2017 2018 Dental Anatomy and Occlusion 1

DENTAL ANATOMY & OCCLUSION LEGEND
Topic Cards Topic Cards
anterior teeth information 1-8 occlusion terms 94-101
canine teeth information 9-14 periodontal 102-113

ligam ent/gingiva
eruption sequence 15-26 prem olar teeth information 114-120
heights of 27-38 tooth components 121-137

contour/contacts
miscellaneous 39-49 tooth terms 138-150
mandibular 50-61 perm anent teeth 151-167

movements/positions
molar teeth information 62-73 pictures of teeth 168-186
muscles 74-80 tem porom andibular joint 187-199
occlusion information 81-93 primary dentition 200-216

anterior teeth information 1
A stray crown is found in your office. It is an anterior tooth and has a

cingulum that is offset from center. What tooth is it most likely to be?
• maxillary canine
• maxillary lateral incisor
• mandibular lateral incisor
• mandibular central incisor
DENTAL ANATOMY & OCCLUSION IM e n ta ld e c k s

Part I • Volume 13 • © 2017
A cingulum (also called the linguocervical ridge) is the lingual lobe of an
anterior tooth. It makes up the bulk of the cervical third of the lingual surface.
Anterior teeth that have a cingulum located in the center of the cervical third of
the lingual surface:
• Maxillary lateral incisor
• Maxillary canine
• Mandibular central incisor
Anterior teeth that have a cingulum which is located off center to the distal in
the cervical third of the lingual surface:
• Maxillary central incisor
• Mandibular lateral incisor
• Mandibular canine
Note: The total number of cingula in each dentition is twelve (six maxillary
anterior teeth and six mandibular anterior teeth).
Mandibular Right Lateral Incisor Mandibular Right Central Incisor
M D
Incisal Incisal
Which characteristic below is common to all mandibular anterior

teeth?
• distinct cingula with grooves and pits

• incisal edges that are facial to the root axis line
• facial surfaces that are marked by pronounced labial ridges
• continuous convexity incisoapically on the facial surface
DENTAL ANATOMY & OCCLUSION i^ d e n ta ld e c k s

Part I • Volume 1 3 * © 2017
• continuous convexity incisoapically on the facial surface
Three characteristics common to all mandibular anterior teeth:
1. Indistinct cingula with smooth lingual anatomy w ithout grooves and pits
2. Incisal edges lingual to the root axis line
3. Continuous convexity incisoapically on the facial surface
Specific information pertaining to mandibular central incisors:
• Occlusion: they only occlude with one other tooth - the maxillary central incisor (in
centric, protrusive, and lateral protrusive as well)
Note: The alveolar process is thinnest facial to both central incisors (for this reason, local
infiltration may be effective for anesthetizing these teeth).
"•Rem em ber: The canines (both maxillary and mandibular) are the only teeth with labial
ridges.
Note: The CEJ curvatures are greater on the mesial than the distal (see pictures below).
Mesial Distal Mesial Distal Mesial Distal

Mandibular right Mandibular right Mandibular right
central incisor lateral incisor canine
A clinical examination of your patient reveals two lower incisors

centered on the midline. The patient gives a history of a car accident
when he was young where he lost two of his lower front teeth. He
says that his dentist used braces to fill in the gaps. Which of the
following criteria would be most reliable to decide if the remaining
teeth were lateral or central incisors?
• difference in root length

• difference in ratio of crown length to root length
• degree of slope of the incisal edge when viewed facially
• difference in rotation of the crown on the root
DENTAL ANATOMY & OCCLUSION ifrd e n ta ld e c k s

• difference in rotation of the crown on the root
***The mandibular lateral incisor crown tips slightly to the distal relative to the root
(facial view).
Other ways to distinguish the mandibular lateral from the mandibular central:
• The lateral is larger overall (especially mesiodistally)
• The lateral is not as bilaterally symmetrical as the central incisor
• The cingulum on the lateral is slightly distal to the center
• On the lateral incisor, the mesial marginal ridge is longer than the distal marginal
ridge. On centrals, they are the same length.
• Lateral incisors have the distal proximal contacts more apical than the mesial
contacts. Centrals are at the same level.
• Lateral incisors have the distoincisal angles more rounded than the mesioincisal
angles. On centrals, the angles are nearly the same.
Note: Both the mandibular central and lateral have a lingual cervical line that is
positioned more aplcally than the facial cervical line.
Mandibular Right
Lateral Indsor Mandibular Right
Central Indsor
M
M — D
I
Labial Indsal Labial Incisal
The mesial and distal aspects of the anterior teeth - central incisors,
lateral incisors, and canines, maxillary and mandibular - may be
included within triangles.
The base of the triangle is represented by the cervical portion of the
crown and the apex by the incisal ridge.
• both statements are true

• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true

• both s ta tem en ts are tru e
Outlines of crown forms within geometric outiines-
triangle, trapezoids, and rhomboids. The upper figure
in each square represents a maxillary tooth, the lower
figure a mandibular tooth. Note that the trapezoidal
outline does not include the cusp form o f posteriors
actually. It does include the crowns from cervix to
contact point or cervix to marginal ridge, however.
This schematic drawing is intended to emphasize cer
tain fundamentals. A, Anterior teeth, mesial or distal
(triangle). B, Anterior teeth, labial or lingual (trape
zoid). C, Premolars, buccal or lingual (trapezoid). D,
Molars, buccal or lingual (trapezoid). E, Premolars,
mesial or distal (rhomboid). F, Molars, mesial and dis
tal (rhomboid).
Summary of Schematic Outlines of the Tooth Crowns:

• Triangles
Six anterior teeth, maxillary and mandibular - mesial and distal aspect
• Trapezoids
Trapezoid with longest uneven side toward occlusal or incisal surface
° All anterior teeth, maxillary and mandibular - labial and lingual aspect
° All posterior teeth - buccal and lingual aspect
Trapezoid with shortest uneven side toward occlusal surface
° All maxillary posterior teeth - mesial and distal aspect
• Rhomboids
° All mandibular posterior teeth - mesial and distal aspect
Which of the following statements best describes the pulp canal of

the mandibular lateral incisor?
• an elliptical shape, consistently wider in the mesiodistal direction

• an elliptical shape, consistently wider in the faciolingual direction
• an elliptical shape, wider in the mesiodistal direction in the pulp chamber,
but wider in the faciolingual direction in the mid-root area
• an elliptical shape, wider in the faciolingual direction in the pulp chamber,
but wider in the mesiodistal direction in the mid-root area

Part I • Volume 1 3 *© 2017
• an elliptical shape, wider in the mesiodistal direction in the pulp
chamber, but wider in the faciolingual direction in the mid-root area
Near the roof of the pulp chamber, the elliptical form of the pulp cavity is widest in the
mesiodistal direction; however, near mid-root the elliptical form is widest in the faciolingual
direction. A small percentage have two canals.
1. Compared to the mandibular central incisor, the mandibular lateral incisor's root is
Notes larger in all dimensions.
2. The crown of the mandibular lateral incisor tips slightly to the distal relative to the
root; thus, the cingulum is slightly off-center to the distal, like that of the maxillary
central incisor and mandibular canine, but unlike that of the mandibular central
incisor.
3. The incisal edge of the mandibular lateral is slightly curved or rotated on the
distal. For this reason it is possible to see a small portion of this distal-incisal edge
when viewing this tooth from the mesial aspect.
M a n d ib u la r R igh t Lateral Incisor M a n d ib u la r R ight Central Incisor
Which of the following line angles is least "square"?
• mesioincisal of the mandibular lateral incisor

• distoincisal of the mandibular lateral incisor
• mesioincisal of the mandibular central incisor
• distoincisal of the mandibular central incisor
DENTAL ANATOMY & OCCLUSION Ifrd e n ta ld e c k s

• distoincisal of the mandibular lateral incisor
The distoincisal angle of most anterior teeth is more rounded compared to the mesioincisal angle. Another
way to say this is that the mesioincisal angles are more square (or acute) than the distoincisal angles, which
are more obtuse. Hint: Distal is rounded like the letter "D"; mesial is straighter like the letter ”M".
1. Important: The mandibular central is the only anterior tooth in which the distoincisal angle
Notes js as sharp and distinct as the mesioincisal angle . All other incisors show a more orless
rounded distoincisal angle.
2. Anterior teeth are highly important aesthetically and play an important role in the formation of
many speech sounds ("V," "F," and "TH”). When viewed from the sagittal plane, the axial
inclination of the anterior teeth inclines facially.
M a x illa ry a n d M a n d ib u la r In c is o rs
8 ,9 7 ,1 0 2 4 ,2 5 2 3 ,2 6
MT a n g le S h a r p r ig h t a n g le S l ig h t r o u n d in g S h a r p r ig h t a n g le S o m e r o u n d in g
DT a n g le S lig h t r o u n d in g D is tin c t ro u n d S h a r p r ig h t a n g le M o re ro u n d e d
M e s i a l p r o f i le S tr a ig h t S l ig h t r o u n d i n g S tra ig h t S tra ig h t
D i s ta l p r o f i le N e a rly ro u n d D is tin c t ro u n d S tra ig h t S tra ig h t
I n c i s a l o u t li n e S tra ig h t S tra ig h t S tra ig h t S t r a i g h t D L tw i s t
P r o x im a l c o n ta c t s
M e sia l I n c i s a l th ir d J u n c tio n I n c i s a l th ir d I n c i s a l th ir d
D i s ta l J u n c tio n M i d d l e th ir d In c is a l th ir d I n c i s a l th ir d
M a x illa r y R ig h t M a x illa r y R ig h t M a n d ib u la r R ig h t M a n d ib u la r R ig h t
C e n tra l In c is o r L a te ra l In c is o r L a te ra l In c is o r C e n tra l In c is o r
L a b ia l L a b ia l L a b ia l L a b ia l
Which tooth has a pulp chamber that is least like the others?
• maxillary central incisor


The pulp chamber of the maxillary central incisor is wider in the mesiodistal dimension than in the
labiolingual dimension. The pulp cavity conforms to the general shape of the outer surface of the tooth.
The pulp cavity is widest at the cervical level, and the pulp cham ber is centered within the dentin of the
root. In young individuals, the pulp chamber is roughly triangular in outline with the base of the triangle at
the labial aspect of the root. As the amount of secondary dentin increases, the pulp chamber becomes
more round or crescent-shaped. Also, the size of the pulp chamber decreases in size.
Th e cervical cross sections o f th e p u lp o f p e rm a n e n t a n te rio r te e th
M a x . C en tra l Incisor M a x. Lateral Incisor M a x . C an ine
M a n d . C en tral Incisor M a n d . L a teral Incisor M a n d . C anine

When looking at the facial or lingual aspect of ail anterior teeth, they
have a:
• trapezoidal outline
• triangular outline
• rhomboidal outline
• square outline
DENTAL ANATOMY & OCCLUSION l^ d e n ta ld e c k s

The trapezoidal outline has its longest uneven side toward the occlusal or incisal
surface.
□ d h n
Facial view of the
Maxillary Right
Central Incisor
Facial view of the
Mandibular Right
Lateral Incisor
Lingual view of
the Maxillary
Right Canine
Lingual view of the
MaxillaryRight
LateralIncisor
Remember (from card #4):

1. The mesial and distal aspects of all maxillary posterior teeth have a
trapezoidal outline. The shortest uneven side is toward the occlusal surface.
2. The buccal and lingual aspects of all posterior teeth have a trapezoidal outline.
The longest uneven side is toward the occlusal surface.
3. The mesial and distal aspects of all mandibular posterior teeth have a
rhomboidal outline.
M esial v ie w o f th e Lingual v ie w o f th e M esial v ie w o f th e

M a x illa ry R ight M a x illa ry R ight M a n d ib u la r Right
First M o la r First M o la r pjrst iviolar
canine teeth information 9
In maximum intercuspation, which anterior tooth is unique in that it

contacts with both anterior and posterior segments of the opposite
arch?
• maxillary first premolar

• mandibular first premolar
• mandibular canine
DENTAL ANATOMY & OCCLUSION l*d e n ta ld e c l< s

There is no contact on the cusp tip. It falls in direct alignment with the facial
embrasure between the mandibular canine and first premolar. This anterior tooth is
unique in that it has antagonists, in the intercuspal position, in both anterior (canine)
and posterior (first premolar) segments of the opposite arch.
M a x illa ry C a n in e s
C h a ra c te ris tic s
F a c ia l/L a b ia l aspect
P r o x im a l c o n t a c ts
M e s ia l J u n c t i o n o f t h e in c is a l a n d m i d d le th i r d
D is ta l M i d d l e th ird
M e s ia l aspect W i d e r f a c i o li n g u a lly
L in g u a l aspect D e e p e r lin g u a l fo ssa e

M a r g in a l r id g e s P ro n o u n c e d : 2 fo ssa e
C in g u l u m L a r g e , c e n te r e d M D
L in g u a l p its , g ro o v e s Com m on
In c is a l aspect M a r k e d s y m m e t r y o f m c s i a l/ d is ta l h a l v e s
ln c is a l/P r o x im a l aspects C u s p ti p m a y b e a t o r la b ia l t o r o o t a x i s lin e
C E J c u r v a tu r e 2 .5 m m ( m e s i a l)
C o n to u r H e ig h t 0 .5 m m
F a c i a l/ lin g u a l B o t h c e r v i c a l th ir d
A hockey player comes into your office with his six upper anterior
teeth in his hand. How can you distinguish the right canine from the
left canine?
• the root always curves to the distal in the apical one-third

• the distal surface is fuller and more convex than the mesial surface
• labially, the cusp tip is placed distal to a line which bisects the crown and
root
• lingually, the cervical line slopes mesially

Part I • Volume 13 *© 2017
the distal surface is fuller and more convex than the mesial surface
Also remember that:
• The curvature of the cervical line is greater on the mesial side than on the distal side
• The mesial surface is straighter than the distal surface
• The distal cusp ridge is longer than the mesial cusp ridge
• The mesial contact point is at the junction of the incisal and middle third
• It is usually thicker labiolingually than it is mesiodistaily
• The tip of the cusp is displaced labially and mesial to the central long axis of the tooth
• The distal contact is in a more cervical position (middle of the middle third)
• Although the apical 1/3 of the root typically curves distal, this is not always true.
M a x illa ry R ig h t C an in e
F acial L in g u a l
Which of the following terms is specific to canines?
• labial ridge
• lingual fossa
• mamelons
• cingulum

• labial ridge
The labial (facial) surface of canines is marked by a pronounced labial ridge (see facial view
below). Shallow developmental depressions lie mesial and distal to the labial ridge. On the
mandibular canines, the labial ridge and the developmental depressions are not as
pronounced.
Important: The canines (both maxillary and mandibular) are the only cusped teeth which
feature a functional lingual surface rather than a functional occlusal surface.
1. Looking at the maxillary canine from a facial view, the distal portion of the facial
No,K surface is convex in the middle third and slightly concave in the cervical third. The
mesial portion is convex in the middle third and nearly flat in the cervical third.
2. From the incisal view, the cervical line is often not visible. This is due to the
convexity of the crown.
Maxillary Right Canine Mandibular Right Canine
Facial Facial
A mother brings her three kids to your office for their annual check
ups. Which of the following statements is most likely to be true?
• the middle child is 11 and has no adult canine teeth

• the youngest child is 10 and has adult mandibular canines only
• the oldest child is 12 and has maxillary canines only
• the youngest child is 10 and has adult maxillary canines only
• the oldest child is 12 and has mandibular canines only

• the youngest child is 10 and has adult mandibular canines only
*** Going by the known eruption ages, the most plausible scenario is that the 10-year-old has her mandibular
canines but not her maxillary canines.
Remember:
• Maxillary canines erupt between the ages ot 11 -12 (after the premolars)
• Mandibular canines erupt between the ages of 9-10 (before the premolars)
Permanent Teeth Eruption Chart

A hockey player comes into your office holding his friend's right
canines (maxillary and mandibular) in his hand. His friend, a lacrosse
player, got hit by a ball flying under his mask. Which of the following
would you look for in the maxillary canine as compared to the
mandibular canine? Select all that apply.
• it is narrower mesiodistally
• it has a more pronounced cingulum
• it is wider mesiodistally
• it has a shorter root
DENTAL ANATOMY & OCCLUSION l*d e n ta ld e c k s

• it has a more pronounced cingulum
• it is wider mesiodistally
Characteristics that distinguish a mandibular canine from a maxillary canine:
• On the mandibular canine, the mesial border is much straighter (viewed facially).
• Contact areas are located more incisally (remember: IM); for the maxillary canine it is JM.
• The cusp tip is displaced lingually on the mandibular canine, whereas on the maxillary
canine the cusp is on or labial to the root axis line (viewed proximally and incisally).
• The mandibular canine has a comparatively narrower mesiodistal dimension (viewed
facially).
• The mandibular canine has a continuous convex facial surface when viewed from the
mesial or distal.
• The mandibular canine has a cingulum that is less pronounced and often slightly to the
distal, whereas the maxillary canine has a cingulum that is more pronounced and centered
mesiodistally (viewed lingually).
• Lingual ridges with mesial and distal fossae are less prominent on mandibular canines
(viewed incisally).
Maxillary Right Canine Mandibular Right Canine
Facial Lingual Incisal Incisal Facial Lingual

Which cusp ridge is the longest on the permanent canines?
• labial
• lingual
• mesial
• distal

• distal (see picture below)
The most prominent labial ridge on the permanent canines is the middle.
M a x illa ry R igh t Canine
M a m lib u la r C a n in e s
C h n ra c w ritric s
F a c ia l L a b ia l a sp e c t
P r o x i m a l c o n ta c ts
M e s ia l I n c is a l t h u d
D is ta l M id d le th ir d
M e sia l asp e c t N a r r o w e r , lo n g e r t h a n m a x illa r y c a n in e
L in g u a l a sp e c t F la t lin g u a l s u rf a c e
M a r g in a l r id g e s P a r a lle l o r s lig h tly c o n v e r g in g
C in g u lu m S m a lle r, p o s s ib ly o f f - c e n te r d is ta lly
L in g u a l p its , g ro o v e s N one
I n c is a l a s p e c t G r e a te i s y m m e tr y th a n m a x illa r y c a iim e ,
d is ta l c u s p r i d g e r o ta te d
I n c i s a l P r o i i m . i l asp e ct* : C u s p tip lin g u a l to r o o t a x is lin e
C 'E J c u r v a t u r e 1 0 m m (d t3 ta l)
C o n t o u r H e ig h t ■- 0 .5 m m
F a c ia l H n g u a l B o th c e rv ic a l t h u d
Remember:
1. The maxillary canine is the longest tooth in the mouth.
2. The faciolingual dimension of the maxillary and mandibular canines is greater than
their mesiodistal dimension.
3. The mandibular canine has the longest crown of any permanent tooth.
4. The mesial surface of the crown of a mandibular canine is nearly parallel with the
long axis of the tooth.
eruption sequence 15
A 7-year-old boy visits your dental office with his mom for a routine
check-up. Which succedaneous teeth are expected to be present in
the child’s mouth?
• permanent mandibular first molars

• permanent mandibular central incisors
• permanent mandibular canines
• permanent mandibular premolars

• permanent mandibular central incisors
A permanent tooth that moves into a position formerly occupied by a primary
tooth is called a succedaneous tooth. The permanent incisors, canines, and
premolars are known as succedaneous teeth because they replace primary
incisors, canines, and molars, respectively. The succedaneous teeth emerge
lingual to the position of their primary predecessors. The permanent maxillary
incisors are an exception as they emerge facial to the position of their primary
predecessors.
A permanent tooth that does not take the place of a primary tooth is known as a
nonsuccedaneous tooth. The permanent molars are nonsuccedaneous
teeth, because they lack primary predecessors. They erupt posterior to the
primary second molars.
Age of eruption
Mandibular tooth Type
(years)
First molar Nonsuccedaneous tooth 6-7
Central incisor Succedaneous tooth 6-7
Lateral incisor Succedaneous tooth 7-8
Canine Succedaneous tooth 9-10
First premolar Succedaneous tooth 10-12
Second premolar Succedaneous tooth 11-12
Second molar Nonsuccedaneous tooth 11-13
Third molar Nonsuccedaneous tooth 17-21
Note: By age seven, among the mandibular teeth, incisors and first molars are
the only permanent teeth that can be expected in a child’s oral cavity.
A mother brings her 1-year-old into your office the day after his first
birthday. She says the pediatrician said to have the first dental check
up by this time. What primary teeth are you expecting to see when
the child opens?
• mandibular incisors only

• maxillary incisors only
• mandibular and maxillary incisors
• all incisors and maxillary canines
• all incisors and mandibular canines
• all anterior teeth

• mandibular and maxillary incisors
Primary Dentition Eruption Chart
Upper Teeth Erupt Shed

Central incisor 8-12 mos. 6-7 yrs.
Lateral Incisor 9-13 mos. 7-8 yrs.
Canine (cuspid) 1 6 -2 2 mos. 10-12 yrs.
First molar 13-19 mos. 9-11 yrs.
Second molar 25-33 mos. 1 0 -1 2 yrs.
Lower Teeth Erupt Shed

Second molar 23-31 mos. 10-12 yrs.
Canine (cuspid) 17-23 mos. 9-12 yrs.

Lateral incisor 10-16 mos. 7-8 yrs.
***Eruption dates are variable. Some infants get teeth early, others do so late.
No(M 1. Calcification of the roots is normally completed by the age of 3 or 4.
2. Active eruption of teeth occurs after two-thirds of the root is formed.
Tommy, a pediatric patient of yours, says he lost his top vampire

tooth last week and the tooth fairy gave him a dollar for it. What is
Tommy's most likely age range when he lost his maxillary canine
tooth?
• 6-7 years old

• 7-8 years old
•10-12 years old
•14-16 years old

• 10-12 years old
U s u a l E x f o lia t io n A g e o f T h e P r im a r y T e e th
M a x i l l a r y T e e th Shed
C e n tra l In c is o r 6 -7 years
L a te ra l In c is o r 7 -8 years
C a n in e 1 0 -1 2 years
F irs t m o la r 9 -1 1 years
Second m o la r 1 0 -1 2 years
M a n d i b u l a r T e e th Shed
C e n tra l in ciso r 6 -7 years
L a te ra l in ciso r 7 -8 years
C an in e 9 -1 2 yea rs
Second m o la r 1 0 -1 2 years
Primary teeth are exfoliated by the phenomenon called resorption of the primary
root. The permanent tooth in its follicle attempts to force its way in to the position held
by its predecessor. The pressure brought to bear against the primary root evidently
causes resorption of the root, which continues until the primary crown has lost its
anchorage, becomes loose, and is finally exfoliated.
Which of the following are the cardinal rules regarding the eruption of
teeth?
Select all that apply.
• boys' teeth usually erupt before girls' teeth of the same age
• girls' teeth usually erupt before boys' teeth of the same age
• maxillary teeth usually erupt before mandibular teeth
• mandibular teeth usually erupt before maxillary teeth
• the teeth of slender children usually erupt before the teeth of stocky
children
• the teeth of stocky children usually erupt before the teeth of slender
children

Part I • Volume 13 *©2017
• girls' teeth usually erupt before boys' teeth of the same age
• mandibular teeth usually erupt before maxillary teeth
• the teeth of slender children usually erupt before the teeth of stocky children
Note: You will probably never find these cardinal rules in a book (we have tried but to no
avail!!!); however, if you see this question or something similar to it asked on the boards,
answer as above.
Also remember:
1. Teeth usually erupt in pairs.
2. Often the permanent mandibular anterior teeth erupt lingual to the primary teeth and give the
appearance for a while that there are two rows of teeth.
U n iv e r s a l T o o th N u m b e r in g
Permanent Teeth
upper left upper right
16 1514 13 12 11 10 9 8 7 6 5 4 3 2 1
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
lower left lower right
Deciduous teeth <baby teeth)
upper left upper right
J l H G F E D C B A
K L M N O P Q R S T
lower left lower right
1
The deciduous dental formula of man is:
• ijc-J-B jM ^ = 1 0 x 2 = 20
• I ^ c| m ^ = 1 0 x 2 = 20
• I ^ c| m | = 1 2 x 2 = 24
• | | c| b | m | = 16 x 2 = 32
• None of the above
DENTAL ANATOMY & OCCLUSION H M e n ta ld e c k s

Part I 'Volum e 13 • © 2017
I a c 1 M i = ? Per qu^ r am = 10 per arch „ 20 tota| teeth
2 1 2 = 5 per quadrant = 10 per arch
I = Incisors
C = Canines
M = Molars
Note: There are no premolars (bicuspids) in the deciduous dentition.

For primary dentition, the crowns of all 20 teeth begin to calcify between 4 and
6 months in utero, and on average take 10 months for completion. In
general, the root of a deciduous tooth is completely formed in just about one
year after eruption of that tooth into the mouth.
In the Palmer system, the arches are divided into four quadrants. The Palmer
notation for the primary dentition is as follows:
EDCBA|ABCDE
EDCBA|ABCDE
The Federation Dentaire Internationale (FDI) recommends a two-digit

system for both the primary and permanent dentitions. This system has been
adopted by the World Health Organization (WHO) and is accepted by other
organizations and in research and public health. The FDI system of notation
for the primary dentition is as follows:
5 5 5 4 5 3 5 2 51 | 61 6 2 6 3 6 4 6 5 Note: Number 5 indicates the right maxillary quadrant;
--------------------------------------------------------- number6.theleftmaxillaryquadrant;number 7, the left
8 5 8 4 8 3 8 2 81 171 7 2 7 3 7 4 7 5 mandibular quadrant; and number 8, the right mandibu
lar quadrant
The permanent dental formula of man is:
• I ^ C-j- M ^ = 16 X 2 = 32
• I^ c| b| m|=14*2=2B
• | | c | b | m | = 1 6 x 2 = 32
• 12C1M|= 12x2 =24

• none of the above
DENTAL ANATOMY & OCCLUSION dJtdentaldecks

11 c 1 B I M I = qyadrcnt = 1<>per arch = 32 , ota| teeth
2 1 2 3 = 8 per quadtant = 16 Per arch
I = Incisors
C = Canines
B = Bicuspids (premolars)
M = Molars
The Palmer system for the permanent dentition divides the arches into four
quadrants with eight teeth in each quadrant. The Palmer notation for the
permanent dentition is as follows:
8 7 6 5 4 3 2 111 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 11 2 3 4 5 6 7 8
The FDI system of notation for the permanent dentition is as follows:

18 1 7 1 6 15 1 4 13 12 11121 2 2 2 3 2 4 2 5 2 6 2 7 2 8
4 8 4 7 4 6 4 5 4 4 43 4 2 4 1 |3 1 32 33 3 4 3 5 3 6 3 7 3 8
Note: In the permanent dentition, the first digit indicates the quadrant and the
second digit indicates the tooth in that quadrant. The right maxillary quadrant
is 1, the left maxillary quadrant is 2, the left mandibular quadrant is 3, and the
right mandibular quadrant is 4.
A child in the ugly duckling stage of dental development belongs to

which of the following age groups?
• 1 to 6 years
• 6 to 12 years
• 12 to 18 years
• 18 years and above

• 6 to 12 years
The period of mixed dentition begins with the eruption of the first permanent
tooth (usually the mandibular first molar) in the oral cavity. It is a transitional
dentition consisting of both primary and permanent teeth that occurs between
6 and 12 years of age. The mixed dentition period ends with the exfoliation of
the last primary tooth (normally the maxillary canine), which occurs around 12
years of age.
During the mixed dentition period, there may be a transient deviation from the
eruption pattern, where the maxillary incisors move labially and assume a
widely spaced position. This physiological spacing occurs because of mesial
displacement of roots of the lateral incisors by the erupting canines. The roots
of the lateral incisors transmit the forces onto the roots of the central incisors,
which also get displaced, creating a temporary diastema between the incisors.
This stage is referred to as the “ugly duckling stage,” as the child undergoes
metamorphosis into an esthetic phase after this stage. The transient diastema
is self-correcting, and closes on its own following the eruption of canines when
the pressure is transferred from the roots to the crowns of the incisors.
• Ugly duckling stage is also known as Broadbent’s phenomenon
or physiologic median diastema.
• Midline diastema up to 2 mm is corrected spontaneously.
• Midline diastema in early mixed dentition is usually self-correcting
and should not be treated.
A 15-month-old child walks into your office and begins to cry and
hold his mouth in pain. Which teeth have probably not been
traumatized, as they are not usually present at 15 months of age?
• primary lateral incisors and canines

• primary canines and first molars
• primary canines and second molars
• primary central and lateral incisors
• primary first and second molars

• primary canines and second molars
Rule of four: This simplified rule will enable you to determine the number of
teeth present at any given time. It implies the eruption of four teeth every four
months beginning with four teeth at age seven months.
R u le o f F o u r
A ge N u m b e r o f T e e th E ru p te d Specific T e e th
(in m onth s)
7 4 4 = m and. and m ax. central incisors
11 8 8 = m aud, and m ax. central and lateral incisors
15 12 12 = m and. and m ax. central and lateral incisors, four

first m olars
19 16 16 = m and. and m ax. central and lateral incisors, four

first m olars and four canines
23 20 2 0 = m and. and m ax. central and lateral incisors, four

first m olars, fou r canines, and fo u r second molars
***The above "rule of four" is not perfect, it is a generalization. For example, at

age 23 months, the child might not have their maxillary second molars yet, the
same holds true for age 7 months, the child might not have their maxillary
centrals yet.
Example from question on front of card: At age 15 months, 12 teeth are
erupted (four centrals, four laterals, and four first molars).
A pediatric patient of yours complains of severe pain on chewing. On

clinical exam, you see an eruption cyst in the place of the mandibular
second molar. What is the most likely age of this patient?
•8
• 10
• 12
• 14

•12
*** The m andibular second m olar erupts between 11 and 13 years of age.
C h r o n o lo g y o f th e P e r m a n e n t D e n t it io n
F i r s t E v id e n c e o f Enam el Root
T o o th C a lc if ic n t io n C o m p le t e E r u p tio n C o m p le t io n
M n ilb r v
C entral 3- 4 months 4 -5 years 7- 8 years
10 years
Lateral 10 months 4- 5 years
8- 9 years
11 years
Canine 4- 5 months 6-7 years 1 1 - 12 years 1 3 - 15 years
First premolar 1 1 / 2 - 1 3 / 4 years 5- 10-11 years
6 years 12-13 years
Second prem olar 2 - 2 1 ^ 4 years 6- 10-12 years
7 years 12-14 years
First m olar A t birth 3 -4 years 6-7 years 9 -10 years
Second m olar 2 1/2 -3 years 7 - 8 years 1 2 - 13 years 1 4 - 16 years
T h ird m olar 7-9 years 1 2-1 4 years 17-21 years 19-21 years
M a n d ib u la r
Central 3 -4 months 4 -5 years 6- 7 years
9 years
Lateral 3- 4 months 4 - 5 years
7- S years
10 years
Canine 4- 5 months 6-7 years 9- 10 12-14
years years
First premolar 1 3 /4 - 2 years 5- 6 years
10- 12-
12 years 13 years
Second premolar 2 1 / 4 - 2 1/2 years 6- 7 years
11- 12 years
13- 14 years
First m olar A t birth 2 1 / 2 - 3 years 6 -7 years 9 -1 0 years
Second m olar 2 1/2 -3 years 7 - 8 years 11-13 years 13-14 years
T h ird m olar 5- 10 years12-14 years 17-21 years 19-21 years
'Apex is fully developed tw o to three years after eruption.

