orofacial system ORAL MORPHOLOGY Ivo Klepáček, MD., PhD.

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1 ORAL MORPHOLOGY Saint Apollonia was one of a group of virgin martyrs who suffered in Alexandria during a local uprising against the Christians prior to the persecution of Decius. According to legend, her torture included having all of her teeth violently pulled out or shattered. For this reason, she is popularly regarded as the patroness of dentistry and those suffering from toothache or other dental problems. By Ivo Klepáček, MD., PhD.

2 OROFACIAL SYSTEM is mutually cooperating biological multifunctional ; its parts support and save each other CNS Muscles Joints fonation speech Teeth gnawing Jaws digestion Periodontium (parodontium)

3 Carcharodon carcharias Great white shark Galeocerdo Cuvieri Tiger shark Isurus oxyrinchus ˇSharp nose shark

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5 Bolk L: Das Gewicht der Zähne. Anat Anz 1925; 59: Multitubercular dimeric theory: Appearance of para teeth means řeseparation of tooth primordia from original multitubercular primordium?? Lodewijk 'Louis' Bolk ( ) Dutch anatomist (fetalization theory (neoteny)) Fully matured organism exhibits juvenile signs

6 TEETH DENTES tooth dens lat. odoús (ὀδoύς), odóntos (ὀδόντος) gr. (incisor, canine, premolar, molar (Y5 dryopithec formula )

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8 Signs of determination deciduous Med 1968 permanent

9 FDI Fedérale Dentaire Internationale ADA American Dental Association Adolph Zsigmondy (1816, ), Hungarian dentist and surgeon

10 M 1 + m IV B : M1+ m2+ 3+B+

11 Deciduous Permanent

12 Number Position Size Color Form (cusps. roots) Pulp cavity

13 Enamel Dentine Pulp Periodontium and cement

14 Enamel Prisms; interprismatic perikymata Hunter Schreger lines Retzius lines substance, crystals Clusters spindles Bulbs tufts Ameloblasts, matrix, fibers laminae

15 Tomes fiber Nexus, desmosomes, tight junctions Secretion Tomes fiber Ameloblast: Structure reabsorbtion Secretion and reabsorbtion during formation of the enamelic matrix

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17 Crossstriations Their diurnal rhytm appearance reflects variations in the rate of ameloblastic secretion) μm

18 Parazonia Diazonia

19 Enamel structure Crystals, prisms, interprismatic matrix (low and high molecules) Enamel prisms proceed surface obliquely or at right angles

20 Retzius bands, lines Hunter-Schreger Perikymata ridges, bands, lines grooves

21 Retzius Enamel lines striae About 7 crossstriations between Structural incremental lines from dentine-enamel neighbouring lines; junction to the surface appears in a rhytm of new production of enamel layer

22 Incremental lines Prismless enamel μm thickness deciduous μm thickness permanent highly mieralized Prismatic enamel

23 Surface enamel Aprismatic, cracks (10-15μm), pits (1-1.5μm), brochs (30-50μm), elevations, prism-end markings Highly mineralized Pits end of ameloblasts; Cracks appear where enamel deposition on top of small deposits of non-mineralisable debris late in development; focal holes loss of the cracks by abrasion; Brochs groups of crystals (mostly on premolars)

24 Tufts - contain non-amelogenin fraction and they are composed from residual matrix Spindles contain odontoblast processes missing during eruption?? Lamellae hypomineralised, contain non-matured prisms, saliva and oral debris 3-7-? μm 8-25 μm 3-7-? μm Enamel-dentine junction Tufts Spindles Laminae (lamellae) Features from the dentine to enamel

25 Preerupting cuticle Nasmyth membrane

26 Plaque

27 demineralization

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30 Dentine odontoblasts Following time of appearance: dentine tubules Retzius lines Primary vonebner Secondary Tertiary Following lcation in tooth: Mantle Circumpulpal Interdentin Globular Predentin Odontoblasts, matrix, fibers

