The physiologic tooth form & the

periodontium
INTRODUCTION
The phyological form of the teeth and periodontium is
contributed to is shape and fanction and interrelation of
the shape or attributes of something with its function. In
dentistry the phrase may indicate the entire masticatory
system, acting as a biomechanical engine for the
reduction of food. If so, then arguably it may be possible
to try to make a case that each of the components of the
masticatory system has some kind of physiological
relationship to its individual functions and to that of the
whole system, including its maintenance. These
relationships have a spectrum of possible associations:1speech and jaw motion:2- arch form and mathematical
function:3- integration of form, function, and esthetics in
mandibular:4- morphological and functional analysis of the
.exorofacial compl
general principle that becomes operant is form follows
function Thus the term form not only means shape but
also biomechanical attributes that contribute to the
maintenance of function. examples include the dependent
relationship between esthetics and optimum occlusion,
physical forces and the periodontal ligament, and arch
form and function, as well as the controversial
interrelationship between the morphology and function of
the discomuscular apparatus of the human
temporomandibular joint. Also the articulation of the
.teethin the jew play role in its function
The periodontium, literally around the tooth, comprises
the tissues that invest and support the teeth in the maxilla
and mandible. The relationship between the teeth and
their supporting tissues is complex, involving multiple
systems: vascular, neurological, and immunological, to

nourish, control, and protect this joint. cementum, the

mineralized tissue that covers the root dentin, the
periodontal ligament (PDL), the structure that attaches to
and holds the tooth in its socket (alveolus), and the
alveolar bone, the portion of the jaws that forms the
alveolus. The gingivae, the portion of the oral mucosa
.adjacent to the teeth, also is part of the periodontium

AIM
How the form and arrangement of the teeth withe the help
of its shrouding structures which is periodontium play a
rule in its function in oral cavity,how they are perform
with their position and arrangement in the structures
involved in oral motor behavior, especially mastication. To
attempt to relate form and function in all the structures
. involved

The teeth defined as distinct organs of a bony structure,

attached to the maxillary bones, and formed for the
purpose of dividing and comminuting the food,
.preparatory to digestion
Each tooth is anatomically divided into the body or crown,"
and the fang or root
It can be assumed that the form of the teeth and their
arrangement are related to incising or crushing food
without causing damage to the supporting structures; for
them to be otherwise might be inconsistent with the
survival of the species. Some of the form must also relate
to that of the jaws and face and to occlusal forces that
dictate that the teeth be at various angles and positions in
the dental arches. Beyond assumptions or teleological
approaches to the morphology of the teeth, the
relationships of tooth form to the form of the supporting

structures, including the gingiva, must be considered in

terms of clinical significance. Thus food impaction may
occur as a result of gingival enlargement and of the
driving of food between the teeth because of improper
marginal ridges and/or contact areas, irrespective of
teleological considerations of tooth morphology. Although
a great deal has been said about the relationship of the
health of the gingiva to the contours of the teeth, as
indicated in the references included at the end of this
chapter, such appraisals are generally descriptive, involve
restorations, and are retrospective observations. To
conclude that the gingival tissues around a tooth (natural
or restored) need neither stimulation nor protection
suggests that the true significance of buccolingual crown
contours has not been evaluated. In no instance has the
influence of axial contours, which begin with the height of
the contour of buccal and lingual surfaces, been tested in
relation to such functions as chewing

efficiency or occlusal
stability. And even though the significance of buccolingual
crown contours to gingival health relative to gingival
stimulation, self-cleansing mechanisms, and gingival
protection has been seriously questioned, the significance
of other contours has also been questioned. Dental plaque
accumulates on teeth in the absence of adequate oral
hygiene, and gingivitis occurs in spite of self-cleansing
mechanisms.The influence of a primitive diet does not
appear to prevent gingivitis. However, plaque formation
and gingivitis may be related more to bacterial

attachment mechanisms, bacterial toxins, and food

substrates than to physical form. It should not be
concluded from such observations that curvatures have
nothing to do with the function and health of the
masticatory system. The effect of overcontouring or
undercontouring of surfaces of the teeth may be related
more to occlusal mechanisms than to self-cleansing
mechanisms and be of more significance to food selfcleansing efficiency and/or musculature
in one patient than in another. The role of protective
reflexes in relation to the contours of the teeth is not
known. Even though the significance of tooth forms has
yet to be clarified, ideas about form and function that
have been held should be understood
the physiologic tooth form and arrangement may affect the periodontium either directly or indirectly

