GUIDED BY:

Dr.P.KARUNAKAR
Dr.M.S.RANGA REDDY PRESENTED BY:
Dr.B.S.KARTEEK C.L.CHARAN REDDY
(1ST YEAR P.G)
Contents:
Introduction
Formation of DEJ
Enamel near DEJ
Dentin at DEJ
Related structures
a)Enamel spindles
b)Enamel tufts
c)Enamel lamellae
Dentinal tubules
Imaging of DEJ
Microstructure of DEJ
Mechanical properties of DEJ
Fracture resistance of DEJ
Stress distribution in teeth
CLINICAL CONSIDERATIONS OF DEJ
Permeability of dentin
Response to external stimuli
Dentin sensitivity
DEJ and dental caries
Related structues
Tooth preparation and DEJ
Pinhole placement and DEJ
Fracture and DEJ
Physiologic enamel cracking and DEJ
Forward and Backward caries
 Infected dentin vs Affected dentin
Blushing of dentin
Dentin Bonding
Dessication of dentin
GIC bonding to tooth structure
conclusion
 INTRODUCTION

Synonym–Amelo Dentinal
Junction

It is a complex
structure uniting
Two dissimilar
calcified tissues
a)Enamel
b)Dentin
 Enamel

DEJ
Dentin
 FORMATION OF DEJ

To understand the formation of DEJ it is necessary to

have knowledge of the development of the tooth.

Dental lamina contributes for the formation of the tooth.

Stages of tooth development :

Bud stage

Cap stage

Bell stage

Advanced bell stage

 Bud stage :

a)Eighth week of IUL (22mm embryo)

b)Enamel organ – simple ,spherical to ovoid
epithelial condensation.

c)Peripherally located low columnar cells

Centrally located polygonal cells.
Cap stage :

a)Tenth week of IUL (43mm embryo)

b)Invagination of enamel organ

c) Central cells – stellate reticulum

d)Peripheral cells – external enamel epithelium

Internal enamel epithelium

e) The area of the condensed ectomesenchyme below IEE is

termed as dental papilla.
f)The condensed ectomesenchyme that surrounds the
enamel organ and dental papila is dental sac.
 Bell stage :

About 4 months of IUL(163mm embryo)

Four distinct layers :
a)EEE
B)IEE -Differentiates into ameloblasts
C)Stellate reticulum
d)Stratum intermedium
Basement membrane
separating
Enamel organ and dental
papilla
Just prior to dentin
formation
Is membrana preformativa
Advanced bell stage:

a) Associated with the formation of dental hard

tissues(enamel and dentin ).
b) under influence of ameloblasts(IEE)adjacent cells of
dental papilla differentiate into odontoblasts .
c)The basal lamina disappeares after first layer of dentin
is formed and leads to formation of DEJ by forming the
enamel over dentin.
video
 Enamel at DEJ:

a)The enamel rods tend to be maintained in rows arranged

circumferentially around long axis of the tooth.

b)The rods in each row runs perpendicular to dej where as at

cusp tip they run more vertically.

c)The diameter of a rod is smallest at dej and increases towar-

ds surface in the ratio of 1:2.

d)The rods are divided into two parts i.e. rod head and rod tail.
The rod tails are directed towards dej.
Enamel rods in
gingival third extend Enamel rods extend
Slightly occlusal Slightly gingivally.
Direction from DEJ.
Dentin at DEJ:

-Mantle dentin = first formed dentin underlying DEJ.

-20 micrometer wide.
-fibrils are perpendicular to DEJ.

-organic matrix = larger collagen fibers(von korffs fibers).

 RELATED STRUCTURES OF DEJ
Enamel spindles:
a)Occasionally odontoblastic processess pass across the dej
into the enamel,since many of them are thickened at their
ends, they are termed as enamel spindles.

b)The enamel spindles are formed before the initiation of ena-

mel formation.
-spindles are about 2 microns in diameter containing small
needle like crystals of about 70 mm in length and about 5mm
in width.

-energy dispersive x-ray microscopy showed that enamel tufts,

lamellae and spindles contained less calcium and phosphor-
ous than enamel prisms.
 Enamel tufts:

-Thin ribbon like structure resembling tufts of grass.

-Arise at dej and reach into enamel to about 1/5th -1/3rd of its
thickness.

-SEM studies revealed tufts to be tubular structures with cross

striations.

-TEM studies showed plate like structures in the center of the

tufts.
 Enamel lamellae:
-leaf like structures that extend from enamel surface toward
DEJ.
-Develop in planes of tension.

Composed of poorly Consists of In erupted teeth

Calcified rod segments. Degenerated cells. Where cracks filled
With organic matter
From saliva.
 Dentinal tubules:

-They follow a gentle curve in the crown less so in the root

where it resembles a gentle s(sigmoid) in shape.These
curvatures are called primary curvatures.
-Branches of dentinal tubules near the terminals are called
terminal branches.