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32 Dentine: structure and formation Outer layer Mantle dentine 10-30um; contains alpha-fibrills Inner dentine Circumpulpal dentine stripped; regular secretion and mineralization Predentin Amorphous; area of synthesis, polymorphous, contains proteoglycans, tropocollagen, glycoproteins

33 Dentine structure Mantle dentine Intermingling processes granular Circumpulpal dentine matrix rich Interdentine interglobular Predentine matrix poor odontoblasts

34 Lines Owen strips associated with curves of tubules Schreger lines

35 Lines Long period associated (Andresen) with lines (16-20 um) matrix deposition and mineralization Short period (von Ebner s) lines (2-4 um)

36 Dentine tubules Tomes fibres Naumann sheath

37 Dentine structure External coat Mantle dentine 10-30um; contains alfa-fibrills Inner dentine Circumpulpal dentine Stripped; exhibits regular secretion and mineralization layers Predentine Amorphous; area of synthesis; polymorphous, contains proteoglycans, tropocollagen, glycoproteins

38 Hypomineralized and matrix rich Tomes s interglobular layer Czermak lacunae

39 Calcospherits - round or ball-like objects Mostly appear in the inner layer of circumpulpal dentin

40 Neonatal Incremental lines line (associated with dentine Mineralizing maturation) in birth Von Ebner Adresen Neonatal Relation between primary and secondary dentine

41 Fluid movement odontoblast processess and nerves in the dentine Influence sensitivity

42 Hypersensitive area Hyposensitive area

43 Primary dentine Secondary dentine

44 Translucent dentine (Tubules are occluded with peritubular dentine)

45 Tertiary dentine Trauma, caries, attrition, microleakage, cavity restoration causes hypermineralization

46 Reactive dentine Response for insult Reparative dentine Relates to stimulus in which newly formed tissues formed by new cells Sclerotic Dentine Response for ageing

47 Dentinogenesis imperfecta

48 Gravity Hardness Stiffness Comprehensive strength Tensile strtength Enamel X dentine

49 Cementum Cementoblasts, mucoprotein Cellulare: substance, fibers Collagen fibers + intercellulare substance + cementocytes Non cellulare: Collagen fibers + intercellular substance

50 Relation between cementum, dentine and enamel

51 Acellular cementum arrangement acellular cellular

52 Berkowitz, Holland, Moxham: Oral anatomy, histology and embryology Mosby

53 Resorption of cementum

54 Hypercementosis

55 Pulp Odontoblasts, Weil subodontoblastic layer Layer rich by nuclei ramification fibroblasts Pulpocytes (mesenchymal cells, fibrocytes) basic substance (collagen fibers, sugars, elastic fibers) free cells (histiocytes, monocytes, plasmatic cells)

56 Raschkow plexus Cell contacts Nerve fibers with vesels Bipolar pulpocyte

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58 Upper view on the teeth: pulp cavity shapes pink areas; enters to root pulp pink spots

59 incorrect correct

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61 Immune activity

62 Exchange of ionts between external environment and pulp

63 Testing drawings

64 Arches parabolic hyperbolic

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66 Contacts between antagonic teeth Occlusal compass

67 Angle classification: normoocclusion

68 Aposition Resorbtion Bodily shift - + Mesial shift

69 Edward Hartley Angle ( ) an American dentist, widely regarded as the father of modern orthodontics.

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71 Spee curve Wilson curve

72 frontal lateral

73 Central occlusion Central relation

74 overjet overbite

75 Teeth as a whole complex mordex = dentition ortodental position (vertical axes of teeth) articulation = occlusion 80% psalidodontia (scissor-like occlusion) = norm progenia = lower teeth in front of the upper ones (hiatodontia (= mordex apertus), stegodontia, prognathia, opisthodontia)

76 Variations and anomalies Mesiodens Paramolar Tuberculum Carabelli Divergention or convergention of roots Fusion of roots Intradental location of tooth (dens in dente) Root hyperplasia

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79 lines giving angle between axes of both the molars yellow Mesiodistal crown width of M3 red Occlusal plane green Space for extraction - blue Lines important for evaluation of the extraction procedure

