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Sometime after enamel completions « remember that there is no root

formation before the tooth has completed its crown «

Interaction between « dental follicle and Epithelial root sheath

This means that root formation is similar to crown formation « crown

formation depends on interaction between enamel organ and dental
papilla « here (in root) we have interaction but between a structure
called Epithelial root sheath {of Hertwing} and dental follicle which are
the cells that surrounds the developing tooth

Epithelial root sheath is a structure derived from cervical loop region

of enamel organ

The onset coincides (yatazamn) with axial phase of tooth eruption

As long as the tooth has not undergone any root formation it is held in
place (la yata7arak) « once the 1st part of the root forms the tooth
starts to move axially (ezan 7araket el senn b al bozoo3· a7ad asbabha
ennoh el root betkawan) for sure when the tooth is inside the bone it
moves but not axially « so we have interaction between: dental papilla,
dental follicle, and Epithelial root sheath these three structures are
going to be discussed next Î
Slide 3 « just to remind you of what happens we have bud stage, cap
stage, bell stage, before bell stage we don·t have any root formation
even during bell stage we don·t have any root formation « as you
remember bell stage is divided into two phases early and late, in early
phase we have movement of cells to establish the 3-D shape of the
crown, and in the late stage we have the beginning of hard tissue
formation « once all enamel is formed now it is time for root to start
to develop

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Forms at the late bell stage « so it forms after hard tissue formation

Amelogenesis and dentinogenesis are well advanced « (lazm yekon

3ende amelogenesis w dentinogenesis otaqademeh w 3ala washk enha
tentahi lama el ERS etbalesh tetkawan)
What is the epithelial root sheath? It is a double layered structure
composed of *Internal & *External enamel epithelium

If you remember from the enamel organ we have: internal enamel

epithelium and external enamel epithelium, we have between these two
cells also SR and SI, what happens now (in root formation) the two
layers of cells that are the internal and external enamel epithelium
they join together or fuse together to form bi-layered structure which
is called ERS

It is located at the cervical margin of the developing crown

Just to have a clearer view slide 5 « in red here this is external enamel
epithelium, and we have the ameloblasts or the internal enamel
epithelium in the crown we have some cells between them which are the
ST and SI, now what happens in root formation the ST and SI
disappear which leads to some sort of joining between the internal
enamel epithelium and external enamel epithelium at the cervical
margin of the tooth forming the ERS of Hertwing (after the scientist
who discovered it)

Notice that we don·t have ST or SI in the root this means that there is
no enamel formation because for it to form it needs ST and SI « and
here something else would form not enamel

Apical proliferation « we also have division of cells toward the apex of

the tooth« and this apical proliferation leads to extension of the ERS
« mapping out the shape of the root (correct it in the slides it is root
not crown) now this structure goes apically and it gives the 3-D shape
of the root {as we said that the IEE gives the 3-D shape of the crown}

Also the ERS migrates apically and as it goes it makes the 3-D shape of
the root

A very important info: this sheath is never a continuous sheath, in

other wards if you came to the tooth in any stage of root development
you will not see this sheath as a continuous sheath why? Because when
this sheath proliferate from the edge of the crown it will be
responsible for the formation of the 1st part of the root, and then it
will go down and form another part of the root and so on « once the 1st
part of the root has formed this sheath disintegrates or precedes
down

Kol ma hada el sheath ada 2ela takowon juzu2 mn el root yanqasim hada
el sheath« faqat bekon active b al makan ele bekawen el root feeh

It will not appear continuous « only appear as a sheath in the apical

parts of the root « the areas that had already formed from the root
adjacent to it the sheath discontinue

Sometimes some mistakes may take place « sometimes the ST and SI

are retained are kept instead of being disappeared at that location we
will see some enamel formation at the root « and this is called u


as you see in slide 6 the molar notice we have enamel structure
on the root «
We know that root should be covered with cementum not enamel, why
in this case we see enamel instead of cementum here? Because at that
spot which is called enamel pearl SI and ST failed to disappear,
normally they should disappear just leaving IEE and EEE, when they
failed to disappear this led to formation of enamel at the root« enamel
pearl is usually present at the root trunk of maxillary molars « it is not
very common less than 1% of the cases « so it is a localized areas of
enamel on the root surface « usually it is located in inter-radicular
regions of molars « and this is because of retention (7abs) instead of
disappearance « retention of ST and SI inside the double layered ERS