At 9 years of age how many primary teeth are present in the mouth?
•0
•4
•8
• 12
• 18

• 12
By age nine, the child has lost the mandibular central (6-7 years), mandibular
lateral (7-8 years), maxillary central (6-7 years) and maxillary lateral (7-8 years)
incisors. The remaining dentition is composed of 6 maxillary and 6 mandibular
teeth.
U s u a l E x fo lia tio n A g e o f T h e P r im a r y T e e tli
M a x i l l a r y T e e t li Shed
C e n tra l In c is o r 6 - 7 years
L a te r a l In c is o r 7 -8 years
C a n in e 1 0 -1 2 yea rs
S e c o n d m o la r 1 0 -1 2 years
M a n d ib u la r T e e th Shed
C e n tra l in c is o r 6 - 7 y e a rs
L a te r a l in c is o r 7 -8 y ears
C a n in e 9 - 1 2 yea rs
S e c o n d m o la r 1 0 -1 2 years
A 1-year-old child is expected to have erupted which of the following
primary maxillary and mandibular teeth? Select all that apply.
• central incisors
• lateral incisors
• canines
• first molars
• second molars

A 12-month-old child generally has all of the primary incisors . Please refer to the primary teeth
eruption chart below. Note: Keep in mind the idea that a 6-month acceleration or delay is considered
normal.
U p p e r Teeth Erupt Sh ed
Central incisor 8- 126-mos. 7 yrs.
Lateral incisor 9- 137-mos.
8 yrs.
Canine (cuspid) 16-22 mos. 10-12 yra.
Lower Tooth Erupt Shed


Canine (cuspid) 17-23 mos. 9-12 yrs.
Lateral incisor 10-16 mos. 7-8 yrs.
Remember: Eruption dates are variable. The timing of the eruption or emergence of the teeth is due
in large part to hereditary and only somewhat to environmental factors. The mean age of eruption of
the primary teeth is demonstrated schematically below.
i» i* ,c ,, 10 Mean age (in months) of emergence

of the primary dentition.
zt -re 29 '9' *
The teeth that are present at the time of birth are known as
• primary teeth
• natal teeth
• neonatal teeth
• prenatal teeth

• natal teeth
The teeth present at the time of birth are known as natal teeth. These teeth
are uncommon and found in around 1 out of 2000 newborn babies. These are
generally found in the mandibular incisor region and are usually attached to
the gingival margin, with little root formation or bony support. Natal teeth are
known to develop from a part of the dental lamina prior to the deciduous bud
or from a bud of the accessory dental lamina. Natal teeth are not true teeth as
they lack proper roots. Histologically, natal teeth are keratinized epithelial
structures. Natal teeth are different from neonatal teeth that erupt within 30
days after birth.
Natal or neonatal teeth may be supernumerary or prematurely erupted primary
teeth. A radiograph can be used to differentiate between the two. Natal teeth
may be associated with anomalies such as cleft palate or syndromes such as
Pierre Robin syndrome, Ellis-van Creveld syndrome, and Hallermann-Streiff
syndrome.
Natal or neonatal teeth may cause discomfort to nursing mothers due to
abrasion or biting of the nipple during feeding. These teeth may also injure the
infant’s tongue. Moreover, there is a risk of tooth aspiration, if the natal or
neonatal tooth is too mobile.
Treatment involves removal of the natal teeth after making sure that they are
not prematurely erupted primary teeth. Treatment prognosis is excellent, and
there are no complications.
heights of contour/contacts 27
A patient comes in with a chief complaint of, “My wife says I wake
her up at night with scraping noises from my mouth.” On clinical
exam you will expect to find which of the following characteristics of
his occlusal contacts?
• point-to-point
• point-to-area
• edge-to-edge
• edge-to-area
• area-to-area

• area-to-area
The character of occlusal contacts in the unworn dental arch are all of the
following:
• point-to-point
• point-to-area
• edge-to-edge
• edge-to-area
Important: In bruxism, however, the direct tooth-to-tooth contact may result
in non-physiological area-to-area contacts.
The character of occlusal contacts makes chewing easier to perform, since
there are abundant food spillways on the occlusal table.
Note: The most difficult bruxism problem to be faced is the patient who has
worn the entire occlusion flat and has shortened the anterior teeth into an end-
to-end relationship. The effect of bruxism is easy to eliminate if the flat anterior
guidance can be maintained, but often such a patient wishes to have the
anterior esthetics improved. There is sometimes no way to improve the
esthetics without steepening the anterior guidance. A steepened anterior
guidance almost always promotes parafunction.
All posterior teeth have proximal contacts in the:
• middle third
• junction of the occlusal and middle third
• occlusal third
• cervical third

• middle third
When viewed from the facial, all posterior teeth have proximal contacts in the middle third. Molars
have contacts lower in the middle third than the premolars. Also, each posterior tooth has the mesial
contact slightly more occlusal than the distal contact.
Summary of contacts in the incisocervical or occlusocervical dimension:
Maxillary teeth: Id, JM, JM, MM, MM, MM, MM, M I = Incisal third M = middle third
Mandibular teeth: II, II, IM, MM, MM, MM, MM, M J = at the junction of the incisal and middle third
A. Centrals and lateral
B. Central, lateral and canine
C. Lateral, canine and first premolar Outline drawings of the maxillary teeth
D. Canine, first premolar, and second pre from the incisal and occlusal aspects with
molar broken line bisecting the contact areas.
E. First molar, second premolar, and first These illustrations show the relative posi
molar tions of the contact areas lablollnguallyand
F. Second premolar, first moiar, and sec buccolingualty. Arrows point to embrasure
ond molar spaces.
G. Fust, second, and third molars
A. Centrals and lateral

B. Central, lateral and canine
C. Lateral, canine and first premolar Contact relation of mandibular teeth
D. Canine, first premolar, and second labiollngually and buccoiingually when
premolar viewed from the incisal and occlusal as
E. First premolar, second premolar, pects. Arrows point to embrasure spaces.
and first molar
F. Second premolar and first, second,
and third molars
Remember:
1. The more anterior the tooth, the more incisal/occlusal are the locations of the proximal
contacts.
2. For any tooth, the mesial contact area is more toward the incisal/occlusal than is the distal
contact area.
Which teeth crowns have the facial height of contour located in or

near the cervical third?
• anterior teeth (incisors and canines)

• posterior teeth (premolars and molars)
• only molars
• all of the above

The height of contour, also known as the crest of curvature, is the greatest
bulge or elevated curvature of the tooth incisocervically or occlusocervically on
a particular surface of the crown. In an ideal tooth alignment, the height of
contour on the proximal (mesial and distal) surfaces usually coincides with
the proximal contact areas, which can be viewed from a labial or buccal and
lingual aspect.
The facial or lingual height of contour can be best viewed from a proximal
(mesial or distal) aspect. The height of contour on a facial or lingual surface of
a crown is a point on the crown outline where a line drawn parallel to the root
axis line touches the greatest bulge. The facial height of contour of all the
teeth, anterior as well as posterior, is located in the cervical third. The
lingual height of contour of anterior teeth is located in the cervical third (on
cingulum), whereas that of posterior teeth is located more occlusally in the
middle third.
The facial and lingual heights of contour help in defining the direction of food
particles when they are pushed cervically over the crown surfaces during the
masticatory process. These contours deflect the food particles away from the
free gingiva and gingival sulcus, thus minimizing trauma to the gingiva.
Note: The heights of contour should be taken into consideration during
fabrication of crowns, finishing, and polishing of restorations near the gingival
line, or when giving a bridge or an implant prosthesis.
Which of the following is true regarding proximal contact of teeth with

their adjacent teeth in an arch?
• helps prevent food from being trapped between the teeth

• stabilizes the dental arch by holding teeth in positive contact with each
other
• protects the interproximal gingival tissue from trauma during chewing

Contact areas, or proximal height of contour, is the location of the greatest
convexity or curve on the proximal surfaces of tooth crowns (mesial and distal),
where the crowns of adjacent teeth in the same arch are in contact with each
other.
The proximal contact of all the teeth with their adjacent teeth within an arch
serves the following functions:
1. Stabilizing the dental arch by holding teeth in positive contact with each
other.
2. Preventing food from being trapped between the teeth, which otherwise
would lead to dental decay and periodontal disease.
3. Protecting the interproximal gingival tissues from trauma during chewing
by diverting the morsel of food buccally and lingually.
When viewed facially, contact areas are located either in the incisal or occlusal
third; or at the junction of the incisal and middle thirds; or in the middle third of
the crown, but normally, not in the cervical third.
From an incisal view, contacts of the anterior teeth are located faciolingually.
From an occlusal view, contact points of posterior teeth are located toward the
facial/buccal surface of the tooth with respect to the buccolingual midline.
Note: Contact areas over the proximal tooth surfaces, which are otherwise
difficult to clean with the toothbrush, should be cleaned with dental floss.
Cervical line (or CEJ) contours are closely related to the attachment
of the gingiva at the neck of the tooth. When doing a crown prep, your
margin will slope with the contours of the cervical lines and gingival
attachments. On which surfaces will your greatest contour be found?
• distal surfaces of anterior teeth

• distal surfaces of posterior teeth
• mesial surfaces of anterior teeth
• mesial surfaces of posterior teeth

Part I •Volume 13 *©2017
• mesial surfaces of anterior teeth
Note: The mesial surface of the maxillary central has the greatest curvature.
^ PA ^ 1
mHHH h wm
2 nd 1 st 2nd 1 st Canine Lateral Central
Molar Molar Premolar Premolar Incisor Incisor
C h a ra c te ris tic s 8,9 7 ,1 0 2 4 ,2 5 2 3 ,2 6 6 ,1 1 2 2 ,2 7
C u rv e a t C E J
M e s ia l 3 .5 m m 3 .0 m m 3 .0 m m 3 .0 m m 2 .5 n iiii
D is ta l 2 .5 m m 2 .0 m m 2 .0 m m 2 .0 m m 1.0 m m
C o n to u r H e ig h t
F a c ia l/lin g u a l C e r v ic a l C e r v ic a l C e rv ic a l C e r v ic a l C e rv ic a l C e r v ic a l
th ird th ird th ird th ird th ird th ird
Remember: All teeth generally have a greater proximal cervical line (CEJ) curvature on the
mesial than the distal. Also, the proximal cervical line (CEJ) curvatures are greater on the
incisors and tend to get smaller when moving toward the last molar, where there may be no
curvature at all. Facial and lingual CEJs curve apically; mesial and distal CEJs curve coronally.
You are fabricating an interim bridge from 19 to 21. The contact areas
on the pontic when viewed from the occlusal view, should be
______of the tooth midline buccolingually.
• directly in line
• slightly to the lingual
• slightly to the facial

slightly to the facial
Look at letter E bottom picture
Outline drawings ot the maxillary teeth from the inicisal and occlusal
aspects with broken lines bisecting the contact areas. These illustrations
show the relative positions of the contact areas labiolingually and
buccolingually. Arrows point to embrasure spaces. A. Central incisors
and lateral incisors. B, Central and lateral incisors and canine. C, Lateral
incisor, canine, and first premolar. D, Canine, first premolar, and second
premolar. E, First premolar, second premolar, and first molar. F, Second
premolar, first molar, and second molar. G. First, second, and third
molars.
Contact relation of mandibular teeth labiolingually and buccolingually

when surveyed from the incisal and occlusal aspects. Arrows point to
embrasure spaces. A, Central incisors and lateral incisors. B, Central and
lateral incisors and canine. C, Lateral incisor, canine, and first premolar.
D. Canine, first premolar, and second premolar. E, First premolar,
second premolar, and first molar. F. Second premolar and first, second,
and third molars.
The mesial contact area of a permanent maxillary lateral incisor is

usually located:
• in the incisal third

• in the middle third
• at the junction of the incisal and middle thirds

at the junction of the incisal and middle thirds
C o n ta c t A r e a s fo r A n te r i o r T e e th
C e n tr a l L a te r a l C a n in e
M a x illa ry u JM JM
M a n d ib u la r n n IM
Note: IJ means that the mesial contact is located in the incisal third (I) and the distal
contact is located at the junction (J) of the incisal and middle thirds. These are all from the
facial aspect (incisocervical or occlusocervical dimension). When viewed from the
occlusal (or incisal), all anteriors have their contacts in the middle third (M or D); thus
they are centered faciolingually.
Remember: Although the mesial and distal contacts of the mandibular lateral are in the
incisal third, the distal contact is slightly cervical to the mesial contact. On the
mandibular central incisor they are both at exactly the same level.
I " l |B|,.
JX JX
m w M »
■3PTfP> B ir
Outline drawing*: of th e maxillary teeth n contact, w ith dotted
lines bisecting th e contact areas at the various levels as found Contact levels found normally on mandibular teath. Arrows point
normally. Arrows point to embrasure spaces, A, Central and lat to embrasure spaces. A, Central and lateral Incisors B, Central and
eral incisors. B, Central and lateral Incisors and canine. C, Lateral lateral Incisors and canine. C, Lateral Incisor, canine and first premo-
lnc:sor, canine and first premolar. D, Canine and first and second lar D, Canine and first and serond premolars. E, First and second pre-
premolars. E, First and second premolars and first molar. F, Sec molars and fit st molar. F, Sen ond premolar, first molar, and sec ond
ond premolai. first molar, and se< ond molai. G, First, second, and molar. G, First second, and third molars
third molars.
From a facial view, mesial and distal contact areas of mandibular

central incisors are located:

• at the junction of incisal and middle thirds
• at the junction of cervical and middle thirds
• cervical to the junction of incisal and middle thirds
• incisal to the junction of incisal and middle thirds

• incisal to the junction of incisal and middle thirds
The contact areas of mandibular central incisors are in the incisal third of the tooth as
seen from the facial. In general, the contact area gets more cervical as you proceed
posteriorly in the arch, with the contact between all maxillary and mandibular molars
being in the middle one third of each tooth.
Outline drawings of the m axillary teeth in contact, with dot

ted lines bisecting the contact areas at the various levels as Contact levels found normally on mandibular teeth. Ar-
found normally. Arrows point to embrasure spaces. A, Central rows P°,nt t0 emt>rasure spaces. A, Central and lateral in-
and lateral Incisors. B, Central and lateral Incisors and canine. cisors- B' Central and lat«ral Incisors and canine. C. Lateral
C, Lateral Incisor, canine and first premolar. D, Canine and first *ncfsor- canine and first premolar. D, Canine and first and
and second premolars. E. First and second premolars and first second premolars. E, First and second premolars and first
molar. F, Second premolar, first molar, and second molar. G, molar- F' Second Premolar' first molar' and second molar
First, second, and third molars. G. First second, and third molars.
The contact area on the mesial surface of a mandibular canine is

located at the:
• middle third
• incisal third
• cervical third
• junction of the middle and cervical thirds
DENTAL ANATOMY & OCCLUSION Hfrdentaldecks

• incisal third
The mandibular canine on its mesial surface contacts the distal surface of
the lateral incisor. The canine almost seems to tilt mesially toward the incisor
tipping into it but meeting it at a contact point near the incisal third. It is similar
to the way in which the mandibular incisors contact each other in the incisal
third. The contact of the distal of the mandibular canine with the mesial of the
first premolar is in its middle third.
Contact levels found normally on m andibular teeth. Arrows point to

embrasure spaces. A, Central and lateral incisors. B, Central and lateral
incisors and canine. C, Lateral incisor, canine and first premolar.
The lingual height of contour on a permanent mandibular second

molar is located:

• in the cervical third
• in the occlusal third
• at the junction of the cervical and middle thirds
• at the junction of the middle and occlusal thirds

Part I-Volum e 13-© 2017
” *From the cervical line, the crown bulges outward reaching the height of contour at the middle third. It then
slopes more sharply inward toward the apex of the mesial lingual or distal lingual cusp tip. In contrast on the
buccal, the height of contour is much lower and is reached almost immediately after the cervical line in the
cervical or gingival third of the tooth.
The location of the crest of curvature (height of contour) on the facial (or buccal) and lingual surfaces of the
crowns of teeth can be seen from the mesial and distal aspects, and are usually in one of two places:
1. In the cervical third of the crown on:
- Facial (or buccal) surfaces of all anterior and posterior teeth (maxillary and mandibular)
Lingual surfaces of all anterior teeth (maxillary and mandibular) on the cingulum
2. In the middle third of the crown on:
» Lingual surface of maxillary and mandibular posterior teeth
Schematic drawings of curvatures labially, buccally, and lingually.

A, Normal curvatures as found on maxillary molar. Arrow shows
theoretical path of food during mastication. B, If molar shows little
or no curvature, there is possibility for food impaction. C, Molar
with curvature in excess of normal. The significance of such an
excess in curvature has not been firmly established. D, Normal
cervical curvatures as found on maxillary incisors. The crests of
curvature are opposite each other labiolingually. E, Curvatures as
found on mandibular posterior teeth.
Which of the following teeth has its mesial contact located within the
incisal or the occlusal one third?
• maxillary first molar
• mandibular second premolar
DENTAL ANATOMY & OCCLUSION ® *d en tald ecks

Part I •Volume 13 *© 2017
• m andibular central incisor
The mesial surface of the mandibular central incisor contacts the mesial surface of the
other mandibular central. They contact in the incisal third. All mandibular incisors
contact with each other or with the mesial of the canine within the incisal third.
Remember: M axillary teeth - 1J, JM, JM, MM, MM, MM, MM, M
M andibular teeth - II, II, IM, MM, MM, MM, MM, M
Outline drawings of the maxillary teeth in contact, with dotted lines bisecting the
contact areas at the various levels as found normally. Arrows point to embrasure
spaces. A, Central and lateral incisors. B, Central and lateral incisors and canine. C,
Lateral incisor, canine and first premolar.
Contact levels found normally on m andibular teeth. Arrows point to embrasure

spaces. A, Central and lateral incisors. B, Central and lateral incisors and canine. C,
Lateral incisor, canine, and first premolar.
What is the location of facial height of contour of the anterior and

posterior teeth?
• occlusal third
• lingual third
• middle third
• cervical third

• cervical third
Height of contour, or the crest of curvature, is the greatest bulge of the
crown of a tooth either incisocervically or occlusocervically. The facial or lingual
height of contour is the point that rests on the outline of a crown where a line
parallel to the long axis of the tooth touches the greatest elevation.
The location of the facial crest of curvature on most crowns (both anterior
and posterior teeth) is located in the cervical third. The lingual crest of
curvature for the anterior teeth rests in the cervical third on the cingulum
while the lingual crest of curvature on posterior teeth lies in the middle
third.
Importance of height of contour:
Height of contour helps to determine the direction in which the food morsel
would be deflected. These bulging contours divert the food away from the
thin free gingiva and gingival sulcus, thus preventing gingival trauma. The
gingiva is more likely to be damaged in cases of inadequate heights of
contour. The dentist and hygienist must reproduce height of contour while
restoring a tooth with fillings, or while replacing a lost tooth with a fixed partial
denture or dental implant.
miscellaneous 39
Concrescence is a type of fusion of the adjacent teeth through the

deposition of alveolar bone.
Hypercementosis involves excessive deposition of cementum around
the root which becomes continuous with the normal cementum of the
root.


• the firs t statem ent is false, the second is true
C oncrescence is a type of fusion of the adjacent teeth at the root through the depo sition o f cem entum . This fusion
takes place after the completion of root formation. Concrescence can occur either before or after the eruption of teeth. Its
diagnosis can be confirmed by radiographic examination.
Concrescence is more often seen in the maxillary and posterior regions, e.g., roots of the second molar that lie in close
proximity of the adjacent impacted third molar.
The e tiology of concrescence can be developm ental (because of close proximity of teeth or crowding during
development that result in the resorption of the interdental bone and cemental union of the teeth) or post inflam m atory
(because of cementum deposition as a part of the repair process following the inflammatory damage of the roots due to
carious lesion).
Note: It is essential for the dentist to rule out concrescence before extraction, as the extraction of one tooth may result in
the extraction of an adjacent tooth.
H ypercem entosis (cemental hyperplasia) is the deposition of excessive cementum around the root of the tooth in
continuation with the normal cementum of the root. The condition may be isolated, affect multiple teeth, or present as a
generalized state.
Factors associated with an increased frequency of hypercementosis are:
• Local factors such as abnormal trauma to occlusion, inflammatory conditions (pulpal, periapical, and periodontal),
teeth without opposing counterparts (impacted, embedded teeth), and process of repair of vital fracture of root.
• System ic facto rs such as pituitary gigantism, acromegaly, arthritis, calcinosis, Paget disease of bone, rheumatic
fever, hypothyroidism, Gardner syndrome, etc.
Radiographically, the tooth demonstrates thickening or blunting of the root with radiolucent periodontal ligament space
and an intact lamina dura.
Note: Patients with hypercementosis generally require no treatment. But hypercementosis can pose a problem for the
dentist during extraction of the tooth involved. In such instances, sectioning of the tooth is done to aid in its removal.
H ypercem entosis C oncrescence

miscellaneous 40
All of the following are variations from normal anatomy in the oral
cavity EXCEPT one. Which one is the EXCEPTION?
• mandibular tori
• exostoses
• plica fimbriata
• linea alba

• plica fimbriata
Torus mandibularis is a bony outgrowth (exostosis) on the lingual surface of
the mandible above the mylohyoid line. It is usually a bilateral condition, but
unilateral incidences are also reported. These protuberances can be single or
multiple, and appear as radiopaque masses on periapical radiographs.
Mandibular tori vary in size and are covered in oral mucosa.
Tori grow slowly and are asymptomatic. They may appear lobulated or nodular,
show surface clefting, and may contact each other at the midline. The
presence of mandibular tori can pose several problems such as interference
with speech, difficulty in oral hygiene procedures, radiographic film placement,
as well as in fabrication mandibular denture. The treatment of choice for
removal of mandibular tori in such cases is surgery.
Exostoses are a variation from the normal anatomy of the alveolar process of
the maxillary arch, seen as overgrowth of bone covered by oral mucosa. It is
usually present on the buccal surface of the maxillary arch and located in the
maxillary premolar to molar region, below the mucobuccal fold.
Clinically, they are seen as small nodular excrescences of bone over which
the mucosa shows blanching. Exostoses range from single to multiple
protuberances, as unilateral or bilateral raised areas. They appear in dental
radiographs as radiopaque areas and may interfere in the radiographic
analysis, and in restorative and periodontal therapy.
Linea alba is a white ridge of calloused (hyperkeratinized) tissue on the
buccal mucosa and tongue perimeter. It extends horizontally at the level of
occlusion of the maxillary and mandibular teeth. It is mostly caused by
clenching of teeth and may be indicative of certain oral parafunctional habits.
Generally, no treatment is necessary.
Note: Plica fimbriata is a normal anatomy on the underside of the tongue
present as fringelike projections lateral to the deep lingual veins.
miscellaneous 41
Which of the following is the loss of tooth structure from non

mechanical means?
• attrition
• abrasion
• ankylosis
• erosion

• erosion
Erosion is the loss of tooth structure from non-mechanical means. It can result from
drinking acidic liquids or eating acidic foods. It is common in bulimic individuals as a result
of regurgitated stomach acids. It affects smooth (especially lingual) and occlusal surfaces.
Attrition is the wearing away of enamel and dentin from the normal function or, more
commonly, from excessive grinding of teeth together by the patient (bruxism). The most
noticeable effects of attrition are polished facets, flat incisal edges, discolored surfaces of
teeth, and exposed dentin. Facets usually develop on the linguoincisal of the maxillary
central incisors, the facioincisal of the mandibular canines, and the linguoincisal of the
maxillary canines.
Types of abrasion:
• Toothbrush abrasion: most often results in V-shaped wedges at the cervical margin
in the canine and premolar areas. It is caused by the use of a hard toothbrush and/or
a horizontal brushing stroke and/or a gritty dentifrice.
• Occlusal abrasion: results in flattened cusps on all posterior teeth and worn incisal
edges. It is caused by chewing or biting hard foods or objects or chewing tobacco.
miscellaneous 42
Agents (chemicals) that are capable of causing developmental

abnormalities in utero are called teratogens. For each numbered
teratogen listed below, select the most closely linked effect from the
list provided.
1. Aspirin, valium, dilantin, A. Microcephaly

and cigarette smoke (hypoxia) B. Central mid-face discrepancy
2. Cytomegalovirus, toxoplasma C. Premature suture closure
3. Ethyl alcohol D. Cleft lip and palate
4. Rubella virus E. Microcephaly, hydrocephaly,
5. X-radiation microphthalmia
6. Vitamin D excess F. Microphthalmia,
cataracts, deafness

• 1. D, 2. E, 3. B, 4. F, 5. A, 6. C
Agents (chemicals) that are capable of causing developmental abnormalities
in utero are called teratogens. The particular type of fetal development
problem is related to not only the type of teratogen but also the time at which
the teratogen interacts with the fetus. Since most organogenesis occurs
during the first three months of gestation, this first trimester (weeks 0-13) is
the time of greatest sensitivity to teratogenic activity.
T e r a to g e n s A f f e c t in g D e n t o f a c ia l D e v e lo p m e n t
T e r a to g e n s E ffe c t
A s p ir in , v a liu m , d ila n tin . a n d cig a re tte C le ft lip a n d p a la te

s m o ke (h y p o x ia )
C y to m e g a lo v iru s , to x o p la sm a M ic r o c e p h a ly , h y d ro c e p h a ly , m ic ro p h th a lm ia
E th y l a lc o h o l C e n tra l m id -fa c e d iscrep an cy
R u b e lla v iru s M ic r o p h th a lm ia , cataracts, deafness
X - r a d ia t io n M ic r o c e p h a ly
V it a m in D excess P re m a tu re suture closure

miscellaneous 43
As you know, there are several kinds of teeth in the human mouth.
They all serve different functions. You are in an argument with your
friend, a law student, and you test his vocabulary. You call him a
____________ , which simply means he has teeth with different
morphologies and functions.
• polyphyodont
• monophyodont
• heterodont
• diphyodont

