7

CHAPTER

Enamel

Overview 92
OVERVIEW
Physical properties 93
Enamel, the hard protective substance that covers the crown
Rod structure 93
of the tooth, is the hardest biologic tissue in the body. It con-
Incremental lines 95 sequently is able to resist fractures during the stress of masti-
Enamel lamellae 96 cation. Enamel provides shape and contour to the crowns of
teeth and covers the part of the tooth that is exposed to the oral
Enamel tufts 96 environment.
Enamel spindles 96 Enamel is composed of interlocking rods that resist mas-
ticatory forces. Enamel rods are deposited in a keyhole
Surface characteristics 97 shape by the formative ameloblastic cells. Groups of amelo-
Permeability 98 blasts migrate peripherally from the dentinoenamel junction
as they form these rods. Ameloblasts take variable paths,
Etching 99 which produces a bending of the rods. These cells maintain
Self-evaluation questions 100 a relationship as they travel in different directions and pro-
duce adjacent rods. The enamel rod configuration viewed in
Consider the patient discussion 100
incidental light appears as light and dark bands of rod
Suggested reading 100 groups termed Hunter-Schreger bands. Because these rods
bend in an exaggerated, twisted manner at the cusp tips, they
are called gnarled enamel.
All enamel rods are deposited at a daily appositional rate
or increment of 4 !m. Such increments are noticeable, like
rings in a cross section of a tree, and appear as dark lines
known as striae of Retzius or lines of Retzius. The growth
Learning Objectives lines become apparent on the surface of enamel as ridges,
■ Describe the physical features of enamel such as the
known as perikymata. Two structures are noticeable at the
structure of the enamel rods, incremental lines, lamellae,
dentinoenamel junction: spindles, the termination of the
tufts, and spindles.
dentinal tubules in enamel, and tufts, hypocalcified zones
■ Discuss how these affect the permeability of enamel.
caused by the bending of adjacent groups of rods.
■ Discuss the surface characteristics and the etching of
Because enamel is composed of bending rods, which in
enamel.
turn are composed of crystals, minute spaces or gaps exist
where crystals did not form between rods. This feature causes
enamel to be variable in its density and hardness. Therefore
some areas of enamel may be more prone to penetration by
small particles. This characteristic leads to tooth destruction
by dental caries. After enamel is completely formed, no more
enamel can be deposited.
Key Terms

Enamelin Perikymata
Gnarled enamel Prismless enamel
Hunter-Schreger bands Spindles CLINICAL COMMENT
Hydroxyapatite Striae of Retzius
Imbrication lines Tufts
Perikymata are surface manifestations of the incremental lines
Lines of Retzius usually found at the cervix of the crown. Some perikymata are
Microlamellae more prominent and present difficulties to the novice clinician,
92 Neonatal line who may confuse them with calculus.
 ENAMEL 7
PHYSICAL PROPERTIES
Mineral orientation in rods
Because enamel is very hard, it is also brittle and subject
to fracture. Fracture is especially likely to occur if the un-
derlying dentin is carious and has weakened the enamel’s
foundation. Head
Enamel is about 96% inorganic mineral in the form of of rod
hydroxyapatite and 4% water and organic matter. Hydroxy-
apatite is a crystalline calcium phosphate that is also found in Tail
bone, dentin, and cementum. The organic component of of rod
enamel is the protein enamelin, which is similar to the protein
keratin that is found in the skin. The distribution of enamelin
between and on the crystals aids enamel permeability. Enamel
is grayish white but appears slightly yellow because it is trans-
lucent, and the underlying dentin is yellowish. Enamel ranges
in thickness from a knifelike edge at its cervical margin to
about 2.5 mm maximum thickness over the occlusal incisal
surface. Fig. 7.2 Diagram showing outline of six-sided ameloblasts
overlying keyhole-shaped enamel rods. Parts of four cells
form each enamel rod. Crystal orientation of three rods can be
ROD STRUCTURE seen on the right side of the model. (From Avery JK: Oral devel-
opment and histology, ed 3, Stuttgart, 2002, Thieme Medical.)
Enamel is composed of rods that extend from their site of
origin, at the dentinoenamel junction, to the enamel outer
surface (Fig. 7-1 ). Each rod is formed by four ameloblasts. ameloblast in contact with the forming keyhole- or racquet-
One ameloblast forms the rod head; a part of two ameloblasts shaped rod, which is columnar in its long axis. The head of the
forms the neck; and the tail is formed by a fourth ameloblast. enamel rod is the broadest part at 5 !m wide, and the elon-
Fig. 7-2 shows the six-sided design that is the shape of the gated thinner portion, or tail, is about 1 !m wide. The rod,
including both head and tail, is 9 !m long. The enamel rod is
about the same size as a red blood cell (Fig. 7-3 ).
Each rod is filled with crystals. Those in the head follow
CLINICAL COMMENT the long axis of the rod, and those in the tail lie in the cross
axis to the head (Figs. 7-4 and 7-5 ). The upper right rod head
Although enamel is the hardest tissue in the human body, it is of Fig. 7-4 indicates how the mineral is oriented during the
permeable to some fluids, bacteria, and bacterial products of
rod’s development, which forms the rod head and tail as seen
the oral cavity. Enamel exhibits cracks, checks, and micro-
scopic spaces within and between rods and crystals, allowing
on the left side of the figure. The architecture of the mineral
penetration. orientation is complex, especially when viewed in any direc-
tion other than cross section (see Fig. 7-5).

