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Dental papilla
Ectomesenchyme
from neural
crest
Dental follicle
95- 1
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Stratum intermedium
The bell stage of tooth development, which ex hibits d ifferentiation of the too th
germ to its fim hest extent. Note the enamel organ and the dental papilla have differentiated into various layers in preparation for the apposition of enamel and
dentin.
308AI
Reproduced \1,-ilh p~nnission from Ba1h-Balogh M, Fehrenbac-h MJ; 11/u.ftraled Demal EmhtJ'illogy. Histology. am/ A11aiMI)~ ed 2. St. Louis. 2006.
Saunders.
Micr oscopic
Appearance
Main Processes
Involved
Induction
Description
Ectodenn lining stomedeum gives
rise to oral epithelium and rhen to
dental lamina. adjacent w deeper
ec1omese.nchyme, which is influenced by the neural crest cells.
Both tissues are separated by a
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baseme-n t membrane.
P-roliferation
* Note that these are approximate prenatal time spans for the development of the primary dentition
3088~
R<'produccd \ltith penni$.iion (rom Ebtb-Balogh M. Fchrcnbacoh MJ; Jlill.~trale(/ Demal Emb'J'ology. Histology. om/ A11a/OP1)~ ed 2. StLouis. 2006.
Saunders.
[0
twelfth weeks
Main Processes
Involved
P-roliferation, ditTerentia.
tion, morphogenesis
Description
Differentiation of enamel organ
into bell with four cell types and
dental papilla into two cell rypes.
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Microscopic
Appearance
Induction. prolifermion
Maturation
* Note that these are approximate prenatal time spans for the development of the primary dentiti on
308 C.l
Reproduced with p..-nnission (rom Bath-Balogh M. Fehrenbach MJ; /1/ii.~trauNI Demo/ EmhtJ'illogy. Histology. om/ AIIOIOPIJ~ ed 2. St Ll"'Uis. 2006.
Saunders.
maxillary canine
maxillary lateral incisor
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A cingulum (also cal led the linguocervical ridge) is the lingual lobe of an anterior
tooth. It makes up the bulk of the cervica l third of the lingual surface.
Anterior teeth that have a cingu lum located in the center of the cervica l third of the
lingual surface:
Maxillary lateral incisor
Maxillary canine
Mandibular centra l incisor
Anterior teeth that have a cingu lum which is located off center to the distal in the
cervical third of the lingual surface:
Maxillary centra l incisor
Mandibular lateral incisor
Mandibular can ine
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Note: The total number of cingula in each dentition is twelve (six maxillary anterior
teeth and six mandibular anteri or teeth).
Mandibular Right Lateral Incisor
Incisal
Incisal
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Note: The CEJ curvat ures are greater on the mesial than the distal (see pictures below).
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...
\\
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/\
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,./
l ))\ l \
I...
\.
....
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Mesial
Distal
Mandibular right
central incisor
Mesial
Distal
Mandibular right
lateral incisor
Mesial
Distal
Mandibular right
canine
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*** The mandibular lateral incisor crown t ips sli ghtly to the distal relative to t he root
(facial view).
Other ways to distinguish the mandibular lateral from the mandibular central:
The lateral is larger overall (especially mesiodistally)
The lateral is not as b il aterally symm etrical as the centra l incisor
The cingulum on the lateral is slightly distal to the center
On the lateral inciso r, the mesial marginal ridge is longer than the distal marginal
ridge. On centrals, they are the same lengt h
Lateral incisors have t he distal p roximal contact s more apical t han the mes ial contacts. Centrals are at the same level
Lateral incisors have the distoincisal angles more rounded than the mesioincisal
angles. On centrals, the angles are nearly the same
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Note: Both the mandibular central and lateral have a lingual cervical line t hat is positioned more apically than the facial cervical line.
Mandibular Right
Lateral Incisor
Labial
4
Incisal
Mandibular Right
Central Incisor
M~
Labial
lnc.isal
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Trapezoids
Trapezoid with longest uneven side toward occlusal or incisal surface
All anterior teeth, maxillary and mandibular - labial and lingual aspect
All posterior teeth- buccal and lingual aspect
Trapezoid with shortest uneven side toward occlusal surface
All maxillary posterior teeth- mesial and distal aspect
Rhomboids
All mandibular posterior teeth- mesial and dista l aspect
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an elliptica l shape, wider in the mesiodistal direction in the pulp chamber, but wider
in the faciolingual d irection in the mid-root area
an elliptical shape, w ider in the facio lingual d irection in the pulp chamber, but w ider
in the mesiodistal direction in the m id-root area
to the mandibular cent ral incisor, the mandibular lateral incisor's root is larger
in all dimensions.
2.The crown of the mandibular lateral incisor tips slightly to the distal relative to the root;
thu s, the cingulum is slightly off-center to the distal, like that of the maxillary central incisor and mandibular canine, but unlike that of the mand ibular central incisor.
3. The incisa l edge of the mandibular lateral is slightly curved or rotated on the distal. For
this reason it is possible to see a small portion of this distal-incisal edge w hen viewing this
tooth from the mesial aspect.
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Mesiodistal
cross-section
Cervical
Cervical
cross-section
cross-section
labiolingual
cross-section
Mesiodis1ol
c ronsection
labiolingual
cross-section
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!. Important: The mandibular central is the only anterior tooth in which the distoincisal
angle is as sharp and disti nct as the mesioincisal angle. All other incisors show a more or
less rounded distoincisal angle.
2. Anterior teeth are highly important aesthetically and play an important role in the formation of many speech sounds ("V~ "F: and "TH"). When viewed from the sagittal plane,
the axial inclination of the anterior teeth inclines facially.
\l:nlllaJ' and \landJb ulaJ
lm1~on
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8,9
1.10
24.;25
2 3.26
Slight rounding
Slight rounding
Oistincc roond
M ot~" rounded
Straight
Slight rounding
Straight
Straiglu
Ncsrlyround
Oistincc round
Straight
Su'3iglu
Straight
Straight
Straight
Straight Ol twist
lncisslthird
Junction
Jun~"1ioo
Middle third
Incisal th ird
lncis:al tb ird
Incisal third
Ml angle
Dl angle
Mcsialprotilc
Dist~ll profile
Incisal outline
Proximal contacts
Mesial
Distal
l nci~al
third
Maxillary Right
Central Incisor
Maxillary Right
Lateral Inci sor
Mandibular Right
Lateral lncisor
Labial
labial
labial
Mandibular Right
Centrallncisor
Labial
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Max. Canine
Mand. Canine
trapezoidal outline
triangular outline
rhomboidal outline
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square outline
trapezoidal outline
The trapezoidal outline has its longest uneven side toward the occlusal or incisal surface.
{j {j
Lingual view of
the Maxillary
Right Canine
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wa
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maxillary canine
There is no contact on the cusp tip. It fa lls in direct alignment with the facial embrasure
between the mandibular canine and first premolar. This anterior tooth is unique in
that it has antagonists, in the intercuspal position, in both anterior (canine) and posterior (first premolar) segments of t he opposite arch.
\l:nillar~
Canines
Characteristics
FaciaULabial a spect
Proxima l contacts
Mes ial
Distal
Mesial aspect
Wider faciolingually
Incisal aspect
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2.5 mm (mesial)
Contour Height
Facial/lingual
O.Smm
Both cervical third
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labially, the cusp tip is placed distal to a line which bisects the crown and root
linguall y, the cervical line slopes mesially
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the distal surface is fuller and more convex than the mesial surface
Also remember that:
The curvature of the cervical line is greater on the mesial side than on t he d istal side
The mesial surface is straighter than the distal surface
The d istal cusp ridge is longer than the mesial cusp ridge
The mesial contact point is at the junction of t he incisal and midd le third
It usually thicker labiolingually than it is mesiodistally
The tip of the cusp is displaced labially and mesial to the central long axis of the tooth
The d istal contact is in a more cervical position (middle of the middle third)
Althoug h the apical l /3 of the root typically curves distal, t his is not always true.
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Maxillary Right Canine
C\ISP~
Facial
lingual
labial ri dge
lingua I fossa
mamelons
cingulum
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labial ridge
The labial (facial) surface of canines is marked by a pronounced labial ridge (see facial view
below). Shallow developmental depressions lie mesial and distal to t he labial ridge. On the
mandibular canines, the labial ridge and the developmental depressions are not as
pronounced.
Important: The canines (both maxillary and mandibular) are the only cusped teeth which
feature a functional lingual surface rather than a functional occlusal surface.
~
1. Looki ng at the maxillary canine from a facial view, the d istal portion of the facial
surface is convex in t he middle t hird and slig htly concave in the cervical third. The
mesial portion is convex in the middle third and nearly flat in the cervical third.
2. From the incisal view, the cervical line is often not visible. This is due to the convexity of t he crown.
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l a bial
ridge
labial
ridge
Cusp
tip
Facial
Facial
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Erupt
78yrs.
3-t )'f$.
u -avr'$.
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y :,.>_
1()..11)"'$.
10.12yn.
6-7yl'$.
1721yn.
LoworToeth
Erupt
1721yn.
U 13vrs.
6-7)"1'$.
1112yn.
1()..12)"'$.
9- IOvrs.
Lllteral ineisor
~tral ~isor
78yrs.
6-7yrs.
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it is narrower mesiodistally
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Facial
Lingual
G g
lnc.isal
Incisal
Facial
Lingual
labial
lingual
mesial
distal
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Characteristics
Facial/ Labial uptt"t
Proximal contacts
Mesial
Distal
Mesial a.spect
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Lingual aspect
labial
Incisal thi1d
Middle third
rid~ ~usptip
Marginal ridges
Cingulum
Lingual pit~. grooves
lnclul aspect
DCRYMCR
CEJ curvature
1.0 mm (distal)
Contour Height
< 0.5 mm
Both cervical [hird
Facial/lingual
Remember:
1. The maxillary canine is the longest tooth in the mouth.
2. The faciolingual d imension of the maxillary and mandibular canines is greater
than their mesiodistal dimension.
3. The mandibular canine has the longest crown of any permanent tooth.
4. The mesial surface of the crown of a mandibular canine is nearly parallel w ith
the long axis of the tooth.
eruption sequence
Nonsuccedaneous teeth include all of the following EXCEPT one? Which one
is the EXCEPTION?
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A permanent tooth that moves into a position formerly occupied by a primary tooth
is called a succedaneous tooth. In each quadrant, five permanent teeth, the incisors,
can ine, and premolars, succeed or take the place of the five pri mary teeth.
Nonsuccedaneous teeth include:
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***These teeth do not move into a position formerly occupied by a primary tooth.
eruption sequence
A mother brings her 1-year-old into your office the day after his first birthday.
She says the pediatrician said to have the first dental check-up by this time.
What primary teeth are you expecting to see when the child opens?
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Erupt
Central incisor
8-12 mos.
6-7 yrs.
Lateral incisor
9-13 mos.
7-8 yrs.
Canine (cuspid)
16-22 mos.
10-12 yrs.
First molar
13-19 mos.
9-1 1 yrs.
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Second molar
Shed
25-33 mos.
10-12 yrs.
Lower Teeth
Erupt
Shed
Second molar
23-31 mos.
10-12 yrs.
First molar
14-18 mos.
9-1 1 yrs.
Canine (cuspid)
17-23 mos.
9-12 yrs.
Lateral incisor
10-16 mos.
7-8 yrs.
Central incisor
6-10 mos.
6-7 yrs.
*** Eruption dates are va ri able. Some infants get teeth early, others do so late.
~~
/fJJiJ 2. Active eruption of teeth occurs after two-thirds of the root is formed.
Saad Alqahtani, Twitter @saaddes
eruption sequence
Tommy, a pediatric patient of yours, says he lost his top vampire tooth last
week and the tooth fairy gave him a dollar for it. What is Tommy's most
likely age range when he lost his maxillary canine tooth?
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l sual t:xfoliation
A~:e
Maxillary Teeth
Shed
Central Incisor
6-7 years
Lateral Incisor
7-8 years
Canine
10- 12 years
First molar
9- 11 years
Second molar
I 0- 12 years
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Mandibular Teeth
Shed
Central incisor
6-7 years
Latera I incisor
7-8 years
Canine
9- 12 years
First molar
9- 11 years
Second molar
I 0- 12 years
Primary teeth are exfoliated by the phenomenon called resorption of the primary
root. The permanent tooth in its follicle attempts to force its way in to the position
held by its predecessor. The pressure brought to bear against the primary root
evidently causes resorpti on of t he root, which continues until t he primary crown has
lost its anchorage, becomes loose, and is finally exfoliated,
eruption sequence
Which of the following are the cardinal rules regarding the eruption of
teeth?
Select all that apply.
boys' teeth usually erupt before girls' teeth of the same age
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girls' teeth usually erupt before boys' teeth of the same age
maxillary teeth usually erupt before mandibular teeth
mandibular teeth usually erupt before maxillary teeth
the teeth of slender ch ildren usually erupt before the teeth of stocky children
the teeth of stocky children usually erupt before the teeth of slender children
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girls' teeth usually erupt before boys' teeth of the same age
mandibular teeth usually erupt before maxillary teeth
the teeth of slender children usually erupt before the teeth of stocky children
Note: You w ill probably never find these cardina l ru les in a book (we have tried but
to no avail!!!); however, if you see th is question or something similar to it asked on the
boards, answer as above.
Also remember:
1. Teeth usually erupt in pairs.
2. Often the permanent mandibular anterior teeth erupt lingual to the primary
teeth and give the appearance for awhile that there are two rows of teeth.
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Universal Tooth Numbering
Permanent Teeth
1 ~ 1 ~
lower left
upper right
~!
:! H_
lower right
eruption sequence
The deciduous dental formula of man is:
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None of the above
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20 total teeth
I = Incisors
C = Canines
M =Molars
Note: There are no premolars (bicuspids) in the deciduous dentition.
For primary dentition, the crowns of all 20 teeth begin to calcify between 4 to 6
months in utero, and on average take 10 months fo r completion. In general, the root
of a deciduous tooth is completely formed in just about one year after eruption of
that tooth into the mouth.
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In the Palmer system, the arches are divided into fou r quadrants. The Palmer notation
for the primary dentition is as follows:
EDCBAIABCDE
E DCBA lA BCD E
The Federation Dentaire lnternationale (FDI) recommends a two-digit system for
both the primary and permanent dentitions. This system has been adopted by the
World Health Organization (WHO) and is accepted by other organizations and in research and public health. The FDI system of notation fo r the primary dentition is as follows:
Note: Number 5 indicates the right maxillary quadrant;
555453525116162636465
858483828117172737475
eruption sequence
The permanent dental formula of man is:
z2 C11 s:i3 M 2z = 16 x 2 = 32
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1l ( 1 M 3. =
2
12 x 2 = 24
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I~ C 18 ~ M ~ = 16 x 2
2 1 2 3
= 32
SAADDES
The Palmer system for the permanent dentition divides the arches into four quadrants with eight teeth in each quadrant. The Palmer notation for the permanent dentition is as follows:
8 7 6 54 3 2 1 11 2 3 4 56 7 8
87654321 11 2345678
18 17 1615 14 13 12 11121 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41131 32 33 34 35 36 37 38
Note: In the permanent dentition, the first digit Indicates the quadrant and the second digit Indicates the
tooth in that quadrant. The right maxillary quadrant Is 1, t he left maxillary quadrant is 2, the left mandib ular quadrant Is 3, and the right mandibular quadrant is 4.
eruption sequence
As soon as a child gets his/her _ _ _ _ _ he/she is considered to be in the
mixed dentition.
permanent canines
permanent first molars
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Remember: After t he permanent teeth have reached full occlusion, small tooth
movements occur to com pensate for wea r at the contact areas (by mesial d rift) and
occl usal surfaces (by deposition of cementum at the root apex).
eruption sequence
A 15-month-old child walks into your office and begins to cry and hold his
mouth in pain. Which teeth have probably not been traumatized, as they are
not usually present at 15 months of age?
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Specific Teeth
(in months)
7
II
15
19
23
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8
12
16
20
***The above"rule of fou r" is not perfect, it is a generalization. For example, at age 23
months, the ch ild might not have their maxillary second molars yet, the same holds
true for age 7 months, the chi ld might not have their maxillary central s yet.
Example from question on front of card: At age 15 months, 12 teeth are erupted
(four centrals, four lateral s, and four first molars).
eruption sequence
A pediatric patient of yours complains of severe pain on chewing. On clinical
exam, you see an eruption cyst in the place of the mandibular second molar.
What is the most likely age of this patient?
8
10
12
14
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12
***The mandibular second molar erupts between 11 and 13 years of age.
Chronolog~
Enamel
Complete
Eruption
Root
Completion
Maxillarv
Central
Lateral
Canine
First pre molar
Second premolar
First molar
Second molar
Third molar
3-4 months
10 months
4 -5 months
I 1/2 -I 3/4 years
2 - 2 1/4 years
At birth
2 112 -3 years
7-9 years
4 -5 years
4 -5 years
6-7 years
S-6 years
6 -7 years
3-4 years
7-8 years
12- 14 years
7-8 years
8-9 years
11-1 2 years
10-1 1 years
10-1 2 years
6-7 years
12-1 3 years
17-21 years
10 years
I I years
13-1 5 years
12-1 3 years
12-14 years
9- 10 years
14 -1 6 years
19-21 years
Mandibular
Central
Lateral
Canine
First pre molar
Second pre molar
First molar
Second molar
Third molar
3-4 months
3-4 months
4 -S months
I 3/4 - 2 years
2 1/4 - 2 112 years
At birth
2 112 -3 years
8- 10 years
4 -5 years
4 -5 years
6 -7 years
S-6 years
6-7 years
2 112 - 3 years
7-8 years
12- 14 years
6-7 years
7-8 years
9- 10 years
10- 12 years
l l - 12years
6-7 years
11 - 13 years
17-21 years
9 years
10 years
12-14 years
12-1 3 years
13-14 years
9- 10 years
13-14 years
19-21 years
T ooth
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eruption sequence
At 9 years of age how many primary teeth are present in the mouth?
8
12
18
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12
By age nine, the chi ld has lost the mandibular centra l (6-7 years), mandibular lateral
(7-8 years), maxillary centra l (6-7 years) and maxillary lateral (7-8 yea rs) incisors. Theremaining dentition is composed of 6 maxillary and 6 mandibular teeth.
Primar~
Maxillary Teeth
Tl'l'th
Shed
Centra l Incisor
6-7 years
Lateral Incisor
7-8 years
Canine
10-12 years
First molar
9- I I years
Second molar
10-12 years
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Mandibular Teeth
Shed
Centra l incisor
6-7 years
Lateral incisor
7-8 years
Canine
9-12 years
First molar
9- I I years
Second molar
10-12 years
eruption sequence
A 1-year-old child is expected to have erupted which of the following primary
maxillary and mandibular teeth?
Select all that apply.
central incisors
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lateral incisors
canines
first molars
second molars
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Erupt
S hed
Central ii)Cisor
812 mos.
913 mos.
16-22 mos.
67 yrs.
7-8 yrs.
First molar
13-- 19 tnOS.
9 11 yrs.
10 12 yrs.
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Second molar
25-33 mos.
10 12 yrs.
Lower Teeth
Erupt
Shed
Second molar
23-31 mos.
10 12 yrs.
First molar
1 4-- 18 tnOS.
9 11 yrs.
Canine (cuspid)
1723 mos.
Lateal incisor
10.1 6 mos.
Central ii')Cisor
610 mos.
912yrs.
78 yrs.
6-7 yrs.
Remember: Eruption dates are variable. The timi ng of the eruption or emergence of the
teeth is due in large part to hereditary and only somewhat to environmental factors. The
mean age of eruption of the primary teeth is demonstrated schematically below.
It
11
!(I
ao ,, a
eruption sequence
A patient with erupted teeth #8, 7, C, B, A, 3 and unerupted 2 and 1 is most
likely what age?
8
10
12
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8
***The patient has an erupted first molar #3, so is at least 6 years old. The maxillary incisors #7 and #8 are erupted, so the patient is at least 8 years old. The unerupted premolars show that the patient is probably not 9 yet.
The sequence of eruption of the permanent dentition is more variable than that of
the primary dentition and does not follow the same anteroposterior pattern. In addition, significant differences in the eruption sequences between the maxillary arch and
the mandibular arch do not appear in the eruption of the primary dentition.
The most common sequences of eruption in the maxilla are 6-1-2-4-3-5-7-8 and 6-12-4-5-3-7-8. The most common sequences for the mandibular arch are (6-1)-2-3-4-5-78 and (6-1)-2 -4-3-5-7-8. These are also the most favorable sequences for the
prevention of malocclusion (see the picture below). Keep in m ind that mandibular
teeth tend to erupt before their maxillary counterpart.
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2
~.....
23
heights of contour/contacts
A patient comes in with a chief complaint of, "My wife says I wake her up at
night with scraping noises from my mouth:' On clinical exam you will expect
to find which of the following characteristics of his occlusal contacts?
point-to-point
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point-to-area
edge-to-edge
edge-to-area
area-to-area
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area-to-area
The character of occl usal contacts in the unworn dental arch are all of the following:
point-to-point
point-to-area
edge-to-edge
edge-to-area
Important: In bruxism, however, the direct tooth-to-tooth contact may resu lt in nonphysiological area-to-area contacts.
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The character of occlusal contacts makes chewing easier to perform, since there are
abundant food spillways on the occlusal table.
Note: The most difficult bruxism problem to be faced is the patient who has worn the
entire occlusion flat and has shortened the anterior teeth into an end-to-end relationship. The effect of bruxism is easy to eliminate if the flat anterior guidance can be mainta ined, but often such a patient wishes to have the anterior esthetics improved. There
is sometimes no way to improve the esthetics w ithout steepening the anterior guidance. A steepened anterior guidance almost always promotes parafunction.
heights of contour/contacts
All posterior teeth have proximal contacts in the:
middle third
junction of the occlusal and middle third
occlusal third
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cervical third
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middle third
When viewed from the facial, all posterior teeth have proximal contacts in the middle third. Molars
have contacts lower in the middle third than the premolars. Also, each posterior tooth has themesial contact slightly more occlusal tha n the distal contact.
Summary of contacts in the incisocervical or occlusocervical dimension:
Maxillary teeth: IJ, JM, JM, MM, MM, MM, MM, M
I = Incisal third M = middle third
Mandibular teeth: II, II, IM, MM, MM, MM, MM, M J = at the junction of the incisal and middle third
A. Centrals and lateral
B. Central, lateral and canine
C. l ateral, canine and first premolar
D. canine, tim premolar, and second premolar
E. First molar. second premolar, and tim
molar
F. Second premolar, first molar, and second molar
G. First, second, and third molars
-~
-d:b .
-~cl
- ~
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~
0
-~-~
~~
G
~-~-~
~
'<lpj'V
A l
-~--~
D
-~-
Remember: 1. The more anterior the tooth, the more incisal/occlusal are the locations of the
proximal contacts.
2. For any tooth, the mesial contact area is more toward the incisal/occlusal than is the
distal contact area.
heights of contour/contacts
The location of the height of contour on the facial and lingual surfaces of the
crowns of teeth can best be seen from the mesial and distal views and is usually located in either the cervical third or the middle third (never the occlusal
or incisal third).
