LECTURE 2 Tooth Development

Dr.
Ali Hadi Fahad PEDODONTICS LECTURE: 2

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Tooth development
Tooth development or odontogenesis is the complex process by which teeth form
from embryonic cells, grow, and erupt into the mouth (starts as early as 28 days of IUL
and continues to the end of eruption of permanent molars). For human teeth to have a
healthy oral environment, all parts of the tooth must develop during appropriate stages
of fetal development. Primary (baby) teeth start to form between the sixth and eighth
week of prenatal development, and permanent teeth begin to form in the twentieth week.
If teeth do not start to develop at or near these times, they will not develop at all,
resulting in hypodontia or anodontia.
Development of teeth passes through the following stages:

A. Development in the prenatal period: in this period three overlapping phases occur:
1. Beginning of the deciduous dentition development
The development of teeth starts at 3rd week of IUL, then the odontogenic epithelium
proliferates in the 5th week to form the dental lamina which form invaginations that
develop into tooth buds.
2. The formation of the successional lamina
It is the lingual extension of the dental lamina develops in the 5 th months of IUL
(permanent central incisor) to 10th months of age (2nd premolar).
3. Initiation of the permanent dentition
It is initiated in the 4th month of IUL.
B. Status of development at birth: the teeth are in different stages of development at

birth.
C. Development in the postnatal period: it shows completion of the crowns of all

primary teeth and initiation of root formation. The permanent teeth continue to develop
in different stages till their root formation is completed.
Life cycle of the tooth
A number of physiological changes take place in the progressive development of
teeth:
1. Growth:
a) Initiation (bud stage): first stage of tooth development occurs around 6-7 weeks
IUL. One of the earliest signs in the formation of a tooth that can be seen
microscopically is the distinction between the vestibular lamina and the dental lamina.
The dental lamina connects the developing tooth bud to the epithelial layer of the mouth
for a significant time.
- In this phase the location of teeth are established with the appearance of tooth germs
(tooth buds) in both jaws (mandible and maxilla) to form primary teeth.
- So, if any problem occurs at this stage or any interruption happened what do you
think the outcome will be?
The initiation is to determine the space of the tooth germ, which appears in this
stage so any problem occurred will result either by hypodontia (some of teeth will not
be formed) or in hyperdontia (extra teeth will be formed, Supernumerary teeth (SNT)).
“Any defect occurred during this stage result in either no teeth buds formed or extra
buds will be formed’'
b) Proliferation (cap stage): second stage of development known as the cap stage. It
results from cellular division and multiplication of cells. As a result of unequal growth
in the different parts of the bud, a cap is formed. A shallow invagination appears on the
deep surface of the bud. The peripheral cells of the cap later form the outer and inner
enamel epithelium.
*** As with a deficiency in initiation, a deficiency in proliferation results in failure of
the tooth germ to develop and in less than the normal number of teeth.
Excessive proliferation of cells may result in epithelial rests. If the cells become
more fully differentiated or detached from the enamel organ, they produce enamel and
dentin, which results in an odontoma or a supernumerary tooth. The degree of
differentiation of the cells determines whether a cyst, an odontoma, or a supernumerary
tooth develops.
c) Histodifferentiation: The epithelium continues to invaginate and deepen until the
enamel organ takes on the shape of a bell, during this stage there is a differentiation of
the cells of the dental papilla into odontoblasts and of the cells of the inner enamel
epithelium into ameloblasts. Histodifferentiation marks the end of the proliferative stage
as the cells lose their capacity to multiply. This stage is the forerunner of appositional
activity. Disturbances in the differentiation of the formative cells of the tooth germ result
in abnormal structure of the dentin or enamel. One clinical example of the failure of
ameloblasts to differentiate properly is amelogenesis imperfecta. The failure of the
odontoblasts to differentiate properly, with the resultant abnormal dentin structure,
results in the clinical entity dentinogenesis imperfecta.
d) Morphodifferentiation: At this stage, the shape of the teeth is determined. The

