2010/3/29 1 Enamel 口腔胚胎及組織學 Oral embryology & histology 臺北醫學大學 牙醫學系 鄧乃嘉醫師 [email protected]學習目標 能了解頭臉部及口腔之發育、結構與功能 ,並發展能有效吸收與傳播相關資訊之辭 彙,將胚胎及組織學上之基本概念,應用 於臨床上之診斷與治療 於臨床上之診斷與治療 參考資料 1.Illustrated Dental Embryology, Histology, and Anatomy: Mary Bath-Balogh, Margaret J. Fehrenbach, 2nd Edition, Elsevier Saunders,2006 2.Esstential of Oral Histology and Embryology--A clinical approach: James K Avery, Denial J Chiego,Jr 3rd Edition, Elsevier Mosby, 2006 3.Ten Cate's Oral Histology: Development, Structure, and Function: Nanci Anatonio, 6th ed. Mosby, 2003 Summary 提供學生探討頭臉部及口腔之發育,認識 牙齒及口腔組織之正常顯微結構,並了解 其功能與結構之關係,進而對生理、病理 與臨床牙科學上之問題能做比較與思考 與臨床牙科學上之問題能做比較與思考, 為各牙科臨床科目之重要基礎課程 ENAMEL Enamel's primary mineral is hydroxyapatite , which is a crystalline calcium phosphate . The large amount of minerals in enamel accounts not only for its strength but also for its brittleness. Dentin, which is less mineralized and less brittle, compensates for enamel and is necessary as a support. Unlike dentin and bone, enamel does not contain collagen . Instead, it has two unique classes of proteins called amelogenins and enamelins . While the role of these proteins is not fully understood, it is believed that they aid in the development of enamel by serving as a framework Physical characteristics the hardest and most highly mineralized substance of the body, and with dentin , cementum , and dental pulp is one of the four major tissues which make up the tooth . It is the normally visible dental tissue of a tooth and must be supported by underlying dentin. 96% of enamel consists of mineral, with water and organic material composing the rest Enamel varies in thickness over the surface of the tooth and is often thickest at the cusp , up to 2.5 mm, and thinnest at its border, which is seen clinically as the cementoenamel junction (CEJ)
Microsoft PowerPoint - 07 enamel().ppt []
2.Esstential of Oral Histology and Embryology--A clinical approach:
James K Avery, Denial J Chiego,Jr 3rd Edition, Elsevier Mosby,
2006
3.Ten Cate's Oral Histology: Development, Structure, and Function:
Nanci Anatonio, 6th ed. Mosby, 2003
Summary
ENAMEL
Enamel's primary mineral is hydroxyapatite, which is a crystalline
calcium phosphate . The large amount of minerals in enamel accounts
not only for its strength but also for its brittleness. Dentin,
which is less mineralized and less brittle, compensates for enamel
and is necessary as a support. Unlike dentin and bone, enamel does
not contain collagen. Instead, it has two unique classes of
proteins called amelogenins and enamelins. While the role of these
proteins is not fully understood, it is believed that they aid in
the development of enamel by serving as a framework
Physical characteristics
the hardest and most highly mineralized substance of the body, and
with dentin, cementum, and dental pulp is one of the four major
tissues which make up the tooth. It is the normally visible dental
tissue of a tooth and y must be supported by underlying dentin. 96%
of enamel consists of mineral, with water and organic material
composing the rest Enamel varies in thickness over the surface of
the tooth and is often thickest at the cusp, up to 2.5 mm, and
thinnest at its border, which is seen clinically as the
cementoenamel junction (CEJ)
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Structure of enamel
The basic unit of enamel is called an enamel rod . Measuring 4 μm -
8 μm in diameter an enamel rod, formerly called an enamel prism, is
a tightly packed mass of hydroxyapatite crystals in an organized
pattern . In cross section, it is best compared to a keyhole, with
the top, or head, oriented toward the crown of the tooth, and the
bottom, or tail, oriented toward the root of the tooth. The area
around the enamel rod is known as interrod enamel. Interrod enamel
has the same composition as enamel rod, however a histologic
distinction is made between the two because crystal orientation is
different in each . The border where the crystals of enamel rods
and crystals of interrod enamel meet is called the rod sheath
.
