NEET MDS Lessons
Dental Anatomy
Periodontal ligament
Composition
a. Consists mostly of collagenous (alveolodental) fibers.
Note: the portions of the fibers embedded in cementum and the alveolar bone proper are known as Sharpey’s fibers.
b. Oxytalan fibers (a type of elastic fiber) are also present. Although their function is unknown, they may play a role in the regulation of vascular flow.
c. Contains mostly type I collagen, although smaller amounts of type III and XII collagen are also present.
d. Has a rich vascular and nerve supply.
Both sensory and autonomic nerves are present.
(1) The sensory nerves in the PDL differ from pulpal nerves in that PDL nerve endings can detect both proprioception (via mechanoreceptors) and pain (via nociceptors).
(2) The autonomic nerve fibers are associated with the regulation of periodontal vascular flow.
(3) Nerve fibers may be myelinated (sensory) or unmyelinated (sensory or autonomic).
Cells
a. Cells present in the PDL include fibroblasts; epithelial cells; cementoblasts and cementoclasts; osteoblasts and osteoclasts; and immune cells such as macrophages, mast cells, or eosinophils.
b. These cells play a role in forming or destroying cementum, alveolar bone, or PDL.
c. Epithelial cells often appear in clusters, known as rests of Malassez.
Types of alveolodental fibers
a. Alveolar crest fibers—radiate downward from cementum, just below the cementoenamel junction (CEJ), to the crest of alveolar bone.
b. Horizontal fibers—radiate perpendicular to the tooth surface from cementum to alveolar bone, just below the alveolar crest.
c. Oblique fibers
(1) Radiate downward from the alveolar bone to cementum.
(2) The most numerous type of PDL fiber.
(3) Resist occlusal forces that occur along the long axis of the tooth.
d. Apical fibers
(1) Radiate from the cementum at the apex of the tooth into the alveolar bone.
(2) Resist forces that pull the tooth in an occlusal direction (i.e., forces that try to pull the tooth from its socket).
e. Interradicular fibers
(1) Only found in the furcal area of multi-rooted teeth.
(2) Resist forces that pull the tooth in an occlusal direction.
Gingival fibers
a. The fibers of the gingival ligament are not strictly part of the PDL, but they play a role in the maintainence of the periodontium.
b. Gingival fibers are packed in groups and are found in the lamina propria of gingiva
c. Gingival fiber groups:
(1) Transseptal (interdental) fibers
(a) Extend from the cementum of one tooth (just apical to the junctional epithelium), over the alveolar crest, to the corresponding area of the cementum of the adjacent tooth.
(b) Collectively, these fibers form the interdental ligament , which functions to resist rotational forces and retain adjacent teeth in interproximal contact.
(c) These fibers have been implicated as a major cause of postretention relapse of teeth that have undergone orthodontic treatment.
(2) Circular (circumferential) fibers
(a) Extend around tooth near the CEJ.
(b) Function in binding free gingiva to the tooth and resisting rotational forces.
(3) Alveologingival fibers—extend from the alveolar crest to lamina propria of free and attached gingiva.
(4) Dentogingival fibers—extend from cervical cementum to the lamina propria of free and attached gingiva.
(5) Dentoperiosteal fibers—extend from cervical cementum, over the alveolar crest, to the periosteum of the alveolar bone.
CONTACT POINT.:-The point on the proximal surface where two adjacent teeth actually touch each other is called a contact point.
INTERPROXIMAL SPACE.:-The interproximal space is the area between the teeth. Part of the interproximal space is occupied by the interdental papilla. The interdental papilla is a triangular fold of gingival tissue. The part of the interproximal space not occupied is called the embrasure.
EMBRASURE. :-The embrasure occupies an area bordered by interdental papilla, the proximal surfaces of the two adjacent teeth, and the contact point (fig 4-18). If there is no contact point between the teeth, then the area between them is called a diastema instead of an embrasure.