Dentinoenamel
junction Enamel
rods

Enamel
rod unit

Fig. 7.1 Enamel rods appear wavy in section of enamel

as they extend from the dentinoenamel junction on the left
to the enamel surface on the right. This figure is possible Fig. 7.3 One rod is pulled out to illustrate how individual
because the section is etched and viewed with a scanning enamel rods interdigitate with neighboring rods. (From Avery
electron microscope. (From Avery JK: Oral development and JK: Oral development and histology, ed 3, Stuttgart, 2002,
histology, ed 3, Stuttgart, 2002, Thieme Medical.) Thieme Medical.) 93
7 ESSENTIALS OF ORAL HISTOLOGY AND EMBRYOLOGY

Rods form nearly perpendicular to the dentinoenamel junction

and curve slightly toward the cusp tip. This unique rod arrange-
ment also undulates throughout the enamel to the surface. Each
rod interdigitates with its neighbor, the head of one rod nestling
against the necks of the rods to its left and right (see Fig. 7-3).
The rods run almost perpendicular to the enamel surface at the
cervical region but are gnarled and intertwined near the cusp tips
(Fig. 7-6 ). The surface of each rod is known as the rod sheath,
and the center is the core. The rod sheath contains slightly more
organic matter than the rod core (Fig. 7-7).
Rod head
Groups of rods bend to the right or left at a slightly different
angle than do adjacent groups (see Fig. 7-6). It is believed that
this feature provides the enamel with strength for mastication
and biting. When light is projected at the surface of a thin slab
of enamel, light and dark bands appear. These bands are seen
Rod tail because the light transmits along the long axis of one group of
rods but not along the adjacent rods, which lie at right angles.
This is known as the Hunter-Schreger bands phenomenon
(Fig. 7-8 ). These bands are named after the dental scientist
Fig. 7.4 The left side of the diagram shows orientation who first noted the Schreger band effect microscopically, John
of crystals in the forming rod head and tail. The right part
Hunter. The repeating pattern from the cervical area to the
shows how forming crystals pack in the rod from the cell
complex (arrows).
incisal or occlusal areas can be seen along the long axis of
the tooth. Hunter-Schreger bands extend through one half to
two thirds of the thickness of enamel as shown in Fig. 7-6
(diagram) and Fig. 7-8 (a tooth section).
CLINICAL COMMENT

Enamel rods interlock to prevent fracture and splitting of the  CONSIDER THE PATIENT
tooth. Enamel rod groups also intertwine, thereby preventing
separation. The rod direction in the crown is normally perpen- A patient has attrition of cusp tips in the enamel of the crowns.
dicular to the incisal surface, which provides additional support What do you expect when you look at the root length radio-
in preventing fracture. graphically? Why would you see this?

