Hertwig’s epithelial root sheath and root

formation:
 The cervical portion of the enamel organ gives rise to the
epithelial root sheath of Hertwig. The Hertwig’s epithelial
root sheath (HERS) outlines the future root and is thus
responsible for the shape, length, size, and number of roots.
 The development of the roots begins after enamel and dentin
formation has reached the future cementoenamel
junction. The enamel organ plays an important part in root
development by forming HERS, which molds the shape of
the roots and initiates radicular dentin formation. Hertwig’s
root sheath consists of the outer and inner enamel
epithelia only, and therefore it does not include the stratum
intermedium and stellate reticulum. The cells of the inner
layer remain short and normally do not produce enamel.
 When these cells have induced the differentiation of radicular
dental papilla cells into odontoblasts and the first layer of
dentin has been laid down, the epithelial root sheath loses its
structural continuity and its close relation to the surface of
the root. Its remnants persist as an epithelial network of
strands or clumps near the external surface of the root. These
epithelial remnants are found in the periodontal ligament of
erupted teeth and are called rests of Malassez.
 There is a pronounced difference in the development of
HERS in teeth with one root and in those with two or more
roots. Prior to the beginning of root formation, the root
sheath forms the epithelial diaphragm .The outer and inner
enamel epithelia bend at the future cementoenamel junction
into a horizontal plane, narrowing the wide cervical opening
of the tooth germ. The plane of the diaphragm remains
relatively fixed during the development and growth of the
root.
 The proliferation of the cells of the epithelial diaphragm is
accompanied by proliferation of the cells of the connective
tissue of the pulp, which occurs in the area adjacent to the
diaphragm. The free end of the diaphragm does not grow into
the connective tissue, but the epithelium proliferates coronal
to the epithelial diaphragm.
 The differentiation of odontoblasts and the formation of
dentin follow the lengthening of the root sheath. At the same
time the connective tissue of the dental sac surrounding the
root sheath proliferates and invades the continuous double
epithelial layer dividing it into a network of epithelial strands
 The epithelium is moved away from the surface of the dentin
so that connective tissue cells come into contact with the
outer surface of the dentin and differentiate into
cementoblasts that deposit a layer of cementum on the
surface of the dentin. The rapid sequence of proliferation and
destruction of Hertwig’s root sheath explains the fact that it
cannot be seen as a continuous layer on the surface of the
developing root.
 In the last stages of root development, the proliferation of the
epithelium in the diaphragm lags behind that of the pulpal
connective tissue. The wide apical foramen is reduced first to
the width of the diaphragmatic opening itself and later is
further narrowed by apposition of dentin and cementum to
the apex of the root. Differential growth of the epithelial
diaphragm in multi- rooted teeth causes the division of the
root trunk into two or three roots.
 During the general growth of the enamel organ the
expansion of its cervical opening occurs in such a way that
long tongue like extensions of the horizontal
diaphragm develop. Two such extensions are found in the
germs of lower molars and three in the germs of upper
molars.
 Before division of the root trunk occurs, the free ends of
these horizontal epithelial flaps grow toward each other and
fuse. The single cervical opening of the coronal enamel organ
is then divided into two or three openings. On the pulpal
surface of the dividing epithelial bridges, dentin formation
starts and on the periphery of each opening, root
development follows in the same way as described for single-
rooted teeth.
 If the continuity of HERS is broken or is not established prior
to dentin formation, a defect in the dentinal wall of the pulp
ensues. Such defects are found in the pulpal floor
corresponding to the furcation or on any point of the root
itself if the fusion of the horizontal extensions of the
diaphragm remains incomplete. This accounts for the
development of accessory root canals opening on the
periodontal surface of the root.
HISTOPHYSIOLOGY

 A number of physiologic growth processes participate in the

progressive development of the teeth .Except for their
initiation, which is a momentary event, these processes
overlap considerably, and many are continuous
throughout the various morphologic stages of odontogenesis.
 Nevertheless, each physiologic process tends to predominate
in one stage more than in another. For example, the process
of histodifferentiation characterizes the bell stage, in which
the cells of the inner enamel epithelium differentiate into
functional ameloblasts. However, proliferation still progresses
at the deeper portion of the enamel organ.
1-Initiation:

 The dental laminae and associated tooth buds represent those

parts of the oral epithelium that have the potential for tooth
formation. Specific cells within the horseshoe-shaped dental
laminae have the potential to form the enamel organ of
certain teeth by responding to those factors that initiate or
induce tooth development.
 Different teeth are initiated at definite times. Initiation
induction requires ectomesenchymal–epithelial interaction.
The mechanism of such interaction is not clearly understood.
However, it has been demonstrated that dental papilla
mesenchyme can induce or instruct tooth epithelium and
even non tooth epithelium to form enamel.
2-Proliferation

 Enhanced proliferative activity begins at the points of

initiation and results successively in the bud, cap, and bell
stages of the odontogenic organ. Proliferative growth causes
regular changes in the size and proportions of the
growing tooth germ. Even during the stage of proliferation,
the tooth germ already has the potential to become more
highly developed
3-Histodifferentiation:

 Histodifferentiation succeeds the proliferative stage. The

formative cells of the tooth germs developing during the
proliferative stage undergo definite morphologic as well
as functional changes and acquire their functional
assignment (the appositional growth potential).
 The cells become restricted in their functions. They
differentiate and give up their capacity to multiply as they
assume their new function; this law governs all differentiating
cells. This phase reaches its highest development in the bell
stage of the enamel organ, just preceding the beginning of
formation and apposition of dentin and enamel.
 The organizing influence of the inner enamel epithelium on
the mesenchyme is evident in the bell stage and causes the
differentiation of the adjacent cells of the dental papilla into
odontoblasts. With the formation of dentin, the cells of the
inner enamel epithelium differentiate into ameloblasts and
enamel matrix is formed opposite the dentin. Enamel does
not form in the absence of dentin, as demonstrated by
the failure of transplanted ameloblasts to form enamel when
dentin is not present.
 Dentin formation therefore precedes and is essential to
enamel formation. The differentiation of the epithelial cells
precedes and is essential to the differentiation of the
odontoblasts and the initiation of dentin formation. The
importance of the basement membrane of this interface has
been recognized.
Morphodifferentiation:

 The morphologic pattern, or basic form and relative size of

the future tooth, is established by morphodifferentiation, that
is, by differential growth. Morphodifferentiation therefore is
impossible without proliferation. The advanced bell
stage marks not only active histodifferentiation but also an
important stage of morphodifferentiation in the crown,
outlining the future dentinoenamel junction.
 The dentinoenamel and dentinocemental junctions, which
are different and characteristic for each type of tooth, act as a
blueprint pattern. In conformity with this pattern the
ameloblasts, odontoblasts, and cementoblasts deposit enamel,
dentin, and cementum, respectively, and thus give the
completed tooth its characteristic form and size. For
example, the size and form of the cuspal portion of the
crown of the first permanent molar are established at birth
long before the formation of hard tissues begin.
Apposition:

 Apposition is the deposition of the matrix of the hard dental

structures. Appositional growth of enamel and dentin is a
layer like deposition of an extracellular matrix. This type of
growth is therefore additive. It is the fulfillment of the plans
outlined at the stages of histodifferentiation and
morphodifferentiation. Appositional growth is characterized
by regular and rhythmic deposition of the extracellular
matrix, which is of itself incapable of further growth. Periods
of activity and rest alternate at definite intervals during tooth
formation.
CLINICAL CONSIDERATIONS

 A lack of initiation results in the absence of either a single

tooth or multiple teeth (partial anodontia), most frequently
the permanent upper lateral incisors, third molars, and lower
second premolars. There also may be a complete lack of teeth
(anodontia). On the other hand, abnormal initiation may
result in the development of single or multiple
supernumerary teeth
Complete and partial anadontia
 Teeth may develop in abnormal locations, for example, in the
ovary (dermoid tumors or cysts) or in the
hypophysis. In such instances the tooth undergoes stages of
development similar to those in the jaws.
 In vitamin A deficiency the ameloblasts fail to
differentiate properly. Consequently, their organizing
influence on the adjacent mesenchymal cells is disturbed,
and atypical dentin, known as osteodentin, is formed.
 Endocrine disturbances affect the size or form of the
crown of teeth if such effects occur during
morphodifferentiation, that is, in utero or in the first year of
life. Size and shape of the root, however, may be altered by
disturbances in later periods.
 Clinical examinations show that the retarded eruption
that occurs in persons with hypopituitarism and
hypothyroidism results in a small clinical crown that is
often mistaken for a small anatomic crown.
 Abnormal curvatures in the root, termed
dilacerations may be due to trauma sustained during
development of the root.
 Disturbances in morphodifferentiation may affect the form
and size of the tooth without impairing the function of the
ameloblasts or odontoblasts. New parts may be differentiated
like formation of supernumerary cusps or roots. Twinning,
i.e. two similar teeth may be produced as a result of splitting
of one tooth germ. Fusion of teeth produced from two
tooth germ joined together before mineralization may occur.
FUSION:
 A suppression of parts may occur like loss of cusps or roots.
An abnormality in shape may result in a peg or
malformed tooth with enamel and dentin that may be
normal in structure.
 Peg shaped teeth (screw-driver shaped) with the
permanent upper central incisor showing a notched
incisal edge may be seen in individuals born with
congenital syphilis
 This condition is known as Hutchinson’s incisor. Genetic
and environmental factors may disturb the normal synthesis
and secretion of the organic matrix of enamel leading to a
condition called enamel hypoplasia. If the organic matrix
is normal but its mineralization is defective, then the enamel
or dentin is said to be hypocalcified or
hypomineralized. Both hypoplasia and hypocalcification
can occur as a result of an insult to the cells responsible for
the apposition stage of tooth development