Scanning electron microscope views of (A) the enamel layer covering
coronal dentin, (B) the complex distribution of enamel rods across
the layer, (C and D) and perspectives of the rod- interrod
relationship when rods are exposed (C) longitudinally or (D) in
cross section. Interrod enamel surrounds each rod. R, Rod; IR,
interrod; DEJ, dentinoenamel junction.
A and B, High- resolution scanning electron microscope images
showing that crystals in rod and interrod enamel are similar in
structure but diverge in orientation.
P63/m
Hydroxyapatite
Ca5(PO4)3OH
Transmission electron microscope images of a rod surrounded by
interrod enamel from (A) young and (B) older forming enamel of a
rodent. The crystals that make up the rod and interrod enamelrod
and interrod enamel are long, ribbonlike structures that become
thicker as enamel matures. They are similar in structure and
composition but appear in different planes of sections because they
have different orientations.
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Cross-sectional profiles of (A) recently formed, secretory stage
enamel crystals and (B) older ones from the maturation stage.
Initially the crystals are thin; as they grow in thickness and
width, their hexagonal g contour becomes apparent. B, The linear
patterns seen in older crystals are a reflection of their
crystalline lattice.
Electron micrograph of mature enamel crystals. The outline is
irregular as they press againstirregular as they press against each
other.
Scanning electron microscope images showing various aspects of rat
incisor enamel. A, The enamel rods (R) are arranged in rows with
alternating orientations. B, The alternating row arrangement is
also evident in the g interrod (IR) cavities that accommodate the
enamel rod. C, Rod and interrod enamel are made up of thin and long
apatite crystals.
Rod and interrod
The rod is shaped somewhat like a cylinder and is made up of
crystals with long axes that run, for the most part,
ll l t th l it di l i f th dparallel to the longitudinal axis of
the rod The interrod region surrounds each rod, and its crystals
are oriented in a direction different from those making up the
rod
Fine structure of enamel. A, Crystal orientation along three faces
of an enamel block. B to D, Transmission electron micrographs of
the three faces.
A and B, Decalcified preparation of cat secretory stage enamel. The
organic matrix near the ameloblasts is younger and shows a
if t t Th di t luniform texture. The distal portion of Tomes’
process (dpTP) penetrates into the enamel. In deeper areas, near
dentin, matrix is older and partly removed. Matrix accumulates at
the interface between rod (R) and interrod (IR) to form the rod
sheath (arrowheads).
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(black dots) immunocytochemical
ti h i thpreparation showing the presence of amelogenin in the
organic matrix that accumulates to form the rod sheath in maturing
cat enamel.
Rodents have no well-defined rod sheath; however, in decalcified
preparations of maturing enamel a concentration of organic matrix
(arrows) seems to occur around (a o s) see s o occu a ou d most of
the periphery of the rod (R), except at the zone of confluence (*)
with interrod (IR). This matrix, like the one at other sites, is
immunoreactive (black dots as enlarged in inset) for
amelogenin.
Interrod partition associated with four rod profiles. At certain
sites (arrows, zone of confluence) crystals from interrod enamel
enter the rod.
Structure of enamel
The arrangement of the crystals within each enamel rod is highly
complex. Both ameloblasts (the cells which initiate enamel
formation) and Tomes' processes affect the crystals' pattern.
Enamel crystals in the head of the enamel rod are oriented parallel
to the long axis of the rod . When found in the tail of the enamel
rod, the crystals' orientation diverges slightly from the long
axisfrom the long axis. The arrangement of enamel rods is
understood more clearly than their internal structure. Enamel rods
are found in rows along the tooth, and within each row, the long
axis of the enamel rod is generally perpendicular to the underlying
dentin . In permanent teeth, the enamel rods near the cementoenamel
junction (CEJ) tilt slightly toward the root of the tooth.
Understanding enamel orientation is very important in restorative
dentistry, because enamel unsupported by underlying dentin is prone
to fracture.
Amelogenesis
1. Produces a partially mineralized (approximately 30%) enamel.
Once the full width of this enamel has been
depositeddeposited……..