Crystals
Interrod

Rod

Rod

Crystals

Interrod

0.1 µm
A B

Fig. 7.5 Orientation of enamel crystals in mature enamel as seen in this transmission electron micrograph of a sagittal section at low
94 (A) and high (B) magnification. (From Nanci A: Ten Cate’s oral histology, ed 8, St. Louis, 2013, Mosby.)
 ENAMEL 7
Gnarled enamel

Outer Cross-sectional
prism-free rods
zone
Longitudinal
rods

Alternating
Hunter-Schreger
bands

Fig. 7.6 Diagram of enamel rod orientation as shown in

both longitudinal and cross section of the crown. Enamel rods Fig. 7.8 Photomicrograph of enamel taken by reflected light
are intertwined at the cusp tip; this is called gnarled enamel. and illustrating phenomena of light and dark (Hunter-Schreger)
Groups of outer enamel rods all run nearly perpendicular to the bands.
surface of the enamel, whereas inner groups of enamel rods
alternate. Some appear in cross section, and adjacent groups
appear longitudinal. (Modified from Avery JK: Oral development
and histology, ed 3, Stuttgart, 2002, Thieme Medical.) INCREMENTAL LINES
The incremental lines in enamel are the result of the rhythmic
recurrent deposition of the enamel. As the enamel matrix min-
eralizes, it follows the pattern of matrix deposition and provides
Head Tail the growth lines in enamel (Fig. 7-9 ). These lines may be
accentuated because of a variation in the mineral deposited at
the point of enamel hesitation in deposition. In some cases, the
Enamel rod incremental lines are not visible. With enamel development, a
row of ameloblasts covering the crown hesitates during deposi-
Neck tion. These hesitation lines mark the path of amelogenesis. The
spaces between the crystals entrap air molecules, accentuating
Rod sheath these lines. Dr. Retzius, who first noted these “growth lines,”
termed them the striae of Retzius.
Rod core Part of the enamel of most deciduous teeth is formed before
birth, and part is formed after birth. Because environment and
nutrition change abruptly at the time of birth, a notable line of
Retzius occurs at that time. This is known as the neonatal line
(Fig. 7-10 ). Although the neonatal line is an accentuated incremen-
Fig. 7.7 Enamel rods in cross section. Each rod has a tal line, it can be seen microscopically that this line is prominent
sheath and core. The rod sheath surrounds rod head and tail. for another reason. The enamel internal to this line is of a different
This enamel sample has been etched to reveal organic matrix. consistency from that external to it because it was formed before
birth, and the external was formed after birth. The prenatal enamel
has fewer defects than the postnatal. The staining of the postnatal
enamel has numerous minute spaces that are stained with pigment.
CLINICAL COMMENT
CLINICAL COMMENT
The rods that form enamel are woven during formation into a
mass that resists average masticatory impact of 20 to 30 pounds Enamel is composed of mineral crystals that are the same as
per tooth. Enamel is thin in the cervical areas where masticatory those found in dentin, cementum, and bone. Unlike bone and
impact is the least and thickest over the areas of crown cusps cementum, the mineral crystals in enamel are not replaced once
where impact is greatest. deposited in enamel. 95
7 ESSENTIALS OF ORAL HISTOLOGY AND EMBRYOLOGY

Incremental
line

Fig. 7.9 Photomicrograph of

dentinoenamel junction showing Spindles
dentin below and enamel above
this junction. Enamel exhibits
incremental lines, tufts, spindles, Dentinoenamel
and lamella. Within dentin, a band junction
of primary dentin is just below the Lamella
dentinoenamel junction. At the Interglobular
lower border of this band of spaces
Tufts
primary dentin is a row of
interglobular spaces.