-The tubules exhibit minute,relatively regular secondary

curvatures that are sinusoidal in shape.
-The tubules are farther apart in peripheral layers and are
more closely packed near the pulp.

-The ratio between no. of tubules per unit area on the pulpal
and outer surfaces of the dentin is about 4:1

-The tubules are larger in diameter near pulp cavity(3-4 micro

meter)and smaller at their outer ends(1 micrometer)
 Imaging of DEJ:

a)SEM:
-Teeth are sectioned bucco-lingually and enamel was ground
to less than 1mm.

-The remaining enamel is removed by the 0.5 M EDTA(ph 7.4)

until dej was revealed,7-10 days.

-Enamel was chalky in appearance when treated with EDTA

and disappearance of this chalky appearance was indication
that enamel was gone.

-Samples were fixed in gluteraldehyde and dehydrated in a

graded ethanol series followed by drying in HMDS,prior to
sputter coating and examination in the SEM.
Enamel

Dentin
 Atomic Force Microscopy:

-Teeth were sterilized by gamma radiation and stored (less

than 4 months) in deionized water at 4°C until prepared
(White et al., 1994).
- Sagittal midcoronal sections (thickness of 2 mm) were pre-
pared by polishing through a series of SiO2 papers and with
a diamond paste to 0.25 mm.
-Ultrasonic treatments in water for 10 s were used to clean the
surface.

-Specimens were glued with cyanoacrylate to a metal

disk for study in the atomic force microscope (AFM)
The functional width of DEJ determined by AFM based
Nanoscratching.
 SRCT:
-Synchrotron Radiation Computed Tomography images of tooth
specimens bonded to composite restorative material,with 3.33
micrometer resolution clearly shows DEJ scalloped structure.
 Micro structure of DEJ

-Laser induced autofluoroscence and emission spectroscopy

demonstrate DEJ as 7-15 micrometer wide.

According to marshall et al.,2003 DEJ consists of a complex

three level structure

a)25-100 micrometer wide scallops

b)2-5 micrometer wide scallops
c)Smaller scallops

-convexities of scallops are directed towards dentin and

concavities directed towards enamel.

-proximal surfaces are more scalloped than buccal and lingual

surfaces.
-DEJ is less mineralized than either enamel or dentin and cont-
ains higher organic matrix.

-symons reported more scalloping near the cusps

-According to fong et al.,2000 scalloped structure was

suggested to increase area between tissues –thus reducing
stress concentration.

-According to lin et al.,1993 scalloped structure may also incr-

ease attachment area for collagen type 1 fibres.
 Mechanical properties of dej:

-An Atomic force microscopic study

 Fracture resistance:
a)Rasmussen et al., used a work of approach to determine
fracture characteristics of enamel,dentin,dej.

b)He found enamel is more resistant to fracture perpendicular

to prisms than parallel to the prisms.
c)Dentin was more resistant to fracture parallel to tubules
than perpendicular to tubules.
Parallel Perpendicular
Enamel 13 j/m2 200 j/m2

Dentin 550 j/m2 270 j/m2

Near DEJ 391 j/m2 221 j/m2

d)When force is applied near dej,the mandrel should be
positioned within 0.2mm of dej ,minimal failure actually
occurred at dej and concluded that work of fracture of
dentin increases in the vicinity of the dej.

-Fracture characteristics indicate that dej differs substantially

from either enamel or dentin and probably provides a critical
link that preserves the physical integrity of the tooth.
 Stress distribution in teeth:

a)Enamel acts as stress distributor which transfers the

compression load vertically to root,horizontally via dej to
dentin of the crown.

b)As stresses are transferred from enamel to dentin shear load

is created near dej.

c)A thick zone(200micrometer) in the dentin at dej undergoes

greater stress than central coronal dentin.

d)Differences in elastic modulus between enamel and dentin

causes vertical delamination and fracture along dej,but bet-
ween them lies DEJ due to its high collagen content has a low
elastic modulus compared to enamel and dentin.
CLINICAL CONSIDERATIONS OF DEJ
 Permeability of dentin:

-Highly permeable – Tubular Nature

-Dentinal tubules = major channels for fluid diffusion

-TRANS DENTINAL: Movement through entire thickness of

Dentin via tubules.

Movement of exogenous substances into

-INTRA DENTINAL: Intertubular dentin seen during bonding,
Leading to passage of irritants towards
Pulp.
-Fluid permeation is proportion to tubule diameter and num-
ber.

-The permeation of radicular dentin is less than coronal dentin.

-Dentin beneath a deep cavity preparation is more permeable

than dentin below a shallow caviy.

