oral orofacial morphology - univerzita karlovaanat.lf1.cuni.cz/souhrny/ofa_a1.pdf · morphology...
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ORAL MORPHOLOGY
By
Ivo Klepáček, MD., PhD.
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 tortureincluded 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.
orofacial system
OROFACIAL SYSTEMis mutually cooperating biological
multifunctional system; its parts support and save each other
CNSMuscles Joints
Teeth Jaws
Periodontium (parodontium)
fonationspeechgnawingdigestion
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Carcharodon carcharias
Galeocerdo Cuvieri
Isurus oxyrinchus
Great white shark
Tiger shark
ˇSharp nose´shark
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Lodewijk 'Louis' Bolk (1866 – 1930) Dutch anatomist(fetalization theory (neoteny))
Bolk L: Das Gewicht der Zähne. Anat Anz 1925; 59:572-574.
Multitubercular dimeric theory: Appearance of ´para teeth´ means ře-separation of tooth primordia from original multitubercular primordium ??
Fully matured organism exhibits juvenile signs
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TEETH
tooth dens lat.
odoús (ὀδoύς), odóntos (ὀδόντος) gr.
DENTES
(incisor, canine, premolar, molar
(Y5 “dryopithec“ formula )
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deciduouspermanent
Signs of determination
Med 1968
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FDIFedérale Dentaire Internationale
ADAAmerican Dental AssociationAdolph Zsigmondy (1816, - 1880), Hungarian dentist and surgeon
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M1+ m1+ 6| IV| 16 54 3 B
: M1+ m2+ 3+B+
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Deciduous
Permanentorofacial system
NumberPositionSizeColorForm (cusps. roots)Pulp cavity
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EnamelDentinePulpPeriodontium and cement
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Enamel Hunter Schreger lines
Retzius lines
Clustersspindles
Ameloblasts, matrix, fibersBulbs tufts
laminae
perikymata
Prisms; interprismatic
substance, crystalsorofacial system
Ameloblast: Structure
Secretion and reabsorbtion during formation of the enamelic matrix
Tomes fiber
Secretion
Tomes fiber
reabsorbtion
Nexus , desmosomes, tight junctions
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Cross-striationsTheir diurnal rhytm appearance reflects
variations in the rate of ameloblastic secretion)
2.5-6 μm
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ParazoniaDiazonia
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Enamel structureCrystals, prisms, interprismatic matrix (low and high molecules)
Enamel prisms proceed surface obliquely or at right angles
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Hunter-Schreger bands, lines
Retzius bands, lines
Perikymata ridges, grooves
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Enamel striae
Structural incremental lines from dentine-enamel
junction to the surface
Retzius lines
About 7 cross-striations between neighbouring lines; appears in a rhytm of new production of enamel layerorofacial system
Prismless enamel20-100 μm thickness deciduous20-70 μm thickness permanenthighly mieralized
Prismatic enamel
Incremental lines
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Surface enamelAprismatic, 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)
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Tufts Spindles Laminae (lamellae) Features from the dentine to enamel
Enamel-dentine junction
8-25 μm
Tufts - contain non-amelogenin fraction and they are composed from residual matrixSpindles – contain odontoblast processes missing during eruption??Lamellae – hypomineralised, contain non-matured prisms, saliva and oral debris
3-7-? μm3-7-? μm
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Preerupting cuticleNasmyth membraneorofacial
system
Plaque
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demineralization
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Dentine odontoblasts
dentine tubules
Retzius linesvonEbner
Following time of appearance:
PrimarySecondaryTertiary
Following lcation in tooth:
MantleCircumpulpalInterdentinGlobularPredentin
Odontoblasts, matrix, fibers
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Dentine: structure and formationOuter layerMantle dentine
Inner dentineCircumpulpal dentine
Predentin
10-30um; contains alpha-fibrills
stripped; regular secretion and mineralization
Amorphous; area of synthesis, polymorphous, contains proteoglycans, tropocollagen, glycoproteins
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Mantle dentineIntermingling processesgranular
Circumpulpal dentinematrix rich
Interdentine interglobular
Predentinematrix poor
odontoblasts
Dentine structure
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Owenstrips
Schregerlines
Lines associated
with curves of tubulesorofacial
system
Long period (Andresen)
lines (16-20 um)
Lines associated
with matrix
depositionand
mineralizationShort period (von Ebner´s) lines (2-4 um)
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Dentine tubulesTomes fibresNaumann sheath
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Dentine structureExternal coatMantle dentine
Inner dentineCircumpulpal dentine
Predentine
10-30um; contains alfa-fibrills
Stripped; exhibits regular secretion and mineralization layers
Amorphous; area of synthesis; polymorphous, contains proteoglycans, tropocollagen, glycoproteins
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Hypomineralized and
matrix rich
Tomes´s interglobular layerCzermak lacunae
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Calcospherits - round or ball-like objectsMostly appear in the inner layer of circumpulpal dentin
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Neonatal line
Incremental lines(associated with dentine maturation) Von EbnerAdresenNeonatalRelation between primary and secondary dentine
Mineralizing in birth
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Fluid movement odontoblast processess and nerves in the dentineInfluence sensitivityorofacial
system
Hypersensitive area Hyposensitive area
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Primary dentine
Secondary dentine
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Translucent dentine
(Tubules are occluded with
peritubular dentine)
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Tertiary dentine
Trauma, caries, attrition, microleakage, cavity restoration causes hypermineralization
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ReactivedentineResponse for insult
ReparativedentineRelates to stimulus in whichnewly formed tissuesformed by new cells
ScleroticDentineResponse for ageing
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Dentinogenesis imperfecta
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GravityHardnessStiffnessComprehensive strengthTensile strtength
EnamelXdentine
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CementumCementoblasts, mucoprotein substance, fibers
Cellulare:Collagen fibers + intercellulare substance + cementocytes
Non cellulare:Collagen fibers + intercellular substance
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Relation between cementum, dentine and enamel
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cellular
acellular
Acellular cementum arrangement
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Berkowitz, Holland, Moxham: Oral anatomy, histology and embryology. 2002 Mosby
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Resorption of cementumorofacial system
Hypercementosis
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Pulp
fibroblasts
ramification
•Odontoblasts,•Weil subodontoblastic layer•Layer rich by nuclei
Pulpocytes (mesenchymal cells, fibrocytes)basic substance (collagen fibers, sugars, elastic fibers)free cells (histiocytes, monocytes, plasmatic cells)
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Raschkow plexus
Nerve fiberswith vesels
Cell contacts
Bipolar pulpocyte
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Upper view on the teeth: pulp cavity shapes –pink areas; enters to root pulp pink spotsorofacial system
incorrect
correct
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Immune activity
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Exchange of ionts between external environment and pulporofacial system
Testing drawings
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Arches
parabolic
hyperbolic
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Contacts between antagonic teeth
Occlusal “compass“
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Angle classification: normoocclusion
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Bodily shift
Mesial shift
Resorbtion-
Aposition+
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Edward Hartley Angle (1855 – 1930) an American dentist , widely regarded as the father of modern orthodontics .