OCCLUSAL
The occlusal surface is the broad chewing surface found on posterior teeth (bicuspids and molars).
OCCLUSION.:-Occlusion is the relationship between the occlusal surfaces of maxillary and mandibular teeth when they are in contact. Many patterns of tooth contact are possible. Part of the reason for the variety is the mandibular condyle's substantial range of movement within the temporal mandibular joint.
Malocclusion occurs when any abnormality in occlusal relationships exist in the dentition. Centric occlusion, is the centered contact position of the chewing surfaces of mandibular teeth on the chewing surface (occlusal) of the maxillary teeth.
OCCLUSAL PLANE.:-Maxillary and mandibular teeth come into centric occlusion and meet along anteroposterior and lateral curves. The anteroposterior curve is called the Curve of Spee in which the mandibular arch forms a concave (a bowl-like upward curve). The lateral curve is called the Curve of Wilson . The composite (combination) of these curves form a line called the occlusal plane, and is created by the contact of the upper and lower teeth
VERTICAL AND HORIZONTAL OVERLAP. :-Vertical overlap is the extension of the maxillary teeth over the mandibular counterparts in a vertical direction when the dentition is in centric occlusion Horizontal overlap is the projection of maxillary teeth over antagonists (something that opposes another) in a horizontal direction.
KEY TO OCCLUSION.:-The occlusal surfaces of opposing teeth bear a definite relationship to each other. In normal jaw relations and when teeth are of normal size and in the correct position, the mesiofacial cusp of the maxillary first molar occludes in the facial groove of the mandibular first molar. This normal relationship of these two teeth is called the key to occlusion.
PERMANENT DENTITION
The permanent dentition consists of 32 teeth. Each tooth in the permanent dentition is described in this section. It should be remembered that teeth show considerable variation in size, shape, and other characteristics from one person to another. Certain teeth show a greater tendency than others to deviate from the normal. The descriptions that follow are of normal teeth.
Dental Terminology.
Cusp: a point or peak on the occlusal surface of molar and premolar teeth and on the incisal edges of canines.
Contact: a point or area where one tooth is in contact (touching) another tooth
Cingulum: a bulge or elevation on the lingual surface of incisors or canines. It makes up the bulk of the cervical third of the lingual surface. Its convexity mesiodistally resembles a girdle encircling the lingual surface at the cervical.
Fissure: A linear fault that sometimes occurs in a developmental groove by incomplete or imperfect joining of the lobes. A pit is usually found at the end of a developmental groove or a place where two fissures intersect.
Lobe: one of the primary centers of formation in the development of the crown of the tooth.
Mamelon: A lobe seen on anterior teeth; any one of three rounded protuberances seen on the unworn surfaces of freshly erupted anterior teeth.
Ridge: Any linear elevation on the surface of a tooth. It is named according to its location or form. Examples are buccal ridges, incisal ridges, marginal ridges, and so on.
Marginal ridges are those rounded borders of enamel which form the margins of the surfaces of premolars and molars, mesially and distally, and the mesial and distal margins of the incisors and canines lingually.
Triangular ridges are those ridges which descend from the tips of the cusps of molars and premolars toward the central part of the occlusal surface. Transverse ridges are created when a buccal and lingual triangular ridge join.
Oblique ridges are seen on maxillary molars and are a companion to the distal oblique groove.
Cervical ridges are the height of contour at the gingival, on certain deciduous and permanent teeth.
Fossa: An irregular, rounded depression or concavity found on the surface of a tooth. A lingual fossa is found on the lingual surface of incisors. A central fossa is found on the occlusal surface of a molar. They are formed by the converging of ridges terminating at a central point in the bottom of a depression where there is a junction of grooves
Pit: A small pinpoint depression located at the junction of developmental grooves or at the terminals of these groops. A central pit is found in the central fossa on the occlusal surfaces of molars where developmental grooves join. A pit is often the site of the onset of Dental caries
Developmental groove: A sharply defined, narrow and linear depression formed during tooth development and usually separating lobes or major portions of a tooth.