The direct factors are

Proximal contact areas.1
Interproximal spaces (formed by proximal surface in .2
contact)
Embrasures (spillways) .3
Labial and buccal contours at the cervical thirds .4
(cervical ridges) and lingual contours at the middle thirds
of crowns
Curvatures of the cervical lines on mesial and distal .5
surfaces (cementoenamel junction CEJ

:The indirect factors are

The shape of the cusp.1
The root, the length, number,distribution and outline .2

Angulation of crown & root.3

a)Lingual angulations of the crown of
lower posterior teeth
b)distal angulations of crown and root of
permenant molars
The self cleansing ability of the teeth .4

Proximal Contact Areas

positive contact relation of one tooth with another in each
arch should be established mesially and distally. Except for
the last molars (third molars, if present), each tooth has
two contacting members
The last molar is in contact only with the tooth mesial to it.
Although the areas of contact are still very circumscribed,
especially on anterior teeth, these are areas and not mere
points of contact .Actually, the term contact point, which is
often used to designate the contact of teeth in the same
arch, is a misnomer
Newly erupted teeth have a pointed contact which is
transformes into contact area due to proximal attrition
The normal size of the contact areasIt increase from anterior to posterior teeth
: Significance of proper proximal contact relation is to
it serves to keep food from packing between the teeth, .1
prevent interproximal food impaction and stagnation with
degenerative effect of periodontium
stabilize the dental arches by the combined anchorage .2
of all the teeth in either arch in
positive contact with each other

protect the interdental gingival from undue frictional .3

trauma of food
Distribute the masticatory forces among the adjacent .4
teeth
each tooth in the arch is supported in part by its contact
with two neighboring teeth, one mesial and one distal. The
third molars (and the second molars if no third molar is
present) are prevented from drifting distally where there is
no contacting tooth by the angulation of their occlusal
surfaces with their roots and by the angle of the direction
of the occlusal forces in their favor
: In case of abnormal proximal contact relations
Food impaction between the teeth cause gingival .1
inflammation which finally leads to
destruction of the supporting tissues and
loss of the teeth
Separation of teeth causes a change in .2
tooth aligment, which results in shifting of
the masticatory forces to an angle that is
not designed for the tooth to withstand, this is in turn
causes destruction of the supporting tissues
If, for any reason, food is forced between the teeth past .
the contact areas, the result may be pathological. The
gingival tissue, which normally fills the interdental spaces,
may become inflamed (gingivitis) and ultimately involve
deeper periodontal structures with loss of bone and
attachment (periodontitis). Excessive occlusal forces on an
individual tooth may occur when normal forces are no
longer distributed over several teeth, as may happen
when teeth are lost or when normal forces become
excessive with loss of supporting structures as a result of
.periodontal diseases
:The normal location of the contact areas

contact areas become more .1

cervical from anterior to
posterior
The distal contact area on .2
the individual tooth is more
cervical than the mesial one
contact areas in anterior .3
teeth are centered
labiolingually ,while in
posterior teeth ,they are
located slightly buccal

: Factors affecting the proximal contact relation

a)length and breadth of crown
b)level and height of the proximal maximal contour
c)Proximal wear
d)Malocclusion
e)Developmental anomlies
f)disproportionate growth between teeth and
jaw
g)Extracted , developmentally missing or
unerupted teeth

Interproximal Spaces
The interproximal spaces between the
teeth are triangularly shaped spaces
normally filled by gingival tissue (gingival
.papillae)

The base of the triangle is the alveolar process, the sides

are the proximal surfaces of contacting teeth and the apex
is the contact area
The labial or buccal view will demonstrate the relative
positions of the contact areas cervicoincisally or
cervicoocclusally. The center of the area from this aspect
is gauged by its relation to the length of the crown portion
of the tooth .The incisal or occlusal view will show the
relative position of the contact areas labiolingually or
buccolingually. In this instance, the center of the area may
be located in its relation to the labiolingual or buccolingual
measurement of the crown .The point at which the contact
area is bisected also depends on the outline of the form of
the crown from the incisal or occlusal aspect. This outline
is governed by the alignment of the tooth in the arch and
also by the occlusal relation with its antagonists in the
opposing arch. The mandibular first molar is an excellent
.example
: Significance of interproximal space is to
provide space for the interdental gingival which carries .1
the blood vessels and nerve supply to all the investing
tissues
Provide a proper spacing for the alveolar bone between .2
the neighboring teeth to support them in their sockets