ÎLet·s hope the dude playing with his laptop is viewing something
related to the material :P Î

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When we have more than one root what happens? In single root we
have the primary apical foramen (like in pic A) we have one hole for the
root « and this leads to the formation of only one root
But when we have two roots forming notice that we have extension of
this root sheath, and then these extensions fuse together dividing the
primary foramen (apical foramen of the root) into two apical foramina
« and in cases when we have three roots we will have three extensions
fusing together and dividing the structure into three parts

Notice that the ERS is not only apically or vertically directed it is also
angled internally « as you can see it goes apically but the margin of this
apical root sheath is tilted inside « so this part which horizontally
located {the horizontal portion of the root sheath} is called u
 
  the whole thing is ERS and the horizontal part of it is called
the Epithelial diaphragm

We are going to imagine that we have one tooth and this tooth has this
inflection {the horizontal inflection of the ERS} and if you want to look
at this tooth from the apical view the outer line represents the edges
of the tooth and the internal represents the edges of the diaphragm
That is why it looks like a circle or a circular band

Primary apical foramen subdivide into a number of secondary apical

foramina

In-growth of epithelial shelves from the margins of ERS « shelves fuse

together dividing the single foramen into foramina « the fuse near the
center of the root « the # and location of the shelves corresponds to
the # of roots « we have two shelves Î two roots in cases we have
three shelves we will have three roots

And this is under the inductive role of dental papilla « so dental papilla
is actually involved in their stability

And as we said in dental anatomy the root starts as a single root we

call it root trunk and then into two or three {and usually between the
cervical third and the middle third of the root}

This is genetics so the cells are coded genetically and they know when
to induce the proliferation of the shelves that leads to division of the
root

ÎIngrowth is believed to occur along paths of low vascularity « some

scantiest say this ingrowth of these shelves is related to areas of low
vascularity, areas of low bl pressure « the next pic is just a summary
of what happens:


     


The primary apical foramen is a description of the hole that is found

inside the root while the root is developing «

When I see a tooth that is still developing I have a hole this is called
or due to the primary apical foramina « but if I have a completed tooth
{in X-sec} it won·t appear this way
There will be very think dentine layer, and we just have a small root
canal in the middle of the root « and this means that a developing root
should all the time have knife edge development of dentine « and
because of this knife edge development we have big holes or big
cavities « big foramen at the end of each root

While the root is being formed the apex is wide « as you see in the
slide and it is open « it is surrounded by thin regular knife edge of
dentine « while the root is forming «

A permanent tooth erupts with about 2/3s of its formed root « this
need 3 or more years before root completion « but in deciduous teeth
we need 1 to 1.5 years until root completion

ÎU
 
 
        «

as the root starts to be completed or as the root completes {reach its
completion} the wide apical foramen starts to get narrowed down «
until it become a small narrow hole

In dental anatomy exam the Dr. brings Qs about the root and if the
apical foramen is empty from inside this means this tooth is still not
completed its root {still developing its root} and it is not fractured «
this means that we have some sort of internal build up of dentine « so
this dentine would transform this big foramen into small apical foramen
« just enough to allow the neurovascular bundle to pass.


 M 
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!ccurs apically « and it encloses the dental papilla « as we can see and
the area in the middle it would be the dental papilla ^^;

This except in apical foramen {the fact that the ERS encloses dental
papilla}

So the growth of the ERS encloses the dental papilla but not totally
except at the apical foramen

Margin of ERS is angled internally to formÎRoot diaphragm « the

angles are internal as we said

Dental follicleÎlies external to ERS « so the cells from outside are the
dental follicle cells!