A supplemental groove is also a shallow linear depression but it is usually less distinct and is more variable than a developmental groove and does not mark the junction of primary parts of a tooth.
Buccal and lingual grooves are developmental grooves found on the buccal and lingual surfaces of posterior teeth.
Tubercle: A small elevation produced by an extra formation of enamel. These occur on the marginal ridges of posterior teeth or on the cingulum of anterior teeth. These are deviations from the typical form.
Interproximal space: The triangular space between the adjacent teeth cervical to the contact point. The base of the triangle is the alveolar bone; the sides are the proximal surfaces of the adjacent teeth.
Sulcus:-An elongated valley or depression in the surface of a tooth formed by the inclines of adjacent cusp or ridges.
Embrasures: When two teeth in the same arch are in contact, their curvatures adjacent to the contact areas form spillway spaces called embrasures. There are three embrasures:
(1) Facial (buccal or labial)
(2) Occlusal or incisal
(3) Lingual
(NOTE: there are three embrasures; the fourth potential space is the interproximal space ).
Introduction. The Jaws and Dental Arches
The teeth are arranged in upper and lower arches. Those of the upper are called maxillary; those of the lower are mandibular.
- The maxilla is actually two bones forming the upper jaw; they are rigidly attached to the skull..
- The mandible is a horseshoe shaped bone which articulates with the skull by way of the temporomandibular joint the TMJ.
- The dental arches, the individual row of teeth forming a tooth row attached to their respective jaw bones have a distinctive shape known as a catenary arch.
Time for tooth development
Entire primary dentition initiated between 6 and 8 weeks of embryonic development.
Successional permanent teeth initiated between 20th week in utero and 10th month after birth Permanent molars between 20th week in utero (first molar) and 5th year of life (third molar)
|
Maxillary (upper) teeth |
|||||||
Permanent teeth |
Central |
Lateral |
|
First |
Second |
First |
Second |
Third |
Initial calcification |
3–4 mo |
10–12 mo |
4–5 mo |
1.5–1.75 yr |
2–2.25 yr |
at birth |
2.5–3 yr |
7–9 yr |
Crown completed |
4–5 yr |
4–5 yr |
6–7 yr |
5–6 yr |
6–7 yr |
2.5–3 yr |
7–8 yr |
12–16 yr |
Root completed |
10 yr |
11 yr |
13–15 yr |
12–13 yr |
12–14 yr |
9–10 yr |
14–16 yr |
18–25 yr |
|
Mandibular (lower) teeth |
|||||||
Initial calcification |
3–4 mo |
3–4 mo |
4–5 mo |
1.5–2 yr |
2.25–2.5 yr |
at birth |
2.5–3 yr |
8–10 yr |
Crown completed |
4–5 yr |
4–5 yr |
6–7 yr |
5–6 yr |
6–7 yr |
2.5–3 yr |
7–8 yr |
12–16 yr |
Root completed |
9 yr |
10 yr |
12–14 yr |
12–13 yr |
13–14 yr |
9–10 yr |
14–15 yr |
18–25 yr |
Mandibular Second Deciduous Molar.
-This tooth resembles the lower first permanent molar that is d
istal to it in the dental arch.
-There are two roots and five cusps. The three buccal cusps are all about the same size. This is in contrast to the lower first molar where the 'distal' cusp is smaller that the mesiobuccal and distobuccal cusps.
-The distal of the three buccal cusps may be shifted of onto the distal marginal ridge.
NOTE
-Upper molars have three roots, lowers have two roots.
-Upper and lower second deciduous molars resemble first permanent molars in the same quadrant.
-Upper first deciduous molars vaguely resemble upper premolars. -Lower first deciduous molars are odd and unique unto themselves.
-First deciduous molars (upper and lower) have a prominent bulge of enamel on the buccal at the mesial. These help in determining right and left.