NEET MDS Lessons
Dental Anatomy
Tooth development is commonly divided into the following stages: the bud stage, the cap, the bell, and finally maturation. The staging of tooth development is an attempt to categorize changes that take place along a continuum; frequently it is difficult to decide what stage should be assigned to a particular developing tooth. This determination is further complicated by the varying appearance of different histological sections of the same developing tooth, which can appear to be different stages.
Bud stage
The bud stage is characterized by the appearance of a tooth bud without a clear arrangement of cells. The stage technically begins once epithelial cells proliferate into the ectomesenchyme of the jaw. The tooth bud itself is the group of cells at the end of the dental lamina.
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
MAXILLARY FIRST BICUSPID (PREMOLARS)
It is considered to be the typical bicuspid. (The word "bicuspid" means "having two cusps.")
Facial: The buccal surface is quite rounded and this tooth resembles the maxillary canine. The buccal cusp is long; from that cusp tip, the prominent buccal ridge descends to the cervical line of the tooth.
Lingual: The lingual cusp is smaller and the tip of that cusp is shifted toward the mesial. The lingual surface is rounded in all aspects.
Proximal: The mesial aspect of this tooth has a distinctive concavity in the cervical third that extends onto the root. It is called variously the mesial developmental depression, mesial concavity, or the 'canine fossa'--a misleading description since it is on the premolar. The distal aspect of the maxillary first permanent molar also has a developmental depression. The mesial marginal developmental groove is a distinctive feature of this tooth.
Occlusal: There are two well-defined cusps buccal and lingual. The larger cusp is the buccal; its cusp tip is located midway mesiodistally. The lingual cusp tip is shifted mesially. The occlusal outline presents a hexagonal appearance. On the mesial marginal ridge is a distinctive feature, the mesial marginal developmental groove.
Contact Points;The distal contact area is located more buccal than is the mesial contact area.
Root Surface:-The root is quite flat on the mesial and distal surfaces. In about 50 percent of maxillary first bicuspids, the root is divided in the apical third, and when it so divided, the tips of the facial and lingual roots are slender and finely tapered.
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
Mixed Dentition Period.
-Begins with the eruption of the first permanent molars distal to the second deciduous molars. These are the first teeth to emerge and they initially articulate in an 'end-on' (one on top of the other) relationship.
-On occasion, the permanent incisors spread out due to spacing. In the older literature, is called by the 'ugly duckling stage.' With the eruption of the permanent canines, the spaces often will close.
-Between ages 6 and 7 years of age there are:
20 deciduous teeth
4 first permanent molars
28 permanent tooth buds in various states of development
Permanent teeth
1. The permanent teeth begin formation between birth and 3 years of age (except for the third molars)
2. The crowns of permanent teeth are completed between 4 and 8 years of age, at approximately one- half the age of eruption
The sequence for permanent development
Maxillary
First molar → Central incisor → Lateral incisor → First premotar → Second pmmolar → Canine → Second molar → Third molar
Mandibular
First molar → Central incisor → Lateral incisor → Canine → First premolar → Second premolar → Second molar → Third molar
Permanent teeth emerge into the oral cavity as
Maxillary Mandibular
Central incisor 7-8 years 6-7 years
Lateral incisor 8-9 years 7-8 years
Canine 11-12 years 9-10 years
First premolar 10-Il years 10-12 years
Second premolar 10-12 years 11-12 years
First molar 6-7 years 6-7 years
Second molar 12-13 years 11-13 years
Third molar 17-21 years 17-21 years
The roots of the permanent teeth are completed between 10 and 16 years of age, 2 to 3 years after eruption
Dentin
1. Composition
a. Inorganic (70%)—calcium hydroxyapatite crystals.
b. Organic (30%)—water and type I collagen.
2. Types of dentin
a. Primary dentin
(1) Dentin formed during tooth development, before completion of root formation.
It constitutes the majority of dentin found in a tooth.
(2) It consists of a normal organization of dentinal tubules.
(3) Circumpulpal dentin
(a) The layer of primary dentin that surrounds the pulp chamber. It is formed after the mantle dentin.