Dentin thickness - Dentin permeability

-The outward flow of dentinal fluid and odontoblasts act as
barriers for entry of bacteria or their toxins.

Tubular occlusion,smear layer

formation&lack of tubular Permeability Dentin
communication between primary of dentin sensitivity
and irregular secondary dentin
Response to external stimuli:

External stimulus:

Dental caries
Attrition
Trauma
-The response to external stimuli comes from pulp but it manif-
est in the structure of dentin it produces.

-Response to external stimuli = Tertiary dentin formation.

(reparative or reactionary)

-The presence of secondary dentin and continuous deposition

through out life and deposition of tertiary dentin provides
a barrier to external stimuli.
 Dentin sensitivity:

Three main hypothesis have been put forward to account for its
sensitivity.

a)Neural theory

b)Odontoblastic transduction theory

c)Hydrodynamic theory
 Neural theory:

This theory states that dentin hypersensitivity occurs due to the

direct stimulation of nerve fibers present in dentin.

Mechanical,chemical Direct stimulation of

or osmotic stimulus nerve fibers in dentin
or pulp

hypersensitivity Painful response

-The nerves in the dentinal tubules are not commonly seen .

-If the nerves are present they do not extend beyond inner
dentin.

-Hence this theory is not accepted.

 Odontoblastic transduction theory:

-Odontoblast process is the primary structure excited by the

stimulus and that impulse is transmitted to the nerve endings
in the inner dentin.

-This is not a popular theory since there are no neurotransm-

itter vesicles in the odontoblast process to facilitate the
synapse.

-However odontoblasts by modifying the local ionic environ-

ment alter the threshold of intradentinal nerves.
 Hydrodynamic theory:

-This theory is most widely accepted physiopathological theory.

(Brannstrom,1962)

-Rapid shifts of the fluids within the tubules,following stimulus

application,result in activation of sensory nerves in the inner
dentin region of tooth.
 Dej and dental caries:

-The DEJ has least resistance to caries attack and allows rapid
lateral spreading when caries has penetrated into enamel.

-When demineralization of enamel reaches DEJ demineralization

of dentin starts.

-Mantle dentin normally has a relatively lower degree of minera-

lization at the dej.
-Lesion originating in pit and fissure affects a greater area of DEJ
than comparable to smooth surface lesion.
 Significance of related structures

Enamel tufts:

-It plays a role in lateral

spread of caries.
 Enamel lamellae:

-May be a site of weakness in a

tooth & may form a road of entry
for bacteria that intiate caries.
 Enamel spindles:

-They may serve as pain receptors

thereby explaining enamel sensitivity
experienced by some patients during tooth
preparation.
 Tooth preparation and DEJ:

-The cavity pulpal floors are not seated on the DEJ as it is very
sensitive where maximum inter connection of the dentinal tubu-
les exist which may lead to dentinal sensitivity.

The pulpal floor or axial wall or pin hole placements

are placed mostly in the area below the DEJ.

Because as the superficial dentin below DEJ consists of more

collagen fibers and has more elasticity and less elastic modulus.
It acts as cushion for restorative materials which in turn
reduces fracture of tooth structure and restorative material
during insertion or function.

-All initial depths of a tooth preparation for amalgam relate to

the DEJ.
Class 1:

Initial depth = 0.2mm

inside DEJ.
Results in greatest thickness
Of amalgam.

Provides resistance to fracture.

Class 1 cavity with buccal or Class 2:
Lingual extension:

Initial depth of axial wall =

0.2mm inside DEJ(retention
locks not used)
0.5mm inside DEJ when locks
are used because of lack of bon-
ding to tooth structure.
Class 3:

Initial axial depth = 0.5-0.6mm

inside DEJ.

Axial depth should be 0.75mm-

0.8mm when gingival margin
is on the root surface which
allows 0.25mm distance between
Retention groove and gingival
Cavosurface margin.
Class 5:

Initial axial depth = 0.5mm inside

DEJ.

If cavity is on root surface the axial

Depth is 0.75mm.
 Pin hole placement and DEJ:

-Caputo and standee states that pin

hole should be located halfway bet-
ween pulp and DEJ.

-Ditts and associates have reported

that pin holes should be placed at
0.5mm inside the DEJ.

-The pin hole should be positioned no closer than 0.5-1mm to

DEJ or no closer than 1-1.5mm to external surface of tooth.
 Fracture and DEJ

-Hardest substance=Enamel.

-Hardness and density of enamel decreases from outer surface

to dej,with lowest hardness at DEJ.

-Enamel is very brittle,have high elastic modulus and low tens-

ile strength which indicates a rigid structure.

-Dentin acts as a cushion and withstand masticatory forces.

