Journal of Oral Rehabilitation

Journal of Oral Rehabilitation 2011 38; 359–365

Review Article
Hunter–Schreger Band patterns and their implications for
clinical dentistry
C . D . L Y N C H * , V . R . O ’ S U L L I V A N †, P . D O C K E R Y ‡, C . T . M C G I L L Y C U D D Y §,
J . S . R E E S ¶ & A . J . S L O A N * * *Senior Lecturer ⁄ Consultant in Restorative Dentistry, Tissue Engineering & Reparative
Dentistry, School of Dentistry, Heath Park, Cardiff, UK, †Professor of Anatomy, Royal College of Surgeons in Ireland - Medical University of
Bahrain, Busaiteen, Bahrain, ‡Professor of Anatomy, School of Medicine, National University of Ireland, Galway, Ireland, §School of Dentistry,
Heath Park, ¶Professor of Restorative Dentistry, Learning & Scholarship, School of Dentistry, Heath Park and **Reader in Bone Biology & Tissue
Engineering, Tissue Engineering & Reparative Dentistry, School of Dentistry, Heath Park, Cardiff, UK

SUMMARY Hunter–Schreger Bands (HSBs) are an patterns have evolved to optimise resistance to
optical phenomenon visualised when a cut or frac- attrition, abrasion and tooth fracture. It appears
tured enamel surface is viewed under reflected light. that certain aspects of HSB packing densities and
These bands demonstrate the synchronous decussa- distributions have beneficial roles in enamel bond-
tion of individual or groups of enamel prisms. While ing. Hunter–Schreger Band patterns seem to pas-
the role of HSB patterns has been investigated in sively facilitate conditions such as abfraction and
comparative anatomical studies, until recently there cracked tooth syndrome.
has been little consideration of HSB patterns in KEYWORDS: abfraction, cracked tooth syndrome,
human teeth. The aim of this paper is to consider enamel, etching, Hunter–Schreger Bands, prism,
the significance of HSB patterns in the human tooth wear
dentition and in relation to clinical dentistry. It is
concluded that within the human dentition, HSB Accepted for publication 4 September 2010

While individual prisms run from the ADJ to the EES,

Introduction
they do not travel in a straight line, rather they follow a
Examination of the surface of fractured or sectioned sinuous path, where they bend ⁄ change direction sev-
tooth enamel reveals a pattern of alternating light and eral times. Until the 1960s, the accepted explanation
dark bands, referred to as Hunter–Schreger Bands was that the appearance of HSBs was caused by
(HSBs) (Fig. 1). The appearance of these HSBs is caused differences in calcification and hardness throughout
by the interaction of incident light and the alternating enamel, demonstrated by acid-etching, silver-staining
direction of adjacent groups of enamel prisms as they and micro-radiography techniques (4–7). It was then
pass from the amelodentinal junction (ADJ) to the realised that such theories failed to appreciate the
external enamel surface (EES). Enamel prisms or ‘rods’ significance of varying enamel prism directions (8).
are the basic structural unit of enamel and are Contemporary opinion suggests that the appearance of
composed of crystallites of hydroxyapatite, orientated HSBs is related to synchronous decussation of enamel
to optimise the mechanical properties of enamel (1–3). prisms in the horizontal plane and is most likely caused
by reflection of light by prism sheaths ⁄ interprismatic
material (9). Questions surrounding the function of
This paper forms part of the material submitted in fulfilment of a PhD
degree from the Royal College of Surgeons in Ireland ⁄ National HSBs have been investigated within comparative ana-
University of Ireland for the first author. tomical studies, with some animal studies relating HSB

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360 C . D . L Y N C H et al.

Fig. 1. Appearance of Hunter–Schreger Bands in human enamel:

longitudinal section through the buccal and occlusal surface of a
maxillary premolar. Fig. 2. Comparison of Hunter–Schreger Band (HSB) patterns in
incisal ⁄ cuspal and cervical enamel. This image is taken from the
distal surface of a maxillary first molar. Note relative absence of
HSBs in the cervical enamel (base of image) and the relative
packing density with consistency of diet and wear abundance of HSBs in the cuspal enamel (upper half of image).
resistance (3). However, until recently, the distributions
of HSB packing densities have not been considered in
any detail within the human dentition. Recently Lynch maxillary first premolar; 15Æ5 HSB per mm maxillary
et al. (10) presented data on the packing densities of first molar), the incisal regions of the labial and palatal
HSBs within the human dentition. Measuring HSB surfaces (12Æ7 HSB per mm maxillary central incisor;
packing densities at 3490 sites within the human 12Æ3 HSB per mm mandibular central incisor), and at
dentition, they observed that HSB packing densities the so-called guiding surfaces such as the palatal
increased when moving from the cervical to the surfaces of maxillary central incisors and canines
incisal ⁄ occlusal regions of the crowns of teeth, with (12Æ0 HSB per mm palatal surface maxillary canine,
significantly greater mean HSB packing densities in the 11Æ3 HSB per mm labial surface mandibular canine),
incisal and occlusal regions of the crowns of teeth and the buccal surfaces of mandibular central incisors
compared with the cervical regions. For example, the and canines, when compared to the relatively HSB-
mean HSB packing density at the incisal region of the devoid cervical regions (3Æ6 HSB per mm mandibular
palatal surface of a maxillary central incisor was first molar, 4Æ1 HSB per mm mandibular first premolar,
13Æ0 HSB per mm, while it was 5Æ7 HSB per mm at 4Æ2 HSB per mm mandibular central incisor). It was also
the palatal cervical region of the same tooth (P < 0Æ05). noted that the appearance of HSBs varied depending on
In a similar way, the mean HSB packing density at the the region of the tooth examined. There were many
occlusal surface of a maxillary first molar was 15Æ5 HSB small, tightly packed, curved HSBs in incisal and cuspal
per mm, while it was 5Æ3 HSB per mm at the palatal regions, while in the cervical region, there was often an
cervical region of the same tooth (P < 0Æ05). The absence of HSBs (Fig. 2).
greatest HSB packing densities in human teeth were What is the significance of HSB patterns in human
noted in those areas subjected to greatest external teeth? Based on the recently described data on HSB
forces, such as the occlusal contact areas of the occlusal packing densities and the available evidence in the
surfaces of premolars and molars (13Æ7 HSB per mm, literature (10), the authors will briefly discuss the likely

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involvement of HSB packing densities in the certain densities in human teeth are present in the enamel
clinical entities, including: regions most likely to be damaged by attritional tooth
1 tooth wear ⁄ tooth surface loss; surface loss, such as the occlusal contact areas of the
2 the fracture resistance of human enamel; occlusal surfaces, the incisal quarters of axial surfaces,
3 cracked tooth syndrome; and the so-called guiding surfaces, such as the palatal
4 enamel bonding; surfaces of maxillary central incisors and canines, and
5 abfraction. the buccal surfaces of mandibular central incisors and
canines, when compared to the relatively HSB-devoid
cervical regions. Intriguingly, no HSBs were observed in
HSBs and tooth surface loss
the mesio-distal plane at the incisal edges of the incisor
Tooth surface loss, or tooth wear, is a non-carious teeth. It is thought that this would facilitate those edges
process by which surface regions of affected teeth are becoming abraded to produce a surface shaped for
damaged and lost. Some commonly used terms to optimal occlusal function, exposing dense HSB regions
describe the aetiological processes involved in tooth in the adjacent incisal edge regions on the labial and
surface loss include ‘attrition’, ‘abrasion’ and ‘erosion’. palatal surfaces which would tend to resist further
UK-based surveys have indicated that 66% of adults wear. A similar occurrence was noted in the creation of
have evidence of tooth surface loss affecting anterior serrated occlusal surfaces in rhinoceros teeth where a
teeth extending into dentine, and 33% of 15-year-olds preferential abrasion of incisal edges produces a highly
have erosion on the palatal surfaces of their maxillary efficient incising and cutting surface (16).
central incisors (11, 12). The consequences of untreated Conversely, the reduced HSB packing density in the
or unchecked tooth surface loss include aesthetic and more cervical regions of the crown suggests a suscep-
functional challenges, episodes of sensitivity or pain tibility of these regions to processes such as abrasion.
because of exposure of dentinal tubules and pulpal Fewer HSBs will result in a less organised enamel
damage in extreme cases. structure, with reduced prism decussation. Enamel
The distribution and orientation of HSBs have a role surfaces in this area will be more vulnerable to damage
to play in the development and prevention of tooth from external abrasives such as over-vigorous tooth-
surface loss in the human dentition. Osborn (8) brushing. While modifications in the organisation of
demonstrated that prisms which lie perpendicular to occlusal enamel and upper regions of the axial surfaces
the enamel surface are more resistant to abrasion than are evolutionary sensible, the relative lack of similar
those that lie parallel to the prepared surface, thereby organisation in the cervical regions do not protect
producing an uneven surface. This has been subse- against recently developed human habits such as
quently confirmed by ‘air – abrasion’ experiments (13). toothbrushing.
It was later noted that the ability of an individual prism
to resist acid erosion was related to its orientation (1).
HSBs and the fracture resistance of human
More detailed investigations of non-human teeth have
enamel
indicated:
1 mammalian teeth have evolved such that individual Human teeth are exposed to considerable masticatory
prisms are optimally orientated to maximally resist forces. Maximal biting forces are traditionally quoted as
abrasion, even if this means that prism distribution being (18):
within a tooth is asymmetric (14, 15); 1 100 N for incisor teeth;
2 the angle at which an individual prism meets the 2 500 N for molar teeth;
tooth surface will determine its resistance to wear 3 500–800 N in parafunctional habits.
(16, 17). The risks for humans when incising or masticating on
Therefore, it seems that increased HSB packing enamel are that it is quite brittle and such maximal
density reflects a more complex arrangement of indi- biting forces would be typically localised to a number of
vidual prisms, which permits the enamel prisms to meet small areas, thereby increasing stress concentrations
the EES at a suitable angle to optimise the resistance of onto number of small areas. The minimum work
the concerned surface to wear. Lynch et al. (10) have required to fracture enamel where it is weakest, i.e.
recently demonstrated that the greatest HSB packing along a plane parallel to the alignment of prisms that do

