NEET MDS Lessons
Dental Anatomy
Differences Between the Deciduous and Permanent Teeth
1. Deciduous teeth are fewer in number and smaller in size but the deciduous molars are wider mesiodistally than the premolars. The deciduous anteriors are narrower mesiodistally than their permanent successors. Remember the leeway space that we discussed in the unit on occlusion?
2. Their enamel is thinner and whiter in appearance. Side by side, this is obvious in most young patients.
3. The crowns are rounded. The deciduous teeth are constricted at the neck (cervix).
4. The roots of deciduous anterior teeth are longer and narrower than the roots of their permanent successors.
5. The roots of deciduous molars are longer and more slender than the roots of the permanent molars. Also, they flare greatly.
6. The cervical ridges of enamel seen on deciduous teeth are more prominent than on the permanent teeth. This 'bulge' is very pronounced at the mesiobuccal of deciduous first molars.
G. Deciduous cervical enamel rods incline incisally/occlusally.
Disturbances to interarch alignment are
a. Excessive overbite where the incisal edge of the maxillary incisors extend to the cervical third of the mandibular incisors
b. Excessive overjet where the maxillary teeth overjet the mandibular teeth by more than 3mm
c. End-to-end relationship: edge-to edge bite where the anterior teeth meet at there incisal edge with no overjet or overbite; cusp-to bite where the posterior teeth meet cusp to cusp with no interdigitation
d. Crossbite where the normal faciolingual relationship of the maxillary to the mandibular teeth is altered for the anterior.teeth. the mandibular tooth or teeth are facial rather than lingual to the maxillary teeth for the posterior teeth, normal inercuspaton is not seen
ARTICULAR SURFACES COVERED BY FIBROUS TISSUE
TMJ is an exception form other synovial joints. Two other joints, the acromio- and sternoclavicular joints are similar to the TMJ. Mandible & clavicle derive from intramembranous ossificiation.
Histologic
- Fibrous layer: collagen type I, avascular (self-contained and replicating)
- Proliferating zone that formes condylar cartilage
- Condylar cartilage is fibrocartilage that does not play role in articulation nor has formal function
- Capsule: dense collagenous tissue (includes the articular eminence)
- Synovial membrane: lines capsule (does not cover disk except posterior region); contains folds (increase in pathologic conditions) and villi
Two layers: a cellular intima (synovial cells in fiber-free matrix) and a vascular subintima
Synovial cells: A (macrophage-like) syntesize hyaluronate
B (fibroblast-like) add protein in the fluid
Synovial fluid: plasma with mucin and proteins, cells
Liquid environment: lubrication, ?nutrition - Disk: separates the cavity into two comprartments, type I collagen
anterior and posterior portions
anetiorly it divides into two lamellae one towards the capsule, the other towards the condyle
vascular in the preiphery, avascular in the center - Ligaments: nonelastic collagenous structures. One ligament worth mentioning is the lateral or temporomandibular ligament. Also there are the spheno- and stylomandibular with debatable functional role.
Innervations
|
Ruffini |
Posture |
Dynamic and static balance |
|
Pacini |
Dynamic mechanoreception |
Movement accelerator |
|
Golgi |
Static mechanoreception |
Protection (ligament) |
|
Free |
Pain |
Protection joint |
Angle classified these relationships by using the first permanent molars
Normal or neutral occlusion (ideal):
Mesiobuccalgroove of the mandibular first molar align with the mesiobuccal cusp of the max laxy first permanent molar
ClassI malocclusion normal molar relationships with alterations to other characteristics of the occlusion such as versions, crossbites, excessive overjets, or overbites
Class II malocclusion a distal relation of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary first permanent molar
Division I: protruded maxillary anterior teeth
Division II: one or more maxillary anterior teeth retruded
Class III malocclusion a mesial relation of the mesiobuccal groove of the mandibular first permanent molar to the mesiobuccal cusp of the maxillary molar
Enamel
Composition: 96% mineral, 4% organic material and water
Crystalline calcium phosphate, hydroxyapatite
Physical characteristics: Hardness compared to mild steel; enamel is brittle
Support from dentin is necessary
Enamel has varies in thickness
Structure of enamel
Ground sections of enamel disclose the information that we have about enamel
Enamel is composed of rods
In the past we used the term prism (do not use)
Enamel rod
The rod has a cylinder-like shape and is composed of crystals that run parallel to the longitudinal axis of the rod. At the periphery of the rod the crystals flare laterally.
Interrod region: surrounds each rod; contain more enamel protein (fish scale appearance)
Rod sheath: boundary where crystals of rods meet those of the interrod region at sharp angles (We used to describe that as a keyhole configuration)
Each ameloblast forms one rod and together with adjacent ameloblasts the interrod region Very close to dentin there is no rod structure since the Tomes' processes develop after the first enamel is formed.
Striae of Retzius and cross striations
Incremental lines
Enamel structure is altered along these lines
Cross striations are also a form of incremental lines highlighting the daily secretory activity of ameloblasts
Bands of Hunter and Schreger
Optical phenomenon produced by changes in rod direction
Gnarled enamel
Twisting of rods around each other over the cusps of teeth
Enamel tufts and lamellae
They are like geologic faults
Tufts project from the DE junction, appear branched and contain greater concentrations of enamel protein than enamel
Lamellae extend from the enamel surface
Enamel spindles
Perikymata
Shallow furrows on surface of enamel formed by the striae of Retzius
Maxillary First Deciduous Molar.
-The notation is B or I.
-It looks a bit like an upper 1st premolar.
-There are three roots.
-It has a strong bulbous enamel bulge that protrudes buccally at the mesial.
-It is the smallest of the deciduous molars in crown height and in the mesiodistal dimension.
MANDIBULAR CUSPIDS
Mandibular canines are those lower teeth that articulate with the mesial aspect of the upper canine.
Facial: The mandibular canine is noticeably narrower mesidistally than the upper, but the root may be as long as that of the upper canine. In an individual person,the lower canine is often shorter than that of the upper canine. The mandibular canine is wider mesiodistally than either lower incisor. A distinctive feature is the nearly straight outline of the mesial aspect of the crown and root. When the tooth is unworn, the mesial cusp ridge appears as a sort of 'shoulder' on the tooth. The mesial cusp ridge is much shorter than the distal cusp ridge.
Lingual: The marginal ridges and cingulum are less prominent than those of the maxillary canine. The lingual surface is smooth and regular. The lingual ridge, if present, is usually rather subtle in its expression.
Proximal: The mesial and distal aspects present a triangular outline. The cingulum as noted is less well developed. When the crown and root are viewed from the proximal, this tooth uniquely presents a crescent-like profile similar to a cashew nut.
Incisal: The mesiodistal dimension is clearly less than the labiolingual dimension. The mesial and distal 'halves' of the tooth are more identical than the upper canine from this perspective. In the mandibular canine, the unworn incisal edge is on the line through the long axis of this tooth.