The location of the height of contour on the facial surface of all crowns is
located in or near the cervical third.
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SAADDES
Facial
of Contour)
( H ~igh t
Cervical third
(gn. alt'~l
huiJ;!l') ol cnn\n
Lingual
(Height of Contour)
Note: There is clinical evidence that smooth and properly contoured (not too convex or
too great a contour) crown surfaces pro mote tooth cleansing and gingival health. In
other words, when fabricating a crown for a patient, make sure the height of contour is
taken into consideration.
heights of contour/contacts
Which three mandibular teeth are so aligned that, when viewed from the
occlusal, a straight line may be drawn that will bisect all contact areas?
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When teeth are in ideal alignment within t he arch, the location of the mesial and dista l heights of contour (when viewed d irectly from the facia l or lingual sides) is essentially the same location as contact areas. Contact areas are the greatest heights of
contour or location of the greatest bulges on the proximal surfaces of tooth crowns,
where one tooth touches an adjacent tooth. When viewing teeth from the facial view,
contact areas are characteristically located in t he incisal or occlusal third, in the m iddle
third, o r at the junction of the incisal and middle thirds, but they are never in the cervical third. When viewing posterior teeth from the occlusal view, contact points are
often slightly to the facial of the tooth m idline buccolingually.
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The contact of each tooth with the adjacent teeth has important functions:
The combined anchorage of all teeth w ithin each arch making positive contact
with each other stabilizes the position of teeth within the dental arches
Contact helps prevent food impaction, which can contribute to decay, along
w ith gingival and periodontal disease
Contact protects the interdental papillae of the gingiva by shunting food toward
the buccal and lingual areas
heights of contour/contacts
Cervical line (or CEJ) contours are closely related to the attachment of the
gingiva at the neck of the tooth. When doing a crown prep, your margin will
slope with the contours of the cervical lines and gingival attachments. On
which surfaces will your greatest contour be found?
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HHKKMMH
HHHHHMN
2nd
Molar
Facial
M esial
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1st
Molar
C ba r actrristic.s
C urvcatCEJ
Mesial
Distal
Contour Height
facial/ lingual
2nd
1st
Canine
Premolar Premolar
8,9
3.5 mm
2.5 mm
Lateral
Incisor
7,10
24,25
23,26
3.0mm
2.0mm
3.0 mm
2.0mm
3.0mm
2.0mm
Central
Inci sor
6,11
22,27
2.5mm
1.0111111
Cervical Cervical
third
third
Remember: All teeth generally have a greater proxim al cervical line (CEJ) curvature on
the mesial than the distal. Also, the proximal cervica l line (CEJ) curvatures are greater on
the incisors and tend to get smaller when moving toward the last m olar, where there m ay
be no curvature at all. Facial and lingual CEJs curve apically; mesial and distal CEJs curve
coronally.
heights of contour/contacts
You are fabricating an interim bridge from 19 to 21. The contact areas on
the pontic when viewed from the occlusal view, should be _ _ of the tooth
midline buccolingually.
directly in line
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Out line drawings of the maxillary teeth from the inici sal
and occlusal aspects w ith broken lines bisecti ng the cont act areas. These ill ustrations show the relative posit ions
of the contact areas l abiolingually and buccolingually.
Arrows point t o embrasure spaces. A, Central incisors
and lat eral incisors. B, Central and lateral incisors and canine. C, Lateral incisor, canine, and first premolar. 0 , Canine, first premolar, and second p remol ar. E, First
p remolar, second premolar, and first mol ar. F, Second
premolar, first molar, and second molar. G, First, second,
and third molars.
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-~- ~- $
I
-~- -~
l Ef
-~'
FI
Contact rel ation of mandibular teeth labiolingually and buccolingually when surveyed from
t he incisal and occl usal aspects. Arrows point to
embrasure spaces. A, Central incisors and lateral
inci sors. B, Central and lat eral incisors and canine.
C, Lateral incisor. canine. and first premolar. 0, Canine, first premolar, and second premolar. E. First
premolar, second premolar, and fi rst molar. F, Second p remolar and first, second, and third molars.
heights of contour/contacts
The mesial contact area of a permanent maxillary lateral incisor is usually
located:
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Lau~ ral
Canint
Maxillary
II
JM
JM
Mandibular
II
II
IM
Note: IJ means that the mesial contact is located in the incisal thi rd (I) and the distal contact is located
at the junction (J) of the incisal and middle thirds. These are all from the facial aspect (incisocervical o r
occlusocervical di mension). When viewed from the occlu sal (or incisal), all anteriors have their contacts in
the middle third (M or D); thus they are centered faciolingually.
Remember: Although the mesial and distal contacts of the mandibular lateral are in the incisal third, the
distal contact is slightly cervical to the mesial contact. On the mandibular central incisor they are both
at exactly the same level.
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-n--n--nrrxx
Xxtt
I O I
t E t
-'!E]C -~
Outline drawings of the maxillary te-eth in contact, \VIth dotted
lines bisecting the contact a reas at the various levels as found
normally. Arrows point to embrasure spaces. A, Central and fat
e ral incisors.. 8, Central and late ral incisors and canine. C., Lateral
inasor, camne and first ptemolar. 0, Camne and first and second
premolars. E., First and second premolars and first molar. F, Sec
ond premolar, fnst molar, and second molar. G, First. second. and
third molars.
heights of contour/contacts
From a facial view, mesial and distal contact area s of mandibular central
incisors are located:
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JJ("
Yy_
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ta l
IFI
-J:!]C -~
heights of contour/contacts
The contact area on the mesial surface of a mandibular canine is located at
the:
middle third
incisal third
cervica l third
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incisal third
The mandibular canine on its mesial surface contacts the distal surface of the lateral
incisor. The canine almost seems to tilt mesiall y towards the incisor tipping into it but
meeting it at a contact point near the incisal third. It is similar to the way in which the
mandibular incisors contact each other in the incisal th ird. The contact of the d istal of
the mandibular can ine with the mesial of the fi rst premolar is in it's middle third.
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n --n +A +
-#J()(-
heights of contour/contacts
The lingual height of contour on a permanent mandibular second molar is
located:
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*** From the cervical line, the crown bulges out ward reach ing the height of contou r at the middle
third. It then slopes more sharply inward toward the apex of the mesial lingual or distal lingual cusp
tip. In contrast on the buccal, t he height of contour is much lower and is reached almost immediately after the cervical line in the cervical or gingival third of the tooth.
The location of the crest of curvature (height of contour) on the facial (or buccal) and lingual surfaces
of the crowns of teeth can be seen from the mesial and distal aspects, and are usually in one of two
places:
l .ln the cervical third of the crown on:
Facial (or bucca l) surfaces of all anterior and posterior t eeth (maxillary and mandibular)
lingual surfaces of all anterior teeth (maxillary and mandibular) on the cingulum
2. In the middle third of the crown on:
lingual surface of maxillary and mandibular posterior teeth
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heights of contour/contacts
Which of the following teeth has its mesial contact located within the incisal
or the occlusal one third?
maxillary canine
maxillary first molar
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The mesial surface ofthe mandibular centra l incisor contacts the mesial surface of the
other mandibular centra l. They contact in the incisal third. All mandibular incisors contact with each other or with the mesial of the can ine w ithin the incisal third.
Remember: Maxillary teeth - IJ, JM, JM, MM, MM, MM, MM, M
Mandibular t eeth - II, II, IM, MM, MM, MM, MM, M
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-u --n--fY
I AI
}j\-
heights of contour/contacts
The height of contour occlusocervically is located within the middle third of
the:
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***The height of contou r of the lingual surface of the maxillary fi rst molar is in the
middle third. On the facial surface it wou ld be in the cervical third.
Remember: The location of the crest of curvature (height of contou r) on the facial
(or buccal) and lingual surfaces of the crowns ofteeth can be seen from the mesial and
distal aspects, and are usually in one of t wo places:
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miscellaneous
For each numbered definition below, select the most closely linked term
from th e list provided.
Definition
T erm
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A. Hypercementosis
B. Mesiodens
C. Concrescence
D. Ankylosis
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1. B, 2. A, 3. 0, 4 .C
Mesiodens is a supernumerary tooth between the maxillary central incisors.
Hypercementosis is the excessive formation of cementum around the root of a tooth
after the tooth has erupted. lt may be caused by trauma, metabolic dysfunction, or periapical inflammation.
Ankylosis is a rare d isorder characterized by the fusion of the tooth to the bone, preventing both eruption and o rthodontic movement. It may be initiated by an infection
or t rauma to the periodontal ligament. The ankylosed tooth has lost its periodontal ligament space and is tru ly fused to the alveolar process or bone.
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Concrescence is a fusion or growing together of two adjacent teeth at the root through
Ankylosis
Hypercementosis
Concrescence
Mesioden s
miscellaneous
The length of the mandibular arch is longer than the maxillary arch.
The difference is only about 2 mm.
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'-<
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miscellaneous
Which of the following is the loss of tooth structure from non-mechanical
means?
attrition
abrasion
ankylosis
erosion
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erosion
Erosion is the loss of tooth structure from non-mechanical means. It can result from drinking acidic
liquids or eating acidic foods. It is com mon in bulimic individualsas a result of regurgitated stomach
acids. It affects smooth (especially lingual) and occlusal surfaces.
Attrition is the wearing away of enamel and dentin from the normal function or, more commonly,
from excessive grinding of teeth together by the patient (bruxism). The most noticeable effects of attrition are polished facets, flat incisal edges, discolored surfaces of teeth, and exposed dentin. Facets
usually develop on the linguoincisal of t he maxillary central incisors, the facioincisal of the mandibular canines, and the linguoincisal of the maxillary canines.
Types of abrasion:
Toothbrush abrasion: most often results in V-s haped wedges at the cervica l margin in the
canine and premolar areas. It is caused by the use of a hard toothbrush and/or a horizontal
brushing stroke and/or a gritty dentifrice.
Occlusal abrasion: results in flattened cusps on all posterior teeth and worn incisal edges. It is
caused by chewing or biting hard foods or objects or chewing tobacco.
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miscellaneous
Agents (chemicals) that are capable of causing developmental abnormalities
in utero are called teratogens. For each numbered teratogen listed below,
select the most closely linked effect from the list provided.
Teratogen
Effect
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A. Microcephaly
2. Cytomegalovirus, toxoplasma
3. Ethyl alcohol
4. Rubella virus
E. Microcephaly, hydrocephaly,
microphthalmia
5. X-radiation
6. Vitamin D excess
F. Microphthalmia, cataracts,
deafness
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1. D, 2. E, 3. B, 4. F, 5. A, 6. C
Agents (chemicals) that are capable of causing developmental abnormali ties in utero
are ca lled teratogens. The particula r type of fetal development problem is related to
not only the type of teratogen but also the time at wh ich the teratogen interacts w ith
the fetus. Since most organogenesis occurs during the first three months of gestation,
this first trimester (weeks 0-13) is the time of greatest sensitivity to teratogenic
activity.
Teratogens .\ffecting Dentof:lcial DeHlopment
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Teratogens
Effect
Ethy l alcohol
Rubella v irus
X-radiation
Microcepha ly
Vitamin D excess
miscellaneous
As you know, there are several kinds of teeth in the human mouth. They all
serve different functions. You are in an argument with your friend, a law
, which simstudent, and you test his vocabulary. You call him a
ply means he has teeth with different morphologies and functions.
polyphyodont
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monophyodont
heterodont
diphyodont
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heterodont
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miscellaneous
Which of the following refers to the congenital absence of many, but not all,
teeth?
hypodontia
anodontia
oligodontia
hypsodontia
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oligodontia
Anodontia is a developmental abnormality characterized by the total absence of
teeth.
Two forms:
1. Complete: is a rare cond ition in which all of the teeth are m issing. It may involve both the pri mary and permanent dentitions. It is usually associated w ith
hereditary ectodermal dysplasia.
2. Partial (commonly referred to as congenitally missing teeth): is rather common.
The most common missing teeth in o rder are: thi rd molars (maxillary more often
than mandibular), maxillary lateral incisors, and mandibular second premolars.
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miscellaneous
A child has maxillary incisor protrusion, an anterior open bite, crowded lower
anteriors, and a high palatal vault. Which of the following most likely caused
this problem?
mouth breathing
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thumb sucking
tongue thrusting
using a pacifier
nocturnal bruxism
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miscellaneous
A patient of yours has enamel hypocalcification. You would expect _ _
quantity of enamel and would describe it as _ _ .
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normal; soft
***Enamel hypoca lcification is a hereditary dental defect in which the enamel of the teeth is soft
and undercalcified in context yet normal in quantity (qualitative enamel problem).
This condition is caused by defective maturation of ameloblasts (defect in mineralization of the
formed matrix). The teeth are chalky in consistency, the surfaces wear down rapid ly, and a yellow to brown stain appears as the underlying dentin is exposed.This condition affects both the
deciduous and permanent teeth.
Enamel hypoplasia is a developmental dental defect in which the enamel of the teeth is hard
in context but thin and deficient in amount (quantitative enamel problem). It is caused by
defective enamel matrix formation with a deficiency in the cementing substance. There is a
lack of contact between teeth, rapid breakdown of occlusal surfaces, and a yellowish-brown
stain that appears where the dentin is exposed. The condition, which affects both the deciduous and permanent teeth, can be transmitted genetically or caused by environmental factors,
as with vitam in deficiency, fluorosis, or metabolic d isturba nces d uring the prenatal period. It is
a common sequela in a child with a history of generalized growth failure in the fi rst six months
of life. Hypoplastic areas on teeth are seen if a child has illnesses in early childhood.
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Enamel hypocalcification
Enamel hypoplasia
miscellaneous
Which ofthe following teeth have the most variability in form?
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The maxillary lateral incisors have the greatest va riabili ty in form ofthe entire dentition
with the exception ofthe th ird molars. Since the form of the tooth varies more than the
others listed, the maxillary lateral would more common ly be in misalignment with the
adjacent central and canine.
If the variation is too great, it is considered a developmental anomaly. A common situation is to find maxillary lateral incisors with a nondescript, pointed form; such teeth
are called peg-shaped laterals (see photo below on right).
One type of malformed maxillary lateral incisor has a large, pointed tubercle as part of
the cingulum (see photo below on left); some have deep developmental grooves that
extend down on the root lingually with a deep fold in the cingulum; and some show
twisted roots, distorted crowns, and so on.
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miscellaneous
A mental foramen would be found on X-ray closest to the root of which tooth?
19
14
29
22
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29
The m ental foram en carries the mental nerve, artery and vein through the mandible onto
the skin overlying the mandible from the mid line to the first premolar area. It also innervates buccal soft tissue and periosteum in the sam e area, as well as portions of the lower
lip. The foram en is seen on X-ray as a lucent ova l or circle most often near the apex of the
mandibu lar second premolars. Important: It is possible in some cases to confuse the foram en w ith periapical pathology.
The mental foram en has been shown to be located at practically the same level on most humans (13 -15 mm superior to the inferior border ofthe m andible). In a study of 40 skull s, the
m ental foramen was fo und to be:
Under the apex of the first premolar- never
Between the apices of the first and second premolars - 40%
Directly under the second premolar- 42.5%
Distal to the apex of the second premolar- 17.5%
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The mental foramen (arrow over apex of
the second premolar) may simulate periapical disease. Continuity of the lamina
dura around the apex, however, indicates
the absence of periapical abnormality.
miscellaneous
Extreme curvature or angulation of tooth roots describes which of the fol lowing conditions?
fusion
gemination
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concrescence
dilaceration
dens invaginatus
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dilaceration
Note: As a general rule, root tips tend to curve towa rd the distal (if at all).
1. Maxillary teeth seem to show the least statistica l va ri ation in root inclination.
2. Mandibular central incisors and canines usually present the greatest va riation.
Fusion is the joining of two developing tooth germs, resulting in a single large tooth
structure (may involve entire length of tooth or only the roots) .
Gemination is the fusion of two teeth from a single enamel organ (usually seen as two
crowns that share one root cana l).
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mandibular movements/positions
Pure rotation of the mandible involves which two planes of movement?
frontal
horizontal
sagittal
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frontal
sagittal
The mandible is moved in a number of planes:
1. Up and down (frontal plane)
2. Side to side (horizontal plane)
3. Forwards and backwards (sagittal plane)
The vert ical axis of rotation can be better visualized when one
looks at a composite of rotation because lateral rotation actually occurs around the lateral po le of the rotating condyle. As
rotation occurs, the orbiting condyle must travel down the
slope of the eminence. The med ial pole of the rotating side
must also travel down its slope but fo r a lesser d istance. Because the condyles load against incli nes, a pure vertical rotation is not possible without being combined with a sagittal
rotation of the working-side condyle.
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Five factors of mandibular movement:
1. Initiating position (centric relation)
- Most stable and most easily reproduced
position
2. Types of motion
- Rotation
- Translation
3. Direction of motion (planes)
- Frontal
- Sagittal
- Horizontal
4. Degree of movement
5. Clinical significance of movements
- Each patient may have different
relationships
mandibular movements/positions
Border movements are the limits to which the mandible can move, whereas
functional movements generally occur within the border movements.
The maximum opening movement is 50 to 60 mm, depending on the age and
size of the individual.
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Schematic represent ation of mandibular movement envelope in the
sagittal plane. CR, Centric relation; CO.. Centric occlusion; F, Maximum
protrusion; R, Rest position; E. Maxi mum opening; 8 to CR, opening and
closing on hinge axis w ith no change in radius {r).
Remember:
1. If the mandible is held back and up by either the patient or the operator, a hinge movement
can be traced for the lower incisors from CR to B. This movement, called the terminal hinge movement of the mandible, maintains a stationary rotation axis through the two temporomandibular joints; this axis is usually located in the condyles.
2. The anterior border movement of the mandible is from F - E.
Note: Food is masticated primarily in lateral contacting movement.
mandibular movements/positions
In the natural dentition, centric occlusion is, in a majority of people, _ _ to
centric relation contact and on the average approximately __ mm.
posterior; 2
anterior; 1
medial; 2
lateral; 1
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anterior; 1
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movement.
In lateral movements, the condyle appears to rotate with a slight lateral shift in the d irection of the movement This movement is called the Bennett movement and may have immediate as well as progressive
components. If a point (the incisive point) located between the incisal edges of the two mand ibular central incisors is tracked during maximal lateral or protrusive movements, in retrusive movement, and wide
opening movement, such movements take place within a border or envelope of movements (Posselt). Functional and parafunctional movements take place within these borders. However, most functional movements, such as those associated with mastication, occur chiefly around centric.
mandibular movements/positions
During sleep, the mandible is in its physiologic rest or postural position. The
contact of teeth is:
maximum
not present
premature
slight
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not present
This position results when the mandible and all of its supporting muscles (four paired
muscles of mastication plus the supra- and infrahyoids) are in their resting posture.
The term used to describe this absence of contact is "freeway space" o r
"interocclusal distance:'The interocclusal space w ith the mandible in rest position
and head in upright position is about 1 to 3 mm at the incisors but has considerable
normal va ri ance even up to 8 to 10 mm w ithout evidence of dysfunction.
Remember: When the teeth are in centric occlusion (intercuspal position), the position of the mandible in relation to the maxilla is determined by the intercuspation of
the teeth.
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Physiological
rest position
1-3mm
mandibular movements/positions
Which jaw position is a ligament-guided position?
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1. Centric occlusion or the intercuspal (I C) position is defined as maximum intercuspation of the teeth. It is a tooth-guided position.
2. The rest position of the mandible or the postural position is determined mostly
by the musculature. The usual reflex cited as the basis for the postural position of
the mandible is the tonic stretch reflex of the mandibular levators (i.e., the
myotatic reflex). It is a muscle-guided position.
3. Centric relation or the retruded contact position (RCP) is a position (or path of
opening and closing w ithout translation of the condyles) of the mandible in which
the condyles are in their most anterior, superior positions in the mandibular fossae
and related anteriorly to the d istal slope of the articu lar eminence. Because the
mandible appears to rotate around a transverse axis through the condyle in centric
relation movement, guidance of the jaw by the dentist in opening and closing
movements that do not have translation is referred to as hinge axis movement. In
this position (CR), the condyles are considered to be in the terminal hinge
position. It is a ligament-guided position.
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mandibular movements/positions
A dental patient is complaining of unilateral jaw pain when chewing. You
notice that she only chews on her right side. When a mandibular movement
to the right is performed, which condyle moves forward, downward, and
medially?
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Remember:
1. Working side is the side that the mandible moves towards in a lateral excursion.
2. Non-working side is t he side that the mandible moves away from during a lateral excursion.
3. The balancing side condyle refers to the left condyle during a right lateral jaw movement and the right condyle d uring a left lateral jaw movement.
mandibular movements/positions
A 7-year-old male patient with a history of thumb-sucking comes into the
orthodontist's office presenting with an anterior open bite. Doing swallowing tests, the orthodontist discovers that the patient needs to involve his
tongue to close the freeway space between his teeth. During typical empty
mouth swallowing, the mandible is braced in which jaw position to allow
for proper stabilization?
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1. The masseter muscles contract and the t ip of the tongue touches the
roof of the mouth during normal swallowing.
2. Tooth contacts are of longer duration in swallowing than in chewing, but
there is w ide variation in frequency and duration from one person to another.
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mandibular movements/positions
During a right working side movement, the right side molar teeth may
contact along the buccal inclines of the maxillary buccal cusps and the
lingual inclines of the mandibular buccal cusps.
Mandibular protrusion will result in the mesiolingual cusp of the maxillary
first molar passing through the central groove toward the distal marginal
ridge ofthe mandibular molar.
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During a right working side movement, the right side molar teeth may contact along the lingual incl ines
of the maxillary buccal cusps and the buccal inclines of the mand ibular buccal cusps. - Look at card #55,
picture A on back. Likewise, the lingual incli nes of the maxillary li ngual cusps may contact the buccal incli nes of the mandi bular li ngual cusps. For the non-working side (left side). contact is also possible along
the buccal incl ines of the left maxillary li ngual cups and the lingual inclines of the left mandibular buccal
cusps.
Remember:
l .ln the intercuspal position, the mesiobuccal triangular ridge of the maxillary first molar opposes
the mesiobuccal groove of the mand ibular fi rst molar.
2. In a working side movement (right o r left), t he obl ique ridge of the maxillary first molar passes
through the di stobuccal sulcus of the mandibular first molar.
3. In a working side movement (right or left), the mesiobuccal cusp of the maxillary second molar
passes through the buccal groove of the mandibular second molar.