• heterodont
***Hetero means “different” - odont means “tooth” = “different teeth”
Human dentition is also described as diphyodont - to produce two sets of
teeth (primary and permanent).
Other terms to know:
• “Monophyodont dentition” = having one set of teeth
• “Polyphyodont dentition” = teeth continually being replaced (fish,
amphibians, and reptiles)
• “Homodont dentition” = teeth are all alike
• “Hypsodont” = long teeth
• “Carnivore” = flesh eating
• “Herbivore” = vegetable eating
• “Omnivore” = mixed diet
miscellaneous 44
A 12-year-old boy comes to your dental office with missing maxillary

lateral incisors and mandibular second premolars. The child is said to
have which of the following condition?
• anodontia
• oligodontia
• hypodontia
• hyperdontia

• hypodontia
Anodontia, which may be partial or total, is a rare condition in which some or
all of the teeth are missing. It may involve both the primary and permanent
dentitions. This rare condition is often associated with hereditary ectodermal
dysplasia.
Hypodontia is absence of one or more teeth (fewer than six teeth, not
including third molars) while oligodontia is absence of more than six
permanent teeth. The teeth may be absent unilaterally or bilaterally.
Hypodontia and oligodontia are common conditions as compared with
anodontia. Third molars, maxillary lateral incisors, and mandibular
second premolars are the most commonly affected teeth.
Congenitally missing deciduous tooth is not a common finding but when
encountered, the commonly missing tooth is the maxillary lateral incisor. Other
deciduous teeth that may be congenitally missing are mandibular lateral
incisors and mandibular cuspids.
Hyperdontia is the presence of teeth in addition to the normal series. They
exist as either supplemental teeth (extra teeth that resemble in shape or form
to an adjoining permanent tooth) or as supernumerary teeth (exist as
mesiodens, which are small conical teeth, or as tuberculate in the maxillary
midline). Pronounced hyperdontia in the permanent dentition can be seen in
cleidocranial dysplasia.
miscellaneous 45
A child has maxillary incisor protrusion, an anterior open bite,

crowded lower anteriors, and a high palatal vault. Which of the
following most likely caused this problem?
• mouth breathing
• thumb sucking
• tongue thrusting
• using a pacifier
• nocturnal bruxism
dental ANATOMY & OCCLUSION i*d e n ta ld e c k s

• th u m b s u c k in g ( o r a n y o th e r s u c k in g h a b it)
The pressure of the thumb against the palate and maxillary teeth during the growth and development
of the teeth and oral cavity can cause anterior open bite and overjet, labial flare of the maxillary
anterior teeth, and a high palatal vault. N o te : Most of the time the anterior open bite is a s y m m e tr ic a l
with normal posterior occlusion.
Open bite relationships are characterized by fa ilu re of the teeth in both arches to meet properly. Open
bites may be observed in the anterior or posterior region and may be attributable to supraeruption of
the adjacent teeth or infraeruption of the teeth in the area in question. In a d d itio n to th u m b s u c k in g ,
open bites may be caused by deviant growth patterns or a forward tongue position.
N o te : Anterior o p e n b ite s are much more common in African Americans than Caucasians, whereas
d e e p b ite s are much more common in Caucasians.
Persistent lo n g -te rm thumb sucking may also result in:
• Protrusion of maxillary incisors
• Rotation of maxillary lateral incisors
• Constriction of the maxillary arch
• Class II malocclusions
• Lingual inclination of mandibular incisors
R e m e m b e r: M o u th b re a th in g typically presents clinically as the gingiva of the facial aspect of the
maxillary anterior being red, edematous and bleeding easily. The affected area is widest in the midline
and tapers laterally, the remaining gingivae are normal.
Anterior open bite can also be associated with tongue
thrust. The patient shown here has a very prominent
open bite secondary to a tongue thrust swallowing
cattern (note the position of the tongue).
miscellaneous 46
A patient of yours has enamel hypocalcification. You would expect

_____quantity of enamel and would describe it as
• less than normal; hard

• less than normal; soft
• normal; soft
• normal; hard
• more than normal; hard
• more than normal; soft

• normal; soft
*** Enamel hypocalcification is a hereditary dental defect in which the enamel of the
teeth is soft and undercalcified in context yet normal in quantity (qualitative enamel
problem).
This condition is caused by defective maturation of ameloblasts (defect in
mineralization of the formed matrix). The teeth are chalky in consistency, the surfaces
wear down rapidly, and a yellow to brown stain appears as the underlying dentin is
exposed. This condition affects both the deciduous and permanent teeth.
Enamel hypoplasia is a developmental dental defect in which the enamel of the
teeth is hard in context but thin and deficient in amount (quantitative enamel
problem). It is caused by defective enamel matrix formation with a deficiency in
the cementing substance. There is a lack of contact between teeth, rapid breakdown
of occlusal surfaces, and a yellowish-brown stain that appears where the dentin is
exposed. The condition, which affects both the deciduous and permanent teeth, can
be transmitted genetically or caused by environmental factors, as with vitamin
deficiency, fluorosis, or metabolic disturbances during the prenatal period. It is a
common sequela in a child with a history of generalized growth failure in the first
six months of life. Hypoplastic areas on teeth are seen if a child has illnesses in early
childhood.
Note: Hypoplastic enamel, which is a dental manifestation of hypoparathyroidism,
can be prevented by early treatment with vitamin D.
Fluorosis is the condition that results from excessive, prolonged ingestion of
fluoride. Typically causes mottled discoloration and pitting of the enamel of
permanent and deciduous teeth.
t i M
Enamel hypocalcification Fluorosis with mottled enamel Enamel hypoplasia

miscellaneous 47
Which of the following teeth have the most variability in form?
• mandibular first premolars

• maxillary first molars
• mandibular second molars
• maxillary lateral incisors
• maxillary second premolars

The maxillary lateral incisors have the greatest variability in form of the entire
dentition with the exception of the third molars. Since the form of the tooth
varies more than the others listed, the maxillary lateral would more commonly
be in misalignment with the adjacent central and canine.
If the variation is too great, it is considered a developmental anomaly. A
common situation is to find maxillary lateral incisors with a nondescript,
pointed form; such teeth are called peg-shaped laterals (see photo below on
right).
One type of malformed maxillary lateral incisor has a large, pointed tubercle as
part of the cingulum (see photo below on left); some have deep developmental
grooves that extend down on the root lingually with a deep fold in the
cingulum; and some show twisted roots, distorted crowns, and so on.
miscellaneous 48
A mental foramen would be found on x-ray closest to the root of

which tooth?
• 19
• 14
•2 9
•2 2
•4

•2 9
The mental foramen carries the mental nerve, artery and vein through the mandible
onto the skin overlying the mandible from the midline to the first premolar area. It also
innervates buccal soft tissue and periosteum in the same area, as well as portions of
the lowerlip. The foramen is seen on x-ray as a lucent oval or circle most often near
the apex of the mandibular second premolars. Important: It is possible in some cases
to confuse the foramen with periapical pathology.
The mental foramen has been shown to be located at practically the same level on
most humans (13-15 mm superior to the inferior border of the mandible). In a study of
40 skulls, the mental foramen was found to be:
• Under the apex of the first premolar - never
• Between the apices of the first and second premolars - 40%
• Directly under the second premolar - 42.5%
• Distal to the apex of the second premolar - 17.5%
The mental foramen (arrow over apex of the

second premolar) may simulate periapical
disease. Continuity of the lamina dura around
the apex, however, indicates the absence of
periapical abnormality.
miscellaneous 49
Match the dim ensions of an anterior tooth on the left with their respective
descriptions on the right.
1. Length of crown A. From the crest of curvature on the

2. Length of root mesial surface to the crest of curvature on
the distal surface
3. Mesiodistai diameter of crown
B. From the junction of the crown and
4. Mesiodistai diameter of crown at the root on the labial surface to the junction of
cervix the crown and root on the lingual surface
5. Labiolingual diameter of crown C. From the junction of the crown and
6. Labiolingual diameter of crown at the root on the mesial surface to the junction
cervix of the crown and root on the distal
surface
D. From the crest of curvature on the
labial surface to the crest of curvature on
the lingual surface
E. From the crest of curvature at the
cementoenamel junction to the incisal
edge
F. From the apex to the crest of curvature
at the crown cervix
DENTAL ANATOMY & OCCLUSION !*d en tald ecl<S

• 1.E, 2.F, 3.A, 4.C, 5.D, 6.B
The dimensions of an anterior tooth can be measured with a Boley gauge.
The long axis of the tooth should be kept vertical.
1. Length of the Measured from the crest of curvature at the
crown/Labial surface of cementoenamel junction (CEJ) to the incisal
the crown edge.
2. Length of the root Measured from the apex of the root (root tip) to the
crest of curvature at crown cervix.
3. Mesiodistal diameter Measured from the crest of curvature on the

mesial surface to the crest of curvature on the
of the crown
distal surface.
4. Mesiodistal diameter Measured from the junction of the crown and root
of the crown at the on the mesial surface to the junction of crown and
cervix root on the distal surface.
Measured from the crest of the curvature on the
5. Labiolingual diameter
labial surface to the crest of curvature on the
of the crown
lingual surface.
Measured from the junction of the crown and root
6. Labiolingual diameter on the labial surface to the junction of the crown
of the crown at the and root on the lingual surface.
cervix
Note:
Root-to-crown ratio: The root-to-crown ratio is the length of the root divided
by the crown length. This ratio is normally greater than one as roots are
longer than crowns.
mandibular movements/positions 50
Pure rotation of the mandible involves which two planes of

movement?
• frontal
• horizontal
• sagittal

• fr o n ta l
• s a g itta l
The m a n d ib le is moved in a number of planes:
1. Up and down (frontal plane)
2. Side to side (horizontal plane)
3. Forwards and backwards (sagittal plane)
The vertical axis of rotation can be better visualized when
onelooks at a composite of rotation because lateral rotation
actually occurs around the lateral pole of the rotating condyle. As
rotation occurs, the orbiting condyle must travel down the slope of
the eminence. The medial pole of the rotating side must also
travel down its slope but for a lesser distance. Because the
condyles load against inclines, a pure vertical rotation is not
possible without being combined with a sagittal rotation of the
working-side condyle.
F iv e fa c to r sof mandibular movement:

1. In itia tin g p o s itio n (centric relation) 4. D e g re e o f m o v e m e n t
- Most stable and most easily reproduced
position 5. C lin ic a l s ig n ific a n c e o f m o v e m e n ts
2. T y p e s o f m o tio n
- Each patient may have different
relationships
- Rotation
- Translation
3. D ire c tio n o f m o tio n (planes)
- Frontal
- Sagittal
- Horizontal
Border movements are the limits to which the mandible can move,
where as functional movements generally occur within the border
movements.
The maximum opening movement is 50 to 60 mm, depending on the
age and size of the individual.

DENTAL ANATOMY & OCCLUSION l*d en tald e cl< S

Part I - Volume 1 3-© 2017
1. Unassisted normal maximum lateral Hinge axis
movements are considered to be
about 10 to 12 mm.
2. The maximum protrusive movement
is approximately 8 to 11 mm.
3. The retrusive range is about 1 mm.
4. Chewing function takes place
usually within a few millimeters of
the ICP or CO.
5. This diagram represents Posselt's
envelope of motion.
Schematic representation of mandibular movement envelope In the

sagittal plane CR, Centric relation; CO, Centric occlusion; F, Maximum
protrusion; R, Rest position; E, Maximumopening; Bto CR, opening and
closing on hinge axis with no change in radius (r).
Remember:
1. If the mandible is held back and up by either the patient or the operator, a hinge
movement can be traced for the lower incisors from CR to B. This movement, called
the terminal hinge movement of the mandible, maintains a stationary rotation axis
through the two temporomandibular joints; this axis is usually located in the condyles.
2. The anterior border movement of the mandible is from F to E.
Note: Food is masticated primarily in lateral contacting movement.
In the natural dentition, centric occlusion is, in a majority of people,
_____to centric relation contact and on the average approximately
____mm.
• posterior; 2
• anterior; 1
• medial; 2
• lateral; 1

• anterior; 1
Right mandibular movement with schematic
representation of movement at the incisal
point in the horizontal plane (CR, LL, P, RL)
and at the condyle (W, C, B, P) made by a
pantograph. Teeth are not in occlusion. CR,
centric relation; LL, left lateral; P, protrusive;
RL, right lateral; CO, centric occlusion; IEC,
incisal edge contact. On the right side, the
condyle moves from C (centric) to right
working (W). On the balancing side, the left
condyle moves from C along line B and
makes an angle BG, called Bennett angle.
C to P, Straight protrusive movement.
In lateral movements, the condyle appears to rotate with a slight lateral shift in the
direction of the movement. This movement is called the Bennett movement and may have
immediate as well as progressive components. If a point (the incisive point) located
between the incisal edges of the two mandibular central incisors is tracked during maximal
lateral or protrusive movements, in retrusive movement, and wide opening movement,
such movements take place within a border or envelope of movements (Posselt).
Functional and parafunctional movements take place within these borders. However, most
functional movements, such as those associated with mastication, occur chiefly around
centric.
During sleep, the mandible is in its physiologic rest or postural
position. The contact of teeth is:
• maximum
• not present
• premature
• slight

Part I - Volume 1 3-© 2017
• n o t p re s e n t
This position results when the mandible and all of its supporting muscles (four paired muscles of
mastication plus the supra- and infrahyoids) are in their resting posture. The term used to describe this
absence of contact is “fr e e w a y s p a c e ” or “ in te r o c c lu s a l d is ta n c e ." The interocclusal space with the
mandible in rest position and head in upright position is about 1 to 3 mm at the incisors but has
considerable normal variance even up to 8 to 10 mm without evidence of dysfunction.
R e m e m b e r: When the teeth are in centric occlusion (intercuspal position), the position of the
mandible in relation to the maxilla is determined by the in te r c u s p a tio n of the teeth.
Physiological
rest position
1-3 mm
Which of the following masticatory muscles is the principal positioner
of the mandible during elevation?
• the temporalis muscle

• the digastric muscle
• the geniohyoid muscle
• the lateral pterygoid muscle
DENTAL ANATOMY & OCCLUSION H ^dentaldecks

• the temporalis muscle
The temporalis is the masticatory muscle that is the principal positioner of
the mandible during elevation. It is a fan-shaped muscle that originates in
the temporal fossa and inserts into the coronoid process of the mandible
and along the anterior border of the mandibular ascending ramus.
The temporalis muscle performs three main actions:
1. Elevation of the mandible
2. Retrusion of the mandible (posterior part)
3. Helps in lateral excursion of the mandible
The anterior part of the muscle along with the masseter helps in clenching.
Deep temporal branches from the mandibular division of the trigeminal
nerve (fifth nerve) innervate the temporalis muscle.
Note: Functions of other muscles of mastication are as follows:
Muscle of mastication Functions
Protrusion, elevation, and lateral positioning of the
Medial pterygoid
mandible
Protrusion, depression, and lateral positioning of
Lateral pterygoid
the mandible
Elevation, protrusion, and lateral positioning of
Masseter
mandible
A dental patient is complaining of unilateral jaw pain when chewing.
You notice that she only chews on her right side. When a mandibular
movement to the right is performed, which condyle moves forward,
downward, and medially?
• working condyle (right)

• non-working condyle (left)

• n o n - w o r k in g c o n d y le ( le ft)
Lateral movement of the mandible is referred to as tr a n s tr u s io n . This movement has
two components:
1. L a te r o tr u s io n - the lateral movement of the working or rotating condyle
2. M e d io tru s io n - the medial movement of the balancing or non-working condyle
In a lateral movement the balancing n o n - w o r k in g c o n d y le goes downward, forward, and medially.
The w o r k in g c o n d y le moves laterally (generally rotating about a vertical axis and translating laterally).
Since the mandible is a solid bone, the amount that the non-working condyle moves medially
determines how far the working condyle moves laterally. This lateral movement is known as B e n n e tt
M o v e m e n t (Bennett Movement is always with the working condyle, Bennett angle is always with the
non-working condyle).
R e m e m b e r:
1. W o r k in g s id e is the side that the mandible m o v e s to w a r d in a lateral excursion.
2. N o n - w o r k in g s id e is the side that the mandible m o v e s a w a y from during a lateral excursion.
3. The b a la n c in g s id e c o n d y le refers to the left condyle during a right lateral jaw movement and the
right condyle during a left lateral jaw movement.
Right side contact relations of maxillary and
mandibular molars; A , Right working side. B,
Centric occlusion (intercuspal position). C , Non
working side
Which of the following modalities can be used to treat symptoms of

malocclusion by changing the shape of the teeth? Select all that
apply.
• occlusal equilibration
• full-mouth rehabilitation
• orthodontic treatment

• occlusal equilibration
•full-mouth rehabilitation
Occlusal equilibration and full-mouth rehabilitation techniques are used to
treat symptoms of malocclusion by changing the shape of the teeth.
Occlusal equilibration is a process that involves occlusal reshaping of
enamel. The dentist adjusts the occlusal and incisal shape of the teeth with
the help of dental handpiece and revolving burs or stones to remove some
enamel at tooth prematurities. To ensure the maintenance of natural
positioning of the mandible and TMJ, an occlusal equilibration should be
preceded by making the patient wear a maxillary device for 1 to 6 weeks.
Occlusal equilibration should be frequently monitored and reevaluated to
ensure that the teeth are in sync with the physiologically relaxed joints.
Full-mouth rehabilitation is another method to perfect the occlusion and
contours of teeth that are not overtly out of alignment. In this technique, most
teeth are restored with fixed partial dentures or crowns to perfect the occlusion,
which in turn also improves the esthetics.
Note: Orthodontic treatment is an example of changing the physical location
of the teeth to treat the malocclusion by improving alignment of the teeth.
During a right working side movement, the right side molar teeth may
contact along the buccal inclines of the maxillary buccal cusps and
the lingual inclines of the mandibular buccal cusps.
Mandibular protrusion will result in the mesiolinguai cusp of the
maxillary first molar passing through the central groove toward the
distal marginal ridge of the mandibular molar.


From the basic contact relations occurring in maximum intercuspation, potential tooth contacts
occur when the mandible moves laterally and protrusively:
• In a normal alignment, the ML cusp of the maxillary first molar opposes the central fossa of
the mandibular first molar.
• From this position, the ML cusp will pass through the lingual groove when a working side
movement occurs. During a non-working side movement, the same cusp will oppose the
distobuccal groove.
• Mandibular protrusion will result in the ML cusp passing through the central groove toward
the distal marginal ridge of the mandibular molar.
A similar pattern exists for mandibular movements as related to the anatomy of maxillary
posterior teeth.
• The DB cusps of the mandibular first molars oppose the central fossa of the maxillary first
molars.
• During a working side movement, the DB cusp will pass through the buccal groove of the
maxillary molar. During a non-working side movement, the DB cusp will oppose the maxillary
ML cusp.
• Maxillary supporting cusps and the mandibular supporting cusps oppose each other during
non-working side movements. ***Look at card #55, picture C on back.
• Protrusive movements result in the mandibular DB cusp passing through the maxillary
central groove toward the mesial marginal ridge.
During a right working side movement, the right side molar teeth may contact along the lingual
inclines of the maxillary buccal cusps and the buccal inclines of the mandibular buccal cusps.
***Look at card #55, picture A on back. Likewise, the lingual inclines of the maxillary lingual
cusps may contact the buccal inclines of the mandibular lingual cusps. For the non-working
side (left side), contact is also possible along the buccal inclines of the left maxillary lingual cups
and the lingual inclines of the left mandibular buccal cusps.
Remember:
1. In the intercuspal position, the mesiobuccal triangular ridge of the maxillary first molar
opposes the mesiobuccal groove of the mandibular first molar.
2. in a working side movement (right or left), the oblique ridge of the maxillary first molar
passes through the distobuccal sulcus of the mandibular first molar.
3. In a working side movement (right or left), the mesiobuccal cusp of the maxillary second
molar passes through the buccal groove of the mandibular second molar.
M axillary
M a n d ib u la r
M — B uccal cu sp o f d ie m d 1st p rem o lar o ccludes w ith th e M e s ia l marginal n d g e o f th e m x 1st prem olar
O — B u cca l c u sp o f the a id . 2 n d p re m o la i occludes w ith th e O c c lu sa l em b rasu re o f th e m x . 1 st an d 2 n d p rem olars
O — M e s io b u c c a l cusp o f th e md. 1st m o lar occludes w ith th e O c c lu s a l em b ra su re o f the m x 2nd p rem olai an d m \. 1st m o lar
C — D istc b u c c a l c u sp o f th e m d. 1st m olar occlu d es w ith the C e n tra l fo ssa o f th e n i x 1st m olai
O — M esio b u cc al cu sp o f the m d. 2 n d m olar o ccludes w ith the O c c lu s a l em b rasu re o f the m x . 1st and 2 n d m olars
C — D isto b tic cal c u sp o f th e m d. 2 n d m o lar occludes w ith th e C entral fo ssa o f th e m x 2 n d m o la r
D — L in g u al c u s p o f the m x 1 st p iem o lar occludes w ith th e D is ta l max ainal rid g e o f th e m d 1st p iem olar
D — L in g u al c u s p o f th e m x 2 n d p re m o la r occlu d es w ith th e D ista l m arginal rid g e o f th e m d 2nd p rem olar
C — M e sio lin g u .il cusp o f th e m x 1 s t m o lar occludes w ith th e C e n tra l fossa o f th e m d 1st m olar
O — D isto lm g u a l cusp o f th e m x. 1st m o lar o cclu d es w ith the O c c lu sa l em brasure o f the m d. 1st a n d 2 n d m olars
C'— M e a o lin g u a l cu sp o f th e m x 2nd molai- o cc lu d es w ith th e C e n tra l fo ssa o f th e m d. 2nd m o lar
O — D isto lm g u a l cusp o f th e m x 2 n d m olar o ccludes w ith th e O c c lu sa l em b rasu re o f th e m d 2 n d and 3rd m o lars ( i f present)
Retrusive movement requires the condyles to move backward and
upward.
In protrusive movement, the condyles of the mandible have moved in
a downward and forward direction.


• b o th s ta te m e n ts a re tr u e
P r o tr u s iv e m ovem ent is accomplished when the mandible is moved straight forward until the
maxillary and mandibular incisors contact e d g e -to -e d g e . This movement is bilaterally symmetrical in
that both sides of the mandible move in the same direction. N o te : Incisors are most likely to fracture
(i.e., restorations involving the incisal edge break off) during protrusive movements.
1. Occlusal contact possibilities occur on m a x illa ry d is ta l inclines and m a n d ib u la r
m e s ia l inclines.
2. Anteriorly the facial surface of the lower incisors will contact the guiding inclines
(lingual) of the upper incisors and canines.
3. In protrusive movement, the condyles of the mandible have moved in a d o w n w a r d
and fo r w a r d direction. N o te : P u re tr a n s la t io n is performed as the mandible moves
from a p u re p r o t r u s iv e m o v e m e n t from maximum intercuspal position to a maximum
protruded position.
4. R e tr u s iv e movement requires the condyles to move b a c k w a r d and u p w a r d .
D istal M e s ia l
M e s ia l Distal
Projected protrusive, working, and balancing side paths on maxillary and
mandibular first molars made by supporting cusps, that is, mesiolingual cusp
of the maxillary molar projected on the mandibular molar and distobuccai cusp
of the mandibular molar on the maxillary molar.
In regards to the picture below, the arrows indicate the path of

_______ movement of mandibular teeth over the maxillary teeth on
th e _______ side.
• right lateral; working

• left lateral; working
• right lateral; non-working
• left lateral; non-working

le ft la te ra l; n o n - w o r k in g
Arrows indicate path of left lateral movement of

mandibular teeth over the maxillary teeth on non
working side. Note the relationship of paths to mor
phological features of the teeth and embrasures.
N o te : An easy way to remember if arrows are indicating w o r k in g s id e movements is to remember that

arrows will be relatively s tr a ig h t, pointing buccal (if right working) or lingual (if left working). For n o n
w o r k in g the arrows will be s la n te d , pointing buccal (if right non-working) or lingual (if left non-working -
as in the picture above).
In these movements the mandible is moving toward the right or left side. The side to w a r d which the
mandible moves is referred to as the w o r k in g s id e . The side fr o m which the mandible is moving is
referred to as the n o n - w o r k in g s id e .
W o r k in g s id e c o n ta c t: cusp tips pass between opposing cusp tips.
N o n - w o r k in g s id e c o n ta c t (interfering contact): the contact takes place on the distal of the maxillary
inclines and on the mesial of the mandibular inclines. The contact area possibilities here are u n iq u e
because they involve the inner aspects of supporting cusps only. This is the only time that the inner
inclines of the supporting cusps can contact outside the intercuspal position.
L a t e r o tr u s iv e m o v e m e n t: contacts of teeth made on the side of the occlusion toward which the
mandible has been moved. Also called w o r k in g m o v e m e n t.
M e d io tr u s iv e m o v e m e n t: contacts of the teeth on the side opposite to the side toward which the
mandible moves in articulation. Also called n o n - w o r k in g m o v e m e n t.
Anterior guidance is a result of:
• horizontal and vertical overlap

• vertical and posterior cusp height
• horizontal overlap and posterior cusp height
• intercondylar distance and free way space
• intercondylar distance and postural vertical dimension

• horizontal and vertical overlap
Anterior guidance (anterior coupling) is the guidance provided by the anterior teeth
when the mandible goes into a lateral or protrusive movement. It is determined by
the vertical overlap of the anterior teeth, termed overbite, and the horizontal
overlap of the teeth, which is overjet.
This overlapping relationship produces disclusion of the posterior teeth when the
mandible protrudes and moves to either side.
Ovvrjol Ovurbifu
Both the condylar guidance at the back and the

anterior guidance at the front should determine
the functional pathways of the mandible. The pos
terior teeth should contact in centric relation but
should be disduded when the mandible moves
from centric relation. Posterior teeth must not In
terfere with condylar guidance or anterior guid
ance during functional jaw movement.
In a patient with a left canine protection, the mesiolingual surface of
the maxillary right first molar contacts the distofacial surface of the
mandibular right first molar during a left lateral excursion. This
contact is:
• normal
• evidence of group function
• a working side interference
• a nonworking side interference
• normal, and a nonworking side interference
DENTAL ANATOMY & OCCLUSION ifcdentaldecks

• a n o n w o r k in g s id e in te r fe re n c e
Left c a n in e p r o t e c tio n refers to the left side contact of the canine during a left w o r k in g m o v e m e n t.
All other teeth of the left side are out of contact at this point. In a left g r o u p fu n c tio n , some left
anterior teeth, the left canine and some left posterior teeth would contact during left side w o r k in g
m o v e m e n t. In all cases of left working movement, however, the right side or nonworking side teeth
a re n o t in contact. So in this case, any or all right side or nonworking side contacts are in te r fe re n c e s
and are not normal.
/\
i
A, Right lateral movement: non-working side.

Multiple working srde contacts (group function}.
8, Right lateral movement: canine (cuspid) guid
ance on working side.
A, Patients left side showing (eft working side contacts (group function) and schematic of work ing side occlusal
contacts and guiding inclines in left lateral movement. 8, Patients right side showing non-working side occlusal
contacts and guiding inclines. Nonworking contacts are not necessary except in complete dentures.
molar teeth information 62
An endodontist is performing root canal therapy on a permanent

maxillary first molar. Since he is a very thorough endodontist, he
knows he should look for a fourth canal. Which root of a maxillary
first molar commonly has two root canals?
• the palatal root

• the distobuccal root
• the mesiobuccal root

• the mesiobuccal root
The maxillary first molar usually has three roots and four canals. The palatal root usually has
the largest dimensions. The mesiobuccal root is often very wide buccolingually.
In approximately 60% of maxillary first molar teeth, a fourth root canal is present with its orifice
being just lingual to the orifice to the mesiobuccal canal. The canal is located in the
mesiobuccal root and may join the mesiobuccal canal or exit through a separate foramen.
The pulp horns are usually prominent in this tooth. The mesiobuccal and mesiolingual (if
present) are higher than the distofacial and palatal pulp horns. This should be kept in mind during
operative procedures.
Note: In all molars, root canals join the pulp chamber apical to the cementoenamel junction.
Maxillary Right
First Molar
Meslodistal
cross-section
BuccoRngual
cross-section
Pulp Cavity
© <$)
®
Cervical Midroot
cross-section cross-section
All of the following teeth show bifurcation from the root trunk
EXCEPT one. Which one is the EXCEPTION?

