavity = need to know microanatomy of enamel + prism

orientation = conserve as much of original strength as possible

- Cutting cavities into enamel with rotary instruments = lead to subsurface

cracking but some of the adhesive materials are capable of reinforcing this
weakened substrate.

Enamel Pearls

- Small isolated spheres of enamel that are occasionally found on the root
towards the cervical margin

- Common in the root bifurcation region

- Predispose to plaque aggregation following gingival recession