NEET MDS Lessons
Dental Anatomy
MAXILLARY LATERAL INCISORS
it is shorter, narrower, and thinner.
Facial: The maxillary lateral incisor resembles the central incisor, but is narrower mesio-distally. The mesial outline resembles the adjacent central incisor; the distal outline--and particularly the distal incisal angle is more rounded than the mesial incisal angle (which resembles that of the adjacent central incisor. The distal incisal angle resembling the mesial of the adjacent canine.
Lingual: On the lingual surface, the marginal ridges are usually prominent and terminate into a prominent cingulum. There is often a deep pit where the marginal ridges converge gingivally. A developmental groove often extends across the distal of the cingulum onto the root continuing for part or all of its length.
Proximal: In proximal view, the maxillary lateral incisor resembles the central except that the root appears longer--about 1 1/2 times longer than the crown. A line through the long axis of the tooth bisects the crown.
Incisal: In incisal view, this tooth can resemble either the central or the canine to varying degrees. The tooth is narrower mesiodistally than the upper central incisor; however, it is nearly as thick labiolingually.
Contact Points: The mesial contact is at the junction of the incisal third and the middle third. The distal contact is is located at the center of the middle third of the distal surface.
Root Surface:-The root is conical (cone-shaped) but somewhat flattened mesiodistally.
lntraarch relationship refers to the alignment of the teeth within an arch
1. In an ideal alignment teeth should contact at their proximal crests of curvature. A continuous arch form is observed in occlusal view
Curves of the occlusal plane (a line connecting the cusp tips of the canines, premolars, and molars) are observed from the proximal view
Curve of Spee: anterior to posterior curve; for mandibular teeth the curve is concave and for maxillary teeth it is convex
Curve of Wilson- medial to lateral curve for mandibular teeth the curve is also convex and for the maxillary it is convex
2. Contact does not always exist Some permanent dentitions have normal spacing
Primary dentitions often have developmental spacing in the anterior area: some primary den titions have a pattern of spacing called primate spaces between the primary maxillary lateral incisors and canine and between the mandibular canine and first mo1ar
Disturbances to the intraarch alignment are described as
a. Qpen contact where interproximal space exist because of missing teeth oral habits, dental disease, or overdeveloped frena
b. where contact or position is at an unexpected area because of developmental disturbances, crowding, dental caries or periodontal ligament for their misplaced position: facial, lingual. mesial, supra(supraerupted) infra (infraerupted) and torso (rotated) version
Age changes in the dentition
I. After the teeth have reached full occlusion, microscopic tooth movements occur to compensate for wear at the contact area (Mesial Drift) and occlusal surfaces (by Deposition of cementum at the root apex)
2. Attrition of incisal ridges and cusp tips may be so severe that dentin may become exposed and intrinsically stained
3. Secondary dentin may be formed in response to dental caries, trauma, and aging and result in decreased pulp size and tooth sensation
Bell stage
The bell stage is known for the histodifferentiation and morphodifferentiation that takes place. The dental organ is bell-shaped during this stage, and the majority of its cells are called stellate reticulum because of their star-shaped appearance. Cells on the periphery of the enamel organ separate into three important layers. Cuboidal cells on the periphery of the dental organ are known as outer enamel epithelium.The cells of the enamel organ adjacent to the dental papilla are known as inner enamel epithelium. The cells between the inner enamel epithelium and the stellate reticulum form a layer known as the stratum intermedium. The rim of the dental organ where the outer and inner enamel epithelium join is called the cervical loop
Other events occur during the bell stage. The dental lamina disintegrates, leaving the developing teeth completely separated from the epithelium of the oral cavity; the two will not join again until the final eruption of the tooth into the mouth
The crown of the tooth, which is influenced by the shape of the internal enamel epithelium, also takes shape during this stage. Throughout the mouth, all teeth undergo this same process; it is still uncertain why teeth form various crown shapes—for instance, incisors versus canines. There are two dominant hypotheses. The "field model" proposes there are components for each type of tooth shape found in the ectomesenchyme during tooth development. The components for particular types of teeth, such as incisors, are localized in one area and dissipate rapidly in different parts of the mouth. Thus, for example, the "incisor field" has factors that develop teeth into incisor shape, and this field is concentrated in the central incisor area, but decreases rapidly in the canine area. The other dominant hypothesis, the "clone model", proposes that the epithelium programs a group of ectomesenchymal cells to generate teeth of particular shapes. This group of cells, called a clone, coaxes the dental lamina into tooth development, causing a tooth bud to form. Growth of the dental lamina continues in an area called the "progress zone". Once the progress zone travels a certain distance from the first tooth bud, a second tooth bud will start to develop. These two models are not necessarily mutually exclusive, nor does widely accepted dental science consider them to be so: it is postulated that both models influence tooth development at different times.Other structures that may appear in a developing tooth in this stage are enamel knots, enamel cords, and enamel niche.
Pulp
1. Four zones—listed from dentin inward
a. Odontoblastic layer
(1) Contains the cell bodies of odontoblasts.
Note: their processes remain in dentinal tubules.
(2) Capillaries, nerve fibers, and dendritic cells may also be present.
b. Cell-free or cell-poor zone (zone of Weil)
(1) Contains capillaries and unmyelinated nerve fibers.
c. Cell-rich zone
(1) Consists mainly of fibroblasts. Macrophages, lymphocytes, and dendritic cells may also be present.
d. The pulp (pulp proper, central zone)
(1) The central mass of the pulp.
(2) Consists of loose connective tissue, larger vessels, and nerves. Also contains fibroblasts and pulpal cells.
2. Pulpal innervation
a. When pulpal nerves are stimulated, they can only transmit one signal pain.
b. There are no proprioceptors in the pulp.
c. Types of nerves:
(1) A-delta fibers
(a) Myelinated sensory nerve fibers.
(b) Stimulation results in the sensation of fast, sharp pain.
(c) Found in the coronal (odontoblastic) area of the pulp.
(2) C-fibers
(a) Unmyelinated sensory nerve fibers.
(b) Transmits information of noxious stimuli centrally.
(c) Stimulation results in pain that is slower, duller, and more diffuse in nature.
(d) Found in the central region of the pulp.
(3) Sympathetic fibers
(a) Found deeper within the pulp.
(b) Sympathetic stimulation results in vasoconstriction of vessels.
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.
MANDIBULAR SECOND MOLAR
Facial: When compared to the first molar, the second molar crown is shorter both mesiodistally and from the cervix to the occlusal surface. The two well-developed buccal cusps form the occlusal outline. There is no distal cusp as on the first molar. A buccal developmental groove appears between the buccal cusps and passes midway down the buccal surface toward the cervix.
Lingual: The crown is shorter than that of the first molar. The occlusal outline is formed by the mesiolingual and distolingal cusps.
Proximal: The mesial profile resembles that of the first molar. The distal profile is formed by the distobuccal cusp, distal marginal ridge, and the distolingual cusp. Unlike the first molar, there is no distal fifth cusp.
Occlusal: There are four well developed cusps with developmental grooves that meet at a right angle to form the distinctive "+" pattern characteristic of this tooth.
Contact Points; When moving distally from first to third molar, the proximal surfaces become progressively more rounded. The net effect is to displace the contact area cervically and away from the crest of the marginal ridges.
Roots:-The mandibular second molar has two roots that are smaller than those of the first molar. When compared to first molar roots, those of the second tend to be more parallel and to have a more distal inclination.