• mandibular second molar
• maxillary second premolar

Part I • Volume 13-© 2017
The root trunk in a multi-rooted tooth divides into distinct roots at an area
called furcation. The area is termed bifurcation in a two-rooted tooth, and
trifurcation in a three-rooted tooth.
The teeth that show bifurcation most often are the maxillary first premolars
and mandibular molars.
The root of the maxillary first premolar bifurcates in the apical third into two
roots: buccal and lingual. In most instances, the lingual root is slightly shorter
than the buccal root. The maxillary first premolar is unique in having a deeper
mesial-side longitudinal root depression as compared to the distal surface.
Mandibular molars have two roots (mesial and distal). Buccally, the root of a
mandibular first molar bifurcates approximately 3 mm below the cervical line
while lingually, the bifurcation starts at approximately 4 mm below the cervical
line. Mandibular second molars also bifurcate below the cervical line.
Typically, a mandibular third molar also has two roots, which may branch
out at a definite point of bifurcation, or may be fused partly or for their entire
lengths.
Note: The maxillary second premolar has a single root and does not show
bifurcation. The single root of the maxillary second premolar is longer than that
of the first premolar.
During a surgical extraction of the maxillary first molar, a rough oral

surgeon accidentally perforates the maxillary sinus. If he perforated
the sinus with one of the roots of the first molar, which root is the
most likely candidate, given that it is the largest, longest, and
strongest of the three roots?
• mesiobuccal
• distobuccal
• palatal

• palatal
*** The distobuccal is the smallest.
The palatal root of a maxillary first molar is the third longest root (13 mm) of any of
the maxillary teeth, after the maxillary canine (17 mm) and second premolar (14 mm)
roots. It is wider buccolingually than mesiodistally (as are all maxillary molars) and
has a longitudinal depression on the lingual. It is concave on its buccal surface.
When viewed from the facial, this root apex is in line with the buccal groove.
Remember: On the maxillary second molars, the roots are much less divergent
than the roots of a first molar. The palatal root is straighter than the palatal root of
the first molar.
Note: During oral surgery if a root is forced into the maxillary sinus it is usually the
root of a permanent maxillary first molar.
Maxillary Right First Molar Maxillary Right Second Molar
Buccal Lingual Buccal Lingual

From a developmental viewpoint, all mandibular molars have__

major cusps, whereas maxillary molars have only______major
cusps.
•6 ; 5
•5 ; 4
•4 ; 3
• 3; 2
DENTAL anatom y & OCCLUSION ifrd e n ta ld e c k s

•4 ; 3
Permanent mandibular molars can be distinguished from permanent
maxillary molars by the following:
• When viewed from the occlusal, mandibular molars appear rectangular,
maxillary molars appear rhomboidal
• Mandibular molars have two roots, maxillary molars have three roots
• Mandibular molars have pits and grooves on the occlusal and buccal
surfaces; maxillary molars have pits and grooves on the occlusal and
lingual surfaces
• Mandibular molars are wider mesiodistally than faciolingually; this is the
opposite of maxillary molars, which are wider faciolingually
• Mandibular molars have two nearly equal-sized lingual cusps; maxillary
molars have one large and one small lingual cusp
• Mandibular molars have a transverse ridge; maxillary molars have an
oblique ridge, which extends from the mesiolingual to the distobuccal
cusps
Remember: The oblique ridge is formed by the union of the distal cusp
ridge of the mesiolingual cusp and the triangular ridge of the
distobuccal cusp.
• When examined from the mesial or distal sides, mandibular molar crowns
appear to be tilted lingually (an arch trait; true for all mandibular teeth).
This is not apparent on maxillary molars. Mandibular molar crowns also tip
distally relative to the long axis of the root.
Important:
As a result of this decided lingual inclination:
1. The height of contour of the crown is lowered apically to the middle third.
2. The placement of instruments subgingivally is more difficult on the lingual
side.
A fissured groove is most frequently found on the:
• facial surface of maxillary molars

• lingual surface of maxillary molars
• facial surface of mandibular molars
• lingual surface of mandibular molars

Part I •Volume 13 *© 2017
• lingual surface of maxillary molars
It is called the lingual developmental groove. Due to its presence, occlusal cavity
preparations often need to be extended onto the lingual surface.
This groove originates at an occlusal pit and terminates in a pit on the lingual
surface.
Maxillary Right
Lingual developmental
Second Molar
groove
Lingual view
Remember: The parotid duct is the duct that conveys saliva from the parotid gland
to the mouth at the level of the maxillary second molar. It is also called Stenson's
duct.
The photo below is a cervical cross section of the pulp cavity of a:

• mandibular first molar
• maxillary second molar

m a n d ib u la r f ir s t m o la r
Im p o r ta n t p o in ts about mandibular molar roots:
• Two pulp canals are usually, if n o t a lw a y s , found in the m e s ia l root. The distal root usually has only
one canal.
• If a cross section is made just apical to the bifurcation of the roots of a m andibular molar, the larger,
kidney-shaped canal is found in the d is ta l root and the smaller, more circular canals are found in the
m e s ia l root
• The MB canal c u r v e s m o re than the ML canal
• The m e s ia l r o o t is typically very thin mesiodistally, much wider faciolingually, and concave on both
the mesial and distal surfaces
• The distal pulp horn is the s m a lle s t
• The pulp horn on the m e s ia l (facially and lingually) is higher than that on the distal (this needs to be
kept in mind during operative procedures)
M a n d i b u la r R ig h t
F irs t M o la r
P u lp C a v ity
Mesiodlstal Buccolingual
Cervical Midroot
A dental student is performing root canal therapy on an extracted

maxillary molar in her preclinical endodontics course. Her pre
operative radiograph shows four canals (two canals in the MB root).
She should expect the shape of the floor of the pulp chamber in this
maxillary molar to be roughly:
• square
• rhomboidal
• triangular
• circular

triangular
Maxillary Right First Molar Maxillary Right Second Molar
Cervical Cervical
Whether there are three root canals or four root canals (as seen often times with the
maxillary first molar), the orifice of each major canal serves as a corner of the pulp
chamber. Therefore, the shape of the pulp chamber is roughly triangular. The base is
formed by the buccal canals and the apex is formed by the palatal canal. Note: The
line connecting the mesial canal with the palatal canalis the longest.
The cervical outline form of the pulp cavities in maxillary first and second molars is
rhomboidal with rounded corners (see pictures above). The MB angle has an acute
angle, the DB angle is obtuse, and the lingual angles are essentially right angles.
The photo below is a buccolingual section of the pulp cavity of a:
• a mandibular right first molar

• a mandibular right second molar
• a mandibular right third molar

a mandibular right first molar
Meitedlltol BuccoUnguol
cross-soction cfsiMKNon
Mandibular Right First Molar Maxillary Right First Molar
Mcsiodistol BuccoUnguol
cross-secllon cross sccllon
Mandibular Right Second Molar Maxillary Right Second Molar
/rf\
jl [Li
\w /'
Maslodistol BuccoUnguol Moslodlslal BuccoUnguol
cross-secHan cross-section cross-section
Mandibular Right Third Molar Maxillary Right Third Molar

From a mesial or distal aspect, all mandibular posterior teeth have a:
• triangular outline
• square outline
• rectangular outline

Part I • Volume 1 3-© 2017
From a mesial or distal view, the crown outline of a mandibular posterior tooth is rhomboidal in shape and
tilts toward the lingual. Because of this lingual inclination, the mandibular molars have long axes positioned with
their root apices facial and their crowns lingual. Note: This design encourages cusp fracture.
Outlines of crown forms within geometric outlines - triangle, trapezoids, and rhomboids. The upper figure in
each square represents a maxillary tooth, the lower figure a mandibular tooth. Note that the trapezoidal outline
does not include the cusp form of posteriors actually. It does include the crowns from cervix to contact point
or cervix to marginal ridge, however. This schematic drawing is intended to emphasize certain fundamentals. A,
Anterior teeth, mesial or distal (triangle). B. Anterior teeth, labial or lingual (trapezoid). C. Premolars, buccal
or lingual (trapezoid). D, Molars, buccal or lingual (trapezoid). E, Premolars, mesial or distal (rhomboid). F,
Molars, mesial and distal (rhomboid).
The distoiingual cusp on the permanent maxillary molars is also

called a:
• cusp of Carabelli
• talon cusp
• dens evaginatus
• trigone

talon cusp
The distolingual cusp on permanent maxillary molars generally is the one that gets progressively
smaller as you go posterior in the arch. This is the most obvious characteristic that
distinguishes permanent first, second, and third molars from each other.
Remember: For maxillary molars, the primary cusp triangle (also called the “trigon”) is formed
by the ML, MB, and DB cusps (large shaded area in center of tooth in picture below). The DL
cusp is called the talon cusp and is not a part of this primary cusp triangle. The talon cusp
might be absent on maxillary second and third molars. Note: A cusp present abnormally is also
called a talon cusp. Sometimes a fifth cusp, the Cusp of Carabelli, is located on the ML cusp of
maxillary molars.
M esio b uccal M ax illa ry rig ht first molar, occlusal aspect.
cusp ridge
MBCR, mesiobuccal cusp ridge; CF, central fossa;
C entral fossa MTF, mesial triangular fossa (shaded area); MMR,
M esial triangular mesial marginal ridge; MLCR, mesiolingual cusp
lossa
ridge; OR, oblique ridge; DLCR, distolingual cusp
M esial m arginal
ridge ridge; DF, distal fossa; DTF, distal triangular fossa
Mesloftngual (shaded area); DMR, distal marginal ridge; DBCR,
cusp ridge
distobuccal cusp ridge. Note: The prim ary cusp
trian g le is the large shaded area in center of
tooth.
M axillary right first molar, occlusal aspect, de

C e n tra l pH
B u c c a l g ro o v e of
velopmental
, K
grooves.
y ,
BG, buccal
,
groove;
‘-6" y , ^
BGCF,
c ’ US3' * ' ;
Transverse g ro o v e
c e n tr a l fossa buccal groove o f central fossa; CGCF, central
of o b liq u e rid g e C e n tra l g ro o v e of groove o f central fossa; FCG, fifth cusp groove;
LG, lingual groove; DOG, distal oblique groove;
TGOR, transverse groove of oblique ridge; CP,
Fifth c u s p g ro o v e c e n t r a | p it i
A dentist is completing a disto-occlusal restoration on a permanent

maxillary first molar. He is carving the distal marginal ridge. He
makes sure to give it width for support and must round it to create an
embrasure. In order to get the correct height occlusocervically, he
should match the distal marginal ridge of the maxillary first molar to
the:
• mesial marginal ridge of the maxillary second premolar

• mesial marginal ridge of the mandibular first molar
• mesial marginal ridge of the maxillary second molar
• distal marginal ridge of the maxillary second premolar

• mesial m arginal ridge of the m axillary second molar
***The marginal ridges of a tooth (M or D) are the same height as the tooth in proximal
contact to it (M or D).
Important: When restoring the marginal ridges of posterior teeth, remember to round
them off to form occlusal embrasures and keep them wide enough for strength.
Remember: Marginal ridges are elevations of enam el that form the mesial and distal
margins of the occlusal surface of the molars and premolars. They also form the
mesial and distal margins of the lingual surfaces of the incisors and the canines.
Maxillary right central incisor (lin g u a l a s p e c t). CL, M esial v ie w o f maxillary right first premolar. MR,
c erv ica l line; Cl, c in g u lu m (also c a lled lin g u o c e rv ic a l m arg in a l ridge; S, sulcus traversing occlusal surface;
ridge); MR, m a rg in a l ridge; IR, incisal ridge; LF, lingual CR, cusp ridge; BCR, b u ccocervical ridge.
fossa.
How many roots are visible from the buccal aspect of a maxillary first
molar?
• one root
• two roots
• three roots
• four roots

• three roots
M a x illa r y R ig h t
1. The palatal, which is the longest
2. The mesiobuccal F irst M o la r
3. The distobuccal, which is the shortest Buccal V ie w
The two buccal roots are well separated and bent in such a way that they look like the handles
on a pair of pliers. The axes of the roots are inclined distaliy. This is in contrast to the roots of
a second molar, which are often close together and less curved. The palatal root often has
concavities both facially and lingually.
Remember: Molar roots originate as a single root at the base of the crown (called a root trunk)
near the cementoenamel junction. The furcation is the place on multirooted teeth where the root
trunk divides into separate roots (bifurcation on two-rooted and trifurcation on three-rooted
teeth).
1. The mesial furcation is closest to the cervical line, while the distal is the farthest
from the cervical line.
2. There is a deep developmental groove buccally on the root trunk of the maxillary
first molar. It starts at the bifurcation and terminates at the cervical line.
Remember: The distal surface of the root trunk has a concavity which requires
special attention when root planing.
3. During surgical removal of the maxillary first molar, be careful not to force root tips
into the maxillary sinus.
muscles 74
Fibers from the ventral ramus of Cl travel with the hypoglossal nerve
(CN XII) to the geniohyoid and thyrohyoid.
Fibers from the ventral rami of C1-C3 combine to form the ansa
cervicalis, which gives off branches to the omohyoid, sternohyoid,
and sternothyroid.


The infrahyoid muscles are depressors of the larynx and the hyoid bone.
These muscles are often referred to as strap muscles due to their ribbon-like
appearance. They lie between the deep fascia and the visceral fascia covering
the thyroid gland, trachea, and esophagus.
Infrahyoid muscles
M uscle O rig in In s e rtio n I n n e rv a tio n A ction
O m o h y o id S c a p u la (s u p e rio r H y o id b o n e A n sa c e rv k a lis o f D e p r e s s e s ( f e e s ) h y o i d d ra w s
(in fe rio r b e lly ) b o rd e r, m e d ia l to c e rv ic a l p le x u s ( C l - C i ) la ry n x a n d h y o id d o w n f o r
s u p r a s c a p u la r n o tc h ) p fe o n a tio n a n d te r m in a l p h a s e s
o f s w a llo w in g
S te rn o h y o id M a n u b riu m a n d
s te rn o c la v ic u la r
jo i n t (p o s te rio r
s u rfa c e )
S te rn o th y ro id M a n u b r iu m T h y r o id
( p o s te r io r s u r f a c e ) c a rtila g e
(o b liq u e
lin e )
T h y r o h y o id T h y ro id c a rtila g e H y o id b o n e V e n tra l ra m u s o f C l v ia D e p r e s s e s a n d f e e s h y o id ;
c n x h ra is e s th e la ry n x d u rin g
s w a llo w in g
Note: These muscles anchor the hyoid bone and depress the hyoid and larynx
during swallowing (deglutition) and speaking.
muscles 75
Which of the following suprahyoid muscles are innervated by the
facial nerve?
• mylohyoid muscle
• anterior belly of digastric muscle
• posterior belly of digastric muscle
• stylohyoid muscle
• geniohyoid muscle
DENTAL ANATOMY & OCCLUSION l*d e n ta ld e c l< s

Part I • Volume 1 3 * © 2017
posterior belly of digastric muscle
• stylohyoid muscle
S u p r a h y o i d M um-I
M u sc le O rig in In s e rtio n I n n e rv a tio n A ctio n

G e n io h y o id M a n d ib le (in f e rio r V e n tra l ra m u s o f C l v ia D r a w s h y o id b o n e t o w a r d
g e n ia l s p in e ) C N X II ( d u rin g s w a llo w in g ): a s s is ts in
o p e n in g th e m a n d ib le
M y lo h y o id M a n d ib le M y lo h y o id n e rv e ( fro m l ig h te n s a n d e le v a te s o ra l llo o r;
(m y lo h y o id lin e ) CN V 3) d r a w s h y o id b o n e fo rw a rd
( d u rin g s w a llo w in g ): a s s is ts in
o p e n in g th e m a n d ib le a n d m o v
H y o id b o n e
in g it s id e t o s id e ( m a s tic a tio n )
D ig a s tric M a n d ib le E le v a te s h y o id b o n e (d u rin g
( a n te rio r b e lly ) (d ig a s tric f o s s a )) s w a llo w in g ) ; a s s is ts in
d e p re s s in g t h e m a n d ib le
D ig a s tr ic T e m p o ra l b o n e F a c ia l n e rv e ( C N V II)
( p o s te rio r b e lly ) (m a s to id n o tc h )
S ty lo h y o id T e m p o ra l b o n e
( s ty lo id p r o c e s s )
1. The geniohyoid and mylohyoid muscles form the floor of the mouth.
2. The digastric, mylohyoid, and geniohyoid muscles are active during jaw
opening.
3. The suprahyoid muscles act as antagonists to the elevator muscles.
4. Voluntary mandibular retrusion with the mouth closed is brought about by
contraction of the posterior fibers of the temporalis muscle and by the
suprahyoid and infrahyoid muscles.
muscles 76
There are two sets of lingual muscles: extrinsic and intrinsic. The
extrinsic muscles:
• alter the shape of the tongue

• move the tongue as a whole
• all originate from the mandible
• are all innervated by the hypoglossal nerve

• m o v e th e to n g u e a s a w h o le
M uscles o f th e l ongue
M u s c le Origin Insertion Innervation Action
E x t r i n s i c l in g u a l m u s c le s
Gemoglossus Mandible (superior Inferior fibers: hyoid body Hypoglossal Protrusion o f tongue
genial | mental j nerve
spine via an intet - Intermediate fibers; Bilaterally: makes dorsum
mediate tendon); posterior tongue concave
more posteriorly the Unilaterally: deviation to
two gemoglossi are Superior fibers: ventral opposile side
separated by the surface of tongue (mix with
lingual septum intrinsic muscles)
Hyoglossus Hyoid hone (greater Lateral tongue, between Depresses the tongue
cornu and anterior styloglossus and inferior
binly) longitudinal muscle
Styloglossus Styloid process of 1.ongitudinul part: dorsolateral Superior and posterior
tempoi ill bone tongue (mix with inferior movement o f the tongue
(anterolateral aspect longitudinal muscle)
o f apex) and stylo
mandibular ligament Oblique part, mix with
fibers of the hyoglossus
Pulntoglossus Palatine aponeurosis Lateral tongue to dorsum and Vagus nerve via Elevates the root of the
(oral surface) fibers of the transverse muscle the pharyngeal tongue: closes the
plexus oropharyngeal isthmus by
contracting the
palatoglossal arch
I n t r i n s i c l i n g u a l m u s c le s
Superior rhm layer o f muscle inferior to the dorsal mucosa, llypoglossul Shortens tongue; makes
longitudinal fibers run anterolateral ly from the epiglottis and nerve dorsum concave (pulls
median lingual septum apex and lateral margin
upward)
Inferior Thin layer o f muscle superior to the genioglossus Shortens tongue; makes
longitudinal and hyoglossus. libers run anteriorly lirom the root to dorsunt convex (pulls apex
the apex o f the tongue down)
Transverse Fibers rtm laterally hunt the lingual septum to the Narrows tongue;
muscle lateral tongue elongates tongue
Vertical In the anterior tongue, libers run interiorly liom the Widens and flattens longue
muscle dorsum of the tongue to its ventral surface
muscles 77
Which muscle presses the cheek against molar teeth, working with
the tongue to keep food between the occlusal surfaces and out of the
oral vestibule?
• zygomaticus major
• depressor labii inferioris
• buccinator
• levator anguli oris

• buccinator
Muscle Origin Insertion Innervation Main action (s)

Note:
Zygoma (reus Zygomatic bone Muscles *1 the Z Pulls comer o f mouth superiorly and
ma tot angle of the laterally
mouth
Innervation - The
Zysoinatictis Upper lip just intlls upper lip superiorly
muscles of facial
ituuor medial to comer expression are
of mouth
innervated by six
BZ
Levator labii
Mipci intis
Maxilla (fioulal
process)
Upper lip and
aim cartilage of
Elevates upper lip: flares nostril branches of the
nlncquc nasi facial nerve. The
Lcvatot labii Maxilla (frontal Skin o f upper lip Elevates upper lip posterior muscles
superioru process)athl in-
frmitbtMl mat gin
are innervated by
Depressor labii Mandible (.anterior Pulls lower lip infexiody and laterally,
the posterior
Lower lip at M
inferimis portion o f oblique midlme also contributes to eversion (pouting) auricular (PA) nerve,
line) which arises before
Levator augiili
oris
Maxilla (canine
lbs'*, below
Muscles at tlie
angle of tlie
B’Z Raises angle o f nioutli, lielps form
nasolabial furrow
the facial nerve
infraorbital mouth enters the parotid
foramen) gland. The anterior
Depressor angnli Mandible (oblique
line. Movv canine,
Skin at comer of
inontli; blends
B/M Pulls angle o f month infcriorly and
laterally
muscles are
premolarand 1st with orbicularis innervated by five
molar teeili) oris
branches of the
Buccinator Alvcolai process of
maxilla and inaudi
Lips, orbicularis
oris, stibmucosa
B Presses check against molar teeth, work
ing with tongue to keep food between
parotid plexus of
ble (by inolais): of lips and cheek occlusal surfaces and out o f oral vestibule the facial nerve:
pteiygouiaudibulai Temporal (T),
raphe Unilateral draws mouth to one side
Orbicularis oris Deeps surface of Mucous B/M Acts as oral sphincter
zygomatic (Z),
skin membrane of ConqHcsscs and protrudes lip (e g., buccal (B),
Superiorly Maxilla lips whistling, sucking, kissing) mandibular (M), and
Infetiotly Mandible
Risorius fascia and superfi Skin at comer of B Retracts comer o f mouth as in smiling,
cervical (C).
cial muscles over mouth laughing, grimacing
ntasseter
Mentalis Frcnuliun of lower Skin o f chin M Elevates and protrudes lower lip
lip (drinking)
Platysma Skin over lower Mandible (' Depresses and wrinkles skin of lower
neck (inferior border) face and mouth: tenses skin of neck
muscles 78
A new patient comes in with a history of malignant cancer. When the

patient opens, the mandible deviates to the left. You suspect a tumor
blocking nervous innervation to which muscle?
• right medial pterygoid

• left medial pterygoid
• right lateral pterygoid
• left lateral pterygoid

Part I • Volume 13*© 2017
*** Important: The m andible will alw ays deviate to the side of injury.
Remember: If the hypoglossal nerve becom es dam aged from injury o r a tum or, the
tongue will also deviate noticeably toward the affected side.
L a te ru o id M u s c le s
M uscle O r ig in I n s e r t io n In n e rv a tio n A c tio n
L a te ra l S u p e r io r G r e a t e r w in g o f M a n d ib le M a n d ib u la r n e r v e ( a n te r io r n ila te r a l: P ro tru d e s th e
p te r y g o id (u p p e r ) h e a d s p h e n o id b o n e (p te r y g o id fo v e a ) d iv is io n o f C N V 3 ) v ia m a n d ib le (p u lls d is k
( i n f r a te m p o ra l c r e s t) and TM J la te ra l p te r y g o id n e r v e fo rw a rd )
( a r tic u la r d is k ) U n ila te r a l: L a te ra l
m o v e m e n ts o f th e
In f e r io r L a te r a l p te ry g o id M a n d ib le
m a n d ib le ( c h e w in g )
( lo w e r ) h e a d p la te (la te ra l s u rf a c e ) (p te r y g o id fo v e a
a n d c o n d y la r
p ro c e s s )
M e d ia l S u p e rf ic ia l M a x i l l a (m a x illa r y P te ry g o id rugosity- M a n d ib u la r n e r v e (a n te r io r E le v a te s ( a d d u c ts ) th e
P te ry g o id ( e x te rn a l t u b e r o s ity ) an d o n m e d ia l s u rf a c e d iv is io n o f C'N V 3 ) v ia m a n d ib le
head) p a la tin e b o n e o f th e m a n d ib u la r m e d ia l p te ry g o id n e r v e
( p y r a m id a l p ro c e s s ) a n g le
D eep M e d ia l s u rf a c e o f
(i n te rn a l) la te r a l p te ry g o id
head p la te a n d p tc iy g o id
fo s s a
Note: W ith a fracture of the con dylar neck, the condylar head rem ains in the
m andibular fossa due to the tem porom andibular ligament. This ligam ent is the main
stabilizing ligam ent of the TM J. It originates from the lateral surface of the zygom atic
arch and a tubercle on its low er border, and is directed obliquely dow nw ard and
backward to insert into the posterior border and lateral surface of the neck of the
mandible. This ligam ent restricts dow nw ard and po sterio r m ovem ent of the m andible
and guides the forw ard m otion of the condyle during opening.
muscles 79
After seating a new crown on tooth #19 you need to check excursive
movements. You ask the patient to slide her jaw to the right to make
sure there are contacts on #19 during this movement. What muscle
does the patient use to move her jaw like this?
• right medial pterygoid

• left medial pterygoid
• right lateral pterygoid
dental a nato m y & OCCLUSION l^ d e n ta ld e c k s

Lateral excursions (moving the jaw sideways) result from the contraction of one lateral
pterygoid muscle on the opposite side.
T h e M u s c le s o f M a s tic a tio n w ith A s s o c ia te d M o v e m e n ts o f th e M a n d ib le
M u s c le s o f M a s tic a tio n M o v e m e n ts o f t h e M a n d ib le
M a ss e te r • E le v a tio n o f th e m a n d ib le ( d u rin g j a w c lo s in g )
T e m p o ra lis • E le v a tio n o f th e m a n d ib le ( d u rin g j a w c lo s in g )

• R e tra c tio n o f th e m a n d ib le ( lo w e r ja w b a c k w a r d )
M e d ia l p te r y g o id • E le v a tio n o f th e m a n d ib le ( d u r in g j a w c lo s in g )
L a te ra l p te ry g o id • O n e m u s c le : la te ra l d e v ia tio n o f th e m a n d ib le ( to
s h if t th e lo w e r ja w to th e o p p o s ite s id e )
• B o th m u s c le s : p r o tr u s io n o f th e m a n d ib le (p u lls
a rtic u la r d is k fo rw a rd )
Important: Protrusion (protruding the jaw) results only from the simultaneous contraction of
both lateral pterygoids. This produces forward movement of the condyle from the mandibular
fossa (articular fossa). They do not need assistance for this movement.
Unilateral contraction deviates the mandible to the contralateral (opposite) side. Contraction
of the muscle on alternating sides produces the side-to-side motion required for grinding food.
Closing the mouth (elevating the mandible) results from the bilateral contraction of three pairs
of muscles:
1. The anterior (vertical) fibers of the right and left temporalis muscles
2. The right and left masseter muscles
3. The right and left medial pterygoid muscles
muscles 80
Retrusion (retruding the jaw) results from:
• the bilateral contraction of the anterior (vertical) fibers of the temporalis

muscle
• the bilateral contraction of the posterior (horizontal) fibers of the temporalis
muscle
• the unilateral contraction of the anterior (vertical) fibers of the temporalis
muscle
• the unilateral contraction of the posterior (horizontal) fibers of the
temporalismuscle