2. Significant influx of additional mineral coincident with the
removal of organic material and water to attain greater than 96%
mineral content. This mineral influx makes the crystal formed
during the first step grow wider and thicker
Amelogenesis
1. Presecretory stage: differentiating ameloblasts acquire their
phenotype, change polarity, develop an extensive protein synthetic
apparatus, and prepare to secrete the organic
t i f lmatrix of enamel. 2. Secretory stage: ameloblsts elaborate
and
organize the entire enamel thickness, resulting in the formation of
a highly ordered tissue.
3. Maturation stage: ameloblasts modulate and transport specific
ions required for the concurrent accretion of mineral.
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Light microscopy of amelogenesis
Enamel matrix formation as seen with the light microscope. The
Tomes’ processes of ameloblasts jut into the matrix, creating a
picket-fence appearance.
The various functional stages in the life cycle of the cells of the
inner dental epithelium. 1, morphogenetic stage; 2,
histodifferentiation stage; 3, initial secretory stage (no
Tomes’
initial secretory stage
secretory stage
Secretory stage
a sec e o y s age ( o o es process); 4, secretory stage (Tomes’
process); 5, ruffle-ended ameloblast of the maturative stage; 6,
smooth- ended ameloblast of the maturative stage; 7, protective
stage.
morphogenetic stage
histodifferentiation stage
g
Composite plate illustrating the morphologic changes that rat
incisor ameloblasts undergo throughout amelogenesis. Am,
Ameloblasts; BL, basal lamina; BV, blood vessel; D, dentin; E,
enamel; IE, secretory stage inner enamel; InE, secretory
i i i l l M l
secretory stage inner enamel
secretory stage initial enamel
secretory stage outer enamel
stage initial enamel; Me, early maturation stage; Ml, late
maturation stage; Mm, midmaturation stage; Od, odontoblasts; OE,
secretory stage outer enamel; PD, predentin; PS, presecretory
stage; TP, Tomes’ process; Tr, maturation stage transition.
maturation stage transition
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Representative micrographs of amelogenesis in the cat. A, Tooth
formation shows an occlusal-to-cervical developmental gradient so
that on some crowns finding most of the stages of the ameloblast
life cycle is possible. The panels on the right (B corresponds with
B1 and C with B2) are enlargements of the boxed areas: B, Secretory
stage, i iti l l f ti C tinitial enamel formation; C, secretory
stage, inner enamel formation. D and E are from the incisal tip of
the tooth (see Fig. 7-15). D, Midmaturation stage, smooth-ended
ameloblasts; and E, late maturation stage, ruffle-ended
ameloblasts. Am, Ameloblasts; D, dentin; E, enamel; N, nucleus; Od,
odontoblasts; PL, papillary layer; RB, ruffled border; SB, smooth
border; SI, stratum intermedium.
ruffle-ended ameloblast of the maturative stage & smooth-ended
ameloblast of the maturative stage
Scanning electron microscope view of the enamel organ during the
maturation stage. Cells from the stratum intermedium, stellate
reticulum, and outer dental epithelium amalgamate into a single
layer. Blood vessels invaginate deeply into this layer to form a
convoluted structure referred to as the papillary layer. BV, Blood
vessel; N, nucleus.
Features of amelogenesis as seen through the light microscope. At A
the inner dental epithelium consists of small, columnar
undifferentiated cells. At B these cells elongate and differentiate
into columnar ameloblasts that induce the differentiation of
odontoblasts and then begin to secrete enamel (C). At D ameloblasts
are actively depositing enamel matrix.
When enamel maturation is completed, the ameloblast layer and the
adjacent papillary layer together constitute the reduced dental
epithelium. Only an enamel space is visible in this histologic
preparation because at this late developmental stage, enamel is
heavily calcified and therefore is lost during
decalcification.
