Ectopic Tooth Enamel. An SEM Study of the Structure of Enamel in Enamel Pearls

Eighteen human molars with enamel pearls ranging in diameter from 0.8 to 2.7 mm were sectioned, acid-etched, and processed for SEM observation. In addition to pearl enamel, the specimens contained crown enamel for comparison. All pearls were of the composite type. The enamel layer reached maximal thicknesses of between 0.3 and 0.7 mm opposite the tip of the dentinal cone. The enamel structure was normal, but more variable and irregular than crown enamel. The prism course was often irregular throughout the whole thickness of enamel. Distinct Hunter-Schreger bands were absent. Prisms and interprism were occasionally difficult to identify as separate entities. The packing of crystals seemed to be less tight in pearl enamel. The scarcity of Retzius lines was attributed to the method of preparation. Prism cross-striations with a periodicity ranging between 1.3 and 4.5 μm were frequently encountered. A superficial prism-free zone with a regular 1.7-2.5-μm striation was present in localized regions of many pearls. The formation time of a medium-sized pearl was calculated to be about 11.5 months. A variety of cross-cut prism configurations was observed. Occasional hypoplastic lesions and hypomineralized areas were encountered. In conclusion, pearl enamel possesses most of the structural attributes of crown enamel, but in general its organization seems to be less orderly. Enamel pearls represent developmental disturbances in position and timing more than in structure.