Part I - Volume 13-© 2017
• the bilateral contraction of the posterior (horizontal) fibers of the tem poralis
muscle
Retrusion results from the bilateral contraction of the posterior (horizontal) fibers of
the tem poralis m uscle. T hey are assisted by the suprahyoid m uscles, specifically the
anterior and posterior bellies of the digastric muscles.
M asse te r and T e m p o ra lis Mi
M u s c le O r ig in I n s e r tio n In n e rv a tio n A c tio n
M a s s e te r S u p e rfic ia l Z y g o m a tic b o n e M a n d ib u la r an g le M a s s e te ric n erv e E le \ a te s m a n d ib le

h ea d (m a x illa r y p ro c e s s ) a n d ra m u s (in fe rio r (a n te rio r d iv isio n
a n d z y g o m a tic arch la te ra l su rfa c e ) o f C N V 3)
( la te ra l a s p e c t o f
a n te rio r tw o -th ird s )
M id d le Z y g o m a tic arch M a n d ib u la r ra m u s
head ( m e d ia l asp e c t o f (c e n tra l p a rt o f
a n te rio r tw o -th ird s) o c c lu sa l su rfa c e )
D e ep Z y g o m a tic arch M a n d ib u la r ra m u s
head ( d e e p s u rf a c e o f ( s u p e rio r lateral
p o s te rio r th ird ) su rfa c e ) a n d in fe rio r
c o r o n o id p ro c e ss
T e m p o r a lis S u p e rfic ia l T e m p o r a l fo ssa C 'o ro n o id p ro c e s s o f D e e p te m p o ra l V e rtic a l (a n te rio r) fib ers:

head m a n d ib le (a p e x , n e r v e (a n te rio r e le v a te s m a n d ib le
m e d ia l s u rf a c e , a n d d iv isio n o f C N H o riz o n ta l (p o s te rio r) fib ers:
D eep head T em p o ral fo ssa a n te r io r su rfa c e o f V 3) re tra c ts (re lru d e ) m a n d ib le
( in f e rio r tem p o ra l m a n d ib u la r ra m u s) U n ila te ra l: la te ra l m o v e m e n t
lin e ) o f m a n d ib le (c h e w in g )
Opening of the jaw (depression of the m andible): The lateral pterygoids do this by
pulling the articular discs and the condyles anteriorly and down onto the articular
em inences. In opening the ja w or depressing the m andible, the lateral pterygoids are
assisted by the an terio r bellies of the digastric m uscles (which are suprahyoid
m uscles) and the om ohyoid m uscles (which are infrahyoid m uscles). T hese m uscles
help fix or hold the hyoid bone.
occlusion information 81
A 22-year-old female dental student comes into your dental practice
for a regular check-up. She states that she has never had any
problems with her teeth, and upon examination you notice that only
one pair of teeth seem to have contact during lateral movements of
the mandible. Which teeth should ideally provide the predominant
guidance through the full range of movement in lateral mandibular
excursions?
• premolars
• first molars
• incisors
• canines

• c a n in e s
This is called c a n i n e or c u s p i d p r o t e c t e d o c c l u s i o n . It is an occlusal relationship in which the
vertical overlap of the maxillary and mandibular canines produces a disclusion (separation) of all
of the posterior teeth when the mandible moves to either side. All other teeth, once they move
from centric relation, d o n o t c o n t a c t . If there is contact of other teeth, it is termed a " w o r k i n g
s id e " or " n o n - w o r k i n g s i d e " interference depending on which side the mandible moves toward.
G r o u p f u n c t i o n (sometimes called unilateral balanced occlusion) is an occlusal relationship in
which there is contact of one or more teeth on the working side during a lateral working
movement.
A, Right lateral movement: non-working side. A, Patients left side showing left w orking side contacts
M ultiple working side contacts (group function). (group function) and schematic of w orking side oc
B, Right lateral movement: canine (cuspid) guid clusal contacts and guiding inclines in left lateral move
ance on w orking side. ment. B, Patient's right side showing non-working side
occlusal contacts and guiding inclines. Nonworking
contacts are not necessary except in com plete den
tures.
1. Some relationships a r e n o t conducive to cuspid protected occlusion, such as
Class II or end to end relationship.
2. Some relationships a r e n o t amenable to group function, such as Class II, deep
vertical overlap.
3. Regardless of what lateral concept is used, it is essential to have n o n o n - w o r k i n g
s i d e c o n t a c t s (except in complete dentures) because:
° They are damaging
° They are difficult to control due to mandibular flexure
° They deliver more force to the teeth than other contacts
In an ideal intercuspal position, the mesiobuccal cusp of the

permanent maxillary first molar opposes the:
• the distobuccal groove of the mandibular first molar

• the buccal groove of the mandibular second molar
• the mesiobuccal groove of the mandibular first molar
• the developmental groove between the distobuccal and the distal cusps of
the mandibular first molar

• th e m e s io b u c c a l g r o o v e o f th e m a n d ib u la r f i r s t m o la r
Normal intercuspation of
maxillary and mandibular
teeth.
y u
A. First molars (buccal as
pect).
B. First molars (mesial as
pect).
C. First molars (distal aspect)
m
Im p o r ta n t:
• The m e s io b u c c a l cusp (specifically, the tr ia n g u la r rid g e of the M B cusp) of the m a x illa r y fir s t
m o la r opposes the m e s io b u c c a l g r o o v e of the m a n d ib u la r f i r s t m o la r. This relationship is a key
factor in the definition of Class I occlusion.
• The d is to b u c c a l cusp of the m a x illa ry fir s t m o la r opposes the d is t o b u c c a l g r o o v e of the
m a n d ib u la r f ir s t m o la r. N o te : This distobuccal groove also serves as an escapeway for the M L
c u s p of the maxillary first molar during non-working excursive movements.
• When the mandible moves to the right, the M L c u s p o f th e m a x illa r y r ig h t f ir s t m o la r passes
through the lin g u a l g r o o v e of the mandibular right first molar.
• The o b liq u e rid g e of the m a x illa ry f ir s t m o la r opposes the d e v e lo p m e n ta l g r o o v e between the
d is to b u c c a l and d is ta l cusps of the m a n d ib u la r f i r s t m o la r.
R e m e m b e r: The maxillary b u c c a l (facial) and the mandibular lin g u a l cusps are g u id in g cusps. The
inner occlusal inclines leading to these cusps are called g u id in g in c lin e s because in contact
movements they guide the supporting cusps away from the midline. Thus, there are b u c c o - o c c lu s a l
inclines (lingual inclines of the buccal cusps) of the maxillary posterior teeth and lin g u o - o c c lu s a l
inclines (buccal inclines of the lingual cusps) of the mandibular posterior teeth.
Identify the following pictures of dental arch relationships as being

either Class I, Class II Div I, Class II Div. II, or Class III.
A B C D
DENTAL ANATOMY & OCCLUSION iM e n ta ld e c k s

A = Class II Div II
In the Class II relationship, the maxillary arch is positioned mesially, with the
mesiobuccal cusp above or approaching the embrasure between the mandibular first
molar and the second premolar. In addition, the maxillary canine is seated anterior to
the mandibular canine. The Angle Class II Division II incisors are retroclined and
have less anterior overjet, but a deeper vertical overbite, than Class II Division I.
B = Class III
In the Class III relationship, the mandibular first molar is mesial to the maxillary first
molar and there is concomitant mandibular prognathism reflected in the patient
profile. The mandibular arch is displaced mesially or the maxillary arch is displaced
distally, with the mesiobuccal cusp of the maxillary first molar occluding distal to the
buccal groove of the mandibular first molar.
C = Class I
In the Class I relationship, the mandibular first permanent molar is slightly anterior
to the maxillary first permanent molar. If there are no irregularities elsewhere, this
would be termed a Class I occlusion. If there were irregularities elsewhere, it would
be termed a Class I malocclusion. The Class I relationship is a normal permanent
molar relationship. In this condition the mesiobuccal cusp of the maxillary first molar
is placed over the buccal groove of the mandibular first molar. In addition, the
maxillary canine is placed in the embrasure between the mandibular canine and the
first premolar in a normal canine relationship.
D = Class II Div I
In the Class II relationship, the maxillary arch is positioned mesially, with the
mesiobuccal cusp above or approaching the embrasure between the mandibular first
molar and the second premolar. In addition, the maxillary canine is seated anterior to
the mandibular canine. The Angle Class II Division I incisors normally display
excessive anterior overjet.
An archaeologist consults a dentist about some findings he had on a

dig. The teeth the archeologist finds have four cusps - two of them
taller and pointed, two of them shorter, rounded, and dull. The dentist
tells the archaeologist that these teeth are similar to our human
molars. The broader, more rounded cusps are:
• non-supporting and working

• supporting and balancing
• supporting and working
• non-supporting and balancing

supporting and working
Five com m on characteristics of supporting cusps:
1. They contact the opposing tooth in the intercuspal position
2. They support the vertical dim ension of the face
3. They are nearer the faciolingual center of the tooth than the non-supporting
cusps
4. Their outer incline has a potential fo r contact
5. They have broader, m ore rounded cusp ridges than non-supporting cusps
Remember: The supporting cusps are the m axillary lingual cusps and the
m andibular buccal cusps. T hese cusps do grinding work because they occlude in a
fossa or m arginal ridge and are also called w orking cusps. T hey are som etim es
called centric cusps because the y hold the occlusion in a m iddle position (centric
position).
The non-supporting cusps are the maxillary buccal cusps and the m andibular
lingual cusps. T hese cusps do not occlude or fit into fossae or m arginal ridge areas
and are called balancing or non-centric cusps. These cusps allow the dentition to
move apart, out of occlusion. T hey allow the teeth to “ unlock” and m ove back and forth
and side to side.
N o n -su p p o rtin g cusps S u p p o rtin g Cusps
-< M a x illa ry R ight

First M o lar
t \
S u p p o rtin g Cusps
/ \
N o n -su p p o rtin g Cusps
Which permanent teeth occlude with only one tooth in the opposite
jaw, assuming ideal relations exist?
• maxillary canines
• maxillary central incisors
• mandibular central incisors
• mandibular third molars

• mandibular central incisors
• Oppose the maxillary central incisors only (right or left)
• Will also contact the maxillary incisors in protrusive and lateral protrusive
movements
Important: In an ideal intercuspal position, the distoincisal aspect of the
mandibular central incisor opposes the lingual fossa of the maxillary central
incisor,
Normally a tooth has contact with two teeth in the opposing arch. The only
exceptions are the lower central incisors and the upper third molars. In the
mandible, a tooth is situated more mesially and lingually than its counterpart in
the maxilla. Accordingly, each mandibular tooth in the intercuspal position
contacts two maxillary teeth (its class counterpart and the tooth immediately
mesial to it. For example, the mandibular first molar makes contact with the
maxillary first molar and second premolar).
N orm al intercu s p a tio n o f m a xil

lary a nd m a n d ib u la r teeth.
A. Central incisors (labial aspect).
B. C entral incisors (m esial as
pect).
A B
In an ideal intercuspal position, the facial cusp tip of a maxillary

first premolar opposes the:
• facial embrasure between the mandibular first and second premolars

• facial embrasure between the mandibular second premolar and the
mandibular first molar
• opposing central fossa
• opposing mesial marginal ridge

• facial embrasure between the mandibular first and second premolars
Remember: The facial cusp tips of permanent maxillary premolars oppose the
facial embrasure between their class counterpart and the tooth distal to it.
Examples:
1. The facial cusp tip of a maxillary first premolar opposes the facial embrasure
between the mandibular first and second premolars (see note below).
2. The facial cusp tip of a maxillary second premolar opposes the facial embrasure
between the mandibular second premolar and mandibular first molar.
Important: For further explanation of the above schematic refer to the illustration
for card 57.
Note: During lateral excursive movements, the facial cusp ridge of the maxillary first
premolar on the working side opposes the distal cusp ridge of the first premolar and
the mesial cusp ridge of the second premolar.
In the intercuspal position, where does the mesiolingual cusp of a

permanent maxillary first molar occlude?
• the distal triangular fossa of first premolar

• the distal triangular fossa of second premolar
• the central fossa of the mandibular first molar
• the distal marginal ridge of mandibular first molar
DENTAL ANATOMY & OCCLUSION i*dentaldecl<S

the central fossa of the m andibular first molar
C o n t a c t s in t h e I n t c r c u s p a l P o s itio n
M a x illa ry O c c lu d e s in to A re a o f M a n d ib u la r T e e th
L in g u a l C u s p s (C la ss c o u n t e r p a r t o r c o u n t e r p a r t a n d to o th d is ta l to it)
F irs t p r e m o la r D is ta l t ria n g u la r f o s s a o f t h e firs t p r e m o la r
S e c o n d p re m o la r D is ta l t ria n g u la r f o s s a o f t h e s e c o n d p r e m o la r
F irs t m o la r
M e s io lin g u a l C e n tra l f o s s a o f t h e firs t m o la r
D is to lin g u a l D is ta l m a r g in a l r id g e o f t h e f ir s t m o la r a n d t h e m e s ia l
m a r g in a l r id g e o f th e s e c o n d m o la r
S e c o n d m o la r
M e s io lin g u a l C e n tra l f o s s a o f t h e s e c o n d m o la r
D is to lin g u a l D is ta l m a r g in a l r id g e o f th e s e c o n d m o la r a n d th e m e s ia l
m a r g in a l r id g e o f th e t h ir d m o la r
Example o f idealized cusp-fossa

relationship.
A. Mesiolingual cusp o f maxillary
first molar occludes in the cen
tral fossa of the mandibular first
molar. Distal buccal cusp of
mandibular first molar occludes
in the central fossa of the maxil
lary first molar.
B. Concept o f occlusion in which
all supporting cusps occlude in
fossae.
A
In the intercuspal position, where does the distal cusp of a permanent

mandibular first molar occlude?
• the distal triangular fossa of the maxillary second premolar

• the distal fossa of the maxillary first molar
• the central fossa of the maxillary second molar
• the mesial marginal ridge of the maxillary first molar and distal marginal
ridge of the maxillary second premolar

the distal fossa of the maxillary first molar
C o n t a c t s in th e I n t e r c i l s p a l P o s i ti o n
M a n d ib u la r O c c l u d e s i n to A r e a o f M a x i l l a r y T e e t h
B uccal C usps ( C l a s s c o u n t e r p a r t o r c o u n t e r p a r t a n d t o o th m e s i a l t o it)
F irs t p r e m o la r M e sia l t r i a n g u la r fo s s a o f th e fir s t p r e m o la r a n d d is ta l m a rg in a l r id g e o f t h e c a n in e
S e c o n d p r e m o la r M e s ia l t r i a n g u la r fo ss a o f th e s e c o n d p r e m o la r
F irs t m o la r
M c s io b u c c a l M e s ia l m a r g in a l rid g e o f th e firs t m o la r a n d th e d is ta l m a r g in a l r id g e o f th e s e c o n d p r e m o la r
D is to b u c c a l C e n tra l fo s s a o f t h e firs t m o la r
D is ta l D is ta l fo s s a o f th e firs t m o la r
S e c o n d m o la r
M e s io b u c c a l M e s ia l m a r g in a l r id g e o f t h e s e c o n d m o la r a n d t h e d is ta l m a rg in a l r id g e o f t h e firs t m o la r
D is to b u c c a l C e n tra l fo s s a o f th e s e c o n d m o la r
Example of idealized cusp-fossa

relationship.
A. Mesiolingual cusp of maxillary
first molar occludes in the cen
tral fossa of the mandibular first
molar. Distal buccal cusp of
mandibular first molar occludes
in the central fossa of the maxil
lary first molar.
B. Concept of occlusion in which
all supporting cusps occlude in
fossae.
Match the following diagrams on the left with the proper Angle's
classification on the right.
A. Class I
B. Class II
C. Class III

1.C, 2. A. 3. B
Classification of Human Occlusion (Angle's)
Class I: most common (about 70% of the population). The mesiobuccal cusp of the maxillary first molarlines
up approximately with the mesiobuccal groove of the mandibular first molar. The maxillary central incisors
overlap the mandibulars. Maxillary canine lies between the mandibular canine and first premolarmandibular
canine and first premolar.
Class II: less common (about 25%). The mesiobuccal cusp of the maxillary first molar falls approximately
between the mandibular first molar and second premolar. The lower jaw and chin may also appear small and
retruded. The mandibular incisors occlude even more posterior to the maxillary incisors so that they may not
touch at all. Maxillary canine is mesial to mandibular canine. The subclassifications of the Angle Class II
relationship are based on the position of the incisors in individuals with Class II relationships, and are referred
to as Class II Division I and Class II Division II relationships.
Class III: the least common (less than 5%). The mesiobuccal cusp of the maxillary first molar falls
approximately between the mandibular first molar and second molar. The chin may also protrude like a bull
dog's does. The mandibular incisors overlap anterior to the maxillary incisors. The maxillary canine is distal to
the mandibular canine.
A dental student is finalizing the temporary crown he fabricated for
his patient. The patient's occlusion is in an ideal relationship, and the
crown has ideal centric contacts. The student has a bad habit of
forgetting about working and balancing contacts. He does remember
the rule that he should avoid laterotrusive contacts on the guiding
cusps on posterior teeth. Which two of the following are considered
to be guiding cusps?
• maxillary lingual cusps

• maxillary buccal cusps
• mandibular lingual cusps
• mandibular buccal cusps

• maxillary buccal cusps
• mandibular lingual cusps
These cusps are also called balancing, non-supporting, non-centric or shearing cusps.
These cusps do not occlude or fit into fossae or marginal ridge areas on the opposite arch. They
allow the dentition to move apart, out of occlusion. They allow the teeth to “unlock” and move back
and forth and side to side.
Supporting cusps are the maxillary lingual cusps and the mandibular buccal cusps. These
cusps are also called working, stamp, or centric cusps. The three areas of centric contacts
or centric stops, between the two arches are height of cusp contour, marginal ridges, and
central fossae are areas of contact that a supporting cusp makes with opposing teeth. For
example, the mesial lingual cusp of the maxillary first molar (a supporting cusp) makes contact
with the central fossa (central stop) of the mandibular first molar.
Supporting cusps contact the opposing teeth in their corresponding faciolingual center on a
marginal ridge or a fossa. Non-supporting cusps overlap the opposing tooth without contacting
it.
The ideal centric stops be

tween the tw o arches are
highlighted. Note that the
stops include the height of
contour, marginal ridges,
and central fossae of the
teeth.
Note: In posterior cross-bite situations, the supporting and guiding cusps are opposite.
***The maxillary buccal and the mandibular lingual would be supporting and the maxillary lingual
and the mandibular buccal would be guiding.
In an ideal intercuspal position, the mesiolingual cusp of a

permanent mandibular molar opposes:
• the opposing central fossae

• the lingual embrasure between their class counterpart and the tooth distal
to it
• the opposing distal marginal ridge
• the lingual embrasure between their class counterpart and the tooth
mesial to it
DENTAL ANATOMY & OCCLUSION lIM e n ta ld e c k s

Part I* Volume 13 *© 2017
• the lingual embrasure between their class
counterpart and the tooth mesial to it
Examples:
1. The mesiolingual cusp of the mandibular first molar opposes the lingual
embrasure between the maxillary first molar and second premolar.
2. The mesiolingual cusp of the mandibular second molar opposes the
lingual embrasure between the maxillary second molar and first molar.
Note: The distolingual cusp of the mandibular first molar fits into (opposes)
the lingual groove of the maxillary first molar.
Remember: The lingual cusp of permanent mandibular first premolars does
not occlude with anything.
Important: During mandibular movements (working, non-working, etc.), the
outer aspects of the lingual cusps of the mandibular molars will not contact
their maxillary antagonists. All other areas of buccal and lingual cusps may
contact during mandibular movements (this is assuming that all occlusal
relationships are normal).
Note: In unilateral balanced occlusion, contact between mandibular buccal
cusps and maxillary buccal cusps, along with simultaneous contact between
mandibular lingual cusps and maxillary lingual cusps, will most likely occur in
laterotrusive movements.
The curve of Wilson is concave in the maxillary arch and convex in
the mandibular arch.
The maximum intercuspation position yields the smallest
measurement of vertical dimension.


Curve of Wilson, also known as the mediolateral curve, connects the buccal and lingual cusps of the
premolars and molars with their counterparts on the opposite side of the arch, forming a side-to-side
curve. The curve of Wilson is convex in the maxillary arch and concave in the mandibular arch.
The curve of Wilson results from the posterior tooth alignment within each arch. The crowns of the
maxillary posterior teeth are tilted more facially while the crowns of the mandibular posterior teeth are
tilted more lingually. Therefore, the buccal cusps of the maxillary posterior teeth appear shorter than
the lingual cusps while the buccal cusps of the mandibular posterior teeth appear longer than their
lingual cusps.
Centric occlusion is the habitual occlusion where maximum intercuspation or tooth contact occurs
between the maxillary and mandibular arches. In maximum intercuspation or centric occlusion, the
teeth are in most contact with each other, which implies the least vertical dimension.
Teeth in intercuspal position/centric occlusion

A patient presents to the dentist for examination and bites into centric
occlusion. The permanent maxillary canine is found to be mesial to
the mandibular canine. This type of occlusion is classified as:
• class I
• class II
• class III
• class IV

• class II
In normal occlusion, the mandibular canine would be slightly mesial to the
maxillary canine. In this question, the maxillary tooth is mesial to the
mandibular, and the maxilla is therefore protruding and/or the mandible is
retruding. This is an Angle Class II relationship and results in a “buck tooth”
appearance.
occlusion terms 94
Which of the following are the areas of centric contacts (centric

stops). Select all that apply.
• marginal ridges
• central fossae
• height of cusp contour

marginal ridgesmarginai ridges
• central fossae
• height of cusp contour
Centric occlusion (habitual occlusion) is a voluntary position of dentition

with maximum contact of the maxillary and mandibular teeth, when in
occlusion.
Centric stops: These are the areas of contact on an occlusal surface of a
tooth that are made with teeth in the opposing arch when the teeth are in
centric occlusion (intercuspal position). In other words, centric stops are the
occlusal contacts in centric occlusion between the maxillary and mandibular
arches to achieve maximum interdigitation. Thus, centric stops provide stability
to occlusion.
The three areas of centric contacts are:
• Height of cusp contour
• Marginal ridges
• Central fossae
The cusps that are working during centric occlusion are known as supporting
cusps. The supporting cusps make contact with the opposing tooth through a
centric stop, e.g., mesiolingual cusp, a supporting cusp of the maxillary first
molar, contacts with the central fossa (centric stop) of the mandibular first
molar.
Note: During restorative or prosthetic treatment, an occlusal evaluation is
done with articulating paper in which the centric stops and supporting cusps
are checked and then adjusted accordingly.
occlusion terms 95
The basic principles for occlusal adjustment include all of the

following EXCEPT one. Which one is the EXCEPTION?
• the maximum distribution of occlusal stresses in centric relation

• the forces of occlusion should be borne as much as possible by the long
axis of the teeth
• when there is surface-to-surface contact of flat cusps, it should be
changed to a point-to-surface contact
• once centric occlusion is established, never take the teeth out of centric
occlusion
• when a slide from CR to ICP is natural, it should never be modified

• when a slide from CR to ICP is natural, it should never be modified
Occlusal adjustment (equilibration) is the reshaping of the occlusal surfaces of teeth to
create harmonious contact relationships between the maxillary and mandibular teeth.
Occlusal adjustment enhances the healing potential of tissues affected by the lesions of
occlusal trauma. It may involve:
• Disking
• Odontoplasty
• Enameloplasty
• Coronoplasty
The basic principles for occlusal adjustment include:
• The maximum distribution of occlusal stresses in centric relation
• The forces of occlusion should be borne as much as possible by the long axis of the
teeth
• When there is surface-to-surface contact of flat cusps, it should be changed to a point-
to-surface contact
• Once centric occlusion is established, never take the teeth out of centric occlusion
Equilibration Procedures in a Nutshell:
1. Find and verify centric relation or adapted centric posture (ACP). Rule out
intracapsular disorders.
2. Mount casts with a facebow and a centric relation or adapted centric bite record.
3. Analyze casts to make sure that equilibration is the best choice of treatment.
4. Eliminate all deflective inclines that interfere with complete closure in centric relation or
ACP.
5. Verify simultaneous contact on both posterior teeth and anterior teeth if arch alignment
permits.
6. Verify that maximum intercuspation occurs in perfect harmony with centric relation or
ACP.
7. Eliminate all excursive contact on posterior teeth. The only posterior tooth contact is in
centric relation or ACP.
8. Refine anterior guidance for all excursions (may need to do more reduction of
excursive inclines on posteriors as anterior guidance is altered).
9. Recheck posterior teeth while firmly clenching and grinding. There should be no
contacts on inclines.
10. Verify dots in black....lines in front.
occlusion terms 96
The determinant factors of occlusion include all of the following

• the temporomandibular joint

• the masticatory muscles
• the tongue and buccal mucosa position
• the biomechanics of the temporomandibular joint
• the dentition and the occlusal table

Part I - Volume 13 *©2017
the tongue and buccal mucosa position
Determinants of occlusion:
1. The right and left temporomandibular joints and their suspensory ligaments as
well as the right and left condyles of the mandible.
***These are the posterior determinants of occlusion and are fixed.
2. The teeth - consist of the inter-occlusal contacting points and inclines of cusps of
the opposing arches; they are variable.
***This is the anterior determinant of occlusion and is variable.
3. The neuromuscular system is programmed by the second determinant (the
teeth and what nature and man do to them).
Five requirements for occlusal stability:
1. Stable stops on all teeth when the condyles are in centric occlusion.
2. Anterior guidance in harmony with the border movement of the envelope of
function.
3. Disclusion of all posterior teeth in protrusive movements.
4. Disclusion of all posterior teeth on the nonworking (balancing) side.
5. Noninterference of all posterior teeth on the working side, with either the lateral
anterior guidance, or the border movements of the condyle. The working-side
posterior teeth may contact in lateral group function if they are in precise harmony
with anterior guidance and condylar guidance, or they may be discluded from
working-side contacts by the lateral anterior guidance.
Five requirements for equilibrium of the masticatory system:
1. Stable, comfortable TMJs (even when loaded).
2. Anterior guidance in harmony with functional movements of the mandible.
3. Noninterference of posterior teeth:
° Equal intensity contacts in centric relation
>Posterior disclusion when the condyle leaves centric relation
4. All teeth in vertical harmony with the repetitive contracted length of the closing
muscles.
5. All teeth in horizontal harmony with the neutral zone.
occlusion terms 97
The centric relation (CR) is the most unstrained, retruded anatomic

and functional position of the heads of the condyles or the mandible
in the____ of the temporomandibular joints. This is a relationship of
the____ of the upper and lower jaws_____ tooth contact. The
presence or absence of teeth, or the type of occlusion or
malocclusion, _ _ _ factors.
• mandibular fossae/bones/independent of/are not

• mandibular foramen/teeth/dependent on/are
• mandibular fossae/bones/dependent on/are
• mandibular fossae/teeth/dependent on/are
• mandibular foramen/bones/independent of/are not

• mandibular fossae/bones/independent of/are not
The centric relation (CR) (also called the retruded contact position) is the
most unstrained, retruded anatomic, and functional position of the heads of
the condyles or the mandible in the mandibular (glenoid) fossae of the
temporomandibular joints. This is a relationship of the bones of the upper and
lower jaws independent of tooth contact. The presence or absence of teeth,
or the type of occlusion or malocclusion, are not factors. Important: Centric
occlusion is typically slightly anterior to centric relation.
Note: The mandible cannot be forced into centric relation from the rest
position because the patient's neuromuscular defense reflex would resist the
applied force. The mandible should be relaxed and gently guided into
centric relation.
Centric occlusion (also called the intercuspal position) is the relationship
between maxillary and mandibular occlusal surfaces that provides the
maximum intercuspation between the teeth. This position is independent of
condylar position; it is a “tooth-guided” position.
Functional occlusion:
• Functional occlusion consists of all contacts during chewing, swallowing, or
normal actions
• Functional contacts: normal contacts made during chewing and
swallowing
• Parafunctional contacts: those made outside the normal range, may
create wear facets or attrition and result from habits (i.e., bruxism,
clenching, nail biting, thumb sucking, cheek biting, etc.)
occlusion terms 98
Anterior guidance (anterior coupling) is the guidance provided by the

anterior teeth when the mandible goes into a lateral or protrusive
movement.
If anterior guidance can be accomplished, the least amount of force
will be placed on the posterior teeth during lateral and protrusive
movements.

DENTAL ANATOMY & OCCLUSION |g*dentaldecks

• both statem ents are true
Anterior guidance (anterior coupling) is the guidance provided by the anterior teeth
when the mandible goes into a lateral or protrusive movement. It is determined by
the vertical overlap of the anterior teeth, termed overbite, and the horizontal
overlap of the teeth, which is overjet.
Anterior teeth have a mechanical advantage over posterior teeth because they are
farther away from the fulcrum (condyles), giving them better leverage to offset the
closing musculature. This is apparent when one tries to occlude maximally with
anterior teeth as opposed to occluding maximally in the molar region. The further away
from the site of muscle action, the less force is exerted.
Important point of all this: If anterior guidance is accom plished, the least amount of
force will be placed on the posterior teeth during lateral or protrusive movements.
Fulcrum: The pressure point of support on

which a lever rotates. Because all upward
force is applied behind the teeth, between Fulcrum
the fulcrum and the teeth, the fulcrum is
always under pressure (compression)
when the elevator muscles contract. This is
a very important fact to understand, as it
affects both the TMJs and the teeth.
Force: Exertion of power that starts or
stops movement. Can result in
compression (loading).... or tension. Force
occlusion terms 99
A patient's mother comes in to complain that her child's upper front

teeth rest in front of his lower lip. You explain to her that this is called
• overjet
• overbite
• underjet
• open bite

• overjet
• O verbite: the vertical distance by which maxillary incisors overlap the mandibular
incisors
***Norm al = incisal edges are within the incisal third of mandibular Incisors
• Overjet: the horizontal distance between the labio-incisal surfaces of the
mandibular incisors and the linguo-incisal surfaces of the maxillary incisors
• Underjet: maxillary teeth are lingual to mandibular teeth
• Open bite: lack of occlusal or incisal contact between maxillary and mandibular
teeth. The teeth cannot be brought together. Also can be called negative overbite.
O v e r je t O v e r b ite
occlusion terms 100
Generally, the deeper the curve of Spee, the more difficult it is to

make and adjust interocclusal appliances that are used in the
treatment of bruxism.
Increasing the curve of Spee can reduce the vertical overlap of the
teeth.