-Enamel rods that fail to possess a dentin base because of caries
or improper preparation design are easily fractured away from
neighbouring rods.

-For maximal strength in tooth preparation all enamel rods

should be supported by dentin.
 Physiologic enamel cracking and DEJ:

-DEJ is a complex fusion regarded as fibril-reinforced bond.

-DEJconsists of parallel course collagen bundles that forms

massive consolidations that can divert and blunt enamel cra-
cks through considerable plastic deformation.

-SEM examination of DEJ specimens have demonstrated crack

deflections to another fracture plane when forced through DEJ.
-Due to inherent brittleness of enamel and collagenous consoli-
dation of DEJ enamel cracking should be considered a normal
aging process.
-Thus enamel cracks can be considered an acceptable enamel
attribute and DEJ plays a significant role in assisting stress tra-
nsfer and in resisting enamel crack propogation.
 Whenever the caries cone in enamel
Forward caries: is larger or at least the same size as
that in dentin.

Whenever the speed of caries along

Backward caries: DEJ exceeds the caries cone in enamel,
the caries extends into enamel from
Junction.
Speed of caries is in backward
direction.
Infected Dentin vs Affected Dentin:

INFECTED DENTIN AFFECTED DENTIN

Softened and contamined Softened,Demineralised

with bacteria. but not yet invaded by
bacteria.
Contains irreversibly Contains reversibly
denatured collagen – denatured collagen.
Stained by caries
detecting dye.
Requires removal. Does not require removal.
 Blushing of Dentin:

-Due to frictional heat, it results of vascular stasis in the sub-

odontoblastic capillary plexus flow.

-If dentin is,

Pinkish hue – reversible under favourable conditions.
Purplish colour – indicates thrombosis,poor prognosis
is expected.

-To minimize the thermal effects,tooth preparation should be

performed using an ultra highspeed handpeice(2,50,000-
4,00,000 rpm)with an air-water spray from multidirectional
water ports.
 Dentin bonding:

-Micromechanical bonding and secondary atomic bonds.

-Bond to enamel and dentin to prevent leakage and recurrent
decay.
-Etching removes dentin ‘smear layer’ and decalcifies layer
of dentin.

-Dentin is rinsed,but not thoroughly dried.

-Adhesion can be affected by the ‘remaining dentin thickness’
after tooth preparation.

-Bond strenghts are generally less in deep dentin than in

superficial dentin.

-Whenever tooth structure is prepared with a bur or an instru-

ment ,residual organic & inorganic components form a
‘smear layer’ of debris on the surface.

-The smear layer fills the orifices of the dentinal tubules,

forming ‘smear plugs’.
 Desiccation of dentin:

-When the surface of freshly cut dentin is dried with a jet of

air,or a cavity drying agent,a strong hydraulic forces are
created on the dentinal tubules,causing a phenomenon
of odontoblast displacement.

-In this reaction the cell bodies of odontoblast are displaced

upward in the dentinal tubules.

-According to Branstrom this can theoretically cause dentinal

fluid to flow outward at a rate of 2 to 3mm per second.
 GIC Bonding to Tooth Structure:

-GIC share the adhesive potential of the polycarboxylate

cement.

-They appear to bond primarily to the inorganic component

(ca) of the tooth structure by initially hydrogen bonding,
forming a metal ion bridges.

-Good isolation to avoid contamination and moisture,smear

layer should be removed and the cement should be used
when its in its glossy stage.
Conclusion:

DEJ which is scalloped structure is critical for stability &

essential for bearing high mechanical stresses & will act
as stress distributor.

Understanding the role of DEJ in tooth & its importance

in its functions is utmost important to dentistry during
treatment procedures.
References :

a)Tencates oral histology (development,structure&function)

-8th edition
b)Orbans oral histology &embryology -14th edition
c)Essentials of oral biology by maji jose – 2nd edition

d)Stefan habelitz,sally j.marshall,grayson w.marshall jr,mehdi

balooch.The functional width of the dej determined by AFM
based nanoscratching.journal of structural biology 135,294-301
(2001)

e)G.W.marshall jr,m.balooch,r.r.gallagher,s.a.gansky,s.j.marshall
mechanical properties of the dej:afm studies of nanohardness,
elastic modulus and fracture-26th oct 2001.
f)Tansui,taoli,micheal a.sandholzer,eric le bourhis,kaiyang zang,
gabriel landini,alexander m.korsunsky-structure property char-
acteristics of the dej.WCE2014,july2-4,2014.

g)Daisuke shimizu,gabriel a.macho-functional significance of the

microstructural detail of the primate dej.a possible example of
exaptation.journal of human evolution-52(2007)103-111.

h)Delia s.brauer,grayson w.marshall,sally j.marshall-journal of de

ntistry 2010jul 38(7):597-601.