Enamel hypomineralization viewed from the pattern of progressive mineralization of human and monkey developing enamel.

Microradiograms and their computer-aided image analysis of ground sections of the developing enamel of human permanent third molars and monkey permanent teeth (Macaca fuscata) indicate that the mode of progressive mineralization of enamel is completely different between the matrix formation and maturation stages. During the former stage, the enamel matrix is slightly mineralized. During the latter stage, which takes a much longer period than the previous stage, the increase in the secondary mineralization takes place first slightly, from the surface toward the inner layer, and then heavily, from the inner layer toward the surface. The narrow outer layer mineralizes very slowly during the middle and late stages of maturation, but finally achieves the highest mineralization of the entire enamel layer. The very narrow innermost layer mineralizes slowly without expanding its width. The former three processes seem to be under the direct control of the ameloblasts. Hypoplastic areas which appear during the matrix formation stages are not necessarily accompanied by hypomineralization. Dysfunction of the cells immediately after the completion of matrix formation appears to cause hypomineralization throughout the entire width of matrix except for the innermost layer. Disorders of the cells occurring during the middle and/or the late stage of maturation--due to chronic metabolic disturbances, such as fluorosis--induced hypomineralization localized mainly at the outer layer. The hypomineralized enamel is not necessarily accompanied by hypoplasia. The process of enamel mineralization is not necessarily fully synchronized with that of tooth eruption. Therefore, the narrow outer layer, especially in the fissure and cervical regions, is sometimes hypomineralized even after the teeth have erupted normally.