Maxillary
1P
D
2P
1M
2M
Mandibular
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l\1- Buc.cal cusp of the md. 1st premola oc.c ludes with the Me-~o;i al
marginal ridgt'
0 - Bucc.al cusp of the. md. 2nd premolar occlude$ with the O cdu...,al embra.o;ure of the ntx. I st and 2nd premolars
0 - "-lesiobuccal ClLo;p o f d1e. nd. 1st molar Ol.'dudes with the O cclusal t -.n.brasure of the mx. 2nd prt-llOiar and mx. 1st mo lar
C-Oistobucc.al cu..o;p of the md. 1st molar ocdude~o; with the Centf<'ll fos.o;a of the nt.x. lst nolar
0 - "-lesiobul.'cal c.u..o;p o f the. nd. 2nd molar occludes with the O cclusal embrasure o f the. nx. 1st and 2nd molars
C-Oish)buccal cu..o;p of the md. 2nd molar ocdudt$ with the Central fos.o;a of the
nt.~ .
2nd molar
D - Lingu al Clt..o;p of the mx. 1st premolar occludes with the D isra.l marginal ridge of the md. 1st prt-llOiar
D- Lingu al <:u..~p of the mx. 2nd preolOiar oc.cludes with the D isral marginal ridge of the md. 2nd pre1llOiar
C-Mesiolingu al <.' lL~p of the mx. 1st molar occlude.~ with the C enrrol fos..~a of the 1nd. 1st molar
0 - 0 i.stolingual c u..~p of the mx. lsr 1no lar oc.clude$ with the O cdusal embrasure of the md. 1st and 2nd mo lars
C-Mesiolingu al cu..~p of the mx. 2nd molar o..:-dudes with the C entral fOssa of the md. 2nd mo lar
0 - 0 i.stolingual <.'-lL~p of the mx. 2nd mo laroeclude$ with the O cdusal embrasu re of the md. 2nd and 3rd llOiars ( if present)
571
mandibular movements/positions
Retrusive movement requires the condyles to move backward and upward.
In protrusive movement, the condyles of the mandible have moved in a
downward and forward direction.
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Db tal
Mesia l
Working
e
Balancing
Mesial
Balancing
Distal
mandibular movements/positions
In regards to the picture below, the arrows indicate the path of _ __
movement of mandibular teeth over the maxillary teeth on the _ _ _ side.
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working side. Note the relationship of paths to morphological features of the teeth and embrasures.
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Note: An easy way to remember if arrows are indicating working side movements is to remember
that arrows will be relatively straight, pointing buccal (if right working) or lingual (if left working).
For non-working the arrows will be slanted, pointing buccal (if right non-working) or lingual (if
left non-working - as in the picture above).
In these movements the mandible is moving towards the right or left side. The side towards which
the mandible moves is referred to as the working side. The side from which the mandible is moving
is referred to as the non-working side.
Working side contact: cusp tips pass bet ween opposing cusp tips.
Non-working side contact (interfering contact): the contact takes place on the distal of the maxillary inclines and on the mesial of the mandibular inclines. The contact area possibilities here are
unique because they involve the inner aspects of supporting cusps only. This is the only time that
the inner inclines of the supporting cusps can contact outside the intercuspa l position.
Laterotrusive movement: contacts of teeth made on the side of the occlusion toward which the
mandible has been moved. Also called working movement.
Mediotrusive movement: contacts of the teeth on the sid e opposite to the side toward which the
mandible moves in articulation. Also called non-working movement.
mandibular movements/positions
Anterior guidance is a result of:
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This overl apping relationship produces disclusion of the posteri or teeth when the
mandible protrudes and moves to either side.
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Overjet
Overbite
mandibular movements/positions
In a patient with a left canine protection, the mesiolingual surface of the
maxillary right first molar contacts the distofacial surface of the mandibular
right first molar during a left lateral excursion. This contact is:
normal
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B
A, Patients left side showing left working side contacts (group function) and schematic of working side occlusal
contacts and guiding inclines in left lateral movement. B, Patients right side showing non-working side occlusal
contacts and guiding inclines. Nonworking contacts are not necessary except in complete dentures.
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Mesiodistal
cross-section
Cervica l
c ross-section
Buccolinguol
cross- section
Maxillary Right
First Molar
Pulp Cavity
Midroot
cro ss-section
mandibular molars
maxillary first molars
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mesiobuccal
distobuccal
palatal
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palatal
***The distobuccal is the smallest.
The palatal root of a maxillary first molar is the third longest root (13 mm) of any of
the maxillary teeth, after the maxillary canine (1 7 mm) and second premolar (1 4 mm)
roots. It is wider buccolingually than mesiodistally (as are all maxillary molars) and
has a longitudinal depression on the lingual. It is concave on its buccal surface. When
viewed from the facial, this root apex is in line with t he buccal groove.
Remember: On the maxillary second molars, the roots are much less divergent t han
the roots of a first molar. The palatal root is straighter than the palatal root of t he first
molar.
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Note: During oral surgery if a root is forced into the maxillary sinus it is usually the
root of a permanent maxillary first molar.
Maxillary Right First Molar
Buccal
Lingual
Buccal
Lingual
6; 5
5; 4
4; 3
-3;2
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4; 3
Permanent mandibular molars can be distinguished from permanent maxillary
molars by the following:
When viewed from the occlusal, mandibular molars appear rectangular,
maxillary molars appear rhomboidal
Mandibular molars have t wo roots, maxillary molars have three roots
Mandibular molars have pits and grooves on the occlusal and buccal surfaces;
maxillary molars have pits and grooves on the occlusal and lingual surfaces
Mandibular molars are wider mesiodistally than faciolingually; th is is the opposite of maxillary molars, wh ich are wider faciolingually
Mandibular molars have two nearly equal-sized lingual cusps; maxillary molars
have one large and one small lingual cusp
Mandibular molars have a transverse ridge; maxillary molars have an oblique
ridge, which extends from the mesiolingual to the d istobuccal cusps
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Remember: The oblique ridge is formed by the union of the distal cusp ri dge of
the mesiolingual cusp and the triangular ri dge of the distobuccal cusp.
When examined from the mesial or distal sides, mandibular molar crowns appear
to be tilted lingually (an arch trait; t rue for all mandibular teeth). This is not apparent on maxillary molars. Mandibular molar crowns also tip distally relative to the
long axis of the root.
Important:
As a result of th is decided lingual inclination:
1. The height of contour of the crown is lowered apically to the middle third.
2. The placement of instruments subgingivally is more difficult on the lingual
side.
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It is ca lled the lingual developmental groove. Due to its presence, occl usal cavity
preparations often need to be extended onto the lingual surface.
This groove originates at an occlusal pit and terminates in a pit on the lingual surface.
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Maxillary Right
Second Molar
Lingual view
Lingual developmental
groove
Remember: The parotid duct is the duct that conveys saliva from the parotid gland
to the mouth at the level of the maxillary second molar. It is also ca lled Stenson's
duct.
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Mandibular Right
First Molar
Pulp Cavity
Mesiodistal
cros.s-section
Cervical
cross-section
8ucco&inguo1
cross-section
Mldroot
crou-section
square
rhomboidal
triangular
circula r
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triangular
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Cervical
cross-section
Cervical
cross-section
Whether there are th ree root cana ls or fou r root canals (as seen often times with the
maxillary fi rst molar), the orifice of each major canal serves as a corner of the pulp
chamber. Therefore, t he shape of t he pulp chamber is roughly triangu lar. The base is
formed by t he buccal canals and the apex is formed by the palatal canal. Note: The
line connecting the mesial canal with t he palatal canal is the longest.
The cervical outline form of the pulp cavities in maxillary fi rst and second molars is
rhomboidal w ith rounded corners (see pictures above). The MB angle has an acute
angle, the DB angle is obtuse, and the lingual angles are essentially right angles.
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~~
Me-slodiJIOI
~rou -~11on
Buccoiii'J9Uol
cros.edlon
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Mandibular Right Second Molar
triangular outline
rhomboida l outli ne
trapezoidal outline
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square outline
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rhomboidal outline
From a mesial or distal view, the crown outline of a mandibular posterior tooth is rhomboidal in
shape and tilts towards the lingual. Because of this lingual inclination, the mandibular molars have
long axes positioned with their root apices facial and their crowns lingual. Note:This design encourages cusp fracture.
\fJJl H
VA u
ts:LJ B
.~ .U J?j .'RJ
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[;Jt;j
E~
FOJ
Outli nes of crown forms w ithin geometric outlines - triangle, trapezo ids, and rhomboids. The upper figu re in each square represents a maxillary tooth, the lower figure a mandibular tooth. Note thatthe trapezoidal outline does not include the cusp form of posteriors actually. It does include the crowns from
cervix t o contact point or cervix t o marginal ridge, however. This schematic drawing is intended to emphasize certain fundamentals. A, Anteriorteeth, mesial or d istal (triangle). 8, Anterior teeth, labial or li ngual (trapezoid). C, Premolars, buccal or li ngual (trapezoid). 0, Molars, buccal or lingual (trapezoid). E,
Premolars, mesial or d istal (rhomboid). F, Molars, mesial and distal (rhomboid).
cusp of Carabelli
talon cusp
dens evaginatus
trigone
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talon cusp
The distolingual cusp on permanent maxillary molars generally is the one that gets prog ressively
smaller as you go posterior in the arch. This is the most obvious characteristic that distinguishes
permanent first, second, and third molars from each ot her.
Remember: For maxillary molars, the primary cusp triangle (also called the "trigon") is formed by
the ML, MB, and DB cusps (large shaded area in center of tooth in picture below). The DL cusp is
called the talon cusp and is not a pa rt of th is primary cusp t riangle. The talon cusp might be absent
on maxillary second and third molars. Note: A cusp present abnormally is also called a talon cusp.
Someti mes a fifth cusp, the Cusp of Carabelli, is located on the ML cusp of maxillary molars.
M axillary right first molar, occlusal aspect.
M BCR, mesiobuccal cusp ridge; CF, cent ral fossa;
MTF, mesial triangular fossa (shaded area); MM R,
mesial marginal ri dge; MLCR, mesiolingual cusp
ridge; OR, o blique ridge; DLCR, di stolingual cusp
ridge; OF, d istal fossa; DTF, di stal triangular fossa
(shaded area); DMR, d istal marginal ri dge; DBCR.
d ist obuccal cusp ridge. Note: The primary cusp
triangle i s t he large shaded area in center of
tooth.
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Mcslol tnongulo1
lasso
..,.. ,. __
M esial morg!nol
ridge
Meslol1nguol
cusp ridge
Buccal groove
C.t!ntrat plt
~~~~~ f~~ve o f
Transverse groove
o f o blique ridg"
Central groove of
c e ntra l fossa
Olstol oblklue
groo\le _,__
lingual groove -
__..._
"';;;;:;:::.;"'-,;
f ttth
cusp groovo
Maxillary right first molar, occlusal aspect, devel opmental grooves. BG, buccal groove; BGCF,
buccal g roove of central fossa; CGCF, central
g roove of central fossa; FCG, fifth cusp g roove;
LG, li ngual groove; DOG, d istal oblique g roove;
TGOR, transverse groove of o bl ique ridge; CP,
central pi t.
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Important: When restoring the marginal ridges of posterior teeth, remember to ro und
them off to form occlusal embrasures and keep them wide enough for strength.
Remember: Marginal ridges are elevation s of enamel that form the mesial and distal
margins of the occlusal surface of the molars and premolars. They also form the mesial
and distal margins of the lingual surfaces of the incisors and the canines.
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't
Mor9inol - - - rid~e
Linguool
foua
~=
"'-- - - ridge
lnci$OI
Marglnol
~ridge
.- r I
~~:e--
\j
Sulcus
one root
two roots
three roots
four roots
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three roots
1. The palatal, which is the longest
2. The mesiobuccal
3. The distobuccal, which is the shortest
Maxillary Right
First Molar
Buccal View
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The two buccal roots are well separated and bent in such a way that they look like the
handles on a pair of pliers. The axes of the roots are inclined distally. Th is is in contrast to
the roots of a second molar, which are often close together and less curved. The palatal
root often has concavities both facially and lingually.
Remember: Molar roots originate as a single root at the base of the crown (called a root
trunk) near the cementoenamel j unction. The furcation is the place on multirooted teeth
where the root trunk divides into separate roots (bifurcation on two-rooted and
trifu rcation on three-rooted teeth).
1. The mesial furcation is closest to the cervical line, w hile the distal is the farthest
from the cervical line.
2. There is a deep developmental groove b uccally on the root trunk of the maxillary first molar. It starts at the b ifurcation and terminates at the cervical line.
Remember: The distal surface of the root trunk has a concavity which requires
special attention when root p laning.
3. During surgical removal of the maxillary first molar, be careful not to force root
tips into the maxill ary sinus.
muscles
Fibers from the ventral ramus of Cl travel with the hypoglossal nerve (CN XII)
to the geniohyoid and thyrohyoid.
Fibers from the ventral rami of C1 -C3 combine to form the ansa cervicalis,
which gives off branches to the omohyoid, sternohyoid, and sternothyroid.
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The infrahyoid muscles are depressors of the larynx and the hyoid bone. These
muscles are often referred to as strap muscles due to their ribbon-like appearance.
They lie between the deep fascia and the visceral fascia covering the thyroid g land,
trachea and esophagus.
lntr~th,Oid
Muscle
Omohyoid
(inferior belly)
Sternohyoid
Origin
Sc-apula (superior
muscll's
Insertion
Innervation
Hyoid bone
A nsa cervic-.alis of
Action
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ce rv i c~ l
border, medial to
suprasc-apular notch)
Manubrium and
sternoclavicular
joint (posterior
surface)
Sternothyroid
Manubrium
(posterior surface)
T hyroid
cartilage
(oblique
line)
Thyrohyoid
Thyroid ca1tilage
Hyoid bone.
CNXII
Note: These muscles anchor the hyoid bone and depress the hyoid and larynx during
swallowing (deglutition) and speaking.
muscles
Which of the following suprahyoid muscles are innervated by the facial
nerve?
Select all that apply.
mylohyoid muscle
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geniohyoid muscl e
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Muscle
Origin
Insertion
Innervation
Action
Geniohyoid
Mandible (inferior
genial spine)
Mylohyoid
Mandible
(mylohyoid line)
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Hyoid bone
Digastric
(anterior belly)
Mandible
(diga..'itric fossa))
Temporal bone
Digastric
(poste rior belly) (mastoid notc h)
Stylohyoid
Temporal bone
(styloid process)
1. The geniohyoid and mylohyoid muscles form the floor of the mouth.
2. The digastric, mylohyoid, and geniohyoid muscles are active during jaw openmg.
3. The suprahyoid muscles act as antagonists to the elevator muscles.
4. Voluntary mandibular retrusion with the mouth closed is brought about by
contraction of the posterior fibers of the temporal is muscle and by the suprahyoid and infra hyoid muscles.
muscles
There are two sets of lingual muscles: extrinsic and intrinsic. The extrinsic
muscles:
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l nntl'\'atlo n
Aclion
Hyoglossus
Mandible (superior
genial (menial)
spine via an inlermcdiate tendon):
mor~ pos.teriorty 1hc
IWO genioglossi are
scparatcd by the
lingual sepnun
Protrusion of congue
lmcrmediatelibers:
posterior tongu~
concave
Ullllotera/1) . deviation to
opposite s tdc
Styloid process of
temporal bone
(anterolateral aspt.-ct
ofapex) and stylo
mandibular ligamenl
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Styloglossus
Palatoglossus Palatine a1>oncurosis Lateral tongue to dorsum and Vagus nerve via
{oral surlilee)
fibers of the transverse muscle he phal)ngeal
plexus
H)pogl0$$tll
Infe rior
longitudinal
Transverse
muscle
Narrows tongue:
elongates tongue
Vl."l1irol
muscle
d O\I,'tl)
muscles
Which muscle presses the cheek against molar teeth, working with the
tongue to keep food between the occlusal surfaces and out of the oral
vestibule?
zygomaticus major
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buccinator
J\tusdt
Z)')tColll:ltteu~
Or'tin
Zyg_unt.Sii.: IXlllw
!USJ')I'
ht$frCtoa
M u~do:~ at l11e
angk of tb.:-
)hlh'l attiun.
IIUI\'t\'llt ii.Hl
t~J
lll Oui)J
Z)')tColll:ltteu~
Uppo."11ipjus:t
medial1,;, oome
IU it hJI
<tfl""uth
l o:vato.)rla.bit
Maxilla(fr<lontal
Ul'lflo.-"1lip and
l!upt n is
J'HOCI:il!)
ab1 C:lrttlag.eof
Maxilla(fr<lontal
BIZ
abe-que n:llli
l o:vato.)rla.b it
I!Upt n ()ti3
J'HOCtl!l!) and i n
Ma.nd ibk(antct"iur
Ut\H""I'l!p:U
portion of oblique
lint)
mnUint
"
Mu~ltsattl1e
angk of tb.:
lll0ut11
D.:pteSSOI' :~ngul i
Ski.n :lt~'<M'tletof
lllOut11. blends
witb ortneub ni
Ofill
B/M
8 uco:-u\31M
AI\OObt p1 ott'S~ of
Lips. otbi~-ularis
oris. !illbtl\IM:Ol:o\
of lijl':land t h.:o."l:
nlOb1 1~111 t
bk\b)'tJ)()Iats):
BIZ
p.tt:tygunX!ndibut:lr
t:lpbe
Ol'bielll:lriiOni
Note:
Innervation -The muscles
of facial expression are i nnervated by six branches of
the facial nerve. Th e posf'llllslo'-"t ' lip uJfcrioly and latctslly.
;.I ~ O:OOlnbuto:s w tw~i oo \J>WhftSt
terior muscles are innervated by the posterio r
Raises angle ofnloull1.. hd ps funn
auricular (PA) nerve, w h ich
n:"lsolabial fu1row
arises before the facial
nerve enters the parotid
l"ulli :~ngl t of nlout11iuftn(~tl y :lnd
gland. The anterior musb tt-rJ.IIy
cles are i nnervated by five
branches of the parotid
Ptessd o:-h..-ck :lilins.t nlol:lr 1~tl1.. v.urt- plexus of the facial nerve:
1ng w1th tunglk' to k.:o:--p foOO bi:twe.:n
Temporal (T), zygomatic
o.:dus:~ l surfaces and out of ()1al Vdllbul.:
(Z), buccal (B), mandibular
Umlato."t:ll: d1:"1ws n'll'>lllh tu ooe side
(M), and cervical (C).
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Ma.xill.s (~:~niue
lb ssa..btlow
inft$01bit:"ll
f()l:"lll\i:n)
Lt-\;uor angttb
ft:Wrbital l'lt.Sigill
Do:pf"d:SUr labii
tnf.:-ri\lr1i
Elt\':'111:~ upper
BIM
AC IS3S()t:l)Sphil'l~'1cr:
Dtepssu1illce of
stin
Superiorly: Maxilla
lnftriorty f\'l:"lndibl.:
Mucous
nlt:ulb1an..- M
lipi
k isonui
Skill:"ll ('l()nlcrOf
moul11
Mentalis
Fn.."uu1un) ofk:Mw
lip
Skill ()f d un
.\1
Plal)'~ltla
Mandible
(il1ft1teotbonkr)
muscles
A new patient comes in with a history of malignant cancer. When the patient
opens, the mandible deviates to the left. You suspect a tumor blocking
nervous innervation to which muscle?
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Origin
Muscle
Lateral
ptt1ygoid
Superior
Greater ~\ in g of
(upper) head sphe.noid bone
(infratemporal cre~n)
Insertion
tvlandible
(pterygoid fovea)
and TMJ
Innenation
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(articular disk)
Unilate-ral: Lateral
moveme-nts of the
tvlandible
Lateral pterygoid
(lower) head plate (lateral surtaee) (pterygoid fove.a
and condylar
proc.ess)
Inferior
Medial
l'lerygoid
A(r-iOn
mandible (ehtwing)
Superficial
Ma:<illa (ma:<illary
(external
tuberosity) and
head)
palatine bone
(pyramidal proc.es..~)
Dee,,
(internal)
Me.dial surface of
latetal pterygoid
plate and pterygoid
fOssa
head
mandible
Note: With a fracture of the condylar neck, the condylar head remains in the mand ibular fossa due
to t he temporomandibular ligament. This ligament is the main stabilizing ligament of the TMJ.It
orig inates from the lateral surface of the zygomat ic arch and a t ubercle on its lower border, and is
directed obliquely downward and backwa rd to insert into the posterior border and lateral surface
of the neck of the mand ible. This ligament restricts downward and posterior movement of the
ma ndible and guides the for ward motion of the condyle du ring opening.
muscles
After seating a new crown on tooth #19 you need to check excursive movements. You ask the patient to slide her jaw to the right to make sure there are
contacts on #19 during this movement. What muscle does the patient use to
move her jaw like this?
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Muscles of Mastication
Masseter
Temporal is
Medial pterygoid
.
..
.
.
.
\10\t.'OH.'Dh of
the \ J.tndihlc
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Lateral pterygoid
Important: Protrusion (protruding the j aw) results only from the simultaneous
contraction of both lateral pterygoids. Th is produces forward movement of the condyle
from the mandibu lar fossa (articular fossa). They do not need assistance for th is
movement.
Unilateral contraction deviates t he mandible to the contralateral (opposite) side.
Contraction of the muscle on alternating sides prod uces the side-to-side motion required
for grinding food.
Closing the mout h (elevati ng t he mandible) res ults from t he b ilateral cont raction of three
pairs of muscles:
1. The anterior (vertical) fibers of the right and left temporal is muscles
2. The right and left masseter muscles
3. The right and left medial pterygoid muscles
muscles
Retrusion (retruding the jaw) results from:
the bilateral contraction of the anteri or (vertical) fibers of the temporalis muscle
the bilateral contraction of the posterior (horizontal) fibers of the tempo ralis muscle
the unilateral contraction of the anterior (vertica l) fibers of the tempora lis muscle
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the bilateral contraction of the posterior (horizontal) fibers of the temporal is muscle
Retrusion results from the bilateral cont raction of the posterior (horizontal) fibers of the
temporalis muscle. They are assisted by the suprahyoid muscles, specifically the anterior and
posterior bellies of the digastric muscles.
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Middle
Zygomatic arch
head
(medial aspect of
(central pa11 of
anterior two-thirds} occlusal sul'fllce}
Deep
head
Zygomatic arch
(deep surface of
posterio1 third)
Mandibula ramus
Mandibula1 ramus
(superio1 lateral
surface) and infel'ior
coronoid
Opening of the jaw (depression of the mand ible): The lateral pterygoids do this by pulling the
articular discs and the condyles anteriorly and down onto the articula r eminences. In opening the
jaw or depressing the mand ible, the lateral pterygoids are assisted by the anterior bellies of the
digastric muscles (which are suprahyoid muscles) and the omohyoid muscles (which are infrahyoid
muscles) . These muscles help fix or hold the hyoid bone.
occlusion information
A 22-year-old female dental student comes into your dental practice for a
regular check-up. She states that she has never had any problems with her
teeth, and upon examination you notice that only one pair of teeth seem to
have contact during lateral movements ofthe mandible. Which teeth should
ideally provide the predominant guidance through the full range of
movement in lateral mandibular excursions?
premolars
first molars
incisors
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canines
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canines
This is called canine or cuspid protected ocdusion. It is an occlu sal relationship in which the
vertical overlap ofthe maxillary and mandibular canines produces a disclu sion (separation) of all of
the posterior teeth when the mandible moves to either side. All other teeth, once they move from
centric relation, do not contact. If there is contact of other teeth, it is termed a working side" or
"non-working side" interference depending on which side the mandible moves towards.