Embrasures (Spillways)
When two teeth in the same arch are in contact, their
curvatures adjacent to the contact areas form spillway
spaces called embrasures. The spaces that widen out from
the area of contact labially or buccally and lingually are
called labial or buccal and
lingual interproximal
.embrasures

These embrasures are continuous with the interproximal

spaces between the teeth. Above the contact areas
incisally and occlusally, the spaces, which are bounded by
the marginal ridges as they join the cusps and incisal
ridges, are called the incisal or occlusal embrasures. These
embrasures, and the labial or buccal and lingual
embrasures, are continuous . The curved proximal
surfaces of the contacting teeth roll away from the contact
area at all points, occlusally, labially or buccally, and
lingually and cervically, and the embrasures and
interproximal spaces are continuous, as they surround the
.areas of contact
:The significance of embrasures is to
it provides a spillway for food during mastication, a (1)
physiological form that reduces the masticatory forces
falling upon the teeth
it prevents food from being forced through the contact (2)
area. When teeth wear down to the contact area so that
no embrasure remains, especially in the
incisors, food is pushed into the contact
.area even when teeth are not mobile
Make the teeth self cleancing as the (3)
rounded smooth surfaces of the crown
are more exposed to the cleansing
action of foods and fluids as well as
friction of the tongue , lip ,cheeks , if the
escape wasnt present or teeth had
angles or corners , lodgment of food
would occur leading to poor oral
hygiene
Protect the gingival from undue frictional trauma by (4)
allowing proper food sliding and thus food exerts
physiologic massage on the gingival

Facial and Lingual Contours at the Cervical

Thirds (Cervical Ridges) and Lingual
Contours at the Middle Thirds of Crowns
The teeth are unique in that their static outside form is
physiological. Even the maxillary teeth, which are firmly
set in their alveoli, when moving through food material
activated by mandibular movement, change their
functional crown form from a static to a dynamic form. All
details of tooth form have some effect on the stabilization
of the tooth in the arch. Examinations show that all tooth
crowns, when viewed from mesial or distal aspects, have
rather uniform curvatures at the cervical thirds and at the
middle thirds labially or buccally or lingually, concepts
about the importance of these contours in relation to
protection and stimulation of the gingiva have been
challenged. However, the evidence does not contradict
the possibility that food impaction or trauma can occur as
a result of faulty contours (undercontouring). It is,
rather, that inflammatory periodontal disease is caused
primarily by bacterial plaque and that buccal and lingual
contours do not appear to be related to plaque removal
during mastication. Thus in the absence of oral hygiene
measures, the self-cleansing mechanisms of the
musculature and suggested cleansing action of coarse
food are not adequate to remove plaque sufficiently well
to prevent gingivitis.
However, the relative
importance of contour on
trauma, food impaction, and,
occasionally, the initiation of
a localized inflammatory
response cannot be

overlooked. The buccal and lingual contours can deflect

food material away from the gingival margins during
.mastication
Undercontoured surfaces can lead to food impaction, but
the significance of overcontouring) has yet to be clarified,
although overcontouring does not appear to be beneficial.
Marginal adaptation of the gingiva and home and
professional cleaning are of far greater significance for
gingival health. The cervical third formation of the crowns
is the area of soft tissue attachment. The epithelial
attachment of soft tissue to the teeth, soon to be
described more fully, is entirely within the area of the
cervical third of the crown cervical curvatures are often
spoken of as cervical ridges. However, cervical curvature
is a more descriptive term, because few of these areas are
pronounced enough to be called ridges and yet
rarely is a normal tooth seen with no curvature at
all. In young persons, and some older ones, most of
the curvature lies beneath the gingival crest. In
older persons, the CEJ may be visible or may be just
under the gingival crest, with most of the prominent
curvature exposed. Gradual recession of the
gingivae throughout life may be a normal
occurrence. However, root exposure may lead to
cemental caries, cervical sensitivity, and abrasion
with improper tooth brushing. All protective
curvatures are most functional when the teeth are
in proper alignment. It should be quite plain that when
teeth are malposed, their curvatures are displaced and
may be ineffective. The curvatures are rather uniform at
the cervical third or lingual third of all of the maxillary
teeth and on the buccal portion of mandibular posterior
teeth. The normal curvature from the CEJ to the crest of
contour is approximately 0.5 mm in extent. When the long
axis of the tooth is placed vertically, it is found that this
curvature is fairly constant and may be recognized as