(b) Its collagen fibers are parallel to the DEJ.
b. Secondary dentin
(1) Dentin formed after root formation is complete.
(2) Is deposited unevenly around the pulp chamber, forming along the layer of dentin closest to the pulp.
It therefore contributes to the decrease in the size of the pulp chamber as one ages.
(3) It consists of a normal, or slightly less regular, organization of dentinal tubules. However,
as compared to primary dentin, it is deposited at a slower rate.
(4) Although the dentinal tubules in secondary dentin can be continuous with those in primary
dentin, there is usually a tubular angle change between the two layers.
c. Tertiary (reparative, reactive) dentin
(1) Dentin that is formed in localized areas in response to trauma or other stimuli such as caries, tooth wear, or dental work.
(2) Its consistency and organization vary. It has no defined dentinal tubule pattern
d. Mantle dentin
(1) The outermost layer of dentin
(2) Is the first layer of dentin laid down by odontoblasts adjacent to the DEJ.
(3) Is slightly less mineralized than primary dentin.
(4) Has collagen fibers that are perpendicular to the DEJ.
(5) Dentinal tubules branch abundantly in this area.
e. Sclerotic (transparent) dentin
(1) Describes dentinal tubules that have become occluded with calcified material .
(2) Occurs when the odontoblastic processes retreat, filling the dentinal tubule with calcium phosphate crystals.
(3) Occurs with aging.
f. Dead tracts
(1) When odontoblasts die, they leave behind empty dentinal tubules, or dead tracts.
(2) Occurs with aging or trauma.
(3) Empty tubules are potential paths for bacterial invasion.
3. Structural characteristics and microscopic features:
a. Dentinal tubules
(1) Tubules extend from the DEJ to the pulp chamber.
(2) The tubules taper peripherally (i.e., their diameters are wider as they get closer to the pulp). Since the tubules are distanced farther apart at the periphery, the density of tubules is greater closer to the pulp.
(3) Each tubule contains an odontoblastic process or Tomes’ fiber.
Odontoblastic processes are characterized by the presence of a network of microtubules, with
Occasional mitochondria and vesicles present.
Note: the odontoblast’s cell body remains in the pulp chamber.
(4) Coronal tubules follow an S-shaped path, which may result from the crowding of odontoblasts as they migrate toward the pulp during dentin formation.
b. Peritubular dentin (intratubular dentin)
(1) Is deposited on the walls of the dentinal tubule, which affects (i.e., narrows)the diameter of the tubule .
(2) It differs from intertubular dentin by lacking a collagenous fibrous matrix. It is also more mineralized than intertubular dentin.
c. Intertubular dentin
(1) The main part of dentin, which fills the space between dentinal tubules
(2) Is mineralized and contains a collagenous matrix.
d. Interglobular dentin
(1) Areas of hypomineralized or unmineralized dentin caused by the failure of globules or calcospherites to fuse uniformly with mature dentin.
(2) Dentinal tubules are left undisturbed as they pass through interglobular dentin; however,
No peritubular dentin is present.
(3) Interglobular dentin is found in the:
(a) Crown—just beneath the mantle dentin.
(b) Root—beneath the dentinocemental junction, giving the root the appearance of a granular
layer (of Tomes).
e. Incremental lines
(1) Dentin is deposited at a daily rate of approximately 4 microns.
(2) As dentin is laid down, small differences in collagen fiber orientation result in the formation of incremental lines.
(3) Called imbrication lines of von Ebner.
(a) Every 5 days, or about every 20 µm, the changes in collagen fiber orientation appear more
accentuated. This results in a darker staining line, known as the imbrication line of von
Ebner.
(b) These lines are similar to the lines of Retzius seen in enamel.
f. Contour lines of Owen
(1) An optical phenomenon that occurs when the secondary curvatures of adjacent dentinal tubules coincide, resulting in the appearance of lines known as contour lines of Owen.
(2) Contour lines of Owen may also refer to lines that appear similar to those just described; however, these lines result from disturbances in mineralization.
g. Granular layer of Tomes
(1) A granular or spotty-appearing band that can be observed on the root surface adjacent to the dentinocemental junction, just beneath the cementum.