Group function (someti mes called unilateral balanced occlusion) is an occlusal relationship in
which there is contact of one or more teeth on the working side duri ng a lateral working movement.
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1. Some relationships are not conducive to cu spid protected occlusion, such as Class II or
occlusion information
In an ideal intercuspal position, the mesiobuccal cusp of the permanent
maxillary first molar opposes the:
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the developmental groove between the d istobuccal and the d istal cusps of the
mandibular first molar
82
Normal intercuspation of
maxillary and mandibu lar
teeth.
A. First molars (buccal aspect).
B. First molars (mesial aspect).
C. First molars(distal aspect)
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Important:
The mesiobuccal cusp (specifically, the triangular ridge of the MB cusp) of the maxillary first
molar opposes the mesiobuccal groove of the mandibular first molar. This relationship is a
key factor in the definition of Class I occlusion.
The distobuccal cusp of the maxillary first molar opposes the distobuccal groove of the
mandibular first molar. Note: This distobuccal groove also serves as an escapeway for the ML
cusp of the maxillary first molar during non-working excursive movements.
When the mandible moves to the right. the ML cusp of the maxillary right first molar passes
through the lingual groove of the mandibular right first molar.
The oblique ridge of the maxillary first molar opposes the developmental groove bet ween
the distobuccal and distal cusps of the mandibular first molar.
Remember: The maxillary buccal (facial) and the mandibular lingual cusps are guiding cusps. The
inner occlusa l inclines leading to these cusps are called guiding inclines because in contact
movements they guide the supporting cusps away from the midline. Thus, there are bucco-ocdusal
inclines (lingual inclines of the buccal cusps) of the maxillary posterior teeth and linguo-ocdusal
inclines (buccal inclines of the lingual cusps) of the mandibular posterior teeth.
occlusion information
Identify the following pictures of dental arch relationships as being either
Class I, Class II Div I, Class II Div. II, or Class Ill.
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A - Cla ss II pjv II
In the Class II relationship, the maxillary arch is positioned mesially, with the mesiobuccal cusp above or approaching the embrasure between the mandibular first molar and
the second premolar. In addition, the maxillary canine is seated anterior to the mandibular
canine. The Angle Class II Division II incisors are retroclined and have less anterior overjet,
but a deeper vertical overbite, than Class II Division I.
B =Class Ill
In the Class Ill relationship, the mandibular first molar is mesial to the maxillary first
molar and there is concomitant mandibular prognathism reflected in the patient profile.
The mandibular arch is displaced mesially or the maxillary arch is displaced distally, w ith
the mesiobuccal cusp of the maxillary first molar occluding distal to the buccal groove
of the mandibular first molar.
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C= Class I
In the Class I relationship, the mandibular first permanent molar is slightly anterior to the
maxill ary first permanent molar. If there are no irregularities elsewhere, this wou ld be
termed a Class I occlusion. If there were irregularities elsewhere, it wo uld be termed a Class
I malocclusion. The Class I relationship is a normal permanent molar relationship. In this
condition the mesiobuccal cusp of the maxillary first molar is placed over the buccal groove
of the mandibular first molar. In addition, the maxillary canine is p laced in the embrasure
between the mandibular canine and the first premolar in a normal canine relationship.
D = Class II Di v I
In the Class II relationship, the maxillary arch is positioned mesially, with the mesiobuccal cusp above or approaching the embrasure between the mandibular first molar and
the second premolar. In addition, the maxillary canine is seated anterior to the mandibular
canine. The Ang le Class II Division I incisors normally display excessive anterior overj et.
occlusion information
An archaeologist consults a dentist about some findings he had on a dig. The
teeth the archeologist finds have four cusps - two of them taller and pointed,
two of them shorter, rounded, and dull. The dentist tells the archaeologist
that these teeth are similar to our human molars. The broader, more rounded
cusps are:
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The non-supporting cusps are the maxillary buccal cusps and the mandibular
lingual cusps. These cusps do not occl ude or fit into fossae or marginal ri dge areas
and are ca lled balancing or non-centric cusps. These cusps allow the dentition to
move apart, out of occlusion. They allow the teeth to "unlock" and move back and
forth and side to side.
Non-supporting cusps
Maxillary Right
First Molar
Supporting Cusps
Supporting Cusps
Mandibular Right
First Molar
Non-supporting Cusps
occlusion information
Which permanent teeth occlude with only one tooth in the opposite jaw,
assuming ideal relations exist?
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occlusion information
In an ideal intercuspal position, the facial cusp tip of a maxillary first
premolar opposes the:
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Examples:
1. The facial cusp tip of a maxillary first premolar opposes the facial embrasure between the
mandibular first and second premolars (see note below).
2. The facial cusp t ip of a maxillary second premolar opposes the facial embrasure between the
mandibular second premolar and mandibular first molar.
1P
1M
2P
2M
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D
1P
D
2P
C
1M
2M
Important: For further explanation of the above schematic refer to the illustration for card 57.
Note: During lateral excursive movements, the facial cusp ridge of the maxillary first premolar on
the working side opposes the distal cusp ridge of the first premolar and the mesial cusp ridge of
the second premolar.
occlusion information
In the intercuspal position, where does the mesiolingual cusp of a permanent
maxillary first molar occlude?
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87
Maxillary
Lingual Cusps
First premolar
Second premolar
First molar
Mesiolingual
Distolingual
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Second molar
Mesiolingual
Distolingual
occlusion information
In the intercuspal position, where does the distal cusp of a permanent
mandibular first molar occlude?
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the mesial marginal ridge of the maxillary first molar and distal marginal ridge of the
maxillary second premolar
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Mandibular
Buccal Cusps
First premolar
ont~u.ts
Mesiobucc-al
Distobucca l
Distal
Second molar
Mesiobuccal
Distobuccal
Mesial marginal ridge of the first molar and the dista l marginal ridge of the second premolar
Central fossa of the first molar
Distal fossa o f the fi rst molar
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Mesial marginal ridge of the second molar and the distal marginal ridge o f the first molar
Central fossa of the second molar
~
~
,,
,,
''
~
A
occlusion information
Match the following diagrams on the left with the proper Angle's
classification on the right.
A. Class I
B. Class II
C. Class Ill
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1. C, 2. A, 3. B
Classification of Human Occlusion !Angle's)
Class 1: most common (about 70% of the population). The mesiobuccal cusp of the maxillary first molar
lines up ap proximately with the mesiobuccal groove ofthemandibular first molar. The maxillary central incisors overlap the mandibulars. Maxillary canine lies between the mandi bula r canine and fi rst premolar.
Class II: less common(about 25%). The mesiobuccal cusp of the maxillary first molarfall s approximately
between the mandibular fi rst molar and second premolar. The lower jaw and chin may al so appear small
and retruded. The mandib ular incisors occlude even more posterior to the maxillary incisors so that they
may not touch at all. Maxillary canine is mesial to mandi bul ar canine. The subclassificati ons of the Angle
Class II relationship are based on the posit ion of the inci sors in ind ividual s with Class II relationships, and
are referred to as Class II Division I and Class II Divi si on II relationship s.
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I
Class Ill: the l east common (less than 5%). The mesiobuccal cusp of the maxi llary fi rst molar fall s app roximately betw een the mandibular first molar and second molar. The chin may also protrude li ke a b ulldog's d oes. The mand ibul ar incisors overlap anterior to t he maxillary inci sors. The maxillary canine is distal
'"" ~"'""""'"'" I
occlusion information
A dental student is finalizing the temporary crown he fabricated for his
patient. The patient's occlusion is in an ideal relationship, and the crown
has ideal centric contacts. The student has a bad habit of forgetting about
working and balancing contacts. He does remember the rule that he should
avoid laterotrusive contacts on the guiding cusps on posterior teeth. Which
two of the following are considered to be guiding cusps?
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Supporting cusps contact the opposing teeth in their corresponding faciolingual center on a
marginal ridge or a fossa. Non-supporting cusps overlap the opposing tooth without contacting it.
Note: In posterior cross-bite situations, the supporting and guiding cusps are opposite.
*** The maxillary buccal and the mandibular lingual would be supporting and the maxillary
lingual and the mandibular buccal would be guiding.
occlusion information
In an ideal intercuspal position, the mesiolingual cusp of a permanent
mandibular molar opposes:
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the lingual embrasure between their class counterpart and the tooth mesial to it
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Remember: The lingual cusp of permanent mandibular first premolars does not
occlude with anything.
Important: Duri ng mandibular movements (working, non-working, etc.), the outer
aspects of the lingual cusps of the mandibular molars will not contact their maxillary
antagonists. Al l other areas of buccal and lingual cusps may contact during mandibular movements (this is assuming that all occlusal relationships are normal).
Note: In unilateral balanced occlusion, contact between mandibular buccal cusps
and maxillary buccal cusps, along w ith simultaneous contact between mandibular
lingual cusps and maxillary lingual cusps, w ill most likely occur in laterotrusive
movements.
occlusion information
Which of the following positions would yield the smallest measurement of
vertical dimension?
reverse overlap
edge-to-edge
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retruded contact
maximum intercuspation
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maximum intercuspation
Maximum intercuspation or centric occlusion is the position in which the teeth are
most fully contacted w ith each other. As such, the jaws are most fully closed and therefore the vertical dimension is the least.
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Teeth in intercuspal position/centric occlusion
occlusion information
A patient presents to the dentist for examination and bites into centric
occlusion. The permanent maxillary canine is found to be mesial to the
mandibular canine. This type of occlusion is classified as:
cl ass I
cl ass II
cl ass Ill
cl ass IV
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cla ss II
In normal occlusion, the mandibular canine would be slightly mesial to the maxillary
can ine. In th is question, the maxillary tooth is mesial to the mandibular, and the maxilla is therefore protruding and/or the mandible is retruding. This is an Angle Class II relationship and results in a "buck tooth" appearance.
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Normal occlusion
Class I malocclusion
occlusion terms
There are four theoretical determinants needed to restore a complete and
functional occlusal surface. They include all of the following EXCEPT one.
Which one is the EXCEPTION?
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the amount and d irection of lateral shift in the working side condyle
the position of the tooth in the arch
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occlusion terms
The basic principles for occlusal adjustment include all of the following
EXCEPT one. Which one is the EXCEPTION?
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occlusion terms
The determinant factors of occlusion include all of the following EXCEPT
one. Which one is the EXCEPTION?
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occlusion terms
The centric relation (CR) is the most unstrained, retruded anatomic and
functional position of the heads of the condyles or the mandible in the
_ _of the temporomandibular joints. This is a relationship of the _ _ of
the upper and lower jaws _ _tooth contact. The presence or absence of
teeth, or the type of occlusion or malocclusion, _ _ factors.
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The centric relation (CR) (also called the retruded contact position) is the most
unstrained, retruded anatomic and functional position of the heads of the condyles
or the mandible in the mandibular (glenoid) fossae of the temporomandibular joints.
This is a relationship of the bones of the upper and lower jaws independent of tooth
contact. The presence or absence of teeth, or the type of occl usion or malocclusion,
are not factors. Important: Centric occlusion is typica lly slightly anterior to centric
relation.
Note: The mandible cannot be forced into centric relation from t he rest position
because the patient's neuromuscular defense reflex wou ld resist the applied force.
The mandible should be relaxed and gently guided into centric relation.
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Centric occlusion (also ca lled the intercuspal position) is the relationship between
maxillary and mandibular occlusal surfaces t hat provides t he maximum
intercuspation between the teeth. This position is independent of condyla r position,
it is a "tooth-guided" position.
Functional occlusion:
Functional occlusion consists of all contacts duri ng chewing, swallowing, or normal actions
Functional contacts: normal contacts made during chewing and swallowing
Parafunctional contacts: t hose made outside the normal range, may create wea r
facets or attri tion and result from habits (i.e., bruxism, clenching, nail biting, t humb
sucking, cheek biting, etc.)
occlusion terms
Anterior guidance (anterior coupling) is the guidance provided by the anterior
teeth when the mandible goes into a lateral or protrusive movement.
If anterior guidance can be accomplished, the least amount of force will be
placed on the posterior teeth during lateral and protrusive movements.
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Important point of all this: If anterior guidance is accomplished, the least amo unt of
force w ill be placed on the posterior teeth during latera l or protrusive m ovem ents.
Fulcrum:The pressure point of support on
which a lever rotates. Because all upward
force is applied behind the teeth, between
the fulcrum and the teeth, the fulcrum is always under pressure (compression) when
the elevator muscles contract. Th is is a very
important fact to understand, as it affects
both the TMJs and the teeth.
Force: Exertion of power that starts or stops
movement. Can result in compression
(load ing) .... or tension.
occlusion terms
A patient's mother comes in to complain that her child's upper front teeth rest
in front of his lower lip. You explain to her that this is called _ __
overjet
overbite
underjet
open bite
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overjet
Overbite: t he vertical d istance by w hich maxillary incisors overlap the mandibular
incisors
*** Normal = incisal edges are w ithin the incisal third of mandibular incisors
Overjet: the horizontal distance between the labia-incisal surfaces of the mandibular incisors and the lingua-incisal surfaces of the maxillary incisors
Underjet: maxillary teeth are lingual to mandibular teeth
Open bite: lack of occlusal o r incisal contact between maxillary and mandibular
teeth. The teeth can not be brought together. Also can be cal led negative overbite.
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Horizontal
overlap
Overjet
Vertical
overlap
Overbite
occlusion terms
Generally, the deeper the curve of Spee, the more difficult it is to make and
adjust interocclusal appliances that are used in the treatment of bruxism.
Increasing the curve of Spee can reduce the vertical overlap of the teeth.
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*** Reducin g the curve of Spee can reduce the vertical overl ap of the teeth.
There are t wo curves of the occlusal plane observed from a buccal and a proximal
view:
1.Curve of Spee - refers to the anteroposterior curvatu re ofthe occlusal surfaces,
beginning at the tip of the lower canine, following the buccal cusp tips of the premolars and molars and continu ing to the anterior border of the ramus. An ideal
curve of Spee would be aligned so that a continuation of its arc would extend
through the condyles.
2.Curve of Wilson- refers to the mediolateral curve that contacts the buccal and
lingual cusp tips on each side of the arch. It results from inward inclination of the
lower posteri or teeth, making the lingual cusps lower than the buccal cusps on the
mandibular arch; the buccal cups are higher than the lingual cusps on the maxillary arch because of the outward inclination of the upper posterior teeth. For
mandibular teeth the curve is also concave and for maxillary teeth it is convex.
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Remember: Combined, the Curve ofSpee and Curve of Wilson form a plane termed the
"Sphere of Monson or the Monson Curve:
Note: From a frontal view, the plane of occlusion of the mandibular arch in a normal
dentition is a concave curve, wh ile the maxillary arch is a convex curve.
occlusion terms
The mandible functions as a:
class I lever
class II lever
class Ill lever
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Force
periodontal ligament/gingiva
Which of the following types of oral mucosa are keratinized under normal
conditions?
Select all that apply.
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buccal mucosa
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Specialized mucosa: is restricted to the dorsal surface of the tongue, and is characterized by the
p resence of surface papillae of several types and by taste buds in the epithelium. The epitheli um is kerati nized.
Important: All oral mucosa, whet her kerati nized, non kerati nized or parakeratinized, is of the stratified
squamous type of epithelium and the underlying central co re of connective tissue. Although the epithelium is predominantly cellular in nat ure, the connective tissue is less cell ular and composed primarily of collagen fibers and ground substance.
periodontal ligament/gingiva
The principal fibers of the periodontal ligament are arranged in four groups.
The molecular configuration of collagen fibers in the periodontal ligament
provides them with a tensile strength greater than that of steel.
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Note: Another principal fiber group (called transseptal fibers) inserts mesially or interdent ally into the
cervical cementum of neighboring teeth over the alveolar crest of the alveolar bone pro per. Thus, the fibers
travel from cementum t o cementum w ithout any bony attachment. The function of this group is t o resist
rot ational forces and thus hold the t eeth in interproximal cont act.
Important: The molecular configuration of collagen fibers provides them w ith a t ensile strength g reater
than that of steel. Conseq uently, collagen imparts a unique combination of flexibility and strength to the
ti ssues.
periodontal ligament/gingiva
The gingival fibers are arranged in five groups. Which of the following is
NOT one of those groups?
circular group
dentogingiva l group
apical g roup
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transsepta l group
dentoperiosteal group
alveologingival group
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apical group
The connective tissue of the marginal gingiva is densely collagenous, containing a prominent system of collagen fiber bundles called the gingival fibers. They consist of type I collagen.
The gingival fibersare arranged in five groups:
Circular group - this fiber subgroup of the gingival fiber group is located in the lamina propria
of the marginal gingiva. The ci rcular ligament encircles the tooth and helps maintain gingival
integrity. They resist rotational forces.
Dentogingival group- this fiber subgroup of the gingival fiber group inserts in the cementum
on the root, apical to the epithelial attach ment, and extends into the lamina propria of the marginal gingiva. Thus, this ligament has only one mineralized attachment to the cementum. The
dentogingivalligament works with the ci rcular lig ament to maintain gingival integrity.
Alveologingival group -this fiber subgroup of the gingival fiber group extend s from the alveolar crest of the alveolar bone proper and radiates coronally into the overlying lamina propria of
the marginal gingiva. These fibers may possibly help to attach the gingiva to the alveolar bone
because of their one mineralized attachment to bone.
Dentoperiosteal group - this fiber subgroup of the gingival fiber group courses from the
cementum, near the cementoenamel j unction, across the alveolar crest These fibers possibly
anchor the tooth to the bone and protect the deeper period ontal ligament.
Transseptal group - this fiber subgroup of the gingival fiber group are located interproximal ly
and form horizontal bundles that extend between the cementum of approxi mating teeth into
which they are embedded.They lie in the area between the epithelium at the base of the gingival
sulcu sand the crest ofthe interdental bone and are sometimes classified with the pri ncipal fibers
of the periodontal ligament.
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1. The attachment apparatus is a term used to describe these gingival fibersand the epithelial attachment.
2. Some studies have also descri bed two more gingival fiber groups: (1) a group of semicircular fibersand (2) a group of transgingival fibers.
3. Tractional forces in the extracellular matrix produced by fibroblastsare believed to be
the forces responsible for generating tension in the collagen. This keeps the teeth tightly
bound to each other and to the alveolar bone.
periodontal ligament/gingiva
The junctional epithelium consists of a collar-like band of stratified squamous
keratinized epithelium.
The reduced enamel epithelium is not essential for its formation.
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The j unctional epithelium is attached to the tooth surface (epithelial attachment} by means of
an internal basa l lamina. It is attached to the gingival connective tissue by an external basal
lamina. The internal basal lamina consists of a lamina densa (adjacent to the enamel} and a
lamina Iucida to which hemidesmosomes are attached. Hemidesmosomes have a decisive
role in the firm attachment of the cells to the interna l basal lamina on the tooth surface.
In order for a new attachment to form after periodontal treatment the following must occur:
1. Complete removal of calculus, altered cementum, d iseased j unctio nal epi thelium, and
pocket epithelium
2. Need for undifferentiated mesenchymal cells
Important: The junctional epithelium in disease (which is referred to as a long j unctional epithelium} is different from the junctional epithelium in health. In disease, migration of t he junct ional epithelium occurs, along wit h degeneration in the connective t issue under the attachment; as t he j unctional epithelium proliferates along t he root surface (gets longer} the coronal
portion detaches. Barrier membranes, which are often used to treat bony defects, help to prevent t his long junctional epith elium from forming.
periodontal ligament/gingiva
Bone consists of:
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In addition, the bones of the jaw include the basal bone, which is the port ion of the jaw located apically, but unrelated to the teeth.
Most of the facial and lingual portions of the sockets are formed by compact bone alone; cancellous
bone surround s the lamina dura in apical, apicolingual, and interradicular areas.
Osteoblasts, the cells that produce the organic matrix of bone, are differentiated from pluripotent
follicle cells. Alveolar bone is formed during fetal growt h by intramembranousossification and consists of a calcifi ed mat rix with osteocytes enclosed within spaces call ed lacunae.
Bone consistsof two-thirds inorganic matter and one-third organic matrix. The inorganic matrix
is composed principally of the minerals calcium and phosphate, along with hydroxyl, carbonate, citrate, and trace amounts of other ions, such as sodium, magnesium, and fl uoride. The mineral salts
are in the form of hydroxyapatite crystalsand constitute approximately two thirdsof the bone structure.
The organic mat rix consists mainly of collagen type I (90%), with small amounts of noncollagenous
proteins such as osteocalcin, osteonectin, bone morphogenetic protein, phosphoproteins, and proteoglycans.
periodontal ligament/gingiva
Although the average width of the periodontal ligament space is documented to be about
, considerable variation exists.
0.002mm
0.2mm
2.0mm
20mm
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0.2mm
***
The periodontal space is diminished aroun d teeth t hat are not in function and in
unerupted teeth, bu t it is increased in teeth subjected to hyperfunction.
The periodontal ligament is composed of a complex vascular and highly cellular connective tissue that surrounds the tooth root and connects it to the inner wall of the alveolar bone. It is
continuous with the connective tissue of the gingiva and communicates with the marrow spaces
th rough vascular channels in t he bone.
The periodontal ligament is abundantly supplied with sensory nerve fibers capable of transmitting tactile, pressure, and pain sensations by the trigeminal pathways. Nerve bund les pass
into the periodontal ligament from the periapical area and through channels from the alveolar
bone that follow the course of the blood vessels. The bundles divide into single myelinated
fibers, which ultimately lose their myelin sheaths and end in one of fou r types of neural term ination:
1. Free endings, which have a t ree-like configuration and carry pain sensation.
2. Ruffini-like mechanoreceptors, located primarily in the apical area.
3. Coiled Meissner's corpuscles, also mechanoreceptors, found mainly in t he mid root
region.
4. Spindle-like pressure and vibration endings, which are surrounded by a fibrous
capsule and located mainly in the apex.
SAADDES
Note: Orthodont ic treatment is possible because the PDL cont inuously responds and changes
as a result of the functional req uirements imposed upon it by externally applied forces.
PDL and its hard tissue anchorage in terms of resisting occlusal force:
1. Anterior teeth have slight or no contact in the intercuspal position.
2. The occlusal table is less t han 60% of the overall faciolingual wid th of the tooth.
3. The occlusal table of the tooth is generally at right angles to the long axis of the tooth.
4. Crowns of mandibular molars are inclined about 15-200 toward the lingual. For t his reason, the root apices of mandibular molars are positioned more facially and the crowns are
position ed more lingually.
periodontal ligament/gingiva
_ _ _ are the most common cells in the periodontal ligament and appear
as ovoid or elongated cells oriented along the principal fibers, exhibiting
pseudopodia-like processes.
cementoblasts
osteoblasts
fibroblasts
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macrophages
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fibroblasts
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periodontal ligament/gingiva
Of the choices listed below, which one describes the boundaries that define
the attached gingiva?