Dental follicle is responsible for the formation of cementum,

periodontal ligament PDL, and the alveolar bone


 ¦
  

Diaphragm is the angled edge of the ERS « it is a circular band as we

discussed

Root diaphragm is sandwiched between the undifferentiated

mesenchyme of:

Úc Dental papilla&

Úc Dental follicle

Inside the root area it is the dental papilla « but at this stage the
dental papilla and dental follicle are still undifferentiated


 

  
 

  

We said ERs is composed of two layers IEE and EEE « the active cells
are the internal cells of the ERS so they induce the peripheral cells of
the dental papilla {the cells located just next to them}, and upon this
induction these dental papilla cells differentiate into 
 

and then root dentine is deposited

As you can see in the picture the epithelial root sheath which is
composed of two layers internal and external « now just next to the
internal layer there is undifferentiated dental papilla cells « so they
induce those cells to become odontoblasts and they lay down root
dentine
Root dentine is deposited « which leads to disintegration (tajazu2) of
the ERS «ERS cells lose continuityand form epithelial rests (of
Malassez) in PDL«

And those rest cells of Malassez stay in the PDL after the root has
completed

The ruminants of the ERS cells are important in the development of

dental cysts {if you ever heard of someone having a cyst in his jaw?} we
call these cysts odontogenic cysts « for example one tooth needs root
canal treatment and you left it and didn·t treat it this will lead to
papiloma « sometimes these rest cells of Malassez if induces somehow
it may proliferate and make a cyst in the jaw and we call this ´radicular
cystµ it doesn·t take place in everybody but in people with chronic
infection
Just remember that those rest cells of malassez are present in
everyone but do not get activated only in people with special situation

Root dentine is exposed to the undifferentiated cells of the dental

follicle (dentine ada ela tajazu2 el root seath f sar juzu2 mn el dentine
exposed)

Exposed root dentine is to the undifferentiated cells of the dental

follicle because of that these cells differentiate into cementoblasts
and lay down cementum

This picture is very nice and summarizes the whole process «


   
  « is divided into 3 layers « dental

follicle which surrounds the tooth from outside « 1. The first layer is
the cells just next to the formed dentine 2. We have intermediate
cells 3. And we have the cells outside « cells just next to dentine they
differentiate into cementoblasts and they lay down cementum « the
cells located in the middle they differentiate into fibroblasts and they
will form the periodontal ligament « the cells located outside they
differentiate into osteoblasts and lay down the alveolar bone

Again we have three layers:

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 forming over them! « Ya3ne bekon fe menha juz2een juzu2
embedded in cementum w juzu2 free

And this free end will attach in a similar way to the bone

So PDL has fibers called PDL fibers the edges of these fibers are
attached to cementum and in the other side are attached to bone
and by this way we attach the tooth to the bone

´Zai el sabeh Matalan lama et7ut 7bal b el esment kaif bekoon

shakelha tal3ah mn el esment nafs el fekrah hoon «

¦
 
 

When the final root length is achieved « when the ERS descends down
to the length wanted for the tooth until it reaches it ya3ne what
happens? Proliferation of epithelium in the diaphragm lags behind that
of the pulp or connective tissue « {btenbanah tabaqat saree3ah mn el
dentine asra3 mn el proliferation}

Usually dentine·s building speed is less than the ERS growth downward
now when the root formations comes to an end this has to stop and the
dentine building up becomes faster and faster and the ERS
proliferation lags behind!

     
to the width of the

diaphragmatic opening itself

After wards it further narrows by apposition of dentine and cementum

at the apex of the root


 p 
 

So far you know that each tooth has to have one root canal but
sometimes we have accessory canals 

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If we suppose that the root dentine is going in its own way and
suddenly finds a structure Bl vessel for Ex so at this area there will
not be ERS « no induction for odontoblasts and no dentine building up «
and we will end up with a space (fara3·) this empty space is the
accessory root canals

So accessory root canals is developed when the continuity of the RES

is broken by any structure that passes in its direction!

¦
 
 "




It is well known that when the root develops the tooth starts to move
anteriorly {lanafred fe ensan ma 2eloh ejren w sar 2eloh ejren hal
ejreeh ra7 te5tareq el ard?} and we will talk about this later on «

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