DENTAL ANATOMY & OCCLUSION l*dentaldecl<S

' “ Reducing the curve of Spee can reduce the vertical overlap of the teeth.
There are two curves of the occlusal plane observed from a buccal and a
proximal view:
1. Curve of Spee - refers to the anteroposterior curvature of the occlusal
surfaces, beginning at the tip of the lower canine, following the buccal cusp
tips of the premolars and molars and continuing to the anterior border of
the ramus. An ideal curve of Spee would be aligned so that a
continuation of its arc would extend through the condyles.
2. Curve of Wilson - refers to the mediolateral curve that contacts the
buccal and lingual cusp tips on each side of the arch. It results from inward
inclination of the lower posterior teeth, making the lingual cusps lower than
the buccal cusps on the mandibular arch; the buccal cusps are higher than
the lingual cusps on the maxillary arch because of the outward inclination
of the upper posterior teeth. For mandibular teeth the curve is also concave
and for maxillary teeth it is convex.
Remember: Combined, the Curve of Spee and Curve of Wilson form a plane
termed the “Sphere of Monson or the Monson Curve.”
Note: From a frontal view, the plane of occlusion of the mandibular arch in a
normal dentition is a concave curve, while the maxillary arch is a convex curve.
occlusion terms 101
The mandible functions as a:
• class I lever
• class II lever
• class III lever

Part I* Volume 13*© 2017
• class III lever
*** The cranium is fixed and the mandible is movable.
In this system (Class III):
• Fulcrum = condyle
• Force = muscles
• Workload = teeth
In a Class III lever system the fulcrum is at one end, the workload at the
other end and the force (effort) lies between the workload and the fulcrum.
Fulcrum: The pressure point of

support on which a lever rotates.
Because all upward force is applied
behind the teeth, between the
fulcrum and the teeth, the fulcrum is
always under pressure
(compression) when the elevator
muscles contract. This is a very
important fact to understand, as it
affects both the TMJs and the teeth.
Force: Exertion of power that starts
or stops movement. Can result in
compression (loading).... or tension.
periodontal ligament/gingiva 102
Which of the following types of oral mucosa are keratinized under

normal conditions?
• vermillion border of the lips

• hard palate
• gingiva
• buccal mucosa
• dorsal surface of the tongue

• vermillion border of the lips
• hard palate
• gingiva
• dorsal surface of the tongue
The three functional types of oral mucosa are masticatory, lining, and specialized mucosa.
These terms provide functional descriptions of the oral mucosa in specific locations.
• Masticatory mucosa: covers the gingiva and hard palate.
° Epithelium: it has a keratinized or parakeratinized stratified squamous epithelium.
■Lamina propria: has two layers: a thick papillary layer of loose connective tissue
and a deep reticular layer of dense connective tissue.
• Lining mucosa: covers all of soft tissue of the oral cavity except the gingiva, hard
palate, and dorsal surface of the tongue.
o Epithelium: generally, the epithelium of the lining mucosa is nonkeratinized. On
the vermillion border of the lip, however, it is keratinized. If subject to unusual
frictional stress, the epithelium may become parakeratinized or keratinized. Other
cells found in the epithelium of the lining mucosa are Langerhans cells,
melanocytes, and Merkel cells.
» Lamina propria: under the epithelium of the lining mucosa, a loose connective
tissue with thin collagen fibers forms a papillary lamina propria that carries blood
vessels, lymphatic vessels, and nerves.
>Submucosa: a distinct submucosa underlies the lining mucosa, except on the
inferior of the tongue. The submucosa contains large bands of collagen and elastic
fibers that bind the mucosa to the underlying muscle. The submucosa also
contains the larger nerves, blood vessels, and lymphatic vessels that supply the
neurovascular networks of the lamina propria throughout the oral cavity. In the lips,
tongue, and cheeks, the submucosa contains many minor salivary glands.
• Specialized mucosa: is restricted to the dorsal surface of the tongue, and is
characterized by the presence of surface papillae of several types and by taste buds in
the epithelium. The epithelium is keratinized.
Important: All oral mucosa, whether keratinized, nonkeratinized or parakeratinized, is of
the stratified squamous type of epithelium and the underlying central core of connective
tissue. Although the epithelium is predominantly cellular in nature, the connective tissue is
less cellular and composed primarily of collagen fibers and ground substance.
The principal fibers of the periodontal ligament are arranged in four

groups.
The molecular configuration of collagen fibers in the periodontal
ligament provides them with a tensile strength greater than that of
steel.


The most important elements of the periodontal ligament are the principal fibers, which are
collagenous and arranged in bundles and follow a wavy course when viewed in longitudinal
section. The terminal portions of the principal fibers that are inserted into cementum and bone
only are termed Sharpey's fibers.
The principal fibers of the periodontal ligament are arranged in five groups that develop
sequentially in the developing root:
• The alveolar crest group of the alveolodental ligament: originates in the alveolar crest of
the alveolar bone proper and fans out to insert into the cervical cementum at various angles.
The function of this group is to resist tilting, intrusive, extrusive, and rotational forces.
• The apical (periapical) group of the alveolodental ligament: radiates from the apical region
of the cementum to insert into the surrounding alveolar bone proper. The function of this
group is to resist extrusive forces, which try to pull the tooth outward (in an occlusal
direction), and rotational forces.
• The oblique group of the alveolodental ligament: the most numerous of the fiber groups
and covers the apical two-thirds of the root. This group originates in the alveolar bone proper
and extends apically to insert more apically into the cementum in an oblique manner. The
function of this group is to resist intrusive forces, which try to push the tooth inward, as well
as rotational forces.
• The horizontal group of the alveolodental ligament: originates in the alveolar bone proper
apical to its alveolar crest and inserts into the cementum horizontally. The function of this
is to resist tilting forces, which work to force the tip either mesialiy, distally, lingually, or
B y, and to resist rotational forces.
• The interradicular group of the alveolodental ligament: found only between the roots of
multirooted teeth (furcation area). Run from the cementum into bone, forming the crest of the
interradicular septum. The function of this group is to work together with the alveolar crest
and apical groups to resist intrusive, extrusive, tilting, and rotational forces.
Note: Another principal fiber group (called transseptal fibers) inserts mesialiy or interdentally
into the cervical cementum of neighboring teeth over the alveolar crest of the alveolar bone
proper. Thus, the fibers travel from cementum to cementum without any bony attachment. The
function of this group is to resist rotational forces and thus hold the teeth in interproximal contact.
Important: The molecular configuration of collagen fibers provides them with a tensile strength
greater than that of steel. Consequently, collagen imparts a unique combination of flexibility and
strength to the tissues.
The gingival fibers are arranged in five groups Which of the following
is NOT one of those groups?
• circular group
• dentogingival group
• apical group
• transseptal group
• dentoperiosteal group
• alveologingival group
DENTAL ANATOMY & OCCLUSION (Utdentaldecks

• apical group
The connective tissue of the marginal gingiva is densely collagenous, containing a
prominent system of collagen fiber bundles called the gingival fibers. They consist of type
I collagen.
The gingival fibers are arranged in five groups:
• Circular group - this fiber subgroup of the gingival fiber group is located in the lamina
propria of the marginal gingiva. The circular ligament encircles the tooth and helps
maintain gingival integrity. They resist rotational forces.
• Dentogingival group - this fiber subgroup of the gingival fiber group inserts in the
cementum on the root, apical to the epithelial attachment, and extends into the lamina
propria of the marginal gingiva. Thus, this ligament has only one mineralized
attachment to the cementum. The dentogingival ligament works with the circular
ligament to maintain gingival integrity.
• Alveologingival group - this fiber subgroup of the gingival fiber group extends from
the alveolar crest of the alveolar bone proper and radiates coronally into the overlying
lamina propria of the marginal gingiva. These fibers may possibly help to attach the
gingiva to the alveolar bone because of their one mineralized attachment to bone.
• Dentoperiosteal group - this fiber subgroup of the gingival fiber group courses from
the cementum, near the cementoenamel junction, across the alveolar crest. These
fibers possibly anchor the tooth to the bone and protect the deeper periodontal
ligament.
•Transseptal group - this fiber subgroup of the gingival fiber group are located
interproximally and form horizontal bundles that extend between the cementum of
approximating teeth into which they are embedded. They lie in the area between the
epithelium at the base of the gingival sulcus and the crest of the interdental bone and
are sometimes classified with the principal fibers of the periodontal ligament.
1. The attachment apparatus is a term used to describe these gingival fibers
and the epithelial attachment.
2. Some studies have also described two more gingival fiber groups: (1) a group
of semicircular fibers and (2) a group of transgingival fibers.
3. Tractional forces in the extracellular matrix produced by fibroblasts are
believed to be the forces responsible for generating tension in the collagen.
This keeps the teeth tightly bound to each other and to the alveolar bone.
What is the depth of the gingival sulcus in an ideal or absolutely
normal (germ-free) condition?
• 2 mm to 4 mm
• 6 mm to 8 mm
• 0 mm or near to 0 mm
• 1.5 mm to 1.8 mm

• 0 mm or near to 0 mm
Clinically, gingiva can be distinguished into various zones:
• the free gingiva and interdental papilla
• the free gingival groove
• attached gingiva
• the mucogingival junction
The free gingiva lies nearest to the crown portion of the tooth. It outlines the
tooth like a collar of tissue, and is not firmly tied to the tooth or the bone. A
potential space, known as the gingival sulcus, lies between the tooth and
epithelium lining the free gingiva. A periodontal probe is required to assess
the gingival sulcus, as it lies hidden between the two regions and is not visible
normally.
Under absolutely normal or ideal conditions that can be created only
experimentally in a germ-free environment or after prolonged plaque control,
the depth of the gingival sulcus is 0 mm or very near to 0 mm. However,
when determined from histological sections, the depth of the gingival sulcus
in a clinically healthy gingiva is noted as 1.8 mm with a variable range of 0
mm to 6 mm. Clinical probing depth and the histological depth can vary, as it
depends on several factors such as extent of infection, probing force, and the
diameter of the probe. In a clinically normal gingival sulcus, the probing depth
is 2 mm to 3 mm.
Which of the following characteristics are observed in a diseased

gingiva?
• rolled-in margins
• soft and spongy consistency throughout the gingiva
• bleeding upon probing

The gingiva is soft tissue present in the oral mucosa that is covered by the
keratinized epithelium. During an oral examination, it is the only visible part of
the periodontium. Healthy gingiva differs from that in a pathological state in the
following ways:
• Although the color of the healthy gingiva varies from individual to individual, it
usually appears pink or coral pink. In dark-skinned individuals, it may be
brownish due to heavy melanin pigmentation. In the diseased state, it is
usually red or blue-red
•The margins of the gingiva in the healthy state are thin and knife-edged
with normal parabolic scalloping. During inflammation, the margins show a
thickened and rolled-in profile with flattened, exaggerated, reversed, or
clefted scalloping.
• The surface texture of the healthy gingiva is stippled with an orange peel
appearance. In the diseased state, the gingiva is smooth and shiny with a
coarse texture (pebbled).
• The probing depth of the healthy gingival sulcus ranges from about 1 to 3
mm and does not bleed upon probing. The inflamed gingiva bleeds
spontaneously or when slightly probed.
•The consistency of the healthy gingiva is firm, resilient, and non-
retractable with air. In the diseased state, the gingiva becomes soft and
spongy and is retractable with air.
•The healthy gingiva shows no signs of purulent exudate or pus. An
inflamed gingiva might have pus exudate that is expressed on
compressing the gingival pocket wall or after probing.
Note: Microscopically, the earliest indication of gingivitis is an increase in
inflammatory cells and connective tissue (collagen) breakdown. This results in
an increase in tissue fluids (edema), proliferation of small blood vessels causing
redness, and loss of integrity of the epithelium that is seen as ulceration. This is
followed by changes in the tissues that can be clinically observed.
The average width of the periodontal ligament is approximately 20
mm.
The width of the periodontal ligament decreases with increasing age.

DENTAL ANATOMY & OCCLUSION i*d e n ta ld e c k s

1
The periodontal ligament is a specialized connective tissue that joins the
cementum that covers the root of the tooth and the bone surrounding the
alveolar socket wall. In a healthy state, the periodontal ligament consists of a
heterogeneous population of mesenchymal cells, and these cells when
triggered adequately, promote bone and cementum formation. Apart from
mesenchymal cells, perivascular and endosteal fibroblasts, when appropriately
induced, also have the capability to form the periodontal ligament, cementum,
and bone.
The width of the periodontal ligament decreases with age. The average
width ranges from 0.15 to 0.38 mm, and its thinnest portion is near the
middle third of the root. The average width of the periodontal ligament is
approximately 0.21 mm in individuals aged 11 to 16 years, around 0.18 mm in
individuals aged 32 to 52 years, and 0.15 mm in individuals aged 51 to 67
years.
Note: Compared with the stem cells in the pulp, the pluripotent stem cells
present in the periodontal ligament are easily accessible. These postnatal
mesenchymal stem cells are capable of self-renewal and can differentiate into
various cells such as adipogenic, cementogenic, osteogenic, and
chondrogenic cells. Stem cells of the periodontal ligament may also express
different mesenchymal and embryonic stem cell markers.
Of the three types of elastic fibers (elastin, oxytalan, and elaunin), only
oxytalan fibers are found in the periodontal ligament and are distributed
extensively, whereas elaunin fibers are present in the gingival ligament fibers.
The functions of elastic fibers are to regulate vascular flow with respect to tooth
function, and to respond to tensional variations through expanding.
All of the following statements are true regarding epithelial cell rests
of Malassez EXCEPT one. Which one is the EXCEPTION?
• they are epithelial remnants of the Hertwig’s epithelial root sheath

• they are present as isolated islands or clusters throughout the cementum
• they play a role in periodontal regeneration
• they can be the source of dental cysts

Part I •Volume 13*© 2017
• they are present as isolated islands or clusters throughout the
cementum
The epithelial cell rests of Malassez (ERM) are considered remnants;
fragmented cell clusters or interlacing strands of the Hertwig’s epithelial root
sheath along the root surface. They are distributed throughout the periodontal
ligament. They are most abundant in the apical area and cervical area.
The cells of ERM are lined by a distinct basal lamina, separating it from the
surrounding connective tissue. The cells contain tonofilaments and are
interconnected by hemidesmosomes. ERM diminish with age by degeneration
or may calcify to form cementicles.
The ERM play an important role in the function of the normal periodontal
ligament. It expresses bone/cementum-related proteins, growth factors, and
cytokeratins that play an important role in periodontal ligament
regeneration and repair.
The ERM can be a source of dental cysts (periapical cysts and lateral root
cysts), leading to future periodontal infections.
Which of the following is NOT an age-related change in the

periodontium?
• decreased keratinization of the gingival epithelium

• decrease in number of fibroblasts and epithelial cell rests in the periodontal
ligament
• decrease in the width of cementum
• coarser and denser gingival connective tissues

• decrease in the width of cementum
The effects of aging on the periodontium are as follows:
• Thinning and decreased keratinization of gingival epithelium. This could
result in increased permeability of the epithelium to pathological agents
(bacterial antigens) and/or reduced resistance to trauma from occlusion.
• Flattening of the rete pegs in the gingival epithelium along with an altered
cellular density.
• Increase in density of gingival connective tissue and coarsening of the
gingiva.
• Decrease in the number of fibroblasts in the periodontal ligament (PDL)
and an unbalanced structure. The PDL also shows a reduced amount of
epithelial cell rests and less organic matrix production, though there
is an increase in elastic fibers.
• Fivefold to tenfold increase in cemental width.
Less-regular insertion of collagen fibers and a more irregular periodontal
surface of the alveolar bone.
The attachment apparatus is composed of all of the following

• periodontal ligament
• cementum
• alveolar process of the maxillae and mandible
• gingiva
DENTAL ANATOMY & OCCLUSION i*d e n ta ld e c l< s

• gingiva
The tissues that surround and support the teeth are collectively called the
periodontium. Their main functions are to support, protect, and provide
nourishment to the teeth. It has been divided into two parts:
1. Gingiva
2. Attachment apparatus - composed of the:
° Periodontal ligament
° Cementum
° Alveolar process of the maxillae and mandible
The cementum is considered a part of the periodontium because, with the
bone, it serves as the support for the fibers of the periodontal ligament.
The gingival fluid (sulcular fluid) contains components of connective tissue,
epithelium, inflammatory cells, serum, and microbial flora inhabiting the
gingival margin or the sulcus (pocket). In the healthy sulcus the amount of
gingival fluid is very small. During inflammation, however, the gingival fluid
flow increases, and its composition starts to resemble that of an inflammatory
exudate.
The main route of the gingival fluid diffusion is through the basement
membrane, through the relatively wide intracellular spaces of the junctional
epithelium, and then into the sulcus.
The gingival fluid is believed to:
• Cleanse material from the sulcus
• Contain plasma proteins that may improve adhesion of the epithelium to
the tooth
• Possess antimicrobial properties
• Exert antibody activity to defend the gingiva
The principal fibers of the periodontal ligament are composed mainly

of collagen type I.
The amount of collagen in a tissue can be determined by its glycine
content.


Collagen is synthesized by fibroblasts, chondroblasts, osteoblasts,
odontoblasts, and other cells. The several types of collagen are all
distinguishable by their chemical composition, distribution, function, and
morphology. The principal fibers of the periodontal ligament are composed
mainly of collagen type I, whereas reticular fibers are composed of collagen
type III. Collagen type IV is found in the basal lamina.
Collagen is a protein composed of different amino acids, the most important of
which are glycine, proline, hydroxylysine, and hydroxyproline. The amount of
collagen in a tissue can be determined by its hydroxyproline content.
Collagen is responsible for maintenance of the framework and tone of tissue.
1. Less regularly arranged collagen fibers are found in the interstitial
connective tissue between the principal fiber groups; this tissue
contains the blood vessels, lymphatics, and nerves.
2. Although the periodontal ligament does not contain mature elastin,
two immature forms are found; oxytalan and eluanin. The so-
called oxytalan fibers run parallel to the root surface in a vertical
direction and bend to attach to the cementum in the cervical third
of the root. They are thought to regulate vascular flow.
3. The principal fibers are remodeled by the periodontal ligament cells
to adapt to physiologic needs and in response to different stimuli.
The ground substance in the periodontal ligament consists of

proteoglycans.
Gingival tissues show increased scarring after surgical procedures.

• the second statement is true, the first is false

The ground substance is an amorphous substance that fills the major amount of
space between the fibers and cells of the periodontal ligament. This ground
substance is composed of two main elements:
• Glycoproteins, such as laminin and fibronectin
• Glycosaminoglycans, such as proteoglycans and hyaluronic acid
Because of its molecular structure and composition, the ground substance resists
compression or compressive loading from any direction.
The cell surface proteoglycans take part in various biological functions such as:
• Cell repair
• Intercellular interactions
• Cell-matrix interactions
• Cell adhesion
• Binding to growth factors as co-receptors
The connective tissue of the gingiva shows a noteworthy healing and regenerative
capacity, mainly due to its high turnover rate. Gingival tissue is supposed to be
one of the best healing tissues in the body, and shows much less scarring after
surgical procedures. The reason behind this is the rapid reconstruction of the fibrous
architecture of the tissues. However, the ability of gingival tissue to repair and
maintain itself is lower than that of the periodontal ligament or the epithelial tissue.
Important note: The gingival connective tissue contains a number of different
cellular elements, and the dominant ones among them are the fibroblasts. These
cells originate from the mesenchyme and play a major role in the development,
maintenance, and repair of gingival connective tissue. Furthermore, mast cells are
also present in huge amounts inside the connective tissue of the oral mucosa and the
gingiva. Components of the mononuclear phagocyte system, such as fixed
macrophages and histiocytes that are derived from the blood monocytes, are also
seen in the gingival connective tissue. The lamina propria consists of adipose cells
and eosinophils, although less in number.
The narrowest band of attached gingiva is found:
• on the lingual surfaces of maxillary incisors and the facial surfaces of

maxillary first molars
• on the facial surfaces of mandibular second premolars and the lingual
surface of canines
• on the facial surfaces of the mandibular canine and first premolar and the
lingual surfaces adjacent to the mandibular incisors and canines

• on the facial surfaces of the mandibular canine and first
premolar and the lingual surfaces adjacent to the
mandibular incisors and canines
***Narrow gingival zones may occur also at the mesiobuccal root of
maxillary first molars, associated with prominent roots and sometimes with
bony dehiscences and at the mandibular third molars.
The width of the attached gingiva is determined by subtracting the sulcus or
pocket depth from the total width of the gingiva (gingival margin to
mucogingival line). This is done by stretching the lip or cheek to demarcate the
mucogingival line while the pocket is being probed. The amount of attached
gingiva is generally considered to be insufficient when stretching of the lip or
cheek induces movement of the free gingival margin.
The width of the attached gingiva on the facial aspect differs in different areas
of the mouth. It is generally greatest in the incisor region (3.5-4.5 mm in the
maxilla, 3.3-3.9 mm in the mandible), and narrower in the posterior
segments (1.9 mm in maxillary first premolars and 1.8 mm in mandibular first
premolars).
Important: A “functionally adequate” zone of gingiva is defined as one that
is keratinized, firmly bound to tooth and underlying bone, about 2.0 mm or
more in width, and resistant to probing and gaping when the lip or cheek is
distended.
1. The "attached" gingivais structured to withstand frictional stresses
of mastication and brushing.
2. The alveolar mucosa appears to be well-adapted to permit
movement but is not able to withstand frictional stresses.
premolar teeth information 114
Which tooth is most likely to be unnecessarily endodontically treated

by a novice dentist who sees a radiolucency on the radiograph?

Part I*Volume 13*© 2017
Note: When viewing an x-ray of this area, the mental foramen is sometimes
misdiagnosed as a premolar abscess. Therefore, before performing root canal
therapy, make sure all diagnostic tests confirm your finding.
Important: When performing endodontics on this tooth, care must be taken to avoid
an overfill that may impinge on the mental foramen.
Remember: This tooth can show three types of occlusal surfaces (pit and groove
patterns). The three types of occlusal surfaces (pit and groove patterns) are:
1. Y-type = 5 lobes, 3 cusps (most common type)
2. H-type = 4 lobes, 2 cusps
3. U-type = 4 lobes, 2 cusps; central developmental groove will appear crescent
shaped.
Meslolin Dlstollngual
cusp cusp
U-Shaped H-Shaped
Three-Cusp Two-Cusp Groove Groove
Occlusal view of two types of permanent mandibular Occlusal view of two-cusp type of permanent
right second premolars: three-cusp type and two-cusp mandibular right second premolar, showing the U- and
type. H-shaped groove patterns.
Which tooth has a mesial marginal ridge that is distinctly shorter in
length and less prominent in height than the distal marginal ridge?

• mandibular first premoiar

m a n d i b u l a r f i r s t p r e m o la r
The distal marginal ridge forms a p r o m i n e n t e le v a t i o n on the distal portion of the crown and
measures nearly twice the length of the mesial marginal ridge.
Both mesial and distal marginal ridges of this tooth have l i t t l e or n o c o n t a c t in the ideal
intercuspal relationship. The contacts are ideally on the m e s ia l or d i s t a l t r i a n g u l a r f o s s a e ,
which are found slightly mesial or distal to the marginal ridges.
This tooth has a s m a ll, n o n - f u n c t i o n i n g lingual cusp. For this reason, the masticatory function
most closely resembles that of the mandibular canine.
1. The mandibular f i r s t premolar shows evidence of crown completion at 5 to 6 years
of age.
2. The mandibular s e c o n d premolar shows evidence of crown completion at 6 to 7
years of age.
3. The m a x illa r y premolars show crown completion at the same approximate time as
the mandibular premolars.
Buccal
triangular ridge
Mandibular Right
First Premolar
Lingual view
On mandibular premolars, the lingual cusps are much smaller than

the buccal cusps.
On maxillary premolars, the buccal cusps are smaller than the lingual
cusps.


Three characteristics of mandibular premolars that clearly distinguish them from
their maxillary counterparts:
1. From a proximal view, the mandibular premolar crowns tilt lingually.
2. On mandibular premolars, the lingual cusps are much smaller than the buccal
cusps. On maxillary premolars, the lingual cusps are smaller; however, they are
only slightly smaller.
3. From an occlusal view, mandibular premolars are more square, while maxillary
premolars are more rectangular (in that they are wider buccolingually).
Important: The common characteristic that all mandibular first premolars have
when viewed from the occlusal aspect is that the buccal lobe makes up the majority
of the tooth.
Remember: A lobe is one of the primary sections of formation in the development of
the crown of a tooth. It is represented by a cusp on posterior teeth, and mamelons
and cingula on anterior teeth.
Mandibular Right First Premolar Mandibular Right Second Premolar
Mesial Distal Occlusal Occlusal Mesial Distal

The pulp cavity shown below is the:
• maxillary right first premolar

• maxillary left second premolar
• mandibular right first premolar
• mandibular left second premolar
DENTAL ANATOMY & OCCLUSION GIMentaldecks

maxillary right first premolar
Remember: Maxillary first premolars:
• Often times both the root outline and pulp chamber are kidney-shaped
• They are the only premolar with two roots
• Buccal root and canal are the largest
Maxillary Right
First Premolar
Mesial view
Mesiodistal Buccolingual
1. Premolars are most difficult to do root canal treatment on because

they are easy to perforate (especially maxillary first premolars).
2. Maxillary premolar roots occasionally penetrate the antrum.
3. The key to determining right from left maxillary first premolars is
that there is a more pronounced developmental groove and
developmental depression on the mesial crown and root surface.
Which premolar is the only one that has a mes ial buccal cusp ridge
that is longer than its distal buccal cusp ridge?