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periodontal ligament/gingiva
The attachment apparatus is composed of all of the following EXCEPT one.
Which one is the EXCEPTION?
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gingiva
The t issues that surround and support the teeth are co llectively called the periodontium. Their main functions are to support, protect, and provide nourishment to
the teeth. It has been divided into two parts:
l.Gingiva
2. Attachment apparatus - composed of the:
Periodontal ligament
Cementum
Alveolar process of the maxillae and mandible
The cementum is considered a part of t he periodontium because, with the bone, it
serves as the support for the fibers of t he periodontal ligament.
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The gingival fluid (sulcular fluid) contains components of connective t issue, epithelium, inflammatory cells, serum, and microbial flora inhabiting t he g ingival margin or
the sulcus (pocket). In the healthy sulcus the amount of gingiva l fl uid is very small.
Duri ng inflammation, however, the gingival flu id flow increases, and its composition
starts to resemble that of an inflammatory exudate.
The main route of the gingival fluid diffusion is th rough the basement membrane,
throug h t he relatively wide intracellular spaces of the junctional epithelium, and then
into the sulcus.
The gingival fluid is believed to:
Cleanse material from t he sulcus
Contain plasma proteins that may improve adhesion of the epithelium to the tooth
Possess antimicrobial properties
Exert antibody activity to defend t he gingiva
periodontal ligament/gingiva
The principal fibers of the periodontal ligament are composed mainly of collagen type I.
The amount of collagen in a tissue can be determined by its glycine content.
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1. Less regu larly arranged co llagen fibers are found in the interstitial connect ive tissue between the pri ncipal fiber groups; this t issue conta ins the blood
vessels, lymphatics, and nerves.
2. Although the periodontal ligament does not conta in mature elastin, two
immature forms are found; oxytalan and eluanin. The so-called oxytalan
fibers run parallel to the root surface in a vertical direction and bend to attach
to the cementum in the cervica l th ird of the root. They are thought to regulate vascu lar flow.
3. The principal fibers are remodeled by the peri odontal ligament cel ls to
adapt to physiologic needs and in response to different stimuli.
periodontal ligament/gingiva
Because of the high turnover rate, the connective tissue of the gingiva has a
remarkably good healing and regenerative capacity.
The reparative capacity of the gingival connective tissues is better than that
of the periodontal ligament and the epithelial tissue.
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periodontal ligament/gingiva
The narrowest band of attached gingiva is found:
on the lingual surfaces of maxillary incisors and the facia l surfaces of maxillary first
molars
on the facial surfaces of mandibular second premolars and the lingual surface of
canines
SAADDES
on the facial surfaces of the mandibular canine and first premolar and the lingual
surfaces adjacent to the mandibular incisors and can ines
none of the above
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on the facial surfaces of the mandibular canine and first premolar and
the lingual surfaces adjacent to the mandibular incisors and canines
* ** Narrow gingiva l zones may occur also at the mesiobuccal root of maxillary first
molars, associated w ith prominent roots and sometimes w ith bony dehiscences and
at the mandibular t hird molars.
The width of the attached gingiva is determ ined by subtracting t he sulcus or pocket
depth from the total w idth of t he g ingiva (gingiva l margin to mucogingiva lline). This
is done by stretching the lip or cheek to demarcate the mucogingivalline w hile the
pocket is being probed. The amount of attached gingiva is generally considered to be
insufficient when stretching of the lip or cheek induces movement of the free gingival
margin.
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The w idth of the attached gingiva on the facial aspect differs in different areas of the
mouth. It is generally greatest in the incisor region (3.5-4.5 mm in the maxilla, 3.3-3.9
mm in t he mandible), and narrower in the posteri or segments (1.9 mm in maxillary
fi rst premolars and 1.8 mm in mandibular first premolars).
Important: A "functionally adequate" zone of g ingiva is defined as one that is keratinized, firm ly bound to tooth and underlying bone, about 2.0 mm o r more in width,
and resistant to probing and gaping when the lip or cheek is distended.
1. The "attached" gingiva is structured to w ithstand fri ctional stresses of mastication and brushing.
2. The alveolar mucosa appears to be well-adapted to permit movement but
is not able to withstand frictional stresses.
mandibular canine
mandibular second premolar
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=
=
=
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~uccol ~
~~
/. ~
Meslollngual
cusp
Oistolingual
cusp
ThreeCusp
~dol
Two Cusp
UShoped
Groove
pit
HShoped
Groove
Occlusal view of two types of permanent mandibular Occlusal view of twocusp type of permanent
right second premolars: threecusp type and twocusp mandibular right second premolar. showing the U and
type.
Hshaped groove patterns.
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auccol
triangular rtdge
Mtsloltosso
Mesial
morginOI Iktg
Melfol nguol
groove
Mandibular Right
First Premolar
Lingual view
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Remember: A lobe is one of the prim ary sections of formation in the development of the
crown of a tooth. It is represented by a cusp on posterior teeth, and mamelons and
cing ula on anterior teeth.
Mandibular Right First Premolar
D M
Mesial
Distal
Occlusal
Occlusal
Mesial
Distal
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Cervical
cross-section
Mesiodistal
cross-section
Buc colingual
cross-section
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Maxillary Right
First Premolar
Mesial view
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Mesial
developmen1ol
d8'pnus.lon
Meslol morglnol
groove
Meslol marginal
ridge
;?~:;~ 1.
Premolars are most difficult to do root canal treatment on because they are
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~ lmbrica ~on
lines
Mesial
developmental
depression
Mesial marginal
groove
Mesial cusp
slope
Distal cusp
51 ope
Buccal features
Mesial marginal
ridge
Mesial features
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Maxillary Right
Second Premolar
Mandibular Right
First Premolar
Mandibular Right
Second Premolar
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I
~ .._____.//
Important:
1. In a mediotrusive movement (nonworking, right or left), the lingual cusp of a
maxillary second premolar passes through the facial embrasure between the
mandibular second premolar and the first molar.
2. In a mediotrusive movement (working, right or left), the lingual cusp of a
maxillary second premolar passes through t he lingual embrasure between the
mandibular second premolar and the first molar.
number of roots
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***This is found on the mandibular fi rst premolar, not on either maxillary premolar.
The maxillary second premolar has the following characteristics compared to the maxillary first premolar:
One root; the first premolar has two roots
Much more symmetrical and less angular (more ovoid ) than the first premolar
DBCR (disto-buccal-cusp-ri dge) is longer than MBCR; opposite of first premolar
Buccal and lingual cusps are almost equal in height; on the first premolar they are
not
Has no mesial developmental depression; first premolar does
Has a less prominent buccal ridge; first premolar has a prominent buccal ri dge
Has a shorter central groove with more supplemental grooves; first premolar has
a long central groove with minimal supplemental grooves
Maxillary Right Second Premolar
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Buccal
Lingual
Occlusal
Mesial
Distal
tooth components
The dental lamina is a horseshoe-shaped band of epithelial tissue that arises
from the
and is surrounded by mesenchymal cells.
basement membrane
basal lamina
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ectomesenchyme
oral epithelium
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Micr oscopic
Appearance
Main Processes
Involved
Induction
Description
Ectodenn lining stomedeum gives
rise to oral epithelium and rhen to
dental lamina. adjacent w deeper
ec1omese.nchyme, which is influenced by the neural crest cells.
Both tissues are separated by a
SAADDES
baseme-n t membrane.
P-roliferation
* Note that these are approximate prenatal time spans for the development of the primary dentition
3088~
R<'produccd \ltith penni$.iion (rom Ebtb-Balogh M. Fchrcnbacoh MJ; Jlill.~trale(/ Demal Emb'J'ology. Histology. om/ A11a/OP1)~ ed 2. StLouis. 2006.
Saunders.
[0
twelfth weeks
Main Processes
Involved
P-roliferation, ditTerentia.
tion, morphogenesis
Description
Differentiation of enamel organ
into bell with four cell types and
dental papilla into two cell rypes.
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Microscopic
Appearance
Induction. prolifermion
Maturation
* Note that these are approximate prenatal time spans for the development of the primary dentiti on
308 C.l
Reproduced with p..-nnission (rom Bath-Balogh M. Fehrenbach MJ; /1/ii.~trauNI Demo/ EmhtJ'illogy. Histology. om/ AIIOIOPIJ~ ed 2. St Ll"'Uis. 2006.
Saunders.
oral epithelium
Important information to remember:
1. During the sixth to seventh weeks of embryonic development, the oral epithelium (ectoderm)
thickens along the future dental arches to form the dental lamina.
2. Around the eighth week of embryonic development. the mesenchymal neural crest (which
contains ectomesenchyme) induces the development of tooth buds at ten locations in the upper
and lower dental lamina.
3. Duri ng the bud stage, the dental lamina grows into the mesenchyme in the shape of a bud.
4. During the ninth to tenth weeks of embryonic development, the tooth bud di fferentiates
into a cap-shaped enamel organ extending from the dental lamina. A vestibular lamina develops to sepa rate the gum from the lip/ cheek. Duri ng the cap stage, an unequal growth of epithelial cells grows down to form a concavity around the mesenchyme, forming the dental papilla.
Other mesenchymal cells encircle the enamel organ, form ing the dental sac.
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By the end of the cap stage (third stage of odontogenesis) the tooth germ is complete and consists of:
1. The enamel organ, which is formed from oral epithelium. It is derived from the ectoderm.
It has four disti nct cell layers: (1) Outer enamel epithelium
(2) Inner enamel epithelium
(3) Stratum intermedium
(4) Stellate reticulum
*"*The enamel organ will give rise to enamel and will eventually form Hert wig's epithelial
root sheath .
2. The dental sac surrounds the developing tooth germ and will give rise to the cementum, the
POL, and the alveolar bone proper.
3. The dental papilla will give rise to the dentin and dental pulp.
Note: The outer layer of cells of the dental papilla differentiates into the odontoblasts (denti nforming cells).
*** Bot h the dental papilla and dental sac are formed from the mesenchymal neural crest (which
contains ectomesenchyme).
tooth components
Enamel matrix is an ectodermal product because ameloblasts are derived
from the inner enamel epithelium of the enamel organ, which was originally
derived from the ectodermal layer of the embryo.
Enamel matrix is first formed in the incisal/occlusal portion of the future
crown near the forming DEJ.
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Important: An important event for the production and organization of t he enamel is t he development of a cytoplasmic extension on ameloblasts, Tomes' process, that j uts into and interd igitates
with the newly forming enamel. In sections of forming human teeth, Tomes' processes give the j unction between the enamel and the ameloblast a picket-fence or saw-toothed appea rance. Note:
Tomes' processes are distinctly different from Tomes' fibers (odontoblastic processes that occupy
dentinal tubules).
Other important facts about enamel:
It has no power of regeneration - the ameloblasts lose their functional ability when the crown
of the tooth has been completed
It has no power of metabolism
It has no means of combating bacterial invasion - the susceptibility of the mineral component
to dissolution in an acid environment is the basis for dental decay
It has no nerve supply
It is a good thermal insulator
The acid solubi lity of the surface enamel is reduced by fluoride (this is the basis for the topical
application of fluorides in dental caries prevention)
tooth components
Mature enamel is by weight:
74% minerali zed or inorganic materi al, 20% o rganic material, and 6% water
80% minerali zed or inorganic materi al, 18% o rganic material, and 2% water
90% minerali zed or inorganic materi al, 9% o rganic material, and 1% water
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96% minerali zed or inorganic materi al, 1% o rganic material, and 3% water
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tooth components
Which of the following are partially calcified vertical defects in the enamel
resembling cracks or fractures that traverse the entire length of the crown
from the surface to the DEJ.
enamel tufts
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enamel spindles
enamel rods
enamel lamellae
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enamel lamellae
Enamel formation begins at the future cusp and spreads down t he cusp slope. As the
ameloblast s ret reat in increment al steps, the ameloblasts create an artifact in the enamel
called the lines of Retzius. Where these lines terminate at t he toot h surface they create t iny
valleys on the tooth surface that t ravel circumferenti ally around the crown known as
perikymata or imbrication lines of Pickerill. One of t he lines of Retzius is accentuat ed and
is more obvious t han the others. It is t he neonatal line that marks the division bet ween
enamel formed before birth and t hat which is produced after birth (this neonatal line is
found in all deciduous teeth and in the larger cusps of the permanent first molars).
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The term Hunter-Schreger bands refers t o the alt ernating light and dark lines seen in
dental enamel t hat begin at the DEJ and end before t hey reach the enamel surface. They
represent areas of enamel rods cut in cross-section dispersed between areas of rods cut
longit udinally.
tooth components
The mesenchymal cells in the dental papilla adjacent to the inner enamel
epithelium differentiate into:
ameloblasts
odontoblasts
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cementoblasts
fibroblasts
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Dental papilla
Ectomesenchyme
from neural
crest
Dental follicle
95- 1
odontoblasts
*** Remember: During the bell stage, the mesenchymal cel ls in the dental papilla adjacent to the
inner enamel epithelium differentiate into odontoblasts, which produce predentin and deposit it
adjacent to the epithelium. Later, the predentin calcifies and becomes dentin. As the dentin thickens,
the odontoblasts regress toward the center of the dental papilla; however, their fingerlike cytoplasmic processes (odontoblastic processes or Tomes' fibers) - remain embedded in the dentin.
Inner enamel epithelium cells continue their differentiation into ameloblasts that produce organic
matrix again st the newly formed dentinal surface. Almost immediately, this organic matrix mineralizes and becomes the initial enamel layer of the crown. Thus although enamel protein secretion occurs before mantle dentin is visible on the crown, these proteins do not assemble as a layer until
dentin is formed.The enamel-forming cells, the ameloblasts, move away from the dentin, leaving behind an ever-increasing thickness of enamel.
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For these events to take place normally, differentiating odontoblasts must receive signals from differentiating ameloblasts (inner enamel epithelium), and vice versa- an example of reciprocal induction.
Usual events in the histogenesis of a tooth:
1. Elongation of the inner enamel epithelial cells of the enamel organ; this influences mesenchymal cells on the periphery of the dental papilla to differentiate into odontoblasts (#2 below)
2. Differentiation of odontoblasts
3. Deposition of the first layer of dentin
4. Deposition of the first layer of enamel
Tooth development is dependent on a series of sequential cellular interactions bet ween epithelial
and mesenchymal components of the tooth germ. Once the ectomesenchyme influences the
oral epithelium to grow down into the ectomesenchyme and become a tooth germ, the above
events occur.
Remember: Histogenesis means the formation and development of the tissues of the body, in
this case the tooth.
tooth components
Which structure is the central core and fills the bulk of the enamel organ?
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Stratum intermedium
The bell stage of tooth development, which ex hibits d ifferentiation of the too th
germ to its fim hest extent. Note the enamel organ and the dental papilla have differentiated into various layers in preparation for the apposition of enamel and
dentin.
308AI
Reproduced \1,-ilh p~nnission from Ba1h-Balogh M, Fehrenbac-h MJ; 11/u.ftraled Demal EmhtJ'illogy. Histology. am/ A11aiMI)~ ed 2. St. Louis. 2006.
Saunders.
stellate reticulum
Four layers ofthe enamel organ:
1. Outer enamel epithelium (OEE) - the outer cellular layer of the enamel organ
(very thin). This layer outlines the shape of the future developing enamel organ.
2.1nner enamel epithelium (lEE)- the innermost cellular layer of the enamel organ
(very thin). The cells in this layer w ill become ameloblasts and produce enamel.
3. Stratum intermedium - this area lies immediately lateral to the inner enamel
epithelium (thicker than both the OEE and lEE). This layer of cells seems to be
essential to enamel formation (prepares nutrients for the ameloblasts of the lEE).
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4. Stellate reticulum -this area is the central core and fills the bulk of the enamel
organ. This layer contains a lot of intercellular fluid (mucus-type fluid ri ch in
albumin) that is lost just before enamel deposition.
After enamel formation is completed, all ofthe above structures of the enamel organ
become one and form the reduced enamel epithelium. This is important in the formation of the dentogingival junction, which is an area where the enamel and epithelium come together as the tooth erupts into the mouth. This forms the initial
junctional epithelium (epithelial attachment), which later migrates down the tooth to
assume its normal position.
tooth components
A patient comes into your dental clinic holding a bag of ice to the side of his
face and a sliver of ice tucked between his cheek and teeth. He says the cold
relieves the pain in his tooth. This is almost indicative of partial necrosis of
the structure which innervates the whole tooth. This structure is a connective tissue that develops from the:
SAADDES
enamel organ
dental papilla
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dental papilla
The pulp is t he innermost tissue of t he tooth. The pulp as well as dentin are formed from the
central cells of the dental papilla.
Anatomy of the Pulp:
Coronal pulp - located in the pulp chamber and forms pulp horns
Radicular pulp - located in t he pulp canals (root portion of tooth)
Apical foramen - communicates wit h the POL
*** Accessory canals may also be associated with t he pulp. Remember: These form when
Hertwig's epithelial root sheath encounters a blood vessel during root formation. Root
structure then forms around the vessel, forming the accessory canal.
SAADDES
tooth components
Which ofthe following statements concerning dentin are true?
Select all that apply.
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it is less m ineralized than cementum or bone but more mineralized than enamel
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it is hard, ela stic, 70% inorganic, 20% organic, and 10% w ater
the main cell type is the odontoblast, w hich is derived from ectomesenchyme
the inorganic component con sists of mainly calcium hydroxyapatite
Dentin is the specialized connective tissue that m akes up the b ulk of the tooth, extending
for almost its entire length. Dentin is hard, elastic, 70% inorganic, 20% organic, and 10%
water. The inorganic component consists of m ainly calcium hydroxyapatite w ith the
chemical formula of Ca10(PO,V6 (0H) 2. This calciu m hydroxyapatite is simil ar to that fo und
in higher percentages in enamel and in lower percentages in bone and cem entum.
Sm all er amounts of other minerals, such as carbonate and fl uoride, are also present.
SAADDES
1. Unlike enamel, which is acellul ar, dentin has a cellu lar component that is
retained after its form ation by odontoblasts.
2. Dentin and p ulp t issue are both formed by the dent al papilla. Pulp t issue is a
loose, very vascu lar, and non-calcified connective t issue while dentin is ava scular and a calcified t issue.
3. The m ain cell type in dentin is the odontoblast, which is derived f rom ectomesenchyme.
4. Dentin is much softer than enamel but harder than bone. Dentin is more
flexible (lower modulus of elasticity) than enamel. Dentin's compress ive
strength is m uch h igher than its tensile strength.
5. Dentin is more mineralized than cementum o r bone but less mineralized
than enamel. Morphologically and chemically, dentin has many characteristics in
comm on with bone.
6. The major organic component of dentin is type I coll agen fi bers (91% to 92%),
w ith type Ill fibers being present in m antle dentin, and type V and VI fibers being
found in t races throughout the dentin.
tooth components
A 3-year-old boy is being rushed by his mother to finish up his ice-cream. He
is unwilling to bite into it because it hurts his teeth. The reason the teeth of
children are more sensitive to thermal changes than those of an adult is that:
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Several large nerves enter t he apical foramen of each molar and premolar with single ones entering the anterior teeth. A young premolar may have as many as 700 myelinated and 2,000 unmyelinated axons entering t he apex. These nerves have two pr imary modalities:
1. Autonomic Nerve Fibers. Only sympathetic autonomies fibers are found in t he pulp. These
fibers extend from the neurons whose cell bodies are found in t he superior cervical ganglion
at the base of the skull. They are unmyelinated fibers and travel with t he blood vessels. They
innervate the smooth muscle cells of the arterioles and therefore function in regulation of
blood flow in the capillary network.
2. Afferent (Sensory) Fibers. These arise from the maxillary and mandibular branches of t he
fifth cranial nerve (trigeminal). They are predominantly myelinated fibers and may terminate in the central pulp. From this region some will send out small individual fibers that form
t he subodontoblastic plexus (of Raschkow) just under t he odontoblast layer.
tooth components
Gemination and fusion occur during which stage of tooth development?
initiation
bud stage
cap stage
bell stage
SAADDES
appositional stage
maturation stage
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Micr oscopic
Appearance
Main Processes
Involved
Induction
Description
Ectodenn lining stomedeum gives
rise to oral epithelium and rhen to
dental lamina. adjacent w deeper
ec1omese.nchyme, which is influenced by the neural crest cells.
Both tissues are separated by a
SAADDES
baseme-n t membrane.
P-roliferation
* Note that these are approximate prenatal time spans for the development of the primary dentition
3088~
R<'produccd \ltith penni$.iion (rom Ebtb-Balogh M. Fchrcnbacoh MJ; Jlill.~trale(/ Demal Emb'J'ology. Histology. om/ A11a/OP1)~ ed 2. StLouis. 2006.
Saunders.
[0
twelfth weeks
Main Processes
Involved
P-roliferation, ditTerentia.
tion, morphogenesis
Description
Differentiation of enamel organ
into bell with four cell types and
dental papilla into two cell rypes.
SAADDES
Microscopic
Appearance
Induction. prolifermion
Maturation
* Note that these are approximate prenatal time spans for the development of the primary dentiti on
308 C.l
Reproduced with p..-nnission (rom Bath-Balogh M. Fehrenbach MJ; /1/ii.~trauNI Demo/ EmhtJ'illogy. Histology. om/ AIIOIOPIJ~ ed 2. St Ll"'Uis. 2006.
Saunders.
cap stage
Stages oftooth development (odontogenesis):
1. Initiation (sixth to seventh weeks) - Ectoderm lining stomodeum gives rise to oral
epithelium and then to dental lamina, adjacent to deeper ectomesenchyme, wh ich is
infl uenced by the neural crest cells. Induction is the main process involved. Congenital
absence of teeth (anodontia) and supernumerary teeth result from an interruption in
this phase.
2. Bud stage (eighth week) - Growth of dental lamina into bud that penetrates growing
ectomesenchyme. Proliferation is the main process involved.
3. Cap stage (n inth to tenth weeks)- Enamel organ forms into a cap, surrounding the
mass of the dental papill a from the ectomesenchyme and surrounded by the mass of
the dental sac also from the ectomesenchyme, thus forming the tooth germ. Proliferation, differentiation, and morphogenesis are the main processes involved. Dens in
dente, gemination, fusion, and tubercle formation occur during this phase.
4. Bell stage (eleventh to twelfth weeks) - final shaping of tooth, cell s differentiate into
specific tissue forming cells (ameloblasts, odontoblasts, cementoblasts, and fi broblasts)
in the enamel organ. Hist odifferentiation and morphodifferentiation are the main
processes involved. Macrodontia/microdontia occur during this stage.
5. Apposition (varies per tooth) - cell s that were differentiated into specific t issue-forming cells begin to deposit the specific dental tissues (enamel, dentin, cementu m, and
pulp). Enamel dysplasia, concrescence, and the formation of enamel pearls occur during
this stage.