Enamel
Postnatal

Prenatal

Fig. 7.10 Photomicrograph of section of enamel

and dentin of primary tooth by transmitted light.
The neonatal line is at the point of the arrow. Enamel
to the left of this line is a darker stain than enamel
to the right of it. The enamel formed before birth is
less pigmented and has fewer defects than postnatal Dentin
enamel. Dentin exhibits numerous dead tracts as dark
lines. Dead tracts are tubules filled with air; hence,
they appear black in transmitted light.

ENAMEL LAMELLAE ENAMEL TUFTS

Enamel lamellae are cracks in the surface of enamel that are Enamel tufts are another developmental defect in enamel filled
visible to the naked eye (see Fig. 7-9 and Fig. 7-11). Lamellae with organic material. They are located at the dentinoenamel
extend from the surface of enamel toward the dentinoenamel junction and appear at right angles to it. They can extend one
junction. Some lamellae form during enamel development, fifth to one tenth of the distance from the dentinoenamel junc-
creating an organic pathway or tract. Spaces between groups tion to the occlusal surface of the tooth (Figs. 7-12 and 7-13).
of rods are another example of lamellae and may be caused by Tufts form between groups of enamel rods, which are oriented
stress cracks that occur because of impact or temperature in slightly different directions at the dentinoenamel junction.
changes. Breathing cold air or drinking hot or cold beverages These spaces are thus developed between adjacent groups
may cause small checks to occur in enamel, especially enamel of rods, which are filled with organic material termed ename-
weakened by underlying caries. Lamellae are not tubular lin. The interface of the junction of dentin and enamel is
defects but appear leaflike, extending around the crown (see scalloped, and often tufts arise from these scalloped peaks (see
Fig. 7-11). Lamellae are a possible avenue for dental caries. Fig. 7-12).

CLINICAL COMMENT ENAMEL SPINDLES

Spindles arise at the dentinoenamel junction and extend into
Temperature changes from breathing cold air or drinking hot or
cold beverages may cause small checks or cracks to develop in
enamel. These spindles are extensions of dentinal tubules
enamel. This is especially evident in enamel weakened by under- that pass through the junction into enamel (see Fig. 7-13).
96 lying caries but can also appear in otherwise normal enamel. Because dentin forms before enamel, the odontoblastic pro-
cess occasionally penetrates the junction, and enamel forms
 ENAMEL 7

Lamella
Fig. 7.11 Enamel lamellae. A, Diagram of possible
location of leaflike enamel lamellae extending from the
cervical to incisal enamel. B, Scanning electron micro-
graph of lamellae in enamel. (Enamel was decalcified
away, and lamellar space was impregnated with resin
for its maintenance.) (Modified from Avery JK: Oral
development and histology, ed 3, Stuttgart, 2002,
Thieme Medical.) A B

Fig. 7.12 Transmitted light micrograph

of the dentinoenamel junction area showing
enamel tufts. In addition to tufts, scalloped Enamel tufts
dentinoenamel junction and fine enamel rod
structure can be seen between tufts. Below the Dentinoenamel
junction
junction are dentinal tubules. (From Avery JK:
Oral development and histology, ed 3, Stuttgart,
2002, Thieme Medical.) Dentin

Enamel
spindles

Dentinoenamel
junction

Fig. 7.13 Enamel spindles at the dentino

enamel junction are extensions of dentinal tubules
that may contain odontoblastic processes in
enamel. (From Avery JK: Oral development and
histology, ed 3, Stuttgart, 2002, Thieme Medical.)

around this process, forming a tubule. These small tubules

may contain a living process of the odontoblast, possibly con- SURFACE CHARACTERISTICS
tributing to the vitality of the dentinoenamel junction. Tubules
are found singularly or in groups and are shorter than tufts, The enamel surface may be smooth or have fine ridges. Such
only a few millimeters in length. The fingerlike spindles ap- ridges result from the termination of the striae of Retzius on the
97
pear quite different than the broader and longer tufts. surface of enamel (Fig. 7-14 ). These surface manifestations are
7 ESSENTIALS OF ORAL HISTOLOGY AND EMBRYOLOGY