DENTAL ANATOMY & OCCLUSION d td e n ta ld e c k s

Remember also: That this tooth has a pronounced cervical concavity on
the mesial surface of its crown, as does the distal surface of the maxillary first
molar.
M a x illa r y R ig h t F irs t P re m o la r
Mesial
developmental
depression
Mesial marginal
groove
Mesial marginal
ridge
B u cca l fe a tu re s M e s ia l fe a tu re s
The largest of all the premolars are the and the smallest are
the ___.
• maxillary first, mandibular first

• maxillary first, mandibular second
• maxillary second, mandibular first
• maxillary second, mandibular second
DENTAL ANATOMY & OCCLUSION d M e n ta ld e c k s

• maxillary first, mandibular first
The maxillary first and second premolars are more a like than the mandibular
premolars and, unlike the mandibular premolars, the maxillary first premolar is larger
than the second. The mandibular first premolar is usually the smallest of all
premolars.
Remember: Both maxillary and mandibular premolar shave their long axis most
perpendicular to the horizontal plane when the teeth are in maximum intercuspation.
In other words, they are the most closely vertically aligned of all the teeth.
M axillary Right M axillary Right M andibular Right M andibular Right
First Premolar Second Premolar First Premolar Second Premolar
Important:
1. In a laterotrusive movement (nonworking, right or left), the lingual cusp of a
maxillary second premolar passes through the facial embrasure between the
mandibular second premolar and the first molar.
2. In a laterotrusive movement (working, right or left), the lingual cusp of a
maxillary second premolar passes through the lingual embrasure between the
mandibular second premolar and the first molar.
A hockey player comes into your office with both of his maxillary
right premolars in hand. Which of the following characteristics would
you NOT use to distinguish the first from the second maxillary
premolar?
• number of roots
• symmetry (one is more symmetrical than the other)
• mesial to distal cusp ridge ratio
• presence of mesio-lingual developmental groove
• central groove size and supplemental groove number
DENTAL ANATOMY & OCCLUSION if r d e n t a ldecks

• presence of mesio-lingual developmental groove
*** This is found on the mandibular first premolar, not on either maxillary premolar.
The maxillary second premolar has the following characteristics compared to the
maxillary first premolar:
• One root; the first premolar has two roots
• Much more symmetrical and less angular (more ovoid) than the first premolar
• DBCR (disto-buccal-cusp-ridge) is longer than MBCR; opposite of first premolar
• Buccal and lingual cusps are almost equal in height; on the first premolar they
are not
• Has no mesial developmental depression; first premolar does
• Has a less prominent buccal ridge; first premolar has a prominent buccal ridge
• Has a shorter central groove with more supplemental grooves; first premolar
hasa long central groove with minimal supplemental grooves
Maxillary Right Second Premolar
Buccal Lingual Occlusal Mesial Distal

tooth components 121
The dental lamina is a horseshoe-shaped band of epithelial tissue that

arises from the and is surrounded by mesenchymal cells.
• basement membrane
• basal lamina
• ectomesenchyme
• oral epithelium

oral epithelium
Important information to remember:
1. During the sixth to seventh weeks of embryonic development, the oral epithelium
(ectoderm) thickens along the future dental arches to form the dental lamina.
2. Around the eighth week of embryonic development, the mesenchymal neural
crest (which contains ectomesenchyme) induces the development of tooth buds at
ten locations in the upper and lower dental lamina.
3. During the bud stage, the dental lamina grows into the mesenchyme in the shape
of a bud.
4. During the ninth to tenth weeks of embryonic development, the tooth bud
differentiates into a cap-shaped enamel organ extending from the dental lamina. A
vestibular lamina develops to separate the gum from the lip/cheek. During the
cap stage, an unequal growth of epithelial cells grows down to form a concavity
around the mesenchyme, forming the dental papilla. Other mesenchymal cells
encircle the enamel organ, forming the dental sac.
By the end of the cap stage (third stage of odontogenesis) the tooth germ is
complete and consists of:
1. The enamel organ, which is formed from oral epithelium. It is derived from the
ectoderm. It has four distinct cell layers:
(i) Outer enamel epithelium
(ii) Inner enamel epithelium
(iii) Stratum intermedium
(iv) Stellate reticulum
*** The enamel organ will give rise to enamel and will eventually form Hertwig's
epithelial root sheath.
2. The dental sac surrounds the developing tooth germ and will give rise to the
cementum, the PDL, and the alveolar bone proper.
3. The dental papilla will give rise to the dentin and dental pulp.
Note: The outer layer of cells of the dental papilla differentiates into the
odontoblasts (dentin-forming cells).
‘ “ Both the dental papilla and dental sac are formed from the mesenchymal neural
crest (which contains ectomesenchyme).
Enamel matrix is an ectodermal product because ameloblasts are
derived from the inner enamel epithelium of the enamel organ, which
was originally derived from the ectodermal layer of the embryo.
Enamel matrix is first formed in the incisal/occlusal portion of the
future crown near the forming DEJ.


Part I-Volum e 13 *©2017
Enamel is the hardest calcified tissue in the human body and the richest in calcium.
Enamel is highly mineralized and is totally acellular. It consists of approximately 96%
inorganic material (primarily calcium and phosphorus as hydroxyapatite), 1% organic
material, and 3% water. Enamel is of ectodermal origin. The organic matrix consists
mainly of protein, which is rich in proline.
The fundamental morphologic unit of enamel is the enamel rod or prism which is
bound together by an interprismatic substance (interrod substance). Each is formed in
increments by a single enamel-forming cell, the ameloblast. Most enamel rods extend
the width of the enamel from the DEJ to the outer enamel surface. Consequently, each
enamel rod is oriented somewhat perpendicular to the DEJ and the outer enamel
surface. The specific shape of the enamel rod is dictated by the Tomes' process of
the ameloblast. In most cases, each enamel rod is cylindrical in the longitudinal
section. In most areas of enamel, the enamel rod is about 4 micrometers in diameter.
Note: The oldest enamel in a fully erupted tooth is located at the DEJ underlying a
cusp or cingulum.
Important: An important event for the production and organization of the enamel is the
development of a cytoplasmic extension on ameloblasts, Tomes' process, that juts
into and interdigitates with the newly forming enamel. In sections of forming human
teeth, Tomes' processes give the junction between the enamel and the ameloblast a
picket-fence or saw-toothed appearance. Note: Tomes' processes are distinctly
different from Tomes' fibers (odontoblastic processes that occupy dentinal tubules).
Other important facts about enamel:
• It has no power of regeneration - the ameloblasts lose their functional ability when
the crown of the tooth has been completed
• It has no power of metabolism
• It has no means of combating bacterial invasion - the susceptibility of the mineral
component to dissolution in an acid environment is the basis for dental decay
• It has no nerve supply
• It is a good thermal insulator
• The acid solubility of the surface enamel is reduced by fluoride (this is the basis
for the topical application of fluorides in dental caries prevention)
Mature enamel is by weight:
• 74% mineralized or inorganic material, 20% organic material, and 6%

water
water
• 90% mineralized or inorganic material, 9% organic material, and 1% water
• 96% mineralized or inorganic material, 1% organic material, and 3% water

water
Enamel is a highly mineralized structure containing approximately 96%
inorganic material. This inorganic component consists of mainly (90-95%)
calcium hydroxyapatite with the chemical formula Ca10(PO4)6(OH)2. Other
minerals, such as carbonate, magnesium, potassium, sodium, and fluoride are
also present in smaller amounts. Note: Due to the high inorganic content,
enamel appears optically clear on a histologic section of the human tooth.
Enamel also consists of an organic matrix (1%) and water (3%). This
organic matrix and water content decreases as enamel matures. At the same
time, the inorganic content increases. Note: The organic portion of enamel
does not contain collagen, whereas dentin and bone do. Instead, it has two
unique classes of proteins called amelogenins and enamelins. The role of
these proteins is not understood fully at this time, but it is believed that these
proteins aid in the development of enamel as a framework support and other
mechanisms.
Enamel is extremely brittle but can endure crushing pressure of
approximately 100,000 pounds per square inch. A layering of dentin and
periodontium, coupled with the hardness of the enamel, produces a
cushioning effect on the tooth's different structures, enabling it to endure the
pressures of mastication.
Enamel is semitranslucent and turns various shades of yellow-white because
of the underlying dentin. The enamel on primary teeth has a more opaque
crystalline form and thus appears whiter than on permanent teeth. Note:
Enamel is a selectively permeable membrane, allowing water and certain
ions to pass via osmosis.
Which of the following are partially calcified vertical defects in the
enamel resembling cracks or fractures that traverse the entire length
of the crown from the surface to the DEJ.
• enamel tufts
• enamel spindles
• enamel rods
• enamel lamellae

• enamel lamellae
Enamel formation begins at the future cusp and spreads down the cusp slope.
As the ameloblasts retreat in incremental steps, the ameloblasts create an
artifact in the enamel called the lines of Retzius. Where these lines terminate
at the tooth surface they create tiny valleys on the tooth surface that travel
circumferentially around the crown known as perikymata or imbrication lines
of Pickerill. One of the lines of Retzius is accentuated and is more obvious
than the others. It is the neonatal line that marks the division between enamel
formed before birth and that which is produced after birth (this neonatal line is
found in all deciduous teeth and in the larger cusps of the permanent first
molars).
1. Enamel tufts are fan-shaped, hypocalcified structures of enamel
rods that project from the dentinoenamel junction into the enamel
proper. They are found in the inner one-third of enamel and
represent areas of less mineralization. Enamel tufts are an anomaly
of crystallization and seem to have no clinical importance.
2. Enamel spindles represent short dentinal tubules near the DEJ.
They result from odontoblasts that crossed the basement membrane
before it mineralized into the DEJ. These dentinal tubules become
trapped during the apposition of enamel matrix, and enamel
becomes mineralized around them. They may serve as pain
receptors.
3. Enamel lamellae are partially calcified vertical defects in the enamel
resembling cracks or fractures that traverse the entire length of the
crown from the surface to the DEJ. They are narrower and longer
than enamel tufts. Enamel lamellae are ananomaly of crystallization
and seem to have no clinical importance.
The term Hunter-Schreger bands refers to the alternating light and dark lines
seen in dental enamel that begin at the DEJ and end before they reach the
enamel surface. They represent areas of enamel rods cut in cross-section
dispersed between areas of rods cut longitudinally.
The mesenchymal cells in the dental papilla adjacent to the inner
enamel epithelium differentiate into:
• ameloblasts
• odontoblasts
• cementoblasts
• fibroblasts

• odontoblasts
"•Remember: During the bell stage, the mesenchymal cells in the dental papilla
adjacent to the inner enamel epithelium differentiate into odontoblasts, which
produce predentin and deposit it adjacent to the epithelium. Later, the predentin
calcifies and becomes dentin. As the dentin thickens, the odontoblasts regress toward
the center of the dental papilla; however, their fingerlike cytoplasmic processes
(odontoblastic processes or Tomes' fibers) - remain embedded in the dentin.
Inner enamel epithelium cells continue their differentiation into ameloblasts that
produce organic matrix against the newly formed dentinal surface. Almost
immediately, this organic matrix mineralizes and becomes the initial enamel layer of
the crown. Thus although enamel protein secretion occurs before mantle dentin is
visible on the crown, these proteins do not assemble as a layer until dentin is formed.
The enamel-forming cells, the ameloblasts, move away from the dentin, leaving
behind an ever-increasing thickness of enamel.
For these events to take place normally, differentiating odontoblasts must receive
signals from differentiating ameloblasts (inner enamel epithelium), and vice versa - an
example of reciprocal induction.
Usual events in the histogenesis of a tooth:
1. Elongation of the inner enamel epithelial cells of the enamel organ; this influences
mesenchymal cells on the periphery of the dental papilla to differentiate into
odontoblasts (#2 below)
2. Differentiation of odontoblasts
3. Deposition of the first layer of dentin
4. Deposition of the first layer of enamel
Tooth development is dependent on a series of sequential cellular interactions
between epithelial and mesenchymal components of the tooth germ. Once the
ectomesenchyme influences the oral epithelium to grow down into the
ectomesenchyme and become a tooth germ, the above events occur.
Remember: Histogenesis means the formation and development of the tissues of
the body, in this case the tooth.
Which structure is the central core and fills the bulk of the enamel
organ?
• outer enamel epithelium

• inner enamel epithelium
• stratum intermedium
• stellate reticulum

Part I • Volume 1 3 * © 2017
• stellate reticulum
Four layers of the enamel organ:
1. Outer enamel epithelium (OEE) - the outer cellular layer of the enamel
organ (very thin). This layer outlines the shape of the future developing
enamel organ.
2. Inner enamel epithelium (IEE) - the innermost cellular layer of the

enamel organ (very thin). The cells in this layer will become ameloblasts
and produce enamel.
3. Stratum intermedium - this area lies immediately lateral to the inner

enamel epithelium (thicker than both the OEE and IEE). This layer of cells
seems to be essential to enamel formation (prepares nutrients for the
ameloblasts of the IEE).
4. Stellate reticulum - this area is the central core and fills the bulk of the
enamel organ. This layer contains a lot of intercellular fluid (mucus-type
fluid rich in albumin) that is lost just before enamel deposition.
After enamel formation is completed, all of the above structures of the

enamel organ become one and form the reduced enamel epithelium. This is
important in the formation of the dentogingival junction, which is an area
where the enamel and epithelium come together as the tooth erupts into the
mouth. This forms the initial junctional epithelium (epithelial attachment),
which later migrates down the tooth to assume its normal position.
A patient comes into your dental clinic holding a bag of ice to the side
of his face and a sliver of ice tucked between his cheek and teeth. He
says the cold relieves the pain in his tooth. This is almost indicative
of partial necrosis of the structure which innervates the whole tooth.
This structure is a connective tissue that develops from the:
• enamel organ
• dental papilla
• epithelial rests of Malassez
• dental sac

• dental papilla
The pulp is the innermost tissue of the tooth. The pulp as well as dentin are formed
from the central cells of the dental papilla.
Anatomy of the Pulp:
• Coronal pulp - located in the pulp chamber and forms pulp horns
• Radicular pulp - located in the pulp canals (root portion of tooth)
• Apical foramen - communicates with the PDL
*** Accessory canals may also be associated with the pulp. Remember: These
form when Hertwig's epithelial root sheath encounters a blood vessel during root
formation. Root structure then forms around the vessel, forming the accessory
canal.
Architecture of the Pulp:
• The peripheral aspect of dental pulp, referred to as the odontogenic zone,
differentiates into a layer of dentin-forming odontoblasts. Immediately subjacent to
the odontoblast layer is the cell-free zone (of Weil). This region contains
numerous bundles of reticular (Korff's) fibers. These fibers pass from the central
pulp region, across the cell free zone and between the odontoblasts, their distal
ends incorporated into the matrix of the dentin layer. Numerous capillaries and
nerves are also found in this zone.
• Just under the cell-free zone is the cell-rich zone containing numerous
fibroblasts, the predominant cell type of pulp. Since odontoblasts themselves are
incapable of cell division, any dental procedure that relies on the formation of new
dentin after destruction of odontoblasts, depends on the differentiation of new
odontoblasts from these multipotential cells of the pulp. Lymphocytes, plasma
cells and eosinophils are other cell types also common in dental pulp.
• Medial to the cell-rich zone is the deep pulp cavity that contains the
subodontoblastic plexus of Raschkow.
***lf cold relieves the pain, then there is almost always partial necrosis of the
dental pulp.
Which of the following statements concerning dentin are true? Select

all that apply.
• it is hard, elastic, 70% inorganic, 20% organic, and 10% water

• the main cell type is the odontoblast, which is derived from
ectomesenchyme
• the inorganic component consists of mainly calcium hydroxyapatite
• it is less mineralized than cementum or bone but more mineralized than
enamel

• it is hard, elastic, 70% inorganic, 20%
organic, and 10% water
• the main cell type is the odontoblast, which
is derived from ectomesenchyme
• the inorganic component consists of mainly
calcium hydroxyapatite
Dentin is the specialized connective tissue that makes up the bulk of the tooth,
extending for almost its entire length. Dentin is hard, elastic, 70% inorganic,
20% organic, and 10% water. The inorganic component consists of mainly
calcium hydroxyapatite with the chemical formula of Ca10(PO4)6(OH)2. This
calcium hydroxyapatite is similar to that found in higher percentages in enamel
and in lower percentages in bone and cementum. Smaller amounts of other
minerals, such as carbonate and fluoride, are also present.
1. Unlike enamel, which is acellular, dentin has a cellular component
that is retained after its formation by odontoblasts.
2. Dentin and pulp tissue are both formed by the dental papilla. Pulp
tissue is a loose, very vascular, and non-calcified connective tissue
while dentin is avascular and a calcified tissue.
3. The main cell type in dentin is the odontoblast, which is derived
from ectomesenchyme.
4. Dentin is much softer than enamel but harder than bone. Dentin is
more flexible (lower modulus of elasticity) than enamel. Dentin's
compressive strength is much higher than its tensile strength.
5. Dentin is more mineralized than cementum or bone but less
mineralized than enamel. Morphologically and chemically, dentin
has many characteristics in common with bone.
6. The major organic component of dentin is type I collagen fibers
(91-92%), with type III fibers being present in mantle dentin, and
type V and VI fibers being found in traces throughout the dentin.
A 3-year-old boy is being rushed by his mother to finish up his ice
cream. He is unwilling to bite into it because it hurts his teeth. The
reason the teeth of children are more sensitive to thermal changes
than those of an adult is that:
• newly erupted teeth have more dentin than older teeth

• newly erupted teeth have larger dental pulps
• newly erupted teeth have more differentiated mesenchymal cells
• newly erupted teeth have less ground substance

1
• newly erupted teeth have larger dental pulps
When a tooth is newly erupted, the dental pulp is large; it becomes
progressively smaller as root formation is completed. The entire pulp and apical
foramen are relatively large in primary teeth and also in young permanent teeth.
For this reason, the teeth of children and young people are more sensitive to
thermal change and dental operative procedures than the teeth of older people.
The dental pulp is a connective tissue, and thus has all of the components of
such a tissue: intercellular substance, tissue fluid, cells, lymphatics, vascular
system, nerves, and fibers (mainly collagen and some reticular fibers).
Cells found in the pulp:
• Fibroblasts: most numerous
• Odontoblasts: only cell bodies are located in the pulp
• Undifferentiated mesenchymal cells
• Lymphocytes, plasma cells and eosinophils
Several large nerves enter the apical foramen of each molar and premolar with
single ones entering the anterior teeth. A young premolar may have as many as
700 myelinated and 2,000 unmyelinated axons entering the apex. These nerves
have two primary modalities:
1. Autonomic Nerve Fibers. Only sympathetic autonomies fibers are found in
the pulp. These fibers extend from the neurons whose cell bodies are found
in the superior cervical ganglion at the base of the skull. They are
unmyelinated fibers and travel with the blood vessels. They innervate the
smooth muscle cells of the arterioles and therefore function in regulation of
blood flow in the capillary network.
2. Afferent (Sensory) Fibers. These arise from the maxillary and mandibular
branches of the fifth cranial nerve (trigeminal). They are predominantly
myelinated fibers and may terminate in the central pulp. From this region
some will send out small individual fibers that form the subodontoblastic
plexus (of Raschkow) just under the odontoblast layer.
Gemination and fusion occur during which stage of tooth
development?
• initiation
• bud stage
• cap stage
• bell stage
• appositional stage
• maturation stage
DENTAL ANATOMY & OCCLUSION !*d e n ta ld e c k s

cap stage
Stages of tooth development (odontogenesis):
1 . Initiation (sixth to seventh weeks) - Ectoderm lining stomodeum gives rise
to oral epithelium and then to dental lamina, adjacent to deeper
ectomesenchyme, which is influenced by the neural crest cells. Induction
is the main process involved. Congenital absence of teeth (anodontia) and
supernumerary teeth result from an interruption in this phase.
2. Bud stage (eighth week) - Growth of dental lamina into bud that
penetrates growing ectomesenchyme. Proliferation is the main process
involved.
3. Cap stage (ninth to tenth weeks) - Enamel organ forms into a cap,
surrounding the mass of the dental papilla from the ectomesenchyme and
surrounded by the mass of the dental sac also from the ectomesenchyme,
thus forming the tooth germ. Proliferation, differentiation, and
morphogenesis are the main processes involved. Dens in dente,
gemination, fusion, and tubercle formation occur during this phase.
4. Bell stage (eleventh to twelfth weeks) - final shaping of tooth, cells
differentiate into specific tissue forming cells (ameloblasts, odontoblasts,
cementoblasts, and fibroblasts) in the enamel organ. Histodifferentiation
and morphodifferentiation are the main processes involved.
Macrodontia/microdontia occur during this stage.
5. Apposition (varies per tooth) - cells that were differentiated into specific
tissue-forming cells begin to deposit the specific dental tissues (enamel,
dentin, cementum, and pulp). Enamel dysplasia, concrescence, and the
formation of enamel pearls occur during this stage.
6. Maturation (varies per tooth) - mineralization
7. Eruption (varies per tooth)
8. Attrition (varies per tooth)
A 14-year-old boy comes into the dental office for a prophylaxis. A
diet evaluation reveals that he consumes 3-4 cans of soda a day and
eats a box of fruit snacks every week. Radiographs show multiple
incipient interproximal carious lesions and one cavitated carious
lesion in his premolar. The cavitated lesion in the premolar is
beginning to encroach on the pulpal tissue. Reparative dentin is
usually formed in response to injury. The primary function of which
tissue is responsible for forming this reparative dentin?
• enamel
• Hertwig's epithelial root sheath
• dental pulp
• cementum

• dental pulp
***The life span of the odontoblasts generally is believed to equal that of the
viable tooth because the odontoblasts are end cells, which means that, once
differentiated, they cannot undergo further cell division. This fact poses an
interesting problem. On occasion, when the pulp tissue is exposed, repair can
take place by the formation of new dentin. This means that new odontoblasts
must have differentiated and migrated to the exposure site from pulp tissue,
most likely from the cell-rich subodontoblast zone.
Remember: The dental pulp is the soft-tissue component of the tooth. It is a
connective tissue originating from the mesenchyme of the dental papilla and
performs multiple functions throughout life. In addition to being the formative
organ of the dentin, it also has the following functions:
• Nutritive - the pulp keeps the organic components of the surrounding
mineralized tissue supplied with moisture and nutrients
• Sensory - extremes in temperature, pressure, or trauma to the dentin or
pulp are perceived as pain
• Protective - the formation of reparative or tertiary dentin (by the
odontoblasts)
Important clinical information:
Pulp capping is more successful in young teeth because:
• The apical foramen of a young pulp is large
• The young pulp contains more cells (odontoblastic)
• The young pulp is very vascular
• The young pulp has fewer fibrous elements
• The young pulp has more tissue fluid
*** The young pulp lacks a collateral circulation
The dental tissue which most closely mimics bone is:
• enamel
• dentin
• dental pulp
• cementum
DENTAL ANATOMY & OCCLUSION U M ientaldecks

• cementum
Cementum is composed of a mineralized fibrous matrix and cells
(cementocytes). The fibrous matrix consists of both Sharpey's fibers and
intrinsic nonperiosteal fibers. Sharpey's fibers are the terminal portions of the
principal fibers of the PDL that are each partially inserted into the outer part
of the cementum at 90 degrees (or a right angle) to the cemental surface, as
well as the alveolar bone on their other end.
Remember: Cementum is the bone-like mineralized tissue covering the
anatomical roots of teeth. The two basic types are acellular and cellular.
Other functions of cementum include the following:
• Compensates for the loss of tooth surface due to occlusal wear by apical
deposition of cementum throughout life
• Protects the root surface from resorption during vertical eruption and tooth
movement
1. Histologically, cementum differs from enamel in the following ways:
° Cementum has collagen fibers
° Cementum has cellular components in the mature tissue
2. Cementoid is the peripheral layer of developing cementum that is
laid down by cementoblasts undergoing cementogenesis.
Cementoid is uncalcified or immature.
3. When the cementoid reaches the full thickness needed, the
cementoid surrounding the cementocytes becomes calcified or
matured and is then considered cementum.
4. Cementocytes are cementoblasts entrapped by the cementum
they produce.
Which of the following statements concerning cementum are true?

• it is formed by cementoblasts from the periodontal ligament

• the organic portion is primarily composed of collagen and protein
• cellular cementum occurs more frequently on the coronal two-thirds of the
root
• it is avascular

• it is formed by cementoblasts from the periodontal
ligament
• the organic portion is primarily composed of
collagen and protein
• it is avascular
Cementum is the bone-like mineralized tissue covering the anatomical roots of teeth. The
primary function of cementum is to attach Sharpey's fibers. It has the following
characteristics:
• Slightly softer and lighter in color (yellow) than dentin
• Formed by cementoblasts from the PDL, as opposed to dentin, which is formed from
odontoblasts of the pulp. It develops from the dental follicle (aka dental sac)
• Most closely resembles bone (more so than dentin), except there are no haversian
systems or blood vessels - it is avascular
• Mature cementum is by composition 45-50% mineralized inorganic material (mainly
calcium hydroxyapatite), and 50% organic material, namely collagen and
noncollagenous matrix protein.
• The organic portion is primarily composed of collagen and protein
• Has no nerve innervation
• Thickest at the tooth's apex and thinnest at the CEJ at the cervix of the tooth
• Important in orthodontics. Cementum is more resistant to resorption than alveolar
bone, permitting orthodontic movement of teeth without root resorption
Two types of cementum (functionally there is no difference):
1. Acellular (sometimes called primary cementum) - consists of the first layers of
cementum deposited at the DCJ; acellular cementum is formed at a slow rate and
contains no embedded cementocytes. usually predominate on the coronal two-
thirds of the root. Thinnest at the CEJ.
2. Cellular (sometimes called secondary cementum) - consists of the last layers of
cementum deposited over the acellular cementum; cellular cementum is formed at a
faster rate than acellular cementum and contains embedded cementoblasts. Cellular
cementum occurs more frequently on the apical third of the root. Cellular cementum
is usually the thickest to compensate for occlusal/incisal wear and passive eruption
of the tooth.
Note: The composition of bone is roughly 50% inorganic, 25% collagen, and 25% water.
The junction between primary and secondary dentin is characterized

by a sharp change in the direction of dentinal tubules.
Tertiary dentin is the dentin formed in a tooth before the completion
of the apical foramen of the root.


Reparative dentin or tertiary dentin is dentin formed very rapidly in localized
regions in response to a localized injury to exposed dentin. The injury could be
caries, cavity preparation, attrition, or recession. Odontoblasts in the area of
the affected tubules might die because of the injury, but neighboring
undifferentiated mesenchymal cells of the pulp move and become
odontoblasts. Tertiary dentin tries to seal off the injured area, thus the term
reparative dentin.
Primary dentin is the dentin formed in a tooth before the completion of the
apical foramen of the root. Primary dentin is characterized by a regular pattern
of tubules.
Secondary dentin is the dentin that is formed after completion of the apical
foramen. Secondary dentin is formed at a slower rate than primary dentin and
is less mineralized. Secondary dentin is a regular and somewhat uniform layer
of dentin around the pulp cavity. Secondary dentin is made by the
odontoblastic layer that lines the dentin-pulp interface.
Note: The junction between primary and secondary dentin is characterized by
a sharp change in the direction of dentinal tubules.
When dentin is damaged, usually by the chronic injury of caries,
odontoblastic processes die or retract, leaving empty dentinal tubules. Areas
with empty dentinal tubules are called dead tracts and appear as dark areas
in ground sections of tooth. With time, these dead tracts can become
completely filled with mineral. This region is called blind tracts and appears
white in sections of ground tooth. A certain type of tertiary dentin called
sclerotic dentin fills the blind tracts. The adaptive advantage of blind tracts is
the sealing off of the dentinal tubules to prevent bacteria from entering the
pulp cavity. Clinically, this sclerotic dentin appears dark, smooth, and shiny.
Which of the following is formed inside the walls of the dentinal
tubules?
• tertiary dentin
• mantle dentin
• peritubular dentin
• intertubular dentin

• peritubular dentin
Dentin is not a uniform tissue in the tooth but differs from region to region. Dentin that
creates the wall of the dentinal tubules is called peritubular dentin. Peritubular dentin is
highly mineralized after dentin maturation. The dentin that is found between the tubules
is called intertubular dentin. Intertubular dentin is highly mineralized, but less so than
peritubular dentin.
Mantle dentin is the first predentin that forms and matures within the tooth. Mantle dentin
shows a difference in the direction of the mineralized collagen fibers compared with the
rest of dentin, with the fibers perpendicular to the DEJ. Mantle dentin also has more
peritubular dentin than the inner portions of the dentin and thus has higher levels of
mineralization.
T y p es o f D entin
T ype l>ocatinn/( h r u n n in g s D e s c r ip tio n
Peritubular Formed in peripheral pails o f the Highly mineralized and it also contains little collagen
(intratubular) mineralized dentin inside the walls o f
dentin tubules
lntcrtubular Formed by odontoblasts through Dense collagen matrix
predentin mineralization between the
tubules
Mantle Outermost layer o f primary dentin First dentin formed, slightly less mineralized than
other layers o f the primary dentin (i.e. circumpulpal)
Circumpulpal Layer around outer pulpal wall Demin formed a Tier mantle dentin
Primary Formed rapidly during tooth More mineralized than secondary
formation. It outlines the pulp chamber
and constitutes the main part of the
dentin mass
Secondary Formed after completion o f the apical Less mineralized than primary
foramen; forms slower than primary
Tertiary Formed as a result ol' injury Irregular pattern o f tubules
(reparative or
reactionary dentin)
After the inner enamel epithelium differentiates into preameloblasts,

dentinogenesis is initiated by the odontoblasts.
In a cross section, enamel tufts and lamellae are seen as a series of
lines extending from the dentinoenamel junction toward the tooth
surface, while in a longitudinal section, they appear as concentric
rings.