average or normal for the

maxillary teeth, labially or
buccally and lingually, and for the
mandibular posterior teeth on the
buccal surfaces. The curvature,
lingually, of mandibular posterior
teeth extends about 1 mm beyond the cervical line. Here,
however, the extreme curvature does not contribute to the
stasis of food material at the cervix because of the activity
of the tongue in keeping the lingual surfaces of these
.teeth clean
The maxillary premolar and molar show the same limited
curvatures. The crest of curvature, lingually, on all
posterior teeth is at or near the middle third of the crowns.
When curvatures are found that are greater in extent than
0.5 mm, rarely is the curvature as much as 1 mm, except
lingually on mandibular posterior teeth and often lingually
on maxillary posterior teeth. In these instances, the crest
of contour is found at the middle third of the crowns
instead of at the cervical third . These crests are always
.lingual

The Height of Epithelial Attachment:

Curvatures of the Cervical Lines
(Cementoenamel Junction [CEJ])
Mesially and Distally
The epithelial attachment seals the soft tissue
to the tooth. It is a remarkable system capable of
adjustment to local physiological changes, but it is
vulnerable to physical injury. Careless treatment can cause
breaks in the attachment, making the tooth liable to
further physical or pathological injury. The teeth can be
injured by careless probing during clinical examination, by
improper scaling during prophylactic treatment, by tooth
preparation techniques in operative procedures, and so

forth. The height of normal gingival tissue, mesially and

distally, on approximating teeth is directly dependent on
the heights of the epithelial attachment on these teeth.
Normal attachment follows the curvature of the CEJ if the
teeth are in normal alignment and contact. This does not
mean that the CEJ and the epithelial attachment are at the
same level, but it does mean that they tend to follow the
same curvature, even though the epithelial attachment
may be higher on the crown on its enamel surface. A
comparison of the curvatures of the CEJ mesially and
distally on the teeth is therefore in order. Measurements
and comparisons.The extent of curvature seems to
depend on the height of the contact area above the crown
cervix and also on the diameter of the crown labiolingually
or buccolingually. The crowns of anterior teeth, which are
narrower and longer from these aspects, show the
greatest curvature. In the use of the words height and
above, the supposition is made that in either the maxillary
or the mandibular arch the occlusal surfaces of the teeth
are above the cervice

II.Indirect factors & their significance in

:protection of periodontium
:Crown form: Which includes-1
.a)Proximal maximal contour
In anterior teeth Proximal maximal contour is located in the incisal
third of the crown. This is due tothe reduction of mesiodistal
diameter at the cervical and middle thirds

In posterior teeth Proximal maximal contour is located in the middle

third of the crown. This is due to the reduction in mesiodistal
diameter of occlusal and cervical one third

:Significances of the proximal contour of the crown

it is responsible for the development and governs the design of the
interproximal form including the embrasure, interproximal space
and the proximal contact of the adjacent crowns. proximal contour
of the crown in the size of the embrasure, and interproximal space
proximal contour of the crown in the size of the contact area
b)Facial and lingual maximal contour. *Crown outline
:c)crown outline
In general all aspects of tooth crown may be described as one of three geometric
figures of different dimensions. trapezoid , triangular & rhomboid
Each tooth has specific form which related to its functions in mastication ,
speech & esthetics
Facial , lingual crown outline of all teeth -1

May be represented by trapezoids of various

dimensions
The shortest of the uneven sides is toward the tooth *
cervix

The longest of the uneven *

sides is toward the occlusal or
incisal aspect

Significances of the trapezoid outline form of the

crown
Provide contact between the teeth at certain areas -1
Provide interproximal spaces which contains inter- -2
proximal tissue