6. Maturation (varies per tooth)- mineralization
7. Eruption (varies per tooth)
8. Attrition (varies per tooth)
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tooth components
A 14-year-old boy comes into the dental office for a prophylaxis. A diet evaluation reveals that he consumes 3-4 cans of soda a day and eats a box of fruit
snacks every week. Radiographs show multiple incipient interproximal carious lesions and one cavitated carious lesion in his premolar. The cavitated lesion in the premolar is beginning to encroach on the pulpal tissue. Reparative
dentin is usually formed in response to injury. The primary function of which
tissue is responsible for forming this reparative dentin?
enamel
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dental pulp
***The life span of the odontoblasts generally is believed to equal that of the viable
tooth because the odontoblasts are end cells, which means that, once differentiated,
they cannot undergo fu rther cell division. This fact poses an interesting problem. On
occasion, when the pulp tissue is exposed, repair can take place by the formation of
new dentin. This means that new odontoblasts must have differentiated and migrated
to the exposure site from pulp tissue, most likely from the cell-rich subodontoblast
zone.
Remember: The dental pulp is the soft-tissue component of the tooth. It is a connective tissue originating from the mesenchyme of the dental papilla and performs multiple functions th roughout life. In addition to being the formative organ of the dent in, it also has the following functions:
Nutritive - the pulp keeps the o rganic components of the surrounding mineralized tissue supplied w ith moisture and nutrients
Sensory - extremes in temperature, pressure, or t rauma to the dentin or pulp
are perceived as pain
Protective - the formation of repa rative or tertiary dentin (by the odontoblasts)
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tooth components
The dental tissue which most closely mimics bone is:
enamel
dentin
dental pulp
cementum
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cementum
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tooth components
Which of the following statements concerning cementum are true?
Select all that apply.
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cellular cementum occurs more frequently on the coronal two-thirds of the root
it is avascular
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tooth components
The junction between primary and secondary dentin is characterized by a
sharp change in the direction of dentinal tubules.
Tertiary dentin is the dentin formed in a tooth before the completion of the
apical foramen of the root.
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Reparative dentin or tertiary dentin is dentin formed very rapidly in localized regions
in response to a localized injury to exposed dentin. The injury could be caries, cavity
preparation, attrition, or recession. Odontoblasts in the area of the affected tubu les
might die because of the injury, but neighbori ng undifferentiated mesenchymal cells
of the pulp move and become odontoblasts. Tertiary dentin tries to seal off the
injured area, thus the term reparative dentin.
Primary dentin is the dentin formed in a tooth before the completion of the apical
foramen of the root. Pri mary dentin is characterized by a regula r pattern of tubules.
Secondary dentin is the dentin that is formed after completion of the apical
foramen. Secondary dentin is formed at a slower rate than pri mary dentin and is less
mineralized. Secondary dentin is a regula r and somewhat uniform layer of dentin
around the pulp cavity. Secondary dentin is made by t he odontoblastic layer t hat
lines the dentin-pulp interface.
SAADDES
Note: The junction between pri mary and secondary dentin is characterized by a
sharp change in t he direction of dentinal tubules.
tooth components
Which of the following is formed inside the walls of the dentinal tubules?
tertiary dentin
mantle dentin
peritubular dentin
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intertubular dentin
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peritubular dentin
Dentin is not a uniform tissue in the tooth but differs from region to region. Dentin that creates
t he wall of the dentinal t ubules is called peritubula r dentin. Peritubular dentin is highly mineralized after dentin maturation. The dentin that is found between the t ubules is called intertubular dentin.lntertubular dentin is highly mineralized, but less so t han peritubular dentin.
Mantle d ent in is t he first predentin that forms and matures within the tooth. Mantle dentin
shows a difference in the direction of t he mineralized collagen fibers compared with the rest
of dentin, with the fibers perpendicular to the DEJ. Mantle dentin also has more peritubular
dentin than the inner portions of the dentin and thus has higher levels of mineralization.
SAADDES
I ' pes ot L>entm
Type
Peri tubular
(intralubular)
Intertubular
Location/Chronology
Description
t u bu le~.::
Man11e
Circumpulpal
Primary
nta.liS
Se.c.ondary
Le~.::s
T crtiary
(reparative o r
reactionary den1jn)
tooth components
After the lEE differentiates into preameloblasts, the outer cells of the dental
papilla are induced by the preameloblasts to differentiate into:
fibroblasts
osteoblasts
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odontoblasts
cementoblasts
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odontoblasts
After the lEE differentiates into preameloblasts, the outer cells of the dental papilla are induced by the
preameloblasts to differentiate into odontoblasts.These cells also undergo repolarization, which results in their nuclei moving from the center to a position in the cell farthest from the basement membrane. These repolarized cells are also lined up adjacent to the basement membrane but in a
mirror-i mage orientation compared with the preameloblasts. The odontoblasts now begin dentinogenesis, which is the apposition of denti n matrix, or predentin, on their side of the basement membrane. Thus the odontoblasts start their secretory activity some time before enamel matrix production begins. This explain s why the dentin layer in any location in a developing toot h is slightly thicker
than the corresponding layer of enamel matrix.
After the differentiation of odontoblasts from the outer cel ls of the dental papilla and their formation of predentin, the basement membrane between the preameloblasts and the odontoblasts disintegrates. This disintegration of the basement membrane all ows the preameloblasts to come into
contact with the newly formed predenti n. This induces the preameloblasts to differentiate into
ameloblasts. Ameloblasts begin amelogenesis, or the apposit ion of enamel matrix, laying it down
on their sid e of the now disintegrating basement membrane. The enamel matrix is secreted from
Tomes' process, a tapered portion of each ameloblast that faces the disintegrating basement membrane.
With the enamel matrix in contact with the predentin, mineralization of the disintegrating basement
membrane now occurs, forming the dentinoenamel junction (DE)), the inner junction between the
dentin and enamel tissues. Apposition of both types of dental matrix becomes regular and rhythmic,
as the cellular bod ies of both the odontoblasts and ameloblasts retreat away from the DEJ.
The odontoblasts, unlike the ameloblasts, will leave attached cellular extensionsin the length of the
predentin called the odontoblastic process (Tomes' fiber). Each odontoblastic process is contained
in a mineralized cylinder, the dentinal tubule.
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underlying a cusp.
4. Research has shown that in order for ameloblasts to form enamel, cells from the
stratum intermedium must be present.
tooth components
The application of excessive heat to a tooth results in pain because:
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blood vessels of the pulp expand and cause strangulation of the t issue
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Note: Proprioceptors (which respond to stimuli regarding movement) are not found
in the pulp.
Important: As the dental pulp ages, the following changes take place:
Decreased:
-intercellular substance, water, and cells
*** Major decrease in the number of undifferentiated mesenchymal cells
-size of the pulp cavity due to the addition of secondary or tertia ry dentin
Increased:
-number of collagen fibers
-calcifications with in the pulp (called denticles or pulp stones)
Important point: As the pulp ages, it becomes more fibrotic, leading to a reduction in
the regenerative capacity of the pulp.
tooth terms
Which of the following is a shallow groove or line between the primary parts
of the crown or root?
fossa
sulcus
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developmental groove
supplemental groove
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developmental groove
A sulcus is a long depression or va lley in the surface of a tooth between ridges and
cusps, the inclines of which meet at an angle. A sulcus has a developmental groove at
the junction of its inclines (the term sulcus should not be confused with the term
groove).
A developmental groove is a shallow groove or line between the primary parts of the
crown or root. A supplemental groove, less distinct, is also a shallow linear depression
on the surface of a tooth, but it is supplemental to a developmental groove and does
not mark the junction of primary parts. Buccal and lingual grooves are developmenta l grooves found on the buccal and lingual surfaces of posterior teeth .
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1. Pits are small p inpoint depressions located at the junction of developmental grooves or at term inals of those g rooves.
2. A fissure is a narrow channel or crevice, sometimes deep, formed at the
depth of a developmental groove.
3. Dental caries (decay) often begins in deep fissures or pits.
A fossa is an irregular depression or concavity. lingual fossae are on the lingual surface of incisors. Central fossae are on the occlusal surface of molars. They are formed
by t he convergence of ridges term inating at a central point in the bottom of the depression w here there is a junction of grooves. Triangular fossae are found on molars
and premolars on the occl usal surfaces mesial or distal to marginal ridges. They are
sometimes found on t he lingual surfaces of maxillary incisors at the edge of the lingual fossae where t he marginal ridges and t he cingulum meet.
tooth terms
When two teeth in the same arch are in contact, their curvatures adjacent to
the contact areas form spillway spaces called embrasures.
The design of contact areas, interproximal spaces, and embrasures varies
with the form and alignment of the various teeth; each section of the two
arches shows similarity ofform.
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tooth terms
When viewed from the facial, all posterior teeth have proximal contacts in
the middle third.
The more posterior teeth (the molars) have contacts higher in the middle
third than the premolars.
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_fi-SAADDES
-11 XX- -n--n-xx
I A I
I BI
1C I
-t3c- -~
tooth terms
A 16-year-old patient is referred to the orthodontist's office needing work to
fix her malocclusion. Before the patient's first appointment, the orthodontist reviews the clinical photographs of the patient and notices mamelons.
Mamelons are unusual in older patients and would indicate that the patient
most likely has which ofthe following malocclusions?
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Remember: Maxillary and mandibular incisors characteristically have three mamelons which are
centered beneath the three facial lobes.
tooth terms
Which ofthe following are true concerning developmental grooves?
Select all that apply.
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they are important escape ways for cusps during lateral and protrusive jaw motions
and for food particles during mastication
they are broad, deep, linear depressions
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Remember: Pits are located at the junction of developmental grooves or at terminals of these grooves.
Developmental
groove
Occlsal
developmental
pit
Marginal ridge
Supplemental
groove
Occlusal View of a Permanent Mandibular First Molar
tooth terms
In many older individuals, gingival recession leads to an unaesthetic problem
affectionately known as "black triangle disease:' This is caused by the Joss of
gingival tissue in the interdental space. The interdental space is the:
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col lar of t issue that is not attached to the tooth or alveola r bone
band or zone of gray to light or cora l pink keratinized masticatory mucosa that is
firmly bound down to the underlying bone
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2. The free gingiva (marginal gingiva) is the collar of tissue that is not attached
to the tooth or alveolar bone. lt surrounds the root of each tooth from the gingival margin to form the col lar of space o r gingival crevice or sulcus (where
dental floss can fit).
3. The attached gingiva is a band or zone of gray to light or coral pink keratinized masticatory mucosa that is firm ly bound down to the underlying bone.
It is present between the free g ingiva and the more movable alveolar mucosa.
tooth terms
Which of the following types of ridges is unique to permanent maxillary
molars?
a labial ridge
a marginal ri dge
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an oblique ri dge
a t ransverse ri dge
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an oblique ridge
*** It crosses the occlusal surface obliquely and is formed by the union of the distal cusp ridge of
t he mesiolingual cusp and the tria ngular ridge of the distobuccal cusp. It normally forms the
dista l boundary of the central fossa.
A labial ridge is a ridg e runn ing cervico-incisally in approximately the center of the labial surface of the canines
A buccal (cusp) ridge is a ridge running cervico-occlusally in approximately the center of the
buccal surface of premolars (more pronounced on the first premolars than second premolars)
A cervical ridge is a ridge run ning mesiodistally on the cervical third of the buccal surface of the
crown . It is found on all primary teeth, but only on the permanent molars.
A marginal ridge; on incisor and canine teet h, it is located on the mesial and distal border of the
lingual surface; on posterior teeth, it is located on the mesial and distal border of the occlusal surface
A triangular ridge is a ridge that projects from the cusp tip to the central groove. It is found on
posterior teeth. Note: The ML cusp on maxillary molars has two triangular ridges.
A transverse ridge is a ridge formed by the union of a lingual tria ngular ridge of a buccal cusp
and a buccal triangular ridge of a lingual cusp. It runs from the buccal surface to the lingual surface across the occlu sal surface of most posterior teeth.
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Dislobuccol
cusp
Oblique
ridge
Dlslollnguol
cusp
Mesiolinguol
cusp
tooth terms
Transverse ridges are very common on which of the following?
Select all that apply.
mandibular premolars
mandibular molars
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maxillary premolars
maxillary molars
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mandibular molars
maxillary premolars
A transverse ridge is the union of the buccal and lingual triangular ridges. Th is ridge crosses the
occlusal surface of most posterior teeth in a buccolingual direction. They occur between the ML
and MB or between the DL and DB cusps on molars or between buccal and lingual cusps on premolars.
Important: Transverse ridges are very common on mandibular molars and maxillary premolars.
Triangular ridges descend from the tips of the cusps of molars and premolars toward the central
part of the occlusal surface. They are called tria ngular because the slopes of each side of the ridge are
inclined to resemble two sides of a t riangle. They are named after the cusps to which they belong
(e.g., the tria ngular ridge of the buccal cusp of the maxillary second premolar).
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Remember: Maxillary molars have a characteristic oblique ridge. An oblique ridge is the union of
two ridges runn ing obliquely across the occlusal su rface. Oblique ridges always run between the distobuccal cusp and the mesiolingual cusp. They are formed by the union of the distal cusp ridge of the
Ml cusp and the triangular ridge of the DB cusp.
Central pit
Mesial pit
Buccal groove
Distal pit
Transverse ridge
tooth terms
A 7-year-old patient comes into your pediatric practice for a routine prophylaxis. When conducting an intra-oral exam you comment to him that you
notice that he has just eaten something sticky like gummy worms or fruit
snacks. The chewing surface of posterior teeth, and the likely location of
sticky food deposits in this patient, is referred to as the:
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cl inical crown
incisal edge
occlusal surface
anatomic crown
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occlusal surface
It consists of cusps, ridges, and grooves and is bounded mesiodistally by the marginal ridges and buccolingually by the cusp ridges. Note: Incisors and can ines do not
have an occl usal surface.
1. The incisal edge is the cutting edge or biting surface of anteri or teeth.
2. The anatomic crown is that part of the tooth covered by enamel.
*** The anatomical crown and root are separated by the CEJ; the anatomical crown does not include cementum, and the anatomical root does not
include enamel.
3. The clinical crown is that part of the tooth that is visible in the oral cavity.
It may be larger or smaller than the anatomic crown.
***The cl inical crown and root are separated by the gingival margin; the
clinical crown or root may be composed of both enamel and cementum.
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tooth terms
All anterior teeth show traces of:
one lobe
two lobes
three lobes
fou r lobes
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four lobes
Tooth development begins with increased cell activity in growth centers in the tooth
germ. A growth center (lobe) is an area of the tooth germ where the cells are
particu larly active. These lobes are primary centers of ca lcification and are primary
sections of formation in the development of the crown of a tooth. They are
represented by a cusp on posteri or teeth and mamelons and cingula on anterior
teeth. They are always separated by developmental grooves, wh ich are very
prominent in the posteri or teeth and form specific patterns. With anteri or teeth, their
presence is much less noticeable and these lobes are separated by what are known
as development al depressions.
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tooth terms
A young patient comes to the clinic complaining that he gets too much food
stuck behind his front tooth when he bites. On examination, the dentist notes
an anomalous, claw-shaped cusp which projects from the cingulum of tooth
#9. This small elevation of enamel found on the crown portion of a tooth
would be classified as a:
tubercle
mamelon
ridge
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developmental depression
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tubercle
It is an extra formation of enam el. The m ost comm on example would be the cusp of Carabelli, which is located on the lingual surface of the m esiolingual cusp of the maxillary first
perm anent mo lar. Note: The maxill ary prim ary second m olar may even have a cusp that re semb les the cusp of Carabelli.
Dens evaginatus is an extra cusp, usually in the central groove or ridge of a posterior tooth
and in the cingulum area of the centra l and lateral incisors. In incisors, these cusps appear
talon-shaped and can approach the level of the incisal edge. This extra portion conta ins
not only enamel but also dentin and p ulp t issue, and therefore pulp exposure can result
from radica l equilibration.
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Dens evaginatus
- Talon cu sp
A cusp is an elevation or mound on the crown portion of a tooth making up a d ivisional part
of the occlusal surface.
A tubercle is a small er elevation on so me portion of the crown produced by an extra form ation of enamel.
A cingulum is the lingual lobe of an anterior tooth. It makes up the bulk of the cervical
third of the lingual surface.
A ridge is any linear elevation on the surface of a tooth and is nam ed according to its lo cation (e.g., buccal ridge, incisal ridge, marginal ridge).
tooth terms
Each tooth has:
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bucca-occlusal
lin guo-occlusal
Because the mesial and d istal incisal angles of anterior teeth are rounded, mesioincisalline angles and distoincisal line angles are usually considered nonexistent. They
are spoken of as mesial and distal incisal angles only.
The line angles (6 of them) of the anterior teeth are:
mesiolabial
mesiolingual
labioincisal
distolabial
distolingual
linguoincisal
tooth terms
Any linear elevation on the surface of a tooth is called:
an incline
a prominence
a ri dge
a tuberosity
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a ridge
A ridge is any linear elevat ion on the surface of a tooth that is named according to its location and
form, such as a buccal ridge, incisal ridge, or marginal rid ge.
Remember: Two ridges that are present on all teeth are the mesial and distal marginal ridges. They
form the mesial and distal margins of the occlusal surfaces of premolars and molars and the mesial
and distal margins ofthe lingual surfaces of the incisors and canines.
Note: The marginal ridges are more prominent on the lingual surface of the maxillary lateral incisors as compared to the maxillary central incisors or mandibular incisors (centralsand laterals).
Cusp ridge: Each cusp has four cusp ridges radiating from its tip. They are named according to the
direction they take away from the cusp tip (for example, mesial. distal. buccal, or lingual).
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Lingual ridge: The ridge of enamel that extends from the cingulum to the cusp tip on the lingual surface of most can ines.
Buccal cusp ridge
of the buccal cusp
Mesial marginal
groove
(buccallrlongular rtdgc)
Central groove
permanent teeth
Which tooth in the mouth has the greatest axial inclination relative to the
occlusal plane?
maxillary canine
maxillary lateral incisor
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Maxillary Right
Central Incisor
~1...---------J~L-....:.,...__,L...____...J
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Labial
Lingual
Incisal
Mesial
Crown: largest of all incisor t eeth. The distal outline is more convex than the mesial outline.lt
is the most prominent tooth in th e mouth. It has the w id est crown mesiodistally of any permanent anterior tooth.
Root: one root w ith a sin gle root canal. It is conica l with a blunt apex. This root is the only maxillary tooth that is as thick at the cervix mesiod istally as faciolingually (the others are thicker faciolingually than mesiodistally).lt is not unusual to find definite pulp horns in the in cisal region
of t he tooth.
Surfaces:the mesial curvature of the cervical line is larger than any other tooth. The d istoincisa l
corner is more rounded (convex) than the mesioincisal corner. The mesial and distal contact
areas are centered faciolingually (as are all permanent incisors). The cingulum is well-developed and is located off-center toward the distal.
Occlusion: occludes in centric w ith the mandibular central and lateral incisors (same in protrusive and there is no contact in retrusive).
Distinguishing features: compared to other in cisors, t hey have the greatest axial inclination
relative to t he occlusa l plane. They usually have three mamelons and four developmental
grooves.
permanent teeth
Which teeth have the most variable crown shape of all permanent teeth?
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Occlusal
permanent teeth
Which of the following statements concerning the mandibular lateral incisor
are true?
Select all that apply.
the mandibular lateral incisor is a little larger in all dimensions than the mandibular
centra l incisor
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the crown of the mandibular lateral incisor is not as bilaterally symmetri cal as the
mandibular central incisor
the cingulum is directly in the center of the lingual surface
the single root is usually straight, slightly longer and wider than that of a mandibular
centra l
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the mandibular lateral incisor is a little larger in all dimensions than the mandibular central
incisor
the crown of the mandibular lateral incisor is not as bilaterally symmetrical as the mandibular central incisor
the single root is usually straight, slightly longer and wider than that of a mandibular central
r---.,
SAADDES
\
'----:-:-"'-:-
Mandibular
Right Lateral
Incisor
Lab1al
Lmgual
Incisal
Crown: not as bilaterally symmetrical as the mandibular central incisor. The crown is tilted distally on
the root . The d istoincisal angle is more rounded than the mesioincisal angl e. It is broader labiolingually than mesiodistally.
Root: one root; usually straight, slightly longer and wider than that ofa mandibular central. Pronounced
p roximal root concavities, especially on the distal surface.
Surfaces: lingual surface is smooth. The cingulum is sli ghtly off-center to the d istal. Mesial marginal
ridge is slightly longer than the d istal margi nal ridge.
Important: The mesial and d istal contact areas of the lateral incisor are not at exactly the same level, a
condition d ifferent from that found on the central incisor. The mesial and d istal contacts are both in the
incisal third; however, the d istal contact is slightly cervical to the level of the mesial contact a rea.
Note: In an anterior cross-bite relationship (Class Ill ), as the mand ible retrudes, the maxillary lateral
contacts the mandibular canine and late ral.
permanent teeth
Which tooth is considered the "cornerstone" ofthe permanent dentition?
maxillary canine
maxillary second molar
mandibular canine
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Crown: it is the largest mandibular tooth . It has the largest mesiodistal dimension of any
tooth. Mesiodistal dimension is slightly greater than the faciolingual dimension. This tooth presents a pentagonal"home plate" occlusal outline that is distinctive for this tooth.
Roots: two roots with three canals (a second canal is in the mesial root) Note: A fourth canal
(in the d istal root) is found 30% of the t ime. The roots are widely separated and the root trunk
is relatively short.
Cusps: five cusps (three buccal- MB, DB, and distal; two lingual- DL and ML). The mesiobuccal
cusp is the largest of the five and the distal cusp is the smallest. Ungual cusps are higher and
more pointed t han the buccal cusps (flattened bucca l cusps are typical of all mandibular
molars).
Occlusal pattern: two transverse ridges, three fossae with pits. The central groove is crooked
in its mesiodistal course.
Distinguishing features: first permanent tooth to erupt (known as six-year molar), it is considered t he "cornerstone" of the permanent dentition. Has two buccal grooves (MB and DB).
Note: The mandibular first molar is the most often restored, extracted and replaced tooth.
permanent teeth
A patient walks into your office holding three crowns in her hand and claims
that they fell out during a car accident. You notice that one of the crowns has
a mesiolingual developmental groove. This is a dead giveaway that this
tooth is a:
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Occlusal
Crown: from the buccal, it is longer and has a more prominent buccal ridge t han the second
premolar. It is bell-shaped and the cervical is very constricted.
Root: one; it is shorter and has a pointed apex (the second premolar is longer with a blunt apex).
It is broader facially than lingually and may have slig ht concavities on the mesial and distal.
Cusps: has a large pointed buccal cusp which occupies almost two-thi rds of the occlusal surface and has a prominent triangular ridge. lt has a small (about two-thirds the heig ht of buccal
cusp), non- functioning lingual cusp (does not occl ude with anything).
Occlusal pattern: small, non-functioning occlusal surface which converges toward the lingual.
The prominent triang ular ridge of the buccal cusp and the small buccal ridge of the ling ual cusp
unite to form a transverse ridge. Usually there is no central groove (may have mesial and distal pits). The mesial marginal ridge is more cervical than the distal marginal ridge.
Distinguishing feature: A developmental groove, the mesiolingual groove, usually separates
the mesial marginal ridge from t he mesial cusp slope of the small lingual cusp.