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362 C . D . L Y N C H et al.

not bend, has been estimated as 13 Jm)2 (19) which is teeth, the incomplete fracture usually travels laterally
very low. The initiation of progressive cracks on the and in some cases, the incomplete fracture is propa-
surface of relatively brittle materials is greatly facilitated gated until the undermined cusp ⁄ proximal tooth sur-
by the presence of irregularities such as sharp angles, face is lost. The location of this fracture is normally
scratch marks, grooves or other imperfections (20), and within the cervical enamel regions, and it does not
all of these features can be found on the surface of seem to occur at a level more coronal than this (27).
enamel. However, the propagation of a fracture plane is The diminished HSB packing densities found in the
readily impeded or inhibited by any structural features cervical enamel regions infer that the tissue in this
that result in a widening or diversion of the fracture region is poorly organised or at best contains parallel
plane tip (21, 22) Enamel tends to cleave along its prism prism arrangements. Consequently, these regions have
boundaries but modifications in the form of various very limited ability to prevent or limit crack propaga-
undulating groups of prisms which manifest as curved tion. It would seem reasonable, therefore, that the
and complex HSB patterns impede the progress of relative absence of HSBs in cervical enamel regions
fracture planes and reduces the likelihood of cata- facilitates the initiation and progression of cracked
strophic failure within the tissue (2, 3, 23, 24). Based on tooth syndrome.
the reported HSB packing densities, it appears that the
regions of greatest packing density are those which are
HSBs and enamel bonding
subjected to increased and repeated occlusal and mas-
ticatory forces, such as the occlusal surfaces of posterior Adhesive dentistry techniques are extremely popular in
teeth, and the incisal regions and guiding surfaces of contemporary clinical practice. Their main advantage
anterior teeth. The data available for the teeth of other lies in their avoidance of the unnecessary removal of
mammalian species indicate a comparable arrangement healthy tooth structure (31). The creation of a reliable
of HSB packing densities to that which exists in human bond to enamel was first described in its current form
dentitions (23, 25, 26). Accordingly, it would seem that by Buonocore in 1955 (32). At present, superior bond
the dentition has evolved to incorporate fracture- strengths are achieved when bonding to enamel (21–
resistant properties manifest as increased HSB packing 35 MPa) in comparison with dentine (14–26 MPa)
densities in strategic intra-tooth regions. (33–35). Enamel bonding is a micro-mechanical reten-
tive system, with no true chemical adhesion being
formed between the enamel substrate and adherent
HSBs and cracked tooth syndrome
bonding system or luting cement (36). This microme-
Cracked tooth syndrome is a clinical entity which chanical retention is achieved by first dissolving enamel
affects vital teeth with large restorations (27). Cracked prisms using an acid such as phosphoric acid (H3PO4),
tooth syndrome refers to the formation of an incom- to create a series of pits of varying depths and
plete tooth fracture in a vital tooth, commonly at the orientations on the cut enamel surfaces (37). A low
base of a deep restoration (28). The typical complaint is viscosity material, such as a resin bonding agent, then
that of an uncomfortable sensation or pain from a tooth flows into these etched pits to provide retention for the
that occurs when chewing hard food and that ceases eventual overlying restoration (38).
when the pressure is withdrawn. Occasionally, the It will be appreciated that the more complex the
symptoms may occur when occlusal pressures are shape of the bonded enamel surface, the more force will
withdrawn. Cracked tooth syndrome is caused by the be required to dislodge the completed restoration. If all
incompletely fractured region of the tooth being sub- enamel prisms treated with an acid etchant on a smooth
jected to occlusal loading. Relative movement of the surface are dissolved evenly, the etched surface will also
portions on either side of the ‘crack’ or fracture occurs, be flat, as will the junction between the adhesive
and this movement causes stimulation of the fluid material and enamel. There would be little resistance to
and ⁄ or nerve endings in the dentinal tubules, resulting dislodgement of the placed restoration in a direction
in pain (29). parallel to this junction. The situation would be
In heavily restored teeth, the incomplete fracture improved if the enamel surface was dissolved to
tends to occur at the line angles at the base of the produce an uneven surface of pits optimally suited to
restoration, because of ‘wedging’ forces (30). In such retain ‘micromechanical tags’. Osborn (1) observed that