Provide spacing between the roots of -3

neighboring teeth
.to allow sufficient supporting alveolar bone
reduc distribute the force exerted on the teeth -4
those transmitted into peri-odontium ,
allow for off set relation of opposing teeth -5

which prevent the

elongation of antagonist ,stabilize the remaining tooth for
.longer period
This arrangement (offset relation)
prevents elongation
of antagonists,if a tooth is missed
and helps to stabilize

the remaining teeth for

a longer period than if
the tooth has a single antagonist
Proximal crown outline of anterior -2
teeth
schematic outline of the crown from the
.proximal aspect can be triangular in form
The base of this triangle is toward the
cervix, while its apex is toward the incisal
ridge
Significance of triangular form of
:proximal aspect of anterior teeth
Increases the teeth strength**
Increases the stability of teeth in the jaw **
Increases the efficient resistance against **
masticatory forces
This is important for the reduction of forces ***
transmitted to the investing periodontium
Progressive incisal constriction
Facilitates penetration and incising food without
elaborating excessive trauma to the marginal gingiva as
food slides over the cervical tooth surface
Proximal outline of maxillary posterior -3
teeth
They are trapezoidal in outline
The largest sides is toward the tooth cervix

while the shortest is toward

the occlusal surface (narrow occlusal surface)
-:Significances of of this trapezoid outline
provide narrow occ. Surface which **
facilitate the initial penetration of -1
.food
reduce the masticatory force when -2
transmitted from
narrow occ. surface to wide cervical base & thus to
.peri-odontium
Make the tooth self cleansable by allowing sliding **
of the food material along the inclination of facial ,
.lingual surfaces
Proximal crown outline of mandibular -4
:posterior teeth

.Are rhomboidal in outline

Due to lingual inclination of the long axis of the crown
to the axis of the root of mandibular posterior teeth ,the
acute angles of the rhomboid forms is pointed out to
the occlusolingual and buccocervical line angles

Significance of the rhomboid outline form of the

crown in protecting the periodontium are
.
Allows for establishment of the-1
intercusp relation between
the opposing teeth when they are
brought into centric occlusal
.relation
.
This arrangement prevents
traumatic occlusion
and its periodontium
.degenerative sequlae
.
To keep the axis of roots of the -2
.mand., max. teeth parallel
If the mandibular crowns and roots
have the same relation as the
,maxillary ones
the cusps would hit , clash during
& function
.would not be in proper intercusp relation
Permits the prominence of the cervical ridge.This -3
physiologic form
permits protection of gingival contour

:Roof form-2
.Length, number and distribution *
teeth have single root if they do little work (insciors) teeth that pierce and tear tough food as canines have single and long root
Premolars and molars perform much work as mastication , so they have more than one root
Root distribution (e.g; three roots in upper molars and two roots in lower molars is important in transmission the occlusal forces into
wide area in the jaw to prevente the periodontium
.Root outline*
It is cone shaped when seen facially which allows for increasing
the amount of alveolar bone among the roots of adjacent teeth and
almost quadrent proximally(the wider dimension proximaly) to
compensate for narrow dimension facially
:Angulation of crown and root-3
.a)Lingual angulations of the crown of lower posterior teeth
The crown is not only lingual to the root of the same tooth, but also
to the crown of the opposing tooth when both come into centric
occlusion , At the same time, the axes of the roots of teeth in both
arches are kept parallel or continuous , if not , cusps would hit and
clash together which disturbs the periodontium due to traumatic
occlusion
.b)Distal angulations of crown and root of permanent molars

The distal angulation of the crown is due to mesiodistal tilting of the occlusal surface towards the cervix, since the crown length
distally is less than meisally
The distal inclination of roots promotes the mesial drift of teeth as the lower molars strike the upper ones during mandibular
movements, the continuous mesial drift maintains the proximal
contact relationship , or else teeth become separated resulting in
the sequelea of the loss of the proximal contact
The self-cleansing ability of the tooth: it is achieved by -4
a.Proper form of the teeth with their smooth rounded surfaces
b.Proper alignment of the teeth in the dental arches
c.Normal gingival attachemnets
d.Brushing activity of the tongue , lips ,cheeks ,in addition to
washing effect of the saliva and fliud intake , friction of food and the
usual home care

The physiologic form of peridontum

The Periodontium consists of the 4 parts
Gingiva (1
periodontal ligament (2
Alveolar bone (3
Cementum (4
These all 4 parts are the investing & supporting tissues of the
tooth. Which holds the tooth in its position fixed to the socket
:The periodontal ligments