Note: The masticatory function of a mandibular first premolar is similar to that of a mandibular canine.
permanent teeth
You are sifting through extracted teeth to practice a root canal. Since you will
rarely do a third molar root canal in practice, you throw those out right away.
What is the most reliable distinguishing feature of the mandibular third
molar?
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./--~.,..,_,_
Buccal
r----~~~
. ,<;-/ .\
.,.i....'.
r--~-----,
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Lingual
Occlusal
Mesial
Distal
Most mandibular third molars have two roots, one mesial and one distal. These roots are usually
shorter, generally with a poorer development than the roots of the first and second molars, and
their distal inclination in relation to the occlusal plane of the crown is greater. This is the most
distinguishing feature of the mandibular third molars.
Characteristics of mandibular third molars:
Bulbous crowns that taper from mesial to distal
The crown can resemble the mandibular second molar (four cusps) or the mandibular first
molar (five cusps)
The mesial-distal dimension of the crown is greater than the buccal-ling ual dimension
Short roots that are often fused. long root trunk.
MB cusps are usually wider and longer than DB cusps
Irregular groove pattern with many supplemental grooves and pits (very shallow)
Note: Oversized anomalies are more common with the mandibular third molar, while undersized anomalies are more common with the maxillary third molar.
permanent teeth
The most distinguishable difference between the maxillary first and second
permanent premolars is:
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Occlusal
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Mesial
Dista l
Occlusal
Mesial
Distal
permanent teeth
The maxillary first molar is the largest tooth in the maxillary arch and also has
the largest crown in the permanent dentition.
All maxillary molars are wider buccolingually than mesiodistally; in comparison, the mandibular molars are wider mesiodistally.
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Crown: it is the largest maxillary tooth. From the occlusal, all maxillary molars are rhomboidal,
with obtuse angles at t he Ml and DB (the other two angles are acute- MB and Dl). Like all maxillary
posterior teeth, the crown outline is trapezoidal from each proximal view. In addition, the crown is
also centered over the root and shows no lingual inclination, like all maxillary molars and unlike
mandibular molars.
Roots: three; MB root often has two canals (MBand Ml). These pulp horns are often higher than the
distal and palatal.
Cusps:fou r, t wo buccal (MBisusually longer and wider than DB) and two lingual (Ml and Dl). Ml is
always the largest and highest on any posterior tooth.The cusp of Carabelli (when present) is seen
lingual to the ML cusp.
Occlusal pattern: ha san oblique ridge (as do all maxillary molars) which run s from the ML cusp to
the DB cusp and meets near the center on a level with the marginal ridges.
Note: The distal surface has a pronounced cervical concavity that needs special attention when
root plan ing. It is the second permanent tooth to erupt (after the mandibular fi rst molar). These
two teeth form t he cornerstone of the arch.lt has a long lingual groove which has a pit.
permanent teeth
The
are the only teeth in the permanent dentition with a vertical
and centrally placed labial ridge.
central incisors
lateral inci sors
canines
premolars
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canines
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Crown:has a prominent labial ridge. The cingulum is large and centered mesiodista lly.lt represents
a transition from anterior to posterior teeth; the mesial resembles the incisors and the distal resembles the premolars. It is wider labio-lingually than mesiodistally. From the proxima l view, it appears
to be positioned vertically in the arch.
Root: one root with one ca nal. It is the longest root The heavy root results in a bony labial ridge
called the canine eminence.
Cusp: when viewed from the incisal, the cusp tip is located on the mesiofacial of the crown . The
mesial cusp ridge is shorter than the distal cusp ridge.
Surface:the lingual surface contains all of the following: a pronounced cingulum, lingual ridge (located between mesio and distolingual fossa), mesio and distolingual fossa, and mesial and distal marginal ridges.
Pits and grooves: has a shallow lingual groove. This groove may contain a lingual pit near its center.
Distinguishing features: least often extracted (together wi th the mandibular canine).
permanent teeth
A linguogingival groove may be present on the root (and possibly on the
crown) of the maxillary lateral incisor.
A maxillary lateral incisor has a single conical root that is relatively smooth
and straight but may curve slightly to the distal.
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Maxillary Right
Lateral Incisor
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Crown: resembles the maxillary central incisor; however, it is smaller in all dimensions except the
root (root lengths are equal). The mesiodistal measurement is greater than the labiolingual measurement.
Root: single conical root that is relatively smooth and straight but may curve slightly to the distal.
Surfaces: lingual pit is common (more pronounced tha n mandibular lateral). lingual surface is the
most concave of any of the incisors (maxillary and mandibular). The linguoincisal ridge is well developed. The distoi ncisal corner or angle is more rounded (convex) than that of the central incisor.
Pits and grooves:a linguogingival groove may be present on the root (and possibly on the crown)
Note: It is prone to decay and also may complicate root planing.
Occlusion: in the intercuspal position, it opposes the incisal edge of the mandibular lateral and the
canine. It is the tooth that is most often in an abnormal relation and contact with adjacent teeth in
the same arch.
Distinguishing features:may be congenitally absent (most often of the permanent anterior teeth).
It is the last anterior tooth to begin calcification (1 0 months). Displays greater variation in form
than any other permanent tooth, except the third molars. It may appearpeg-shaped " or manifest as
"dens in dente.
permanent teeth
When filling a Class II amalgam you are having trouble fitting the matrix band
perfectly and keep getting an overhang in the cervical area. What surfaces
are you preparing?
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f\ ~
.
.i
'
Mesial developmental
depression
Maxillary Right
First premolar
i.
....
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,..../
''\, __ ,
Buccal
Lmgual
Occlusal
Crown: widest of all premolars (maxillary and mandibular). The oblong crown outline is greater
buccolingually than mesiodistally. They are longer cervico-occlusally than the second premolar,
first molar, or second molar.
Roots: two roots, one buccal and one lingual, each with one ca nal. This is the only premolar that has
two roots. When viewed from the proxima l, the axial inclination of the roots appears vertical.
Cusps:two; the lingual cusp is shorter than the buccal cusp. The buccal cusp tip is sharp and is placed
slightly to the distal. The mesial buccal cusp ridge is longer than the distal buccal cusp ridge. The
lingual cusp tip is located toward the mesial half ofthe lingual surface. Cusp inclines are very steep.
Surfaces: mesial surface has a pronounced (deep) cervical concavity (developmental depression)
that requires special consideration when performing periodontal maintenance. Has a prominent
buccal ridge.
Occlusal pattern: has a deep sulcus and long central groove. Also has a mesial marginal developmental groove. Usually few supplemental grooves and no pits.
Comparison:resembles the second premolar, except it is larger and more angular; the MBCR is longer
than the DBCR, the buccal ridge ismore prominent and it has a longer central groove.
permanent teeth
A mandibular canine is wider labiolingually and mesiodistally than a maxillary canine.
The crown of the mandibular canine can be as long or even longer than that
of a maxillary canine.
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Mandibular Right
Canine
~~~
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Incisal
Crown: labial surface is smooth and convex. Labial ridge is not as prominent as the maxillary canine. The greatest faciolingual measurement is greater tha n the greatest mesiodistal measurement.
Root:one; may be bifurcated into labial and lingual parts. A developmental depression may appear
on the mesial root surface. In cross-section, the root is ovoid, but wider mesiodistally at the labial.
Cusps: the cusp tip is displaced lingually. The mesial cusp ridge is shorter than the distal cusp rid ge
(more so than on maxillary can ines).
Surfaces: the mesial surface of the crown is almost parallel to t he long axis of the tooth. The cingulum is less bulky and less prominent than the maxillary can ine.
Comparisons: it appears more slender and is smoother tha n the maxillary canine in al l respects;
the labial and lingual ridges are less well developed. This feature allows them to be very caries resistant.
***All can ines have a mesiolabial developmental depression that is fou nd on the labial crown
surface in the incisal third, just mesial to the labial ridge.
permanent teeth
Which tooth has two forms: the three-cusp type and the two-cusp type?
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*** Remember: The three-cusp type shows the Y-shaped groove pattern and the two-cusp type
shows either the U- or H-shaped groove pattern.
Mandibular Right Second Premolar
.----=--,
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Occlusal
Crown: three-cusp type occurs most often (one buccal and two lingual cusps). From the buccal, it is
shorter and wider than the first premolar. From the occlusal, it has a square outline. It resembles
other premolars from the buccal aspect only.
Root: one; apex approximates the mental foramen. It is thicker and longer than the root of the
mandibular first premolar.
Cusp: buccal cusp is shorter, not as sharp, and the cusp slopes are less steep than the mandibular first
premolar. Mesiolingual cusp is always larger than the Dl cusp which may be absent. lingual inclines
of the buccal cusps are functional. From a distal view, it is usually possible to see the outline of all
three cusps.
Pits and grooves: central developmental groove is sometimes "U"- shaped or looks like acrescent It end s in the mesial and distal fossae, where it often joins a MB and a DB supplemental groove.
Occlusal pattern:larger occlusal surface than first premolar. General shape is more nearly square, especially three-cusp type, than the first premolar. Most frequently has a single central pit. There is no
mesiolingual groove or transverse ridge (both are common on first premolar).
permanent teeth
The outline of the crown of a maxillary second molar is narrower mesiodistally than that of a maxillary first molar but is about the same width buccolingually.
Two crown outline types are possible on the maxillary second molar when
viewed from the occlusal: rhomboidal and heart-shaped.
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.-------;:=------,
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Buccal
Lingual
Mesial
Crown: second molar is smaller than first molar, particularly in its width on the lingual side,
which has a smaller or nonexistent DL cusp (tooth may only have t hree cusps} and is also
smaller mesiodistally. When viewed from the occlusal, t he mesiobuccal line ang le is the most
acute. Buccal is broader than lingual due to absence of the fifth cusp (Carabelli}.lt is more angular than the first molar.
Roots: t hree; they are as long as first molar but are less spread apart mesiodistally and faciolingually. They bend more to the di stal and have a longer root trunk (as compared to the
first molar}.
Cusps: cusp of Carabelli is absent. The ML cusp is t he largest, DL cusp is the smallest (same as
maxillary first molar}. The primary cusp triangle is formed by the ML, MB, and DB cusps (same
for all maxillary molars}. Note: The DL cusp is not a part of this triangle.
Occlusal pattern: smaller oblique ridge and a more varied pit and groove pattern compared
to first molar. The transverse groove of the oblique ridge connects the central and d istal pits
(same for all maxillary molars}.
Note: The lingual groove is shorter and does not have a pit (compared to first molar}. DL cusp
may also be absent on maxillary third molars.
permanent teeth
You buy a batch of pre-fabricated temporary crown restorations for your office for the first time. Your assistant drops the entire box on the ground and
they all get mixed up. The hardest tooth to distinguish left from right will be
the:
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Buccal
.------.,...,...---, ,....,..,.-------,
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Lingual
Occlusal
Mesial
Distal
Crown: resembles the mandibular first molar except, it has no fifth cusp and it is smaller.
Occl usal outline can be rhombo idal (most common) or heart-shaped. The greatest faciolingual diameter is located in the mesial third of the crown.
Root: two; they are closer together and straighter than the first molar roots and are inclined more distally. Mesial root is not as broad faciolingually compared to first molar. It
has a longer root t runk.
Cusps: four (two buccal and two lingual). Th is contributes to symmetry.
Occlusal pattern: looks like plu s sign (+). Facial and lingual grooves form right angles with
the central groove. Central groove is straight. Has more secondary develop mental
grooves (three of them) than the first molar. Has two transverse ridges and three fossae
w ith p its.
Distingui shing features: has on ly one buccal groove and one buccal pit.
permanent teeth
The mandibular central incisors are the smallest and simplest teeth of the
permanent dentition.
The mandibular central has a simple root, which is very narrow labiolingually
and wide mesiodistally.
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Labial
Lingual
Incisal
Mesial
Distal
*** The mandibular central incisor is the least variable tooth in the mouth. It is also the smallest tooth
in the dentition. lt is smaller than the mandibular lateral which is not the case in the maxillary arch.
Crown:very smooth; lacks anatomical features. The incisal outline is straight and perpendicular to the
long axis. The mesial and distal incisal angles are almost 90.
Root:one; tapers evenly to a sharp apex. Very narrow mesiodistally, wide labiolingually, and concave on both the mesial and distal surfaces.
Surfaces: lingual surface (concave) and lingual fossa are very smooth.The cingulum, MMR, DMR, and
incisal ridge come together, forming a shallow lingual fossa.The cing ulum is centered. The labial surface is convex.
Pits and grooves: few if any developmental lines and grooves.
Occlusion: in the intercuspal position, each one occludes with only one tooth, the opposing maxillary central incisor. Only tooth in the dentition that occludes wi th a single tooth (all others occlude
with two).
Important: In an ideal intercuspal position, the distoincisal aspect of the mandibular central incisor opposes the lingual fossa of the maxillary central incisor.
permanent teeth
A permanent maxillary central incisor usually has how many mamelons and
developmental lobes?
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The permanent maxillary central incisor is generally considered to have 3 mamelons and 4
developmental lobes. Each of the 3 mamelons develops from a separate center of calcification. The cingulum is thought to arise from the fourth developmental lobe.
Tooth development begins with increased cell activity in growth centers in the tooth
germ. A growth center (lobe) is an area of the tooth germ where the cell s are particularly
active. These lobes are primary centers of calcification and are primary sections of
formation in the development of the crown of a tooth. They are represented by a cusp on
posterior teeth and mamelons and cingula on anterior teeth. They are always separated
by developmental grooves, which are very prominent in the posterior teeth and form
specific patterns. With anterior teeth, their presence is much less noticeable and these
lobes are separated by what are known as developmental depression s.
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pictures of teeth
Which permanent tooth is shown below?
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D
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Maxillary Right First Molar
Buccal
Lingual
Mesial
Distal
pictures of teeth
The picture below is:
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Distal view of maxillary
right first molar
Mesiodistal
cross-section
Buccollnguol
cross-sectio n
C&rvical
M idroot
cross-section
cross-sectio n
pictures of teeth
Which permanent tooth is shown below?
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Buccal
Lingual
~~
Mesiodlstol
l~colinguol
CI OU. 1oeCfloft
CIOU 5Kii0ft
Maxillary
Right Second
Molar
Pulp Cavity
Mesial
@
Cervical
crosssecHon
Distal
~G
Midroot
c ross-section
pictures of teeth
Which permanent tooth is shown below?
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Mandibular Right Second Molar
Buccal
Lingual
Mesial
Distal
pictures of teeth
The picture below is:
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Mandibular Right
Second Molar
Lingual
Buccal
Mandibular
Right Second
Molar
Pulp Cavity
CJ
Cervical
crosssection
Mesiodistal
cross-section
Midrool
cross-section
Buccolinguol
cross-secHon
pictures of teeth
The picture below is a facial view of what permanent mandibular tooth?
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cingulum of a canine is similar to the lingual cusp of a mandibu lar first premolar.
...., 2. When viewed from either proximal surface, the facial outline from cusp tip to root
apex is made up of one continuous arc (from the facial, the proximal surfaces from
the contact to apex look like a straight line).
3. One variation of this tooth is that on occasion, the root is bifurcated (facial and
lingual roots) near its tip. The double root may, or may not be accompa nied by deep
depressions in the root.
~
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Mandibular Right
Canine
Incisal
Lingual
Mesial
Distal
pictures of teeth
Which permanent tooth is shown below?
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Cervical
c ross-sec:tion
8uccolingual
croJssection
Mesiodistal
c ross-section
Buccal
Lingual
Mesial
Pulp cavity
pictures of teeth
Which permanent tooth is shown below?
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Note: The attached gingiva is very narrow on the facial (compared to any other ma ndibu lar tooth).
Mandibular Right First Premolar
Pulp cavity
Cervical
cross-section
Mesiodislol
Buccal
Lingual
Mesial
crou-s.eclion
8uccolingual
cross-section
pictures of teeth
Which permanent tooth is shown below?
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Note: When a protrusive mandibular movement is achieved, the mandibular first molar has
t he potential to contact the maxillary second premolar and t he first molar.
Mandibular Right First Molar
Pulp Cavity
tijW
Mesiocl dol
crou-secflon
cemeot
Mesial
Distal
cron~cliOn
e.uoecotlnguOI
aonsection
Midfool
c ron.uteflon
pictures of teeth
Which permanent tooth is shown below?
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Mesiolpit
U-Shaped
Groove
H-Shaped
Groove
Occlusal view of the two-cusp type of permanent mandibular right second premolar, showing the U- and H-shaped
groove patterns.
Cervical
cronsection
M esiodistal
CfOSSSeC:tion
8uccollngual
cross-section
pictures of teeth
The picture below is:
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Distal
Mesial
Occlusal
Buccal
Lingual
pictures of teeth
Which permanent tooth is shown below?
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Buccal
Lingual
Mesial
Distal
Mesiodis-tal
c:ron-secfkN\
6uecolinguol
c rousec.flon
pictures of teeth
The picture below is a facial view of what permanent maxillary tooth?
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Maxillary Right Canine
Lingual
Incisal
Mesial
MttlO<IiUOI
~llngt,;Qf
OOU Secflon
CI010S SoeCiiOn
Dista l
pictures of teeth
The picture below is a lingual view of what permanent maxillary tooth?
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Facial
Incisal
Mesial
Distal
pictures of teeth
The picture below is a facial view of what permanent maxillary tooth?
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Lingual
Incisal
Mesial
Distal
pictures of teeth
The picture below is a buccal view of what permanent mandibular tooth?
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Lingual
Occlusal
Mesial
Distal
pictures of teeth
The picture below is a labiolingual section of the pulp cavity of which
permanent mandibular tooth?
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Cervical
cross-sec tion
Mesiodistal
c ross-section
Labiolingual
cross-section
pictures of teeth
The picture below is a facial view of what permanent mandibular tooth?
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Lingual
Incisal
Mesial
Distal
Mandibular Right
Lateral Incisor
Pulp Cavity
pictures of teeth
The picture below is a lingual view of what permanent mandibular tooth?
.--
--\
\
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Labial
Incisal
Mesial
Distal
Mandibular Right
Central Incisor
Pulp Cavity
temporomandibular joint
Which ligaments below are considered to be accessory ligaments of the TMJ?
Select all that apply.
sphenomandibular ligament
temporomandibular ligament
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stylomandibular ligament
lateral d iscal ligament
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sphenomandibular ligament
stylomandibular ligament
The sphenomandibular and stylomandibular ligaments are considered to be accessory ligaments. The former is attached to the lingula of the mandible and the latter at the angle of the
mandible. These ligaments are responsible for limitation of mandibular movements (they limit excessive opening).
The temporomandibular ligament (also called the lateral ligament) runs from the articular eminence to the mandibular condyle. It provides lateral reinforcement for the capsule. This ligament prevents posterior and inferior displacement of the condyle (it isthe main stabilizing ligament of the
TMJ).
Collateral ligaments (medial and lateral) also referred to as "discal ligaments," are ligaments that
arise from the periphery of the disc. They are attached to the medial and lateral poles of the condyle
respectively, and stabilize the disc on the top ofthe condyle. These ligaments restrict movement of
the disc away from the condyle during function. Note: They are composed of collagenous connect ive tissue; thus they do not stretc h.
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Spine of
sphenoid bone
Sphenomandibular - -t ---.,llgament
Styloid process
of temporal bone
Stylomandibular
ligament
Angle of mandible
temporomandibular joint
A patient comes into your dental office complaining of chewing difficulties.
When you ask him to protrude his mandible, the mandible markedly
deviates to the right. Which muscle, which inserts fibers into the capsule and
articular disc of the TMJ, is most likely damaged?
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Muscles of Mastication
Masseter
Temporalis
Medial pterygoid
l ateral pterygoid
temporomandibular joint
A patient with constant, unexplained headaches is referred to a TMJ specialist by his physician. In order to check for tenderness, the specialist must palpate the joint. What is the best way to palpate the posterior aspect of the
mandibular condyle?
intraorally
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externally over the posterior surface of the condyle with the mouth open
through the external auditory meatus
any of the above
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externally over the posterior surface of the condyle with the mouth open
The temporomandibular joint should be evaluated for tenderness and noise. When
checking for joint noises (clicking and crepitus), t he joint is palpated laterally (in front
of the external auditory meatus) wh ile the patient opens and cl oses the mandible.
Tenderness can be assessed by palpating the lateral aspects of t he joints when the
mouth is closed and during opening of the mouth. The joint should also be palpated
for tenderness while the patient opens maximally, and t he fingertip should be
positioned slightly posteri or to the condyle to apply force to determine if t here is
inflammation of t he retrodisca l t issue.
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Note: Placing fingertips in t he patient's external auditory meatus, can produce false
joint sounds during mandibular function because of pressure against the thin ear
canal carti lage.
Remember:
1. The posterior aspect of the condyle is rounded and convex, whereas the
anteroinferior aspect is concave.
2. The condyles are not symmetrical nor identical.
3. Sleep bruxism is characterized by episodes of massive bilateral clenching t hat
lasts up to 5 minutes; it often coincides w ith passage from deeper to lighter sleep,
not lighter to deep sleep; it occurs approximately every 90 minutes.
4. There is no single factor that is responsible for all bruxing. The most common
treatment for bruxing is a nightguard.
temporomandibular joint
A 56-year-old man comes into the ER with his mouth wide open. His wife
explains that he can't close his mouth. The resident on-call quickly diagnoses
this as a bilateral dislocation of the TMJ and treats it promptly with reduction. Dislocation of the TMJ is almost always:
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Note: The term subluxation refers to hypermobi lity or hypertranslation of the mandible.
When t here is natural laxity or looseness of the ligaments associated with the TMJ, the
mandible is able to open beyond the usual anterior limit and can appear to be a d islocation, as
previously described. However, with a subluxation, the patient can self-reduce, or return, the
mandible to its normal position without the assistance of a dentist.
Closed Position
Open Position
Anterior Dislocation
temporomandibular joint
Which component of the TMJ has the most vasculature and innervation?
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retrodiscal tissue
The articular disc (meniscus) is composed of dense fibrous connective tissue, and it is positioned
in between the condyle and the fossa, thereby dividing the joint into superior and inferior joint
spaces.
The articular disc (meniscus) varies in thickness; the thinner central intermediate zone separates
the thicker portions, which are the anterior and posterior bands. The posterior band of the
art icular disc is the thickest of the two bands, and it is attached with posterior loose connective
tissues called retrodisca l tissues (bilaminar zone; posterior attachment). The less thick anterior
band of the articular disc is contiguous with the capsular ligament, the condyle, and the superior
belly of the lateral pterygoid muscle.
Note: The retrodiscal tissue is highly vascula rized and innervated, whereas the articular disc for
the most part is not. Only the extreme periphery of the articular disc is slightly innervated.
