Amelogensis is the process of enamel formation. It occurs in four main phases: morphogenic, secretory, maturation, and protective. In the morphogenic phase, inner enamel epithelial cells interact with dental papilla cells to determine tooth shape. In the secretory phase, ameloblasts secrete enamel matrix proteins and minerals to form enamel rods. During maturation, the enamel mineralizes further as proteins are removed. In the protective phase, ameloblasts become cuboidal cells that protect the enamel surface from the dental sac until eruption.

1. Amelogensis
By:dr.Nafha Shihab
(Periodontist)

2. Amelogensis is a two step process when enamel first forms, it
mineralizes partially to approximately 30٪. As the organic matrix breaks
down and is removed, crystals grow wider and thicker until the full
thickness of enamel layer has been formed to attain greater than 96٪
mineral content. The process of amelogeneis is under cellular control and
the associated cells undergo significant morphologic changes throughout
amelogensis reflecting their evolving physiologic activity.
Enamel formation begin at early crown stage of tooth
development and involves the differentiation of the cells of the
inner enamel epithelium first at the tips of cusp and incisal
edge. Ameloblasts secrete matrix proteins and are responsible
for creating and maintaining an extracellular environment
favorable to mineral deposition. This epithelial cell exhibits a
unique life cycle characterized by progressive phenotype
changes that reflect its primary activity at various times of
enamel's formation.

3. Amelogensis has been divided into :
•Morphogenic phase:- in this phase the inner enamel epithelia, are low columnar or
cuboidal, with large centrally located nucleus. IEE close to the undifferentiated mesenchymal
cells of dental papilla interact with these cells to determined the shape of the crown
(morphodifferentiation). Mitochondria and other cytoplasmic components are scattered
throughout the cells.
•Differentiation phase:- in this stage the IEE differentiate into pre ameloblasts, they
elongate and their nuclei shift proximally toward the stratum intermedium. The cytoplasmic
organells aggregate at the distal side of the cell (secretory end of the cells). During ameloblasts
differentiation, proximal and distal junctional complex appear between them. These junctional
complex play an important role in amelogenesis by tightly holding together ameloblasts and
determining at different times what may, and what may not, pass between them to enter or leave
the enamel.
Presecretory stage

4. Secretory stage
When the first layer of dentin is formed the preameloblast become ameloblasts. The cell
become highly columnar, nucleus at proximal end, cytoplasm fill with synthetic
organells like RER, mitochondria, Golgi apparatus, secretory vesicles, and ribosomes.
The secretory stage begins with the formation of thin layer of enamel matrix opposite to
the dentin (rodless enamel).
The secretory end of ameloblasts becomes pyramidal in shape forming
a process called Tomes' process which is responsible for secretion and
orientation of enamel rods and their crystals.
At this stage ameloblasts synthesis and secrete enamel matrix which
consist of proteins like amelogenin, enamelin, ameloblastin, tuftelin,
amelin, these proteins matrix form about 66%. About 25-30% minerals
which are hydroxyapatite crystals of enamel matrix which secreted by
ameloblasts at the same time. The ameloblasts where secrete enamel
matrix, it retard back word toward the enamel organ, and it secret the
whole enamel matrix at one time.

5. Maturation stage
•Transitional phase:- after full thickness of immature enamel has formed, ameloblasts
undergo significant morphological involving a reduction in height of the ameloblasts
and decrease in their volume and organelle content. Ameloblasts undergo programmed
cell death (apoptosis). Approximately 25% of the ameloblasts die during transition
phase, and another 25% die as enamel maturation proceeds. In this phase the Tomes'
process disappear, microvilli or brush borders appear instead.
•Maturation Proper:- massive influx of calcium and phosphates occurs and at the same
time there is selective loss of enamel proteins, mainly amelogenin and water. The
ameloblasts modulate between two phenotypes depending on the morphology of their
distal ends. The ameloblasts either have numerous microvilli forming a rumed border or
their distal ends are even (straight), thus forming two morphologically different types,
namely Rume-ended ameloblasts ( 80 % of maturation ameloblasts) and Smooth-ended
ameloblasts (20 %), respectively. The two morphological types of ameloblasts are
grouped into alternating bands during this stage, thus maturation ameloblasts modulate
i.e. change their morphology from one type to the other and back.

6. Protective stage
Ameloblasts lose their differentiation and become short cuboidal cells which together
with the remnants of the other layers of the dental organ form a multilayered structure,
namely the reduced enamel (dental) epithelium. This structure remains on the surface of
fully formed enamel until the tooth erupts. It separates the enamel from the dental sac
and thus protect it from being in contact with connective tissue cells in the dental sac. If
this contact accidentally happens, either enamel is resorbed resulting in pitting or dental
sac cells in the contact area differentiate into cementoblasts and lay down cementum on
the enamel surface. Both produce adverse (unsightly) effects on enamel appearance.
The reduced dental epithelium and the oral epithelium jointly form the dentogingival
junction of the erupting tooth.
Desmolyic stage
The reduce enamel epithelium elaborate the desomolytic enzyme to destroy connective
tissue fibers that surround the crown of the tooth to facilitate the eruption of the tooth.
After that the reduce enamel epithelia fuse with oral epithelium and form eruptive canal
from which the tooth will erupt without any bleeding.

7. Mineralization pattern of enamel:-
Mineralization starts in the oldest enamel (tip of cusp) and proceeds in 2 general
directions: spreading down along the D-E junction and progressing toward the enamel
surface. If the tooth is a multicuspid, enamel formation starts at the tip of each cusp,
spreads down and fuses at the base of the cusps in the regions of pits and fissures in
the occlusal surface of tooth.
Factors affect growth of crystals are:-
•Non collagenous protein able to bind to different surface of crystals
preventing further growth.
•Pyrophosphate inhibit further growth of crystal.
•Alkaline phosphatase enzyme is associated with production of any
mineralized tissue, it is involved with blood vessels and cell membrane
of ameloblasts. Alkaline phosphatase activity breaks down
pyrophosphate, thereby permitting crystal growth to proceed.

8. Defects of amelogensis
•Defect in enamel can be caused by febrile disease resulting in distinctive
bands of malformed enamel.
•Defects can be formed by tetracycline induced disturbances in teeth.
Tetracycline antibiotics are incorporated into mineralizing tissues, in case
of enamel, this incorporation may result in a band of brown pigmentation
or even total pigmentation, hypoplasia or absences of enamel also may
occur.
•Fluoride ions can interfere with amelogensis. chronic ingestion of
fluoride ion concentrations in excess of 5ppm (5 times the amount in
fluoridated water supplies) interferes sufficiently with ameloblast
function to produce mottled enamel, mottled enamel is seen as white
patches of hypo mineralized and altered enamel.