PERMEABILITY
Enamel permeability is a feature of clinical importance. The
passage of fluid, bacteria, and bacterial products through
enamel is an important consideration in clinical therapy. Per-
meability of enamel is caused by several factors, some of
which are evident as they relate to leakage around faulty res-
torations and decomposition of the tooth by dental caries.
These latter examples need no further explanation, but fluid
and fine particles can also pass through unbroken enamel by
way of pathways described previously in this chapter, such as
lamellae, cracks, tufts, and spindles. These all contribute to
the microporosity of enamel. The minute spaces between or
around enamel rods and through crystal spaces within rods
are also important and are called microlamellae. Differences
Fig. 7.14 Fine ridges on the enamel surface of the crown are in crystal orientation can cause enamel to have minute spaces,
perikymata or imbrication lines. (From Avery JK: Oral develop- which can be seen at high magnification (Fig. 7-16 ). Also,
ment and histology, ed 3, Stuttgart, 2002, Thieme Medical.) surface irregularities, such as those found in central fissures
and near the cervical region, are important in influencing
permeability.
ridges called perikymata or imbrication lines. Perikymata are Enamel and dentin are both composed of hydroxyapatite
produced by the ends of rod groups accentuated by hesitation of crystals, although the crystals in enamel are about 30 times
ameloblasts before the next group of rods contact the enamel larger than those in dentin (Fig. 7-17). Crystal size is a factor
surface (Fig. 7-15 ). This manifestation is more prominent on in the extreme hardness of enamel in contrast to dentin.
the facial surface of the tooth, near the cervical region (see
Fig. 7-14). Another feature of outer enamel near its surface is the
zone of prismless enamel, which is 20 to 40 !m thick.
Throughout this zone, no Schreger band effect is noted. This
zone is not accentuated except near the cervical region and in CLINICAL COMMENT
deciduous teeth. The prismless zone of enamel is important be-
cause it appears as a structureless microcrystalline environment Decalcifying agents such as lemon juice and sodas can remove
of enamel rods oriented nearly perpendicular to the enamel the mineral from the surface of the enamel crystals. However, the
surface. This enhances the integrity of the enamel surface and various constituents of saliva, including calcium and phosphate,
should be recognized when a bevel for restorations is prepared. help to maintain the integrity of the enamel surface.

CLINICAL COMMENT

When caries has spread from the tooth’s surface to near the denti-
noenamel junction, the hypocalcified tufts allow a lateral spread
along this junction. Other hypocalcified structures in enamel such as
lamellae and incremental lines can also modify the spread of caries.

Fig. 7.15 Scanning electron micrograph of perikymata in Fig. 7.16 Transmission electron micrograph of a cross sec-
Fig. 7-14 at a much higher magnification, which shows alter- tion of enamel rods that shows differences in rod sheath and
nating ridges and valleys. (From Avery JK: Oral development rod core crystal orientation. (From Avery JK: Oral development
and histology, ed 3, Stuttgart, 2002, Thieme Medical.) and histology, ed 3, Stuttgart, 2002, Thieme Medical.)
98
 ENAMEL 7
Rod sheath

Rod core

Enamel

Fig. 7.18 Acid-etched enamel rod core dissolved to greater

extent than rod sheath, which provides for attachment of sealant.

Enamel
crystal Partially dissolved
enamel crystal

Dentin

Plastic resin infiltrates

A B around and into crystals
Fig. 7.17 Dentinoenamel junction. Enamel is above and
dentin below. Crystallites of enamel and dentin are different
in size and orientation. Whereas crystals of human enamel
may be 90 nm (900 Å) in width and 0.5 !m in length, those of
dentin are only 3 nm (30 Å) in width and 100 nm (1000 Å) in
length. Crystals of dentin are similar in size to bone. (Electron
micrograph " 35,000.)

CLINICAL COMMENT

Some etched areas of enamel can be remineralized by solutions

of sodium fluoride or stannous fluoride. Tests show that the fluo-
ride ion penetrates the porous etched surface enamel. Low levels
of fluoride stimulate remineralization. C
Fig. 7.19 A, Intact enamel crystal. B, Loss of crystal core
in acid-etched enamel. C, Demineralized enamel crystals.
Medium-toned areas show plastic replacing enamel, lightest
ETCHING areas are dissolved crystals, and the darkest areas are intact
enamel crystals.
Etching with dilute acids, such as citric acid, may alter the
surface of enamel. This dilute acid selectively etches the ends
of the enamel rods and provides adherence of a plastic sealant
CLINICAL COMMENT
to the surface of enamel rods (Fig. 7-18 ). The rod sheath re-
sists demineralization to a greater extent than the rod core.
The use of sealants, especially in children, can help prevent car-
The core of the crystal is rich in coronated apatite and is more
ies in susceptible areas of the teeth. In order for the sealant to be
sensitive to demineralization than the peripheral hydroxyapa- effective and retained, the surface enamel must be etched to
tite (Fig. 7-19 ). The purpose of this procedure is to produce improve adhesion. 99
an intact surface and thus prevent caries.
7 ESSENTIALS OF ORAL HISTOLOGY AND EMBRYOLOGY

3. Define striae of Retzius. What is a synonym?

 CONSIDER THE PATIENT
4. Describe gnarled enamel. Where is it located?
Discussion: A radiograph would reveal a lengthened root with 5. What are perikymata and imbrication lines?
excessive cemental deposition that is the result of hypereruption
of the tooth. Because of the hypereruption, space is provided for 6. What are the location and importance of tufts?
compensating cemental deposition.
7. Define and give the cause of neonatal lines.
8. What is prismless enamel?
9. What is the inorganic component of enamel, dentin,
QUANDARIES IN SCIENCE and bone?
10. What is the organic component of enamel?
Enamel is a unique tissue that does not have the ability to heal
after it matures. Although it is the most mineralized tissue in the
body, it is still subject to challenges by bacteria and wear by
occlusal attrition. The dental practitioner has a complete arma-
mentarium of techniques and materials to treat caries and occlusal
attrition and restore function. Whereas the mechanical issues of
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enamel are easily fixed, the genetic issues are not well under-
Bhaskar SN, editor: Orban’s oral histology and embryology, ed 11, St. Louis,
stood, and therefore the resultant treatments are technical and not
1991, Mosby.
usually related to the genetic basis of the specific dental problem.
Boyd A, Lester KS, Martin LB: Basis of the structure and development of
Many scientists are actively researching the genetic basis of
mammalian enamel as seen by electron microscopy, Scanning Microsc
various enamel disorders such as amelogenesis imperfecta with
2:1479–1490, 1988.
the hopes of treating this genetic disorder in utero or informing the
Diekwisch TG, Berman BJ, Anderton X, et al: Membranes, minerals, and
patient of what to expect when their children inherit the genes.
proteins of developing vertebrae enamel, Micros Res Tech 59(5):373–395,
Active researchers have a much clearer understanding of the
2002.
biology of enamel formation and the proteins involved in enamel
Fearnhead RW, editor: Tooth enamel V, Yokohama, 1989, Florence Publishers.
growth and maturation. The precise mechanisms involved in the
Kodaka T, Natajima F, Higashi S: Structure of the so-called “prismless”
synthesis, secretion, and maturation of enamel crystals are begin-
enamel in human deciduous teeth, Caries Res 23:290–296, 1989.
ning to be elucidated, and perhaps in the future the practicing
Satchell PG, et al: Conservation and variation in enamel protein distribution
dentist will be able to use natural enamel as a restorative agent.
during vertebrate tooth development, J Exper Zoology 294(2):91–106,
2002.
Zeichner-David M, et al: Control of ameloblast differentiation. In Ruch JV,
Self-Evaluation Questions editor: Odontogenesis: embryonic dentition as a tool for developmental
biology, Int J Dev Biol 39:69–92, 1995.
1. Describe the shape and size of the enamel rods. Zeichner-David M, et al: Timing of the expression of enamel gene products
2. Define Hunter-Schreger bands. during mouse tooth development, Int J Dev Biol 41:27–38, 1997.

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