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 HSBS AND THEIR IMPLICATIONS 363

enamel prisms could be preferentially dissolved by acid and cervical margins porcelain veneers has also been
etchants, and that the degree to which prisms were reported (42).
dissolved was dependent on the angle at which they From available in vitro and in vivo studies, it is evident
intercepted the surface being treated. Hunter–Schreger that the quality of adhesion achieved in cervical enamel
Band-rich regions of enamel contain many prisms of is inferior to that obtained elsewhere in that tissue. It is
rapidly changing orientation, compared with regions suggested that this is in keeping with the low HSB
where HSB packing densities are reduced, and where packing densities characteristic of cervical enamel,
prisms are often relatively parallel. Acidic treatment of indicating that enamel prisms are poorly organised
HSB-rich regions will create an etched surface contain- there compared with incisal ⁄ cuspal regions. The clinical
ing many etched pits of varying depth and orientation, significance of this for enamel bonding should not be
thereby increasing the potential for micromechanical underestimated.
retention. This also increases the surface area of the
available enamel surface for bonding, thereby increas-
HSBs and abfraction
ing the potential bond strength of placed restorations.
Consequently, it would seem that enamel bonding is Abfraction lesions are angular, wedge-shaped defects
more predictable or successful in regions with increased found at the cervical region of teeth which are thought
HSB packing densities in comparison with regions that to occur by a mechanical overloading of these regions
have reduced HSB packing densities or even lack HSBs. initiated by cuspal flexure. (43). Clinically, these lesions
A number of in vitro studies have examined the inter- are most prevalent on the labial aspect of maxillary
actions between prism orientation and quality of enamel incisor teeth. The prevalence of these lesions is increas-
bonding and have reported that the orientation of ing, and in varying patient and population groups, it
enamel prisms had an effect on the bond strengths ranges from 27% to 85% (44, 45).
achieved when traditional ‘total–etch’ systems were Traditionally, abfraction lesions were thought to be
used (39). These studies found that superior bond abrasion lesions, i.e. tooth surface loss processes
strengths are achieved when enamel prism patterns are induced at the cervical regions of teeth because of wear
more complex and intercept the restoration – tooth caused by objects other than teeth, such as a tooth-
interface at acute or perpendicular angles (39), and also brush. It was also considered that erosive tooth surface
that the weakest bond strengths occur where the prisms loss patterns had a role in the development of these
are poorly organised or are aligned parallel to the lesions, e.g. acid from dietary sources (46). However,
restoration – tooth interface. Other studies have dem- there are several characteristics of abfraction lesions
onstrated the hazards of trying to achieve a reliable bond which do not accord with either erosion or abrasion:
between the restorative material and aprismatic enamel, 1 abfraction lesions are narrow, wedge-shaped and
suggesting that this procedure results in the relatively only affect the cervical regions of teeth, while
constant loss of enamel from the etched surface, with erosion tends to produce rounded defects which
little being gained in terms of micromechanical reten- effect larger regions on the affected tooth surface;
tion (40). Similarly, HSB-free regions of enamel, and 2 abfraction lesions may occur in specific ⁄ individual
regions with significantly reduced HSB packing densities teeth, while adjacent teeth (not subjected to the same
which may contain parallel-orientated prisms, will lateral forces) remain unaffected. In contrast, tooth-
provide little in the way of micromechanical retention. brush abrasion and acid erosion patterns usually
Evidence from clinical studies provides circumstan- affect multiple adjacent teeth;
tial evidence to support the importance of prism 3 abfraction lesions may be found on the lingual
orientation on the bond strength of adhesive restora- surfaces of mandibular incisors, where access for
tions to enamel. A 5-year clinical retrospective study of toothbrushes, or other external agents capable of
composite restorations applied along the mesial sur- causing abrasion, is limited;
faces of maxillary central incisors found a significantly 4 mobile teeth do not seem to exhibit abfraction lesions
greater incidence of marginal defects surrounding the as frequently as non-mobile teeth; erosive or abrasive
cervical margins of these restorations (41). Evidence of processes would not be able to discriminate between
marginal failure ⁄ marginal gaps ⁄ marginal staining of these teeth, and this characteristic seems to implicate
the cervical margins of Class V composite restorations occlusal loading in the aetiology of the condition;

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364 C . D . L Y N C H et al.

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