formative cells are arranged to outline the form and size of the tooth. This process occurs
before matrix deposition. The morphologic pattern of the tooth becomes established
when the inner enamel epithelium is arranged so that the boundary between it and the
odontoblasts outlines the future dentinoenamel junction.
So, if any disturbance happened what do you think the outcome will be?
Disturbances and aberrations in morphodifferentiation lead to abnormal forms and sizes
of teeth. Resulting conditions include peg-shape laterals, microdontia, macrodontia,
dens evaginatus.
e) Apposition: appositional growth is the result of a layer-like deposition of a non vital

extracellular secretion in the form of a tissue matrix. This matrix is deposited by the
formative cells, ameloblasts, and odontoblasts, which line up along the future
dentinoenamel and dentinocemental junction at the stage of morphodifferentiation.
These cells deposit the enamel and dentin matrix according to a definite pattern and at
a definite rate.
Any systemic disturbance or local trauma that injures the ameloblasts during enamel
formation can cause tin interruption or an arrest in matrix apposition, which results in
enamel hypoplasia. Hypoplasia of the dentin is less common than enamel hypoplasia
and occurs only after severe systemic disturbances.
f) Calcification: This process starts between 14 and 16 weeks of intrauterine life for
primary teeth. Calcification (mineralization) takes place following matrix deposition
and involves the precipitation of inorganic calcium salts within the deposited matrix.
The process begins with the precipitation of a small nidus, and further precipitation
occurs around it. The original nidus increases in size by the addition of concentric
laminations. There is an eventual approximation and fusion of these individual
calcospherites into a homogeneously mineralized layer of tissue matrix.
Notes:
 It begins in cusp tips and incisal edges of teeth and continues cervically.
 Very sensitive process that takes place over a long period.
 If the calcification process is disturbed, there is a lack of fusion of the
calcospherites. These deficiencies are not readily identified in the enamel, but in
the dentin, they are evident microscopically and are referred to as interglobular
dentin.
 Any disturbances during the period of pregnancy as early as 14 or 16 weeks in
utero might result in disturbances or anomalies in child’s teeth as soon as the
primary teeth erupt.
2. Eruption: includes two processes intrabony phase and intra oral phase. They take 5
years to be completed. The tooth emerge when 3/4 its root formation has occurred. The
tooth usually reaches the occlusal plane before its root development is completed, the
teeth of girls erupt earlier than that of boys. When the tooth is not fully formed its root
shape is funnel shaped.
3. Attrition: a physiological process characterized by wearing of a tooth during tooth-

to-tooth contact as in mastication. The surfaces involved are incisal, occlusal and
proximal. Basically attrition is an aging process and it continues throughout the life.
Importance of time eruption

1. For the dentist in the diagnosis and treatment plan.
2. For the dental epidemiologist.
3. For the physician, e.g. Malnutrition lead to delayed or retained primary teeth.
4. For the orthodontist e.g. ugly duckling stage.
5. For the psychologist e.g. mentally retarded patient and the importance of the replacing
the tooth or not.
6. For the forensic odontologist.
7. In the anthropologist.
Influence of premature loss of primary molars on eruption time of their successors

1. In children who lose primary molars at 4 or 5 years of age and before eruption of the
premolar teeth will be delayed.
2. If extraction of the primary molars occurs after the age of 5 years, there is a decrease
in the delay of premolar eruption.
3. At 8, 9 and 10 years of age, premolar eruption resulting from premature loss of
primary teeth is greatly accelerated.
Premature loss of teeth associated with systemic disease usually results from some
change in the immune system or connective tissue. The most common of these
conditions appears to be hypophosphatasia and early-onset periodontitis.

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Dr.

Ali Hadi Fahad PEDODONTICS LECTURE: 2

Development of teeth passes through the following stages:

B. Status of development at birth: the teeth are in different stages of development at

C. Development in the postnatal period: it shows completion of the crowns of all

d) Morphodifferentiation: At this stage, the shape of the teeth is determined. The

e) Apposition: appositional growth is the result of a layer-like deposition of a non vital

3. Attrition: a physiological process characterized by wearing of a tooth during tooth-

Importance of time eruption

Influence of premature loss of primary molars on eruption time of their successors

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