Light microscopy of amelogenesis
KEY 1. Inner dental epi. Became the ameloblast 2. Initial layer of
enamel, which does not contain
any rods T ’3. Tomes’ process
4. Postsecretory transition stage occurred just after the full
thickness of enamel is completed
5. Papillary layer 6. Reduced dental epithelium 7. Protective phase
8. Junctional epithelium
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Electron microscopy of amelogenesis
Morphogenetic phase
mantle predentin
p g forming mantle predentin. The basement membrane is fragmented
and removed before the active deposition of enamel matrix. mv,
Matrix vesicle; sg, secretory granule.
ameloblasts
In Situ Hybridization In situ hybridization (ISH) is a type of
hybridization that uses a labeled complementary DNA or RNA strand
(i.e., probe) to localize a specific DNA or RNA sequence in a
portion or section of tissue (in situ), or, if the tissue is small
enough (e.g. plant seeds, Drosophila embryos), in the entire tissue
(whole mount ISH) This is distinct fromthe entire tissue (whole
mount ISH). This is distinct from immunohistochemistry, which
localizes proteins in tissue sections. DNA ISH can be used to
determine the structure of chromosomes. Fluorescent DNA ISH (FISH)
can, for example, be used in medical diagnostics to assess
chromosomal integrity. RNA ISH (hybridization histochemistry) is
used to measure and localize mRNAs and other transcripts within
tissue sections or whole mounts.
In Situ Hybridization
Colloidal gold immunocytochemical preparations illustrating the
expression of amelogenin by differentiating ameloblasts. A,
Amelogenin molecules are immunodetected (black dots)
extracellularly early during the presecretory stage, before the
removal of the basement membrane (BM) separating ameloblasts from
the developing predentin matrix. Thereafter, enamel proteins (B)
accumulate as patches (arrowheads) at the interface with dentin and
then (C) as a uniform layer of initial enamel. djc, Distal
junctional complex; im, infolded membrane; mv, matrix vesicle; Odp,
odontoblast process; ppTP, proximal portion of Tomes’ process; sg,
secretory granule.
A, Differentiated ameloblasts develop a junctional complex at their
distal extremity. The cell extension above the complex is Tomes’
process and is divided into two parts. The proximal portion of
Tomes’ process (ppTP) extends from the junctional complex to the
surface of the enamel layer, whereas the more distal portion (dpTP)
penetrates into enamel. B, Cross-sectional view of ameloblasts at
the level of the distal junctional complex. This beltlike complex
extends around the entire circumference of the ameloblast and
tightly holds the cells together. Bundles of microfilaments (Cell
web) run along the cytoplasmic surface of the complex. dcw, Distal
cell web; DEJ, dentinoenamel junction; sg, secretory granule.
Differentiation phase
Secretory stage
Golgi complex is extensive and form a cylindrical organelle
surrounded by rough endoplasmic reticulum Rod and interrod
A, Cytochemical preparation for an enzyme resident in the Golgi
complex showing the extent of this organelle throughout the
supranuclear compartment of secretory stage ameloblasts. B,
Scanning electron microscope image of a cross-fractured ameloblast.
The Golgi complex has a cylindrical configuration and is surrounded
by rough endoplasmic reticulum (rER). N, Nucleus; SI, stratum
intermedium.
Comparative (A) scanning and (B) transmission electron microscope
views of cross-cut secretory stage ameloblasts. The Golgi complex
is located centrally and surrounded by cisternae of rough
endoplasmic reticulum (rER). The preparation in B is immunolabeled
(black dots) for amelogenin. Labeling is found not only in the
Golgi complex and secretory granules (sg) but also in organelles
involved in protein degradation such as multivesicular bodies
(mvb). C, The organization of secretory stage ameloblasts as would
be revealed in a section along their long axis.
SEE Fig 7-26
Immunocytochemical preparations for amelogenin. A, Immature (isg)
and mature (msg) secretory granules are found on the mature face of
the Golgi complex. B, Secretory granules are translocated into
Tomes’ process and accumulate near secretory surfaces, recognized
by the presence of membrane infoldings (im). dpTP, Distal portion
of Tomes’ process; IR, interrod; R, rod; rER, rough endoplasmic
reticulum; RGS, rod growth site; sg, secretory granule; tf,
tonofilaments.
Double-labeled immunocytochemical preparations; the fine black dots
indicate the presence of ameloblastin (AMBN), whereas the larger
ones that of amelogenin (AMEL). A, Both proteins are processed
simultaneously in the Golgi complex. B, Although the majority of
secretory granules (sg) found near the Golgi complex or in Tomes’
process contain both proteins (4), some show the presence of only
ameloblastin (2), only amelogenin (3), or neither protein (1). This
indicates that both proteins are cosecreted. m, Mitochondria.