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So~ head
Articulardist
$upet"ior
comportment
~--5~~~~!1~:::::::::=-
lnfet"lor
sur;.e11or1om"o
Jtefrodlscol pod
Inferior lomino
temporomandibular joint
A relatively unsuccessful treatment option for individuals suffering from
osteoarthritis is to inject or implant hyaline cartilage into areas of articular
cartilage degeneration. If osteoarthritis were to involve the TMJ, this treatment modality would definitely be unsuccessful because the articular surfaces of the TMJ are covered with:
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elastic cartilage
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The disc completely divides the TMJ into two compartments. These two compartments are
synovial cavities, an upper and a lower synovial cavity. The synovial membrane lin ing the
j oint capsu le produces the synovial flu id that fill s these cavities.
The disc is attached to the lateral and medial poles of the mandibular condyle. The disc is
not attached to the temporal bone anteriorly, except indirectly through the capsul e. Posteriorly, the disc is divided into two areas. The upper division ofthe posterior portion of the
disc is attached to the temporal bone's postglenoid process, and the lower division attaches
to the neck of the condyle. The disc blends with the capsule at these points. Note: The posterior area of attachment of the disc to the capsule is one of the places where nerves and
blood vessels enter the joint.
The disc consists of dense fibrous connective tissue. Few cells are present, but
fibroblasts and wh ite blood cell s are among these. The central area of the disc is avascular
and lacks innervation, and the peripheral reg ion has b lood vessels and nerves.
temporomandibular joint
A patient with chronic TMJ inflammation is being treated by a dental TMJ
expert. To supplement his examination, the dentist wants to image the soft
tissues of this patient's TMJ. Which of the following is the best imaging
modality for identifying the position of the articular disc in the temporomandibular joint?
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panoramic radiograph
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Magnetic resonance Imaging showing the disc centered over the condyle (A). Note the image is reversed from typical radiographs. The cortical bone and the disc appear dark. 8, The disc is dearly visible in front of the condyle.
Depending on the depth of the slice, the medial pole can be distinguished from the disc position at the lateral pole.
Reproduced with permission from Dawson, Peter E.; Functional Occlusion From TMJ to Smile Design, St. louis,
2007, Mosby.
temporomandibular joint
Reciprocal clicking is always a sign of damage to the ligaments that fasten
the disc in place.
A disc cannot click if the posterior and collateral ligaments are intact.
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like centri c relation, adapted centric posture is a horizontal axis position of the
condyles. It occurs irrespective of vertica l d imension or tooth contact. It is also a m idmost position, because even if a d isc is completely displaced, the medial pole of each
condyle adapts to the concavity of the fossae and maintains contact against the medial incline of each fossa wal l.
The mandible is in adapted centric posture if five criteria are fulfil led:
1. The condyles are comfortably seated at the highest point against the articular eminentiae.
2. The medial pole of each condyle is braced by bone (the d isc may be partially interposed).
3. The inferi or head of the lateral pterygoid muscles have released contraction and
are passive.
4. The condyle-to-fossa relationship is manageably stable.
5. Load testing produces no sign of tension or tenderness in either TMJ.
temporomandibular joint
A patient with temporomandibular disorder comes to the dental office for
treatment. He has bilateral "clicking" of the condyles upon opening and
tenderness on palpation of the joint. An MRI shows damaged collateral
ligaments. The most common direction in which the articular disc in the TMJ
will be displaced in this patient is:
laterally
medially
posteriorly
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anteromedially
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anteromedially
In a healthy temporomandibular joint (TMJ), the articular disc is seated on the condyle
and is held in place by the collateral ligaments (medial and lateral, also ca lled "discal
ligaments") that are attached to the medial and lateral poles of the condyle. Attached
to the anterior portion of the articular disc are muscle fibers from the lateral pterygoid
muscle.
When the collateral ligaments become elongated or torn, they become loose and this
allows the lateral pterygoid muscle to pull the articular d isc out of place. When this occurs, it is cal led a disc displacement. Because of the anteromedial direction of the lateral pterygoid muscle, the articular d isc is usuall y d isplaced anteromedially.
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Note:When the articular d isc is displaced anteromedially to the condyle, a click sound
is usually demonstrated when the mouth is opened and the condyle moves past the
thick posteri or band of the articular d isc. There can also be a clicking sound when the
mandible moves to the opposite side, as the condyle again moves past the th ick posterior band of the articular disc. Often another reciproca l cl ick wil l be demonstrated
when the mouth is subsequently closed and the condyle moves from the thin central
area ofthe disc and then past the thicker posterior band as the articular disc once again
becomes d isplaced. A crepitation sound (also known as crepitus) is usually associated
w ith a degenerative process (osteoarthritis) of the condyle, the dull thud is usually associated w ith a self-reducing subluxation of the condyle, and tinnitus is descri bed as
ear ring ing.
temporomandibular joint
The TMJ is a(an):
arthrodi al joint
ginglymus joint
ginglymoarthrodial joint
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ginglymoarthrodial joint
The TMJ is a ginglymoarthrodial joint (meaning that it glides and rotates), permitting both hingelike rotation and sl iding (gliding) movements. Note: Ginglymus means rotat ion, and arthrodial
means freely movable.
Components of the TMJ:
Mandibular condyle (sometimes called the condyloid process of the mandible) - the art iculat ing
surface or functioning part of the condyle is located on the superior and anterior surfaces of the
head of the condyle. This surface is covered with a layer of dense fibrous connective tissue.
Articular fossa -this fossa is the anterior three-fourths of the larger mandibular fossa. It is considered to be a non-functioning portion of the joint. Remember: The mandibular fossa (glenoid
fossa) is the temporal component of the TMJ; it is bounded in front by the articular eminence, and
behind, by the tympanic part of the temporal bone, which separates it from the ext ernal auditory
meatus.
Articular eminence (also called the articular tubercle) is a rid ge that extends mediolaterally just
in front ofthe mandibular fossa. It is considered to be the functional portion of the joint It is lined
with a thick layer of dense fibrous connective tissue.
Articular disc (also called the meniscus) is a biconcave fibroca rtilaginous disc interposed between the condyle of the mandible and the mandibular (glenoid) fossa of the temporal bone, which
provides the gliding surface for the mandibular condyle, resulting in smooth joint movement The
central part is avascular and devoid of nerve tissue; only the extreme periphery is slightly innervated.
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Upper synovial
cavity
Articular eminence
Joint disc
lower synovial
cavity
temporomandibular joint
All of the following structures make up the articulating parts of each temporomandibular joint EXCEPT one. Which one is the EXCEPTION?
mandibular condyle
articula r fossa and articular eminence
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retrodiscal tissue
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retrodiscal tissue
The articular disc (meniscus) is composed of dense fibrous connective tissue, and it is positioned
in between the condyle and the fossa, thereby dividing the joint into superior and inferior joint
spaces.
The articular disc (meniscus) varies in thickness; the thinner central intermediate zone separates
the thicker portions, which are the anterior and posterior bands. The posterior band of the
art icular disc is the thickest of the two bands, and it is attached with posterior loose connective
tissues called retrodisca l tissues (bilaminar zone; posterior attachment). The less thick anterior
band of the articular disc is contiguous with the capsular ligament, the condyle, and the superior
belly of the lateral pterygoid muscle.
Note: The retrodiscal tissue is highly vascula rized and innervated, whereas the articular disc for
the most part is not. Only the extreme periphery of the articular disc is slightly innervated.
SAADDES
So~ head
Articulardist
$upet"ior
comportment
~--5~~~~!1~:::::::::=-
lnfet"lor
sur;.e11or1om"o
Jtefrodlscol pod
Inferior lomino
temporomandibular joint
Which of the following structures secretes the fluid which lubricates the TMJ?
retrodiscal tissue
internal synovial layer of the fibrous capsule
outer fibrous layer of the fibrous capsu le
articula r d isc
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External ocou.stic;:
me-atus
Joint capsule-
temporomandibular joint
Translatory movements take place in which compartment of the TMJ?
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The temporomandibular joints are considered the most complex joints in the human
body because they must provide for rotational movements, sliding movements (translatory motion) and an infinite range of combined movements and functions, unlike
any other joint in the body.
When the mouth opens, two distinct motions occur at the joint. The first motion is rotation around a horizontal axis through the condylar heads. The second motion is
translation. During these movements the condyle and meniscus move together anteriorly beneath the articular eminence. In the closed mouth position, the thick posterior band of the meniscus lies immediately above the condyle. As the condyle
translates forwa rd, the thinner intermediate zone of the meniscus becomes the articulating surface between the condyle and the articular eminence. When the mouth is
fully open, the condyle may lie beneath the anterior band of the meniscus.
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In the lower (condyle- articula r disc) compartment, only a hinge-type or rota ry motion can occur. This rotational or terminal hinge-axis opening of the mandible is possible only when the mandible is retruded in centric relation w ith the conscious effort
by the patient or by the dentist's control. Note: Duri ng mouth opening, the articula r
disc moves anteriorl y in relation to the articular eminence.
In the upper (mandibular fossa -articu lar disc) compartment, only sliding movements or translatory motion can occur. When the lateral pterygoid muscles contract
simultaneously, the discs and condyles can slide forward, down over the articular eminence (protrusion ).
Note: The inferior compartment (lower) allows for rotation of the mandible corresponding to the first 20 mm or so of opening. After 20 mm the articular disc and upper
compartment become active and allow fo r forwa rd t ranslation of the condyle.
primary dentition
All of the following statements are true EXCEPT one. Which one is the
EXCEPTION?
t he crowns of the primary anterior teeth are wider mesiodistally and shorter incisocervically
than their permanent counterparts
the crowns of the primary molars are shorter and more narrow mesiodistally at the cervical
third as compared to the permanent molars
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the pulpal horns are lower in primary molars, especially the distal horns, and the pulp chambers are proportionately smaller
the roots of the primary anterior teeth taper more rapidly than do those of the permanent
anteriors
the roots of t he primary molars are longer and more slender than t hose of the permanent
molars
the enamel ends abruptly at the cervical line on primary teeth, rather t han becoming t hinner,
which occurs on permanent teeth
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the pulpal horns are lower in primary molars, especially the distal
horns, and the pulp chambers are proportionately smaller
***The pulpal horns are higher in primary molars, especially the mesial horns, and the pulp chambers are proportionately larger.
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Comparison of maxillary, primary, and permanent second molars, linguobuccal cross section. A, The
enamel cap of primary molars is thinner and has a more consistent depth. 8, A comparatively greater
thickness of dentin is over the pulpal wall at the occlusal fossa of pri mary molars. C, The pulpal horns
are higher in primary molars, especially the mesial horns, and pulp chambers are proportionately
larger. 0, The cervical ridges are more pronounced, especially on the buccal aspect of the first primary
molars. E, The enamel rods at the cervix slope occlusally instead of gingivally as in the permanent
teeth. F, The primary molars have a markedly constricted neck compared with the permanent molars.
G, The roots of the primary teeth are longer and more slender in comparison with crown size than
those of the permanent teeth. H, The root sof the primary molars flare out nearer the cervix than do
those of t he permanent teeth.
primary dentition
Stainless steel crowns are often used in pediatric dentistry. Also common in
pediatric dentistry are kids throwing temper tantrums. One day a 4-year-old
patient throws a tantrum and knocks over your case of stainless steel
crowns. When picking out the primary mandibular first molars you
remember which of the following statements?
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none of the above; their anatomy is unlike any other tooth in the mouth (pri mary or
permanent)
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Note: The primary first and second molars first show calcification at five to six months in utero. In
general. the root of a deciduous tooth is completely formed in j ust about one year after eruption of
that tooth into the mouth.
The Primary Mandibular Right First Molar
Buccal
L.ingual
Occlusal
Mesial
Distal
primary dentition
A frantic mother calls you on the phone asking what to do about her child's
first tooth. You want to impress her. Before she can say it, you tell her what
tooth it is. It is a:
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You got that right, and now you really impress her and tell her how old her
child is. She is about:
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Labial
Lingual
Incisal
Mesial
Distal
1. The first permanent tooth to erupt is the mandibular first molar ("six year
molars"), followed shortly thereafter by the maxillary first molar.
2. The first permanent tooth to begin calcifying is the mandibular first molar (at
birth).
3.The first succedaneous tooth to erupt is the mandibular central incisor (around
six to seven years old). (Remember: The mandibular first molar and the maxillary first
molar are not succedaneous teeth).
4. The permanent maxillary central incisors erupt at approximately seven to eight
years of age. The permanent maxillary lateral incisors erupt at approximately eight
to nine years of age.
primary dentition
A 10-1/ 2- year-old patient comes into your office. You are not sure whether
his maxillary canines are permanent or primary. Which of the following
statements will help you determine which they are?
the cusp on the primary maxillary canine is much shorter than the cusp on the
permanent maxillary canine
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the mesial cusp ri dge on the primary maxillary canine is shorter than the d istal cusp
ri dge; this is the opposite of all other can ines
the cusp on the primary maxillary canine is much longer and sharper than the cusp
on the permanent maxillary can ine
the primary maxillary canine is much narrower and longer than the permanent
maxillary canine
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Primary Maxillary
Right Canine
Facial view
Permanent Maxillary
Right Canine
Facial view
Primary Mandibular
Right Canine
Facial view
Permanent Mandibular
Right Canine
Facial view
primary dentition
The picture below is the buccal view of which primary molar?
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D
Primary ri ght molars, buccal aspect. A, Maxillary first molar. 8, Maxillary second molar. C,
Mandibular first molar. 0, Mandibular second
molar.
Primary right molars, lingual aspect. A, Maxillary first molar. 8, Maxillary second molar. C,
Mandibular first molar. 0, Mandibular second
molar.
primary dentition
When attempting a MO Class II amalgam preparation and filling on a primary tooth, you encounter a very large mesial marginal ridge that resembles
a cusp. You also notice a transverse ridge that runs from the mesiolingual
cusp to the mesiobuccal cusp that is rather large. This tooth often proves
difficult to restore, which tooth is it?
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This transverse ridge separates t he mesial portion from the remainder of the occlusal surface.
Other characteristics of t he primary mandibular first molar:
It does not resemble any other pri mary or permanent tooth
The mesiobuccal cusp is always t he largest and longest cusp, occupying nearl y
two-thirds of the buccal surface
The mesiolingual cusp is larger, longer, and sharper than the d istolingual cusp
The crown is wider mesiodistally t han high cervico-occlusall y
The mesial marginal ridge is very well developed and resembles a cusp
It has a prominent mesiobuccal cervical ridge
Class II cavity preparations are difficult due to morphology and a high mesial
pulp horn
It has no central fossa
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Primary Mandibular Right First Molar
Buccal
Lingual
Occlusal
Mesial
Distal
primary dentition
How many lobes develop to form a primary canine tooth?
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4
All canines (permanent and primary) have four lobes, th ree on the facial (mesiofacial, midfacial, and distofacial) and one on the lingual. The cusp tip is located on the midfacial (central
facial) lobe.
.~ 1.The pulp cavities of canines when viewed in a mesiodistal section normally appear
~1 pointed at the incisal tip.
?I
2. When viewed from the facial, prima ry canines resemble a pentagon (five-sided).
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0
Primary right anterior teeth, facial aspect. A, Max
illary central incisor. B, Maxillary lateral incisor. C,
Maxi llary canine. 0, mandibular central incisor. E,
Mandibular lateral incisor. F, Mandibular canine.
primary dentition
A 10-year-old patient comes into your office with his mother. They are
concerned about affording orthodontic treatment for his slightly crowded
anterior teeth. He has not lost his primary molars yet. From thi s information
alone, you tell his mother...
don't worry, the premolar teeth that replace these pri mary molars take up less space
in the arch, so we can expect to see more room in a few years
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get a second job, the premolar teeth that replace these primary molars take up more
space in the arch so we can expect to see even less room than there is now
the premolar teeth that replace these primary molars take up the same amount of
space in the arch. Based on th is we cannot tell at this point whether you r son will
need o rthodontic t reatment
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don't worry, the premolar teeth that replace these primary molars take up Jess
space in the arch, so we can expect to see more room in a few years
Remember: The sum of the mesiodistal widths of the primary molars in any one quadrant is greater
than the permanent teet h that succeed them (premolars). Roughly 2 - 5 mm greater.
Some differences between primary and permanent molars:
Primary molarshave crowns that are shorter and more bulbous, with pronounced buccal and
lingual cervical ridges and a constricted cervical area
Pri mary molars have an occlusal table that is narrower faciolingually
Primary molars have anatomy that is shallow (i.e., the cusps are short, the ridges are not pro-
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primary dentition
Although it usually isn't much of a problem, which of the following criteria
would NOT be used to distinguish primary maxillary central incisors from
their permanent counterparts?
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The primary incisors (centrals and laterals) are very similar to the permanent incisors,
but d iffer in one important trait, the newly erupted primary incisors do not show
mamelons. The most characteristic featu re of the primary max illary incisor is the
mesiodistal width of the crown. It is the only primary or permanent incisor with a
mesiodistal d iameter (6.5 mm) greater than its crown height (6.0 mm).
1. The primary maxillary central incisor has a shorter length incisocervica lly
(6.0 mm) than the permanent maxillary central incisor (1 0.5 mm).
2. Also, compared to the permanent central incisor, the incisal edge of the
pri mary central incisor is straighter.
3. Labial and lingual cervica l ri dges are promin ent on all primary central and
lateral incisors.
4. Remember: When extracting primary incisors (centrals and laterals) where
the roots have been partially resorbed due to pressure from the developing
permanent teeth, the facial part of the remaining primary root w ill usually be
the longest and the most securely attached to the g ingiva.
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primary dentition
The crowns of all 20 primary teeth begin to calcify between:
1 to 2 months in utero
2 to 3 months in utero
4 to 6 months in utero
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8 to 9 months in utero
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4 to 6 months in utero
Dedduous
Tetth
First E'idenct of
Calcification
Maxillary
Five-sixths
1.5
2.5
1.5
Canine
One-thitd
3.25
First molar
5 months in urero
Ocdus.al completely
c.akifit.d plus 1/2 to
3/4 crown height
2.5
Second 1nolar
6 months in utero
Occlusal completely II
cakilied; calcified
tissue covers 1/5 to
1/4 CtOWn heig_ht
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Mandibular
2.5
1.5
1.5
Canine
5 months in utero
One-thitd
3.25
First molar
5 months in utero
2.5
Occlusal completely 10
c.akilie.d
primary dentition
Sally and Annie, ages six and eight respectively, come into your office and get
their picture put up on the "Cavity-Free Board:' On the back of each picture,
your assistant writes how many baby teeth they have lost and how many adult
teeth they have. Which numbers are correct?
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Remember:
Mandibular centrals erupt between the age of 6-7 (usually closer to age 7)
Maxillary centrals erupt between the age of 7-8
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Ordinarily, a 8-year-old child wou ld have the fol lowing teeth clinica lly visible in the
mouth: 12 primary and 12 permanent teeth.
The 12 permanent teeth include the:
Mandibular first molars (2) - right and left
Maxillary fi rst molars (2)- right and left
Mandibular central incisors (2)- ri ght and left
Maxillary central incisors (2)- right and left
Mandibular lateral incisors (2)- right and left
Maxillary lateral incisors (2)- right and left
The primary teeth incl ude t he maxillary and mandibular can ines along with t he maxillary and mandibular first and second molars (12 total).
~!if?:~
primary dentition
The mesiolingual cusp is the most prominent cusp on the primary maxillary
first molar.
The mesiolingual cusp is the longest and sharpest cusp on the primary maxillary first molar.
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The Primary Maxillary Right First Molar
Buccal
Lingual
Occlusal
Mesial
Distal
primary dentition
A preschool child is shown below with a normal dentition. Note the spaces
between the maxillary lateral incisor and canine and the mandibular canine
and first primary molar. These spaces are termed
spaces, and their
presence allows for the space to be filled by permanent teeth as they erupt.
primitive
private
primate
hawley
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Copyright 200().2004 Unrversrty o f Washmgton. All r igh ts
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primate
Primate spaces appear in the deciduous dentition . The spaces appear between the maxillary lateral incisors and the maxillary canines. They also appear between the mandibular canines and the
mandibular fi rst molars.
***Spacing is normal throughout the anterior part of the primary dentition, but is most noticeable
in these two locations.
These primate spaces are normall y present from the time the teeth erupt. Developmental spaces
bet ween the incisors are often present from the beginning, but become somewhat larger as the
ch ild grows and the alveolar processes expand. Generalized spacing of the primary teeth is a
requ irement for proper alignment of the permanent incisors. This spacing is most frequently
caused by the growth of the dental arches.
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,9 ~ '.L
;U U,V
B
~::.,,7
primary dentition
A neophyte dental student, only about two weeks into the program, gets
scared when her 10-year-old cousin gets hit in the face and loses a tooth.
She calls you up and says that her cousin lost his permanent mandibular first
molar. Once she tells you more about the root morphology of the tooth, you
realize it is primary and the child simply lost his ...
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Mesial
Buccal
Lingual
Occlusal
Distal
1. Primary second molars have the greatest faciolingual diameter of all primary teeth.
The maxillary second molar measures 10 mm faciolingually and the mandibular second
molar measures 8.7 mm. The first molars measure 8.5 mm (max.) and 7.0 mm (mand.)
respectively.
2. The primary teeth that present the most noticeable morphologic deviations from
permanent teeth are the first molars.
r.;~-
primary dentition
Morphologically, the primary maxillary second molar strikingly resembles
the:
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Primary Maxillary
Right Second Molar
~J
Permanent Maxillary
Right First Molar
Universal numbering system for primary dentit ion. !, Maxillary arch. II, Mandibular arch
primary dentition
Primary molar relationships are known as:
class relationships
step relationships
primitive relationships
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occlusion relationships
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step relationships
The primary molar relationship shown in the figure to the left is a mesial-step relationship, as the
d istal surface of the lower second primary molar
is mesial to the d istal surface of t he upper second
primary molar. The mesial-step molar relationship allows for the first permanent molars to
erupt into a normal occlusion immediately on
eruption. Note that the permanent molars are in
a normal Class I occlusion.
This figure to the left demonstrates t he flush-terminal-plane relationship for primary molars. The
distal surfaces of t he maxillary and mand ibular
second primary molars are in an end-to-end relationship.
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In t hese cases (the flush-terminal-plane), the first permanent molars do not erupt immediately
into a normal relationship. As you can see, the first permanent molars are in a Class II relationship. The Class II relationship usually is temporary until the second primary molars are lost and
t he permanent molars move into a Class I relationship. This occurs at approximately age ten or
eleven and is called t he late mesial shift. Both the mesial-step and flush-terminal-plane relat ionships usually result in the development of a Class I permanent molar occlusion, although the
flush-terminal-plane relationship can result in a Class II relationship if the late mesial shift does
not occur. Another step relationship involves a situation w here the d istal surface of the
mandibular primary second molar is located to the distal of the distal surface of the maxillary primary second molar.Thi s is termed a distal-step relationship. In these cases, the permanent molars erupt into a Class II relationship. Important: The terminal plane relationship of primary
second molars determines the future anteroposterior positions of permanent first molars.
primary dentition
Both the mesial-step and flush-terminal -plane relationships usually result in
the development of a:
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A. Flush-terminal-plane relationship
B. Distal-step relationship
C. Mesial-step relationship
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B
A
c
Note: Primary molars should be assigned terminology according to step relationships, and permanent molars should be assigned terminology according to the Angle Classification system.