NEET MDS Lessons
Dental Anatomy
The periodontium, which is the supporting structure of a tooth, consists of the cementum, periodontal ligaments, gingiva, and alveolar bone. Cementum is the only one of these that is a part of a tooth. Alveolar bone surrounds the roots of teeth to provide support and creates what is commonly called a "socket". Periodontal ligaments connect the alveolar bone to the cementum, and the gingiva is the surrounding tissue visible in the mouth.
Periodontal ligaments
Histology of the Periodontal Ligament (PDL)
Embryogenesis of the periodontal ligament
The PDL forms from the dental follicle shortly after root development begins
The periodontal ligament is characterized by connective tissue. The thinnest portion is at the middle third of the root. Its width decreases with age. It is a tissue with a high turnover rate.
Crown stage
Hard tissues, including enamel and dentin, develop during the next stage of tooth development. This stage is called the crown, or maturation, stage by some researchers. Important cellular changes occur at this time. In prior stages, all of the inner enamel epithelium cells were dividing to increase the overall size of the tooth bud, but rapid dividing, called mitosis, stops during the crown stage at the location where the cusps of the teeth form. The first mineralized hard tissues form at this location. At the same time, the inner enamel epithelial cells change in shape from cuboidal to columnar. The nuclei of these cells move closer to the stratum intermedium and away from the dental papilla.
The adjacent layer of cells in the dental papilla suddenly increases in size and differentiates into odontoblasts, which are the cells that form dentin. Researchers believe that the odontoblasts would not form if it were not for the changes occurring in the inner enamel epithelium. As the changes to the inner enamel epithelium and the formation of odontoblasts continue from the tips of the cusps, the odontoblasts secrete a substance, an organic matrix, into their immediate surrounding. The organic matrix contains the material needed for dentin formation. As odontoblasts deposit organic matrix, they migrate toward the center of the dental papilla. Thus, unlike enamel, dentin starts forming in the surface closest to the outside of the tooth and proceeds inward. Cytoplasmic extensions are left behind as the odontoblasts move inward. The unique, tubular microscopic appearance of dentin is a result of the formation of dentin around these extensions.
After dentin formation begins, the cells of the inner enamel epithelium secrete an organic matrix against the dentin. This matrix immediately mineralizes and becomes the tooth's enamel. Outside the dentin are ameloblasts, which are cells that continue the process of enamel formation; therefore, enamel formation moves outwards, adding new material to the outer surface of the developing tooth.
HISTOLOGY OF THE ODONTOBLAST
Formation of Dentin
Mantle dentin: First formed dentin
Type I collagen with ground substance
Formation of the odontoblast process
Matrix vesicles
Appearance of hydroxyapatite crystals
Predentin
Primary physiologic (circumpulpal) dentin
All organic matrix is formed from odontoblasts
Smaller collagen fibers
Presence of phosphophoryn
Mineralization
Globular calcification
Interglobular dentin: Areas of incomplete calcification
Incremental lines of von Ebner: Daily, 4mm of organic matrix is deposited. Also every 5 days the arrangement of collagen fibers changes. This creates the incremental lines of von Ebner.
Intratubular dentin
Dentin tubules
S-shaped in the coronal aspect, straight in root dentin
Von Korff fibers
They are an artifact
Alveolar bone (process)
1. The bone in the jaws that contains the teeth alveoli (sockets).
2. Three types of bone :
a. Cribriform plate (alveolar bone proper)
(1) Directly lines and forms the tooth socket. It is compact bone that contains many holes, allowing for the passage of blood vessels. It has no periosteum.
(2) Serves as the attachment site for PDL (Sharpey’s) fibers.
(3) The tooth socket is constantly being remodeled in response to occlusal forces. The bone laid down on the cribriform plate, which also provides attachment for PDL fibers, is known as bundle bone.
(4) It is radiographically known as the lamina dura.
b. Cortical (compact) bone
(1) Lines the buccal and lingual surfaces of the mandible and maxilla.
(2) Is typical compact bone with a periosteum and contains Haversian systems.
(3) Is generally thinner in the maxilla and thicker in the mandible, especially around the buccal area of the mandibular premolar and molar.
c. Trabecular (cancellous, spongy) bone
(1) Is typical cancellous bone containing Haversian systems.
(2) Is absent in the maxillary anterior teeth region.
3. Alveolar crest (septa)
a. The height of the alveolar crest is usually 1.5 to 2 mm below the CEJ junction.
b. The width is determined by the shape of adjacent teeth.
(1) Narrow crests—found between teeth with relatively flat surfaces.
(2) Widened crests—found between teeth with convex surfaces or teeth spaced apart.
MANDIBULAR CENTRAL INCISORS
These are the first permanent teeth to erupt, replacing deciduous teeth, and are the smallest teeth in either arch
Facial Surfaces:-The facial surface of the mandibular central incisor is widest at the incisal edge. Both the mesial and the distal surfaces join the incisal surface at almost a 90° angle. Although these two surfaces are nearly parallel at the incisal edge, they converge toward the cervical margin. The developmental grooves may or may not be present. When present, they appear as very faint furrows.
Lingual: The lingual surface has no definite marginal ridges. The surface is concave and the cingulum is minimal in size.
Proximal: Both mesial and distal surfaces present a triangular outline.
Incisal: The incisal edge is at right angles to a line passing labiolingually through the tooth reflecting its bilateral symmetry.
Root Surface:-The root is slender and extremely flattened on its mesial and distal surfaces.
MANDIBULAR SECOND BICUSPID
Facial: From this aspect, the tooth somewhat resembles the first, but the buccal cusp is less pronounced. The tooth is larger than the first.
Lingual: Two significant variations are seen in this view. The most common is the three-cusp form which has two lingual cusps. The mesial of those is the larger of the two. The other form is the two-cusp for with a single lingual cusp. In that variant, the lingual cusp tip is shifted to the mesial.
Proximal: The buccal cusp is shorter than the first. The lingual cusp (or cusps) are much better developed than the first and give the lingual a full, well-developed profile.
Occlusal: The two or three cusp versions become clearly evident. In the three-cusp version, the developmental grooves present a distinctive 'Y' shape and have a central pit. In the two cusp version, a single developmental groove crosses the transverse ridge from mesial to distal
Contact Points; Height of Curvature: From the facial, the mesial contact is more occlusal than the distal contact.The distal marginal ridge is lower than the mesial marginal ridge
Root Surface:-The root of the tooth is single, that is usually larger than that of the first premolar
the lower second premolar is larger than the first, while the upper first premolar is just slightly larger than the upper second
There may be one or two lingual cusps
Periodontal ligament development
Cells from the dental follicle give rise to the periodontal ligaments (PDL).
Formation of the periodontal ligaments begins with ligament fibroblasts from the dental follicle. These fibroblasts secrete collagen, which interacts with fibers on the surfaces of adjacent bone and cementum. This interaction leads to an attachment that develops as the tooth erupts into the mouth. The occlusion, which is the arrangement of teeth and how teeth in opposite arches come in contact with one another, continually affects the formation of periodontal ligaments. This perpetual creation of periodontal ligaments leads to the formation of groups of fibers in different orientations, such as horizontal and oblique fibers.