When initial enamel forms, the ameloblast only has a proximal
portion of Tomes’ process (ppTP). The distal portion develops as an
extension of the proximal one slightly later when enamel rods begin
forming. dcw, Distal cell web; sg, secretory granules.
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Transmission electron micrographs of initial enamel formation. A,
This micrograph shows the close intermingling of dentin collagen
with the ribbonlike crystals of enamel. B, A higher magnification
shows the apparent continuity between calcified collagen and enamel
crystallites.
In three dimensions, interrod (IR) enamel surrounds the forming rod
(R) and the distal portion of Tomes’ process (dpTP); this portion
is the continuation of the proximal portion (ppTP) into the enamel
layer. The interrod (IGS) and rod (RGS) growth sites are associated
with membrane infoldings (im) on the proximal and distal portions
of Tomes’ processdistal portions of Tomes process, respectively.
These infoldings represent the sites where secretory granules (sg)
release enamel proteins extracellularly for growth in length of
enamel crystals and, consequently, the thickening of interrod and
rod enamel.
Scanning electron micrograph of the surface of a developing human
tooth from which ameloblasts have been removed. The surface
consists of a series of pits previously filled by Tomes’ processes
the walls of which are formed by interrod enamel.
In cross section the distal portions of Tomes’ processes (dpTP)
appear as ovoid profiles surrounded by interrod enamel (IR). They
decrease in size toward the dentinoenamel junction (dashed arrow)
as the rod (R) grows in diameter. The crystals making up rod blend
in with those of interrod enamel (small arrows, zone of confluence)
at the point where the rod begins forming. RGS, Rod growth sites;
sg, secretory granule.
Light microscope radioautographic preparations following
administration of 3H- methionine to radiolabel secretory products
(mainly amelogenins) of ameloblasts. The black silver grains over
enamel indicate the presence of newly formed amelogenins. A and B,
As expected, secretory stage ameloblasts actively secrete proteins
during inner (IE) and outer (OE) enamel formation. C and D, The
presence of grains over the surface enamel during the transition
phase (Mt) and early maturation (M) indicates that ameloblasts
still produce amelogenins during the early part of the maturation
stage. BV, Blood vessel; PL, papillary layer; SI, stratum
intermedium; TP, Tomes’ process.
A and B, Scanning electron microscope illustrations showing the
complex trajectory of rods in the inner two thirds of the enamel
layer. B, The rods are organized in groups exhibiting different
orientations; this illustration shows four adjacent groups.
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The (A) first (initial) and (B) last (final) enamel layers are
aprismatic, that is, they do not contain rods.
Maturation stage
Amelogenesis is a rather slow process, may take around 5 years, up
to about 2/3 formation time can be occupied by th t ti tthe
maturation stage Transitional phase, occurred just after the full
thickness of enamel is completed Maturation proper
Scanning electron microscope views of the (A) ruffle-ended and (B)
smooth-ended apices of maturation stage ameloblasts. m,
Mitochondria.
Maturation proper
Related to calcium transport and alternations in permeability of
the enamel organ Ruffle-end: secret [bicarbonate ions] HCO3−
The functional morphology of ruffle- ended and smooth- ended
maturation stage ameloblasts.
Ca
Ca
polypeptide
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Charge selective property
At the start of the maturation stage, ameloblasts deposit a basal
lamina–like structure (BL) against the enamel surface to which it
adheres firmly. Cytochemical detection (black dots) of sugar
residues using lectins indicates that this structure is rich in
glycoconjugates. Inset, The cell surface attaches to the basal
lamina by means of hemidesmosomes (HD).
Enamel protein
Amelogenins: 90% regulate growth in thickness and width, nucleate
crystals Nonamelogenin
1. Ameloblastin: promote mineral formation and crystal elongation 2
Enamelin: the molecule binds HA crystal nucleation and growth2.
Enamelin: the molecule binds HA, crystal nucleation and growth 3.
Sulfated glycoprotein 4. Tuftlin: cell signaling?? For DEJ 5.
Enzymes
Metalloproteinase: enamelysin MMP20 Serines proteinase: bulk
degradation Phosphatase
6. Dentin phosphoprotein/ dentin sialoprotein
Hypothetical scheme for amelogenin-mediated enamel
biomineralization.
A, Transmission electron microscope image illustrating the
relationship of rod enamel crystals to a distal portion of Tomes’
process (dpTP) and surrounding interrod enamel. The elongating
extremity of the rod crystals abut the infolded membrane (im) at
the secretory surface. B, In cross section, newly formed crystals
appear as small, needlelike structures (arrows) surrounded by
granular organic matrix. sg, Secretory granules.
Comparative immunocytochemical preparations illustrating the
differential distribution of (A) amelogenin (AMEL) and (B)
ameloblastin (AMBN), here in relation to a distal portion of Tomes’
process (dpTP). Amelogenins are less concentrated in a narrow
region near the secretory surface on the process (fewer black dots
occur between the cell and the dashed line than beyond), whereas
most of the ameloblastin is found in this region. sg, Secretory
granule.
Four phases of enamel mineralization.
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Longitudinal ground section showing disposition of the striae of
Retzius (arrows).the outermost layer is the enamel, the two
sections
Striae of Retzius
the two sections adjacent to the enamel represent the dentin, and
the pulp chamber is in the center.
enamel rod rod
Light microscope view of striae of Retzius in a ground section. In
cross section, the striae appear as a series of concentric, dark
lines (arrowheads). An enamel lamella can be seen running from the
outer surface to the dentinoenamel junction.
In scanning electron microscopy, periodic varicosities and
depressions are seen along enamel rods (R) in (A) rodent and (B)
human teeth, producing the impression of cross- striations along
their length. IR, Interrod enamel.
Cross striations
Human enamel is known to form a rate of approximately 4um/day
Longitudinal section of enamel viewed by incident light. The series
of alternating light and
Bands of Hunter and Schreger
of alternating light and dark bands of Hunter and Schreger are
apparent.
The differing orientation of enamel rods
Higher- power view of a band of Hunter and Schreger as viewed by
incident light.
viewed under transmitted light. The differing orientation of enamel
rods is clearly evident.
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Enamel tufts & lamellae
Enamel tufts: abrupt changes in the direction of groups of rods
that arise from different regions of the scalloped DEJDEJ Lamellae:
longitudinal oriented defects filled with organic material (enamel
organ or connective tissue)
Enamel tufts & lamellae
Transverse ground section of enamel. Enamel tufts are the branched
structures extending from the dentinoenamel junction (DEJ) into the
enamel (arrowheads). The junction is seen as a scalloped
profile.
Geologic faults
Dentinoenamel junction. A, Ground section. B, Demineralized section
after the enamel has been lost. The scalloped nature of the
junction when seen in one plane is striking C A transmission
electronstriking. C, A transmission electron micrograph shows the
intermingling of dentin and enamel crystals. D, A low-power
scanning electron micrograph of a premolar from which the enamel
has been removed shows that the scalloping is accentuated where the
junction is subjected to most functional stress.
Enamel spindles
Enamel spindles (arrows) in a ground section extend from the
dentinoenamel junction into the enamel and most frequently are
found at cusp tips.
Odontoblast processes extend into the ameloblast layer
Freeze-fracture preparation at the dentinoenamel junction
(arrowheads). The distinctive appearance of the collagenous dentin
and noncollagenous (initial) enamel layer i t blis notable.
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Scanning electron micrograph of the labial surface of a tooth,
showing the perikymata. (Courtesy D. Weber.)
perikymata
Ground section of enamel showing the relationship between the
striae of Retzius and surface perikymata.
The relationship between the striae of Retzius and surface
perikymata (arrows).
Gnarled enamel
Bundles of enamel rods appear to intertwine in a highly irregular
manner in the cusp region of teeth to form gnarled
l Th h f l denamel. The phenomenon of gnarled enamel appears to be
an optical illusion.
Gnarled Enamel Aging
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Febrile diseases Tetracycline-induced disturbaneces Fluoride ion
>5ppmpp
Dentition of a patient who had two illnesses at separate times. The
enamel defects, separated by normal enamel, are clearly
visible.
Acid etching
Scanning electron micrographs of etching patterns in enamel. A,
Type I pattern: rod preferentially eroded. B, Type II pattern: rod
boundary (interrod) preferentially eroded; C, Type III pattern:
indiscriminate erosion. D, Junction between type I and type II
etching zones.
END