NEET MDS Lessons
Dental Anatomy
TEMPOROMANDIBULAR JOINT
There are three kind of joints:
· Fibrous
Two bones connected with fibrous tissue
Examples
suture (little or no movement)
gomphosis (tooth - PDL - bone)
syndesmosis (fibula & tibia, radius and ulna; interosseous ligament)
· Cartilagenous
Two subtypes:
2a) primary: bone<--->cartilage (costochondral joint)
2b) secondary: bone<-->cartilage<-->FT<-->cartilage<--> bone (pubic symphysis)
· Synovial
Two bones; each articular surface covered with hyaline cartilage in most cases
The bones are united with a capsule (joint cavity)
In the capsule there is presence of synovial fluid
The capsule is lined by a synovial membrane
In many synovial joints there maybe an articular disk
Synovial joints are characterized by the presence of ligaments
Synovial joints are classified according to the number of axes of bone movement: uniaxial, biaxial, multiaxial
the shapes of articulating surfaces: planar, ginglymoid (=hinged), pivot, condyloid
The movement of the joints is controlled by muscles
The temporomandibular joint is a synovial, sliding-ginglymoid joint (humans)
Embryology of the TMJ
Primary TMJ: Meckel's cartilage --> malleus & incal cartilage. It lasts for 4 months.
Secondary TMJ: Starts developing around the third month of gestation
Two blastemas (temporal and condylar); condylar grows toward the temporal (temporal appears and ossifies first)
Formation of two cavities: inferior and upper
Appearance of disk
Bones: glenoid fossa (temporal bone) and condyle (mandible)
Gingiva
The connection between the gingiva and the tooth is called the dentogingival junction. This junction has three epithelial types: gingival, sulcular, and junctional epithelium. These three types form from a mass of epithelial cells known as the epithelial cuff between the tooth and the mouth.
Much about gingival formation is not fully understood, but it is known that hemidesmosomes form between the gingival epithelium and the tooth and are responsible for the primary epithelial attachment. Hemidesmosomes provide anchorage between cells through small filament-like structures provided by the remnants of ameloblasts. Once this occurs, junctional epithelium forms from reduced enamel epithelium, one of the products of the enamel organ, and divides rapidly. This results in the perpetually increasing size of the junctional epithelial layer and the isolation of the remenants of ameloblasts from any source of nutrition. As the ameloblasts degenerate, a gingival sulcus is created.
Stationary Relationship
a) .Centric Relation is the most superior relationship of the condyle of the mandible to the articular fossa of the temporal bone as determined by the bones ligaments. and muscles of the temporomandibular joint; in an ideal dentition it is the same as centric occlusion.
(b) Canines may also be used to confirm the molar relationships to classify occlusion when molars are missing; a class I canine relationship shows the cusp tip of the maxillary canine facial to the mesiobuccal cusp of the first permanent molar
c) Second primary molars are used to classify the occlusion in a primary dentition
(d) In a mixed dentition the first permanent molars will erupt into a normal occlusion if there is a terminal step between the distal surfaces of maxillarv and mandibular second primary molars; if these surfaces are flush, a terminal plane exists and the first permanent molars will first erupt into an end-to-end relationship until there is a shifting of space or exfoliation of the second primary molar
Compensating curvatures of the individual teeth.
- the gentle curvature of the long axes of certain posterior teeth to exhibit a gentle curvature.
-These are probably analogous to the trabecular patterns seen in the femur and therefore reflect lines of stress experienced during function.
Posteruptive tooth movement.
These movements occur after eruption of the teeth into function in the oral cavity. These movements, known collectively as occlusomesial forces.
A. Continuous tooth eruption eruption of teeth after coming into occlusion. This process compensates for occlusal tooth wear.. Cementum deposition and progressive remodelling of the alveolar bone are the growth processes that provide for continuous tooth movement
B. Physiological mesial drift :Tthe tendency of permanent posterior teeth to migrate mesially in the dental arch both before and after they come into occlusion. Clinically, it compensates for proximal tooth wear.
(1) It describes the tendency of posterior teeth to move anteriorly.
(2) It applies to permanent teeth, not deciduous teeth.
(3) The distal tooth have the stronger is the tendency for drift.
(4) It compensates for proximal wear.
(5) In younger persons, teeth drift bodily; in older persons, they tip and rotate.
(6) Forces that cause it include occlusal forces, PDL contraction, and soft tissue pressures. There may be other more subtle factors as well.
Height of Epithelial Attachment
The height of normal gingival tissue . mesiallv and distallv on approximating teeth, is directly dependent upon the height of the epithelial attachment on these teeth. Normal attachment follows the curvature of the cementoenamel junction if the teeth are jn proper, alignment and contact.
The mixed dentition
I. Transition dentition between 6 and 12 years of age with primary tooth exfoliation and permanent tooth eruption
2. Its characteristic features have led this to be called the ugly duckling stage because of
a. Edentulated areas
b. Disproportionately sized teeth
c. Various clinical crown heights
d. Crowding
e. Enlarged and edematous gingiva
f. Different tooth colors
TOOTH MORPHOLOGY
Descriptive anatomy
- Median sagittal plane: the imaginary plane in the center that divides right from left.
- Median line: an imaginary line on that plane that bisects the dental arch at the center.
- Mesial: toward the center (median) line of the dental arch.
- Distal: away from the center (median) line of the dental arch.
- Occlusal plane: A plane formed by the cusps of the teeth. It is often curved, as in a cylinder. We will speak often of the occlusal surface of a tooth.
- Proximal: the surface of a tooth that is toward another tooth in the arch.
- Mesial surface: toward the midline.
- Distal surface: away from the midline.
- Facial: toward the cheeks or lips.
- Labial: facial surface of anterior teeth (toward the lips).
- Buccal: facial surfaceof anterior teeth (toward the cheeks).
- Lingual: toward the tongue.
- Occlusal: the biting surface; that surface that articulates with an antagonist tooth in an opposing arch.
- Incisal: cutting edge of anterior teeth.
- Apical: toward the apex, the tip of the root.
INNERVATION OF THE DENTIN-PULP COMPLEX
- Dentine Pulp
- Dentin
- Nerve Fibre Bundle
- Nerve fibres
The nerve bundles entering the tooth pulp consist principally of sensory afferent fibers from the trigeminal nerve and sympathetic branches from the superior cervical ganglion. There are non-myelinated (C fibers) and myelinated (less than non, A-delta, A-beta) fibers. Some nerve endings terminate on or in association with the odontoblasts and others in the predentinal tubules of the crown. Few fibers are found among odontoblasts of the root.
In the cell-free zone one can find the plexus of Raschkow.