80 wedge from contact form Abrasion VII classes to palate to tongue

81 ? Tooth development = Odontogenesis? Oral ectoderm Mesoderm mesenchym (ectomesenchym or Neural crest cells mesectoderm) Enamel develops from ectoderm Other tissues from mesenchyme

82 SOUKUP, V. & ČERNÝ, R. (2007):Oral presentation Orální morfogeneze axolotla a první evidence vzniku zubů z entodermu u čelistnatců. Přednáška (V.S.) na konferenci Zoologické dny Brno 2007, V. Soukup, H. Epperlein, I. Horacek and R. Cerny, Dual epithelial origin of vertebrate oral teeth, Nature 455 (2008), pp CERNY, R & SOUKUP, V. (2009): Oral presentation The origin of a dental regulatory network and the evolution of teeth. Morphology 2009, 45th International Congress on Anatomy and 45th Lojda Symposium on Histochemistry, Plzeň, Combined transplantation, based on labelled tissues: Transgenic ( green ectoderm, containing protein GFP) axolotle Mexic axolotle ( red endoderm) Potency to develop teeth relates to mesenchyme (neural crest cells order to epithelium: make tooth). In the case when above host endoderm lies donor ectoderm, tooth primordium develops from ectoderm and vice versa. New theory???: mesenchym is a source of signals ordering to tissues: make tooth, as well as a material for most of tooth parts.!!

83 Relax position Second position The similar demand produces functional adaptation - even on-tooth tissues develop teeth-like structures

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85 Tooth development week 6 development of the dental lamina (dental molding) Thick epithelium inside oralmucous membrane Each molding has about 10 center of the proliferations Dental buds

86 Enamel and dentin apposition Eruption Dental lamina Bell stage Fully erupted tooth Bud stage

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88 Tooth developmental stages Dental bud (hat) bell External dental organ Dental reticulum Inner dental organ Dental papilla dental pulp Dentl sac cementum, periodontal ligaments week 10

89 Tooth developmental stages month 3 Epithelial dental sheath (cervical sling) Area of the contact between inner and outer enamelic epithelium Ingrowth to the mesenchyme; root induction

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91 month 6

92 M 3 position (I. developmental stage) in the right part of mandible Scheme where development of the M 3 is shown (Kominek and Rozkovcova classification)

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94 Eruption

95 Enhancement of occlusion through gradual eruption of teeth I. Enhancement of occlusion II. Enhancement of occlusion Year 1 Year 6 Year 7 ^ Ash, M. M. and Stanley J. Nelson, S. J.: Dental Anatomy, Physiology, and Occlusion. 8th edition III. Enhancement of occlusion

96 Distance between oppostie teeth Pillar teeth

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100 Sources Berkowitz et al.: Oral Anatomy, Histology and Embryology. 3 rd ed.. Mosby 2002 Woelfel, Scheid: Dental Anatomy, 6 th ed. Williams & Wilkins, 2002 Feneis, Dauber: Pocket Atlas of Human Anatomy. Georg Thieme, 2007 Weber: Memorix Zahnmedizin. 2 nd. ed., Georg Thieme Verlag 2003 Schuenke,Schulte,Schumacher: Head and Neuroanatomy. Thieme, 2006 Fehrenbach,Herring: Anatomy of the Head and Neck. 3 rd ed., Saunders Elsevier, 2007 Snell: Clinical Anatomy for Medical Students. Williams and Wilkins, 2004 Moore, Agur: Essential Clinical Anatomy, Williams and Wilkins 2002 Lang: Clinical Anatomy of the Masticatory Apparatus and Peripharyngeal Spaces. Stuttgart, Thieme, 1995 White, Pharoah: Oral Radiology: Principles and Interpretation 5 th ed., Mosby, 2003 Bath-Balogh: Workbook for Illustrated Dental Embryology, Histology and Anatomy. 2 nd ed. 2005, Saunders Whaites: Essentials of Dental Radiography and Radiology. 4 th ed., 2006 Churchill Livingstone Ivo Klepáček, J. Mazánek et al.: Klinická anatomie ve stomatologii. Grada 2002 Own archive see: or: