NEET MDS Lessons
Dental Anatomy
Histology of the Pulp
PARTICIPATING CELLS
1. Odontoblasts (body and process)
Most distinctive cells of the pulp
Single layer
The cells are columnar in the coronal portion, cuboidal in the middle portion, flat in the apical portion
Individual odontoblasts communicate with each other via junctions. The number of odontoblasts corresponds to the number of dentinal tubules.
The lifespan of an odontoblast equals the one of a vital tooth.
The morphology of the odontoblasts reflects their functional activity.
(There are three stages that reflect the functional activity of a cell: active, transitional and resting)
The odontoblastic process
2. Fibroblasts
Most numerous cells
Produce collagen fibers and ground substance
Ground substance consists of: proteoglycans and glycoproteins
Again, active and resting cells
Fibroblasts have also capability to degrade collagen
3. Undifferentiated mesenchymal cells A pool of cells from which connective tissue cells can derive.
They are reduced with age.
4. Endothelial cells, Schwann cells, pericytes and immunocompetent cells
MATRIX
It is composed of fibers and ground substance
55% of the fibers are Type I collagen. 45% of the fibers are Type III collagen.
The ground substance is gelatinous in the coronal aspect and more fibrous in the apical.
VASCULARITY
Superior and inferior alveolar arteries that derive from the external carotids
Afferent side of the circulation: arterioles
Efferent side of the circulation: venules
Lymphatics
Small, blind, thin-walled vessels in the coronal region of the pulp and exit via one or two larger vessels.
Mandibular First Deciduous Molar
-This tooth doesn't resemble any other tooth. It is unique unto itself.
-There are two roots.
-There is a strong bulbous enamel bulge buccally at the mesial.
- the mesiolingual cusps on this tooth is the highest and largest of the cusps.
Embryonic development
The parotid derives from ectoderm
The sublingual-submandibular glands thought to derive from endoderm
Differentiation of the ectomesenchyme
Development of fibrous capsule
Formation of septa that divide the gland into lobes and lobules
The parotid develops around 4-6 weeks of embryonic lofe
The submandibular gland develops around the 6th week
The sublingual and the minor glands develop around the 8-12 week
Amelogenesis and Enamel
Enamel is highly mineralized: 85% hydroxyapatite crystals
Enamel formation is a two-step process
The first step produces partially mineralized enamel: 30% (secretory)
The second step: Influx of minerals, removal of water and organic matrix (maturative)
Again, dentin is the prerequisite of enamel formation (reciprocal induction)
Stratum intermedium: high alkaline phosphatase activity
Differentiation of ameloblasts: Increase in glycogen contents
Formation of the enamel matrix
Enamel proteins, enzymes, metalloproteinases, phosphatases, etc.
Enamel proteins: amelogenins (90%), enamelin, tuftelin, and amelin
Amelogenins: bulk of organic matrix
Tuftelin: secreted at the early stages of amelogenesis (area of the DE junction)
Enamelin: binds to mineral
Amelin
Mineralization of enamel
No matrix vesicles
Immediate formation of crystallites
Intermingling of enamel crystallites with dentin
"Soft" enamel is formed
Histologic changes
Differentiation of inner enamel epithelium cells. They become ameloblasts
Tomes' processes: saw-toothed appearance
Collapse of dental organ
Formation of the reduced enamel epithelium
Hard tissue formation (Amelogenesis )
Enamel formation is called amelogenesis and occurs in the crown stage of tooth development. "Reciprocal induction" governs the relationship between the formation of dentin and enamel; dentin formation must always occur before enamel formation. Generally, enamel formation occurs in two stages: the secretory and maturation stages. Proteins and an organic matrix form a partially mineralized enamel in the secretory stage; the maturation stage completes enamel mineralization.
In the secretory stage, ameloblasts release enamel proteins that contribute to the enamel matrix, which is then partially mineralized by the enzyme alkaline phosphatase. The appearance of this mineralized tissue, which occurs usually around the third or fourth month of pregnancy, marks the first appearance of enamel in the body. Ameloblasts deposit enamel at the location of what become cusps of teeth alongside dentin. Enamel formation then continues outward, away from the center of the tooth.
In the maturation stage, the ameloblasts transport some of the substances used in enamel formation out of the enamel. Thus, the function of ameloblasts changes from enamel production, as occurs in the secretory stage, to transportation of substances. Most of the materials transported by ameloblasts in this stage are proteins used to complete mineralization. The important proteins involved are amelogenins, ameloblastins, enamelins, and tuftelins. By the end of this stage, the enamel has completed its mineralization.
Permanent teeth
1. The permanent teeth begin formation between birth and 3 years of age (except for the third molars)
2. The crowns of permanent teeth are completed between 4 and 8 years of age, at approximately one- half the age of eruption
The sequence for permanent development
Maxillary
First molar → Central incisor → Lateral incisor → First premotar → Second pmmolar → Canine → Second molar → Third molar
Mandibular
First molar → Central incisor → Lateral incisor → Canine → First premolar → Second premolar → Second molar → Third molar
Permanent teeth emerge into the oral cavity as
Maxillary Mandibular
Central incisor 7-8 years 6-7 years
Lateral incisor 8-9 years 7-8 years
Canine 11-12 years 9-10 years
First premolar 10-Il years 10-12 years
Second premolar 10-12 years 11-12 years
First molar 6-7 years 6-7 years
Second molar 12-13 years 11-13 years
Third molar 17-21 years 17-21 years
The roots of the permanent teeth are completed between 10 and 16 years of age, 2 to 3 years after eruption
Disturbances to interarch alignment are
a. Excessive overbite where the incisal edge of the maxillary incisors extend to the cervical third of the mandibular incisors
b. Excessive overjet where the maxillary teeth overjet the mandibular teeth by more than 3mm
c. End-to-end relationship: edge-to edge bite where the anterior teeth meet at there incisal edge with no overjet or overbite; cusp-to bite where the posterior teeth meet cusp to cusp with no interdigitation
d. Crossbite where the normal faciolingual relationship of the maxillary to the mandibular teeth is altered for the anterior.teeth. the mandibular tooth or teeth are facial rather than lingual to the maxillary teeth for the posterior teeth, normal inercuspaton is not seen
SURFACES OF THE TEETH
Facial, Mesial, Distal, Lingual, and Incisal Surfaces
- The facial is the surface of a tooth that "faces" toward the lips or cheeks. When there is a requirement to be more specific, terms like labial and buccal are used. The labial is the surface of an anterior tooth that faces toward the lips. The buccal is the surface of a posterior tooth that faces toward the cheek.
- The mesial is the proximal surface closest to the midline of the arch. The distal is the opposite of mesial. The distal is the proximal surface oriented away from the midline of the arch.
- The lingual is the surface of an anterior or posterior tooth that faces toward the tongue. Incisal edges are narrow cutting edges found only in the anterior teeth (incisors). Incisors have one incisal edge
- Proximal Surfaces
A tooth has two proximal surfaces, one that is oriented toward the midline of the dental arch (mesial) and another that is oriented away from the midline of the arch (distal).