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Wilson curve
Spee curveorofacial system
frontal
lateral
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Central occlusion
Central relation
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overjet overbite
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Teeth as a whole complexmordex = 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)
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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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Lines important
for evaluation of the
extraction procedure
lines giving angle between axes of both the molars –yellow Mesiodistal crown width of M3 – redOcclusal plane – greenSpace for extraction - blueorofacial system
“to palate““to tongue“
“wedge from“
“contact form“
AbrasionVII classes
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? Tooth development = Odontogenesis ?
mesenchym(ectomesenchym or mesectoderm)
• Oral ectoderm• Mesoderm• Neural crest cells
Enamel develops from ectodermOther tissues from mesenchyme
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SOUKUP, V. & ČERNÝ, R. (2007):Oral presentationOrální morfogeneze axolotla a první evidence vzniku zubů z entodermu u čelistnatců. Přednáška (V.S.) na konferenci Zoologické dny Brno 2007, 8.-9. 2. 2007.
CERNY, R & SOUKUP, V. (2009): Oral presentationThe 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, 7.-9. 9.
V. Soukup, H. Epperlein, I. Horacek and R. Cerny, Dual epithelial origin of vertebrate oral teeth, Nature 455 (2008), pp. 795–796.
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.!!
Combined transplantation, based on labelled tissues:Transgenic (´green´ ectoderm , containing protein GFP) axolotle
Mexic axolotle (´red´ endoderm)
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Second position
The similar demand “produces“ functional adaptation -
even “on-tooth“ tissues develop teeth-like structures
Relax position
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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
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Bell stage
Enamel and dentin apposition
Eruption
Fully erupted tooth
Bud stage
Dental laminaorofacial system
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• Dental bud (hat) → bell– External dental organ– Dental reticulum– Inner dental organ– Dental papilla → dental pulp– Dentl sac → cementum, periodontal ligaments
Tooth developmental stages
week 10
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• Epithelial dental sheath(cervical sling)– Area of the contact between
inner and outer enamelicepithelium
– Ingrowth to the mesenchyme; root induction
Tooth developmental stagesmonth 3 orofacial
system
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month 6
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M3 position (I. developmental stage) in the right part of mandible
Scheme where development of the M3 is shown (Kominek and Rozkovcova classification)
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Eruption
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I.
II.
III.
´Enhancement of occlusion´through gradual eruption of teeth
^ Ash, M. M. and Stanley J. Nelson, S. J.: Dental
Anatomy, Physiology, and Occlusion. 8th edition. 2003
Enhancementof occlusion
Enhancementof occlusion
Enhancementof occlusion
Year 1
Year 6
Year 7
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Distance betweenoppostie teeth
Pillar teethorofacial system
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END
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Berkowitz et al.: Oral Anatomy, Histology and Embryology. 3rd ed.. Mosby 2002Woelfel, Scheid: Dental Anatomy, 6th ed. Williams & Wilkins, 2002Feneis, Dauber: Pocket Atlas of Human Anatomy. Georg Thieme, 2007Weber: Memorix Zahnmedizin. 2nd. ed., Georg Thieme Verlag 2003Schuenke,Schulte,Schumacher: Head and Neuroanatomy. Thieme, 2006Fehrenbach,Herring: Anatomy of the Head and Neck. 3rd ed., Saunders Elsevier, 2007Snell: Clinical Anatomy for Medical Students. Williams and Wilkins, 2004 Moore, Agur: Essential Clinical Anatomy, Williams and Wilkins 2002Lang: Clinical Anatomy of the Masticatory Apparatus and Peripharyngeal Spaces. Stuttgart, Thieme, 1995White, Pharoah: Oral Radiology: Principles and Interpretation 5th ed., Mosby, 2003Bath-Balogh: Workbook for Illustrated Dental Embryology, Histology and Anatomy. 2nd
ed. 2005, SaundersWhaites: Essentials of Dental Radiography and Radiology. 4th ed., 2006Churchill LivingstoneIvo Klepáček, J. Mazánek et al.: Klinická anatomie ve stomatologii. Grada 2002Own archive
see: www.lf1.cuni.czor: http://anat.lf1.cuni.cz/aindex.html
Sources
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