The Periodontal Fiber or Periodontal Ligament, commonly

abbreviated as the PDL ,is a group of the

specialized connective tissue fibers that essentially attach
a tooth to alveolar bone within which it sits.
These fibers help the tooth withstand the
naturally substantial compressive forces
which occur
during mastication(chewing) and remain
embedded in the bone. It consists of bands
of collagen fibers connecting the cement of
the tooth to both gingival and alveolar bone
and to the cement of adjacent teeth. Interspersed among the
collagen fibers are loose connective tissue, blood vessels,
.lymphatic vessels, and nerves

The thickness of the periodontal ligament varies from tooth to *

.tooth
.The thinnest portion of the PDL is near the middle of the root *
The width of the PDL shows a progressive decrease with age. *
* The most important thing to consider about PDL that it is
.always in a state of remodeling
:Peridontal fibers
The PDL collagen fibers are categorized according to their

.orientation and location along the tooth

Transseptal fibers: extend interproximally over the alveolar
bone crest and are embedded in the cementum of adjacent
teeth; they form an interdental ligament. These fibers keep all
the teeth aligned. These fibers may be considered as

.1

belonging to the gingiva because

.they don't have osseous attachment
Alveolar crest fibers: extend .2
obliquely from the cementum just
beneath the junctional epithelium to the
alveolar crest. These fibers prevent the
extrusion of the tooth and resist lateral
.tooth movements
Horizontal fibers: attach to the .3
cementum apical to the alveolar crest fibers and run
.perpendicularly from the root of the tooth to the alveolar bone
Oblique Fibers: are the most numerous fibers in the periodontal .4
ligament, running from cementum in an oblique direction to insert
.into bone coronally
Apical Fibers: radiating from cementum around the apex of the .5
.root to the bone, forming base of the socket
:Interradicular Fibers .6
Interradicular fibers are only found between the roots of multirooted teeth, such as molars. They also attach from the cementum
.and insert to the nearby alveolar bone
:Function of PDL
It provides a support mechanism for the tooth; it cushions teeth .1
against excessive occlusal forces, preventing damage to the blood
.vessels and nerves at the root apex
It maintains the functional position of a tooth by keeping the .2
.teeth in contact and prevents the tooth from drifting or tilting

The periodontal fibers undergo continuous change. Its cells .3

.form, maintain and repair the alveolar bone and cementum
Sensors in the periodontal ligament provide proprioceptive input, .4
.detecting pressures on the tooth
The periodontal ligament has a rich supply of blood, which .5
.provides nutrients to the cementoblasts
An alveolar bone
is a specialized type of bone which is designed to accommodate
teeth. In humans, alveolar bone is found in the mandible, or lower
part of the jaw, along with the maxilla, the upper part of the jaw.
Alveolar bone is especially thick and dense when compared to
other types of bone so that it can provide adequate support for the
teeth, along with attachment points for muscles involved in the jaw
and for the gums which provide protection for teeth and bone. This
bone is also known as the Alveolar Process. It includes sockets
which are designed to accommodate the roots and lower part of
the teeth, with each socket separated from the
.next by an interdental septum
The gums attach to the alveolar process, and
the bone has accommodations to allow blood
vessels to enter for the purpose of supplying
blood to the teeth. Damage to the alveolar
bone can have serious consequences,
including the risk of loss of teeth and
septicemia if the damage is caused by an
.infection
:Function of alveolar bone

PROTECTION: Alveolar bone forms and protects the sockets (1

.for the teeth
ATTACHMENT: It gives the attachment to the PDL fibers, (2
which are the principle fibers. These fibers which enter the bone
.are regarded as Sharpeys Fibers
SUPPORT: It supports the tooth roots on the facial & on the (3
.palatal/lingual sides
SHOCK-ABSORBER: It helps absorb the forces placed (4
.upon the tooth by disseminating the force to underlying tissues
:Cementum
ACELLULAR CEMENTUM: It is the first cementum forms,
covers approximately cervical third or half of the root & does not
.contain cells
CELLULAR CEMENTUM: It forms after the tooth reaches the
occlusal plain. It is more irregular and contain
cells (cementocytes) and in individual spaces
(lacunae)