After inner enamel epithelium formation, the innermost cells further elongate
and differentiate into preameloblasts. This is followed by the differentiation of
the outer cells of the dental papilla into odontoblasts. These cells then undergo
repolarization, which shifts the nuclei from the center to the farthest point from
the separating basement membrane.
After repolarization and differentiation, dentinogenesis is initiated by the
odontoblasts. The synthetic and secretory functions of the odontoblasts are
started before enamel matrix production begins.
After the complete differentiation of odontoblasts, the basement membrane
between the odontoblasts and preameloblasts disintegrates. This process
allows the contact of the newly formed dentin with the preameloblasts, which
induces the differentiation of preameloblasts to ameloblasts. This leads to
initiation of appositional or layered growth of the enamel matrix, known as
amelogenesis, with the help of newly formed ameloblasts.
The enamel matrix is formed directly by the distal portion of each ameloblast
known as the Tomes process. Contact of the enamel matrix with the
predentin causes mineralization of the disintegrated basement membrane,
thereby leading to formation of the dentinoenamel junction (DEJ).
Some enamel tufts and lamellae are hypomineralized, geologic faults seen
in the transverse sections of enamel. These structures have no clinical
significance. The enamel tufts contain increased enamel protein concentration
and extend from the DEJ to the enamel for a short distance. In contrast,
enamel lamellae consist of longitudinally oriented defects, and project from
different depths of the enamel surface.
The application of excessive heat to a tooth results in pain because:
• excessive stimulation of a heat receptor always results in pain

• heat receptors in the pulp have a low threshold to pain
• all stimuli to the pulp results in a pain sensation
• blood vessels of the pulp expand and cause strangulation of the tissue

1
all stimuli to the pulp results in a pain sensation
Remember:
1. The only type of nerve ending found in the pulp is the free nerve ending,
which is a specific receptor for pain. These pain receptors are located in the
plexus of Raschkow. Regardless of the source of stimulation (heat, cold,
pressure), the only response will be pain.
2. The nerve bundles that enter the tooth pulp consist principally of sensory
afferent nerves of the trigeminal (fifth cranial) nerve and sympathetic
branches from the superior cervical ganglion.
3. Each bundle contains myelinated and unmyelinated axons.
4. Although most of the nerve bundles terminate in the subodontoblastic
plexus (of Raschkow) as free, unmyelinated nerve endings, a small number
of axons pass between the odontoblast and sometimes extend into dentinal
tubules.
Note: Proprioceptors (which respond to stimuli regarding movement) are not
found in the pulp.
Important: As the dental pulp ages, the following changes take place:
• Decreased:
° intercellular substance, water, and cells
***Major decrease in the number of undifferentiated mesenchymal cells
° size of the pulp cavity due to the addition of secondary or tertiary dentin
• Increased:
° number of collagen fibers
° calcifications within the pulp (called denticles or pulp stones)
Important point: As the pulp ages, it becomes more fibrotic, leading to a
reduction in the regenerative capacity of the pulp.
tooth terms 138
For each numbered term on the left, select the most closely linked
description from the list on the right.
1. sulcus A. an irregular depression or

2. fossa concavity on the occlusal surfaces of
posterior teeth and on the lingual
3. pit surface of incisors
4. fissure B. V-shaped depression on the
occlusal surface of posterior teeth
C. crack-like fault, caused by
incomplete fusion of enamel during
tooth development
D. formed at the depth of fossa where
two or more grooves meet
DENTAL ANATOMY & OCCLUSION ifcdentaldecks

• 1.B, 2.A, 3.D, 4.C
1. Fossa: An irregular depression or concavity found both on anterior as well
as posterior teeth. The different types of fossae are
° Lingual: Present on the lingual surfaces of incisors.
° Central: Found on the occlusal surfaces of posterior teeth. A central
fossa is formed by the convergence of ridges that terminate at a central
point at the junction of grooves.
“ Triangular: Found on the occlusal surfaces of the molars and
premolars, mesial or distal to marginal ridges.
2. Mostly, the number of fossae in two-cusped premolars is two (mesial and
distal), whereas it is three in molars and three-cusped premolars (mesial,
central, and distal).
3. Sulcus: Broad V-shaped depression on the occlusal surface of posterior
teeth. The two triangular ridges move toward a developmental groove
(shallow line between the primary parts of the crown or root) in the depth of
the occlusal sulcus. Sulci along with grooves serve an important escape
way for food during chewing.
4. Fissure: Crack-like fault, seen as a narrow cleft or gap at the depth of any
groove, formed when the fusion of enamel remains incomplete during tooth
development. Dental caries often form in the deepest part of a fissure.
5. Pit: Enamel defect formed at the depth of a fossa where two or more
grooves meet. Pits are also sites for the commencement of dental decay.
tooth terms 139
When two teeth in the same arch are in contact, their curvatures
adjacent to the contact areas form spillway spaces called
embrasures.
The design of contact areas, interproximal spaces, and embrasures
varies with the form and alignment of the various teeth; each section
of the two arches shows similarity of form.

DENTAL ANATOMY & OCCLUSION l*d e n ta ld e d < S

W hen tw o teeth in the sam e arch are in contact, their curvatures adjacent to the
contact areas form spillw ay spaces called em brasures. T he spaces that w iden out
from the area of contact labially or buccally and lingually are called labial or buccal
and lingual interproxim al em brasures. T hese em brasures are continuous with the
interproxim al spaces between the teeth. A bove the contact areas incisally and
occlusally, the spaces, w hich are bounded by the m arginal ridges as they join the
cusps and incisal ridges, are called the incisal or occlusal em brasures. These
em brasures, and the labial or buccal and lingual em brasures, are continuous. The
curved proxim al surfaces of the contacting teeth roll aw ay from the contact area at all
points, occlusally, labially, or buccally, and lingually and cervically, and the
em brasures and interproxim al spaces are continuous, as they surround the areas of
contact. Note: For esthetics and function, em brasures m ust be sym m etrical.
Three functions of em brasures:
1. Function as spillw ays to direct food aw ay from the gingiva.
2. M ake the teeth m ore self-cleansing.
3. Protect the gingival tissue from undue frictional traum a, but at the sam e tim e
provide the proper degree of stim ulation to the tissue.
The lingual em brasures are ordinarily larger than the facial em brasures because
most teeth are narrow er on the lingual side than on the facial side, and also because
the ir contact points are located in the facial third of the crowns.
The design of contact areas, interproxim al spaces, and em brasures varies with the
form and alignm ent of the various teeth; each section of the tw o arches shows
sim ilarity of form . In other words, the contact form , interproxim al spacing, and the
em brasure form seem rather consistent in sectional areas of the dental arches.
1. Pronounced developm ental grooves are usually associated with
em brasures betw een perm anent m axillary canines and first prem olars,
and between perm anent m andibular canines and first prem olars.
2. The largest incisal/occlusal em brasure is found betw een the maxillary
canines and first prem olars.
tooth terms 140
When viewed from the facial, all posterior teeth have proximal
contacts in the middle third.
The more posterior teeth (the molars) have contacts higher in the
middle third than the premolars.


• the first statem ent is true, the second is false
W hen view ed from the facial, all posterior teeth have proxim al contacts in the middle
third. The m ore posterior teeth (the molars) have contacts low er in the m iddle third
than the prem olars. Also, each posterior tooth has the m esial contact slightly more
occlusal than the distal contact.
Note: Four teeth have mesial surfaces that contact each other. T hey are the m axillary
and m andibular central incisors. In all other instances, the m esial surface of one
tooth contacts the distal surface of its neighbor, except the distal surfaces of
perm anent third m olars and the distal surfaces of prim ary second m olars.
The loss of proxim al contact may result in periodontal disease, m alocclusion, food
im paction, or drifting of teeth.
D E
F G
Out line drawings o f the maxillary teeth in conlac 1. w ith do ited lines
tooth terms 141
A 16-year-old patient is referred to the orthodontist's office needing

work to fix her malocclusion. Before the patient's first appointment,
the orthodontist reviews the clinical photographs of the patient and
notices mamelons. Mamelons are unusual in older patients and
would indicate that the patient most likely has which of the following
malocclusions?
• posterior crossbite
• posterior open bite
• anterior open bite
• edge-to-edge class III dental occlusion

• anterior open bite
M am elons usually develop in groups of three. They resem ble rounded protuberances
and they are found on the incisal edges of newly erupted incisor teeth, both m axillary
and m andibular. W hen each of the anterior teeth develops, they originate from four
lobes - m esial, labial, distal, and lingual (or cingulum ).
Each one of these lobes term inates form ation incisally in these rounded em inences.
They are usually the m ost profound right after eruption, but with tim e they usually wear
down after the tooth com es into fun ctiona l position. Note: The presence of m am elons
in a tee nag er o r adult is indicative of m alocclusion. M ost likely there is an anterior
open bite relationship w here the incisors do not touch (see picture below).
Part of the reason that the m am elons are so noticeable is because these extensions
are made of pure enam el with no dentin layer underneath. T his and the ir thinness
contributes to the ir transluce nt appearance as opposed to the rest of the clinical crown
which is alm ost alw ays m ore opaque than the m am elons. W ith this translucent
quality, they often appear to be a different shade than the rest of the tooth and
therefore are som etim es much m ore distinct.
Remember: M axillary and m andibular incisors characteristically have three m am elons
which are centered beneath the three facial lobes.
Photo shows mamelons

present on m axillary and
m andibular incisors as well
as an a nterior open bite.
tooth terms 142
Which of the following are true concerning developmental grooves?

• they are formed during tooth development

• they usually separate the primary parts of the crown or root
• they are important escape ways for cusps during lateral and protrusive jaw
motions and for food particles during mastication
• they are broad, deep, linear depressions

• they are formed during tooth development
• they usually separate the primary parts of the crown or root
• they are important escape ways for cusps during lateral and
protrusive
jaw motions and for food particles during mastication
A developmental groove is a shallow groove or line between the primary
parts of the crown or root. A supplemental groove, less distinct, is also a
shallow linear depression on the surface of a tooth, but it is supplemental to a
developmental groove and does not mark the junction of primary parts.
Buccal and lingual grooves are developmental grooves found on the buccal
and lingual surfaces of posterior teeth.
Remember: Pits are located at the junction of developmental grooves or
at terminals of these grooves.
O cclu sal V ie w o f a P e rm a n e n t M a n d ib u la r F irs t M o la r

tooth terms 143
In many older individuals, gingival recession leads to an unaesthetic

problem affectionately known as “black triangle disease.” This is
caused by the loss of gingival tissue in the interdental space. The
interdental space is the:
• occlusal (incisal) border at which the gingiva meets the tooth

• portion of the gingiva that fills the interproximal space
• collar of tissue that is not attached to the tooth or alveolar bone
• band or zone of gray to light or coral pink keratinized masticatory mucosa
that is firmly bound down to the underlying bone
DENTAL ANATOMY & OCCLUSION iM e n ta ld e c k s

• portion of the gingiva that fills the interproximal space
This interproximal space is triangular. The sides of the triangle are the proximal
surfaces of the adjacent teeth, the apex of the triangle is the area of contact of
the two teeth, and the base of the triangle is the alveolar bone.
The interdental gingiva which occupies this space (papilla) between the facial
and lingual papillae conforms to the shape of the contact area.
1. The gingival margin is the occlusal (incisal border) at which the
gingiva meets the tooth.
2. The free gingiva (marginal gingiva) is the collar of tissue that is not
attached to the tooth or alveolar bone. It surrounds the root of each
tooth from the gingival margin to form the collar of space or gingival
crevice or sulcus (where dental floss can fit).
3. The attached gingiva is a band or zone of gray to light or coral
pink keratinized masticatory mucosa that is firmly bound down to
the underlying bone. It is present between the free gingiva and the
more movable alveolar mucosa.
tooth terms 144
Which of the following types of ridges is uniqu to permanent
maxillary molars?
• a labial ridge
• a marginal ridge
• an oblique ridge
• a transverse ridge
DENTAL ANATOMY & OCCLUSION d M e n ta ld e c k s

• an oblique ridge
*** It crosses the occlusal surface obliquely and is formed by the union of the distal cusp ridge of
the mesiolingual cusp and the triangular ridge of the distobuccal cusp. It normally forms the
distal boundary of the central fossa.
• A labial ridge is a ridge running cervico-incisally in approximately the center of the labial
surface of the canines
• A buccal (cusp) ridge is a ridge running cervico-occlusally in approximately the center of the
buccal surface of premolars (more pronounced on the first premolars than second
premolars)
• A cervical ridge is a ridge running mesiodistally on the cervical third of the buccal surface of
the crown. It is found on all primary teeth, but only on the permanent molars.
• A marginal ridge; on incisor and canine teeth, it is located on the mesial and distal border
of the lingual surface; on posterior teeth, it is located on the mesial and distal border of the
occlusal surface
• A triangular ridge is a ridge that projects from the cusp tip to the central groove. It is found
on posterior teeth. Note: The ML cusp on maxillary molars has two triangular ridges.
• A transverse ridge is a ridge formed by the union of a lingual triangular ridge of a buccal
cusp and a buccal triangular ridge of a lingual cusp. It runs from the buccal surface to the
lingual surface across the occlusal surface of most posterior teeth.
D isto bu cca l
cu sp \ M e sio b u cca l
X cuso
O bliqu e
ridg e
Distolingual M esiolingual
cusp cusp
Occlusal view of a permanent maxillary molar
tooth terms 145
Transverse ridges are very common on which of the following?
• mandibular premolars
• mandibular molars
• maxillary premolars
• maxillary molars

♦ mandibular molars
• maxillary premolars
A transverse ridge is the union of the buccal and lingual triangular ridges. This ridge
crosses the occlusal surface of most posterior teeth in a buccolingual direction. They occur
between the ML and MB or between the DL and DB cusps on molars or between buccal and
lingual cusps on premolars.
Important: Transverse ridges are very common on mandibular molars and maxillary premolars.
Triangular ridges descend from the tips of the cusps of molars and premolars toward the
central part of the occlusal surface. They are called triangular because the slopes of each side of
the ridge are inclined to resemble two sides of a triangle. They are named after the cusps to
which they belong (e.g., the triangular ridge of the buccal cusp of the maxillary second premolar).
Remember: Maxillary molars have a characteristic oblique ridge. An oblique ridge is the union
of two ridges running obliquely across the occlusal surface. Oblique ridges always run between
the distobuccal cusp and the mesiolingual cusp. They are formed by the union of the distal cusp
ridge of the ML cusp and the triangular ridge of the DB cusp.
Centtal pit Buccal groove
Occlusal features o f the perm anent m andibular rig h t second molar

tooth terms 146
A 7-year-old patient comes into your pediatric practice for a routine
prophylaxis. When conducting an intra-oral exam you comment to
him that you notice that he has just eaten something sticky like
gummy worms or fruit snacks. The chewing surface of posterior
teeth, and the likely location of sticky food deposits in this patient, is
referred to as the:
• clinical crown
• incisal edge
• occlusal surface
• anatomic crown

• occlusal surface
It consists of cusps, ridges, and grooves and is bounded mesiodistally by
the marginal ridges and buccolingually by the cusp ridges. Note: Incisors and
canines do not have an occlusal surface.
1. The incisal edge is the cutting edge or biting surface of anterior
teeth.
2. The anatomic crown is that part of the tooth covered by enamel.
*** The anatomical crown and root are separated by the CEJ; the
anatomical crown does not include cementum, and the anatomical
root does not include enamel.
3. The clinical crown is that part of the tooth that is visible in the oral
cavity. It may be larger or smaller than the anatomic crown.
***The clinical crown and root are separated by the gingival
margin; the clinical crown or root may be composed of both
enamel and cementum.
tooth terms 147
All anterior teeth show traces of:
• one lobe
• two lobes
• three lobes
• four lobes

• four lobes
Tooth development begins with increased cell activity in growth centers in the
tooth germ. A growth center (lobe) is an area of the tooth germ where the cells
are particularly active. These lobes are primary centers of calcification and
are primary sections of formation in the development of the crown of a tooth.
They are represented by a cusp on posterior teeth and mamelons and
cingula on anterior teeth. They are always separated by developmental
grooves, which are very prominent in the posterior teeth and form specific
patterns. With anterior teeth, their presence is much less noticeable and
these lobes are separated by what are known as developmental
depressions.
Summary of number of lobes:
• All anterior teeth: three labial and one lingual (cingulum)
• Premolars: three buccal and one lingual
• Exception: The mandibular second premolar has three buccal and two
lingual lobes.
• First molars: maxillary - four lobes (or five if Carabelli); mandibular - five
lobes
• Second molars (maxillary and mandibular): four lobes
• Third molars: at least four lobes. Variations are seen.
***The number of lobes forming molars is one per cusp, including the cusp
of Carabelli.
Important: The minimum number of lobes from which any tooth may develop
is four.
tooth terms 148
A young patient comes to the clinic complaining that he gets too
much food stuck behind his front tooth when he bites. On
examination, the dentist notes an anomalous, claw-shaped cusp
which projects from the cingulum of tooth #9. This small elevation of
enamel found on the crown portion of a tooth would be classified as
a:
• tubercle
• mamelon
• ridge
• developmental depression

• tubercle
It is an extra formation of enamel. The most common example would be the cusp of
Carabelli, which is located on the lingual surface of the mesiolingual cusp of the
maxillary first permanent molar. Note: The maxillary primary second molar may even
have a cusp that resembles the cusp of Carabelli.
Dens evaginatus is an extra cusp, usually in the central groove or ridge of a
posterior tooth and in the cingulum area of the central and lateral incisors. In incisors,
these cusps appear talon-shaped and can approach the level of the incisal edge.
This extra portion contains not only enamel but also dentin and pulp tissue, and
therefore pulp exposure can result from radical equilibration.
A
D ens e v a g in a tu s
-T a lo n cusp
cusp is an elevation or mound on the crown portion of a tooth making up a divisional

part of the occlusal surface.
A tubercle is a smaller elevation on some portion of the crown produced by an extra
formation of enamel.
A cingulum is the lingual lobe of an anterior tooth. It makes up the bulk of the
cervical third of the lingual surface.
A ridge is any linear elevation on the surface of a tooth and is named according to its
location (e.g., buccal ridge, incisal ridge, marginal ridge).
tooth terms 149
How many line angles are there in an anterior tooth?
• four
• five
• six
• eight

’ SIX
A line angle is formed by the joining of two crown surfaces, thus forming an angle.
The name of each line angle is derived from the two surfaces involved. There are six
line angles per tooth in anterior teeth and eight line angles per tooth in posterior
teeth.
Line Angles of Anterior Teeth (six) Line Angles of Posterior Teeth (eight)
• mesiobuccal
• mesiolabial • mesiolingual
• mesiolingual • distobuccal
• distolabial • distolingual
• distolingual • mesio-occlusal
• labioincisal • bucco-occlusal
• linguoincisal • linguo-occlusal
• disto-occlusal
The reason for the fewer line angles in anterior teeth as compared to the posteriors is
that the mesioincisal and distoincisal line angles are practically nonexistent in the
anteriors since the mesial and distal incisal line angles are rounded.
Note: The angle formed at the junction of three crown surfaces is called a point
angle. All teeth (anteriors as well as posteriors) have four point angles each.
Point Angles of Anterior Teeth Point Angles of Posterior Teeth
• mesiolabioincisal • mesiobucco-occlusal
• mesiolinguoincisal • mesiolinguo-occlusal
• distolabioincisal • distobucco-occlusal
• distolinguoincisal • distolinguo-occlusal
tooth terms 150
Any linear elevation on the surface of a tooth is called:
• an incline
• a prominence
• a ridge
• a tuberosity

• a ridge
A ridge is any linear elevation on the surface of a tooth that is named according to its
location and form, such as a buccal ridge, incisal ridge, or marginal ridge.
Remember: Two ridges that are present on all teeth are the mesial and distal marginal
ridges. They form the mesial and distal margins of the occlusal surfaces of premolars and
molars and the mesial and distal margins of the lingual surfaces of the incisors and
canines.
Note: The marginal ridges are more prominent on the lingual surface of the maxillary
lateral incisors as compared to the maxillary central incisors or mandibular incisors
(centrals and laterals).
Cusp ridge: Each cusp has four cusp ridges radiating from its tip. They are named
according to the direction they take away from the cusp tip (for example, mesial, distal,
buccal, or lingual).
Lingual ridge: The ridge of enamel that extends from the cingulum to the cusp tip on the
lingual surface of most canines.
Perm anent M axillary Right First Premolar: Occlusal view

permanent teeth 151
Which tooth in the mouth has the greatest axial inclination relative to
the occlusal plane?

maxillary central incisor
M a x illa ry R ight
C entral Incisor
Crown: largest of all incisor teeth. The distal outline is more convex than the mesial outline. It is
the most prominent tooth in the mouth. It has the widest crown mesiodistally of any
permanent anterior tooth.
Root: one root with a single root canal. It is conical with a blunt apex. This root is the only
maxillary tooth that is as thick at the cervix mesiodistally as faciolingually (the others are thicker
faciolingually than mesiodistally). It is not unusual to find definite pulp horns in the incisal region
of the tooth.
Surfaces: the mesial curvature of the cervical line is larger than any other tooth. The
distoincisal corner is more rounded (convex) than the mesioincisal corner. The mesial and
distal contact areas are centered faciolingually (as are all permanent incisors). The cingulum
is well-developed and is located off-center toward the distal.
Occlusion: occludes in centric with the mandibular central and lateral incisors (same in
protrusive and there is no contact in retrusive).
Distinguishing features: the maxillary central incisors have the narrowest incisal
embrasures. Compared to other incisors, they have the greatest axial inclination relative to
the occlusal plane. They usually have three mamelons and four developmental grooves.
permanent teeth 152
Which teeth have the most variable crown shape of all permanent
teeth?

• mandibular lateral incisors
• maxillary third molars
• mandibular second premolars

maxillary third molars
Maxillary Right Third Molar
Characteristics of maxillary third molars:

• They have greater morphological variance than any other tooth.
• They are the shortest permanent tooth.
• They are often congenitally missing or non-functional - may be present but
unerupted (this is also true of the mandibular third molar).
• Crown tapers more from buccal to lingual.
• They frequently have only three cusps. It is sometimes difficult to identify them
individually (MB, DB, and lingual cusps). The DL cusp is frequently absent.
Oblique ridge is poorly developed and often absent.
• Roots are unpredictable (usually short and fused).
• Sometimes a small fourth molar (paramolar) will be fused to this molar.
• They occlude only with the mandibular third molars (all other teeth occlude with
two teeth except the mandibular central incisors).
Remember: The mandibular third molar is often anomalous as well, but not as
often as the maxillary third molar.
permanent teeth 153
Which of the following statements concerning the mandibular lateral
incisor are true?
• the mandibular lateral incisor is a little larger in all dimensions than the
mandibular central incisor
• the crown of the mandibular lateral incisor is not as bilaterally symmetrical
as the mandibular central incisor
• the cingulum is directly in the center of the lingual surface
• the single root is usually straight, slightly longer and wider than that of a
mandibular central

• the mandibular lateral incisor is a little larger in all dimensions than the
mandibular central incisor
• the crown of the mandibular lateral incisor is not as bilaterally symmetrical
as the mandibular central incisor
• the single root is usually straight, slightly longer and wider than that of a
mandibular central
M a nd ib ula r
R ight Lateral
Incisor
Crown: not as bilaterally symmetrical as the mandibular central incisor. The crown is tilted distally
on the root. The distoincisal angle is more rounded than the mesioincisal angle. It is broader
labiolingually than mesiodistally.
Root: one root: usually straight, slightly longer and wider than that of a mandibular central.
Pronounced proximal root concavities, especially on the distal surface.
Surfaces: lingual surface is smooth. The cingulum is slightly off-center to the distal. Mesial marginal
ridge is slightly longer than the distal marginal ridge.
Important: The mesial and distal contact areas of the lateral incisor are not at exactly the same level,
a condition different from that found on the central incisor. The mesial and distal contacts are both in
the incisal third; however, the distal contact is slightly cervical to the level of the mesial contact area.
Note: In an anterior cross-bite relationship (Class III), as the mandible retrudes, the maxillary lateral
contacts the mandibular canine and lateral.
permanent teeth 154
Which tooth is considered the “cornerstone” of the permanent

dentition?
DENTAL ANATOMY & OCCLUSION H^dentaldecks

M a n d ib u la r R ight First M olar
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Crown: It is the largest mandibular tooth. It has the largest mesiodistal dimension of any
tooth. Mesiodistal dimension is slightly greater than the faciolingual dimension. This tooth
presents a pentagonal “home plate” occlusal outline that is distinctive for this tooth.
Roots: two roots with three canals (a second canal is in the mesial root.) Note: A fourth canal
(in the distal root) is found 30% of the time. The roots are widely separated and the root trunk is
relatively short.
Cusps: five cusps (three buccal - MB, DB, and distal; two lingual - DL and ML). The
mesiobuccal cusp is the largest of the five and the distal cusp is the smallest. Lingual cusps are
higher and more pointed than the buccal cusps (flattened buccal cusps are typical of all
mandibular molars).
Occlusal pattern: two transverse ridges, three fossae with pits. The central groove is
crooked in its mesiodistal course.
Distinguishing features: first permanent tooth to erupt (known as six-year molar), it is
considered the “cornerstone” of the permanent dentition. It has two buccal grooves (MB and
DB).
Note: The mandibular first molar is the most often restored, extracted, and replaced tooth.
permanent teeth 155
A patient walks into your office holding three crowns in her hand and
claims that they fell out during a car accident. You notice that one of
the crowns has a mesiolingual developmental groove. This is a dead
giveaway that this tooth is a:


mandibular first premolar
M a n d ib u la r R ig h t First P re m o lar
Crown: from the buccal, it is longer and has a more prominent buccal ridge than the
second premolar. It is bell-shaped and the cervical is very constricted.
Root: one; it is shorter and has a pointed apex (the second premolar is longer with a
blunt apex). It is broader facially than lingually and may have slight concavities on the
mesial and distal.
Cusps: has a large pointed buccal cusp which occupies almost two-thirds of the occlusal
surface and has a prominent triangular ridge. It has a small (about two-thirds the height of
buccal cusp), non-functioning lingual cusp (does not occlude with anything).
Occlusal pattern: small, non-functioning occlusal surface which converges toward the
lingual. The prominent triangular ridge of the buccal cusp and the small buccal ridge of
the lingual cusp unite to form a transverse ridge. Usually there is no central groove
(may have mesial and distal pits). The mesial marginal ridge is more cervical than the
distal marginal ridge.
Distinguishing feature: A developmental groove, the mesiolingual groove, usually
separates the mesial marginal ridge from the mesial cusp slope of the small lingual cusp.
Note: The masticatory function of a mandibular first premolar is similar to that of a
mandibular canine.
permanent teeth 156
You are sifting through extracted teeth to practice a root canal. Since
you will rarely do a third molar root canal in practice, you throw those
out right away. What is the most reliable distinguishing feature of the
mandibular third molar?
• fused and compressed root system

• short, bulbous outline of the crown
• marginal ridge forming a smooth circle
• marked distal inclination of the root trunk
• great morphologic resemblance to the first molar

• marked distal inclination of the root trunk
Mandibular Right Third Molar
Most mandibular third molars have two roots, one mesial and one distal. These roots
are usually shorter, generally with a poorer development than the roots of the first and
second molars, and their distal inclination in relation to the occlusal plane of the crown
is greater. This is the m ost distinguishing feature of the mandibular third molars.
Characteristics of m andibular third molars:
• Bulbous crowns that taper from mesial to distal
• The crown can resemble the mandibular second molar (four cusps) or the
mandibular first molar (five cusps)
• The mesial-distal dimension of the crown is greater than the buccal-lingual
dimension
• Short roots that are often fused. Long root trunk.
• MB cusps are usually wider and longer than DB cusps
• Irregular groove pattern with many supplemental grooves and pits (very
shallow)
Note: O versized anomalies are more common with the m andibular third molar, while
undersized anomalies are more common with the m axillary third molar.
permanent teeth 157
The most distinguishable difference between the maxillary first and

second permanent premolars is:
• the size of the crown

• the number of roots
• the curvature of the facial surface
• the length of the lingual cusp

• the number of roots
Maxillary Right First Premolar Maxillary Right Second Premolar
Occlusal Mesial Distal Occlusal Mesial Distal
Maxillary second premolar:

• Crown: smaller than first premolar. From the occlusal, it is much more
symmetrical and less angular (more ovoid) than the first premolar. The crown is
wider faciolingually than mesiodistally.
• Root: one
• Cusps: two, the buccal and lingual are almost equal in height. Mesial
inclination of lingual cusp (same as first premolar). The distobuccal cusp ridge
(DBCR) is longer than the mesiobuccal cusp ridge (MBCR) - opposite of
maxillary first premolar.
• Surfaces: has no mesial developmental depression (as seen on maxillary first
premolars). Less prominent buccal ridge: maxillary first premolar has prominent
buccal ridge.
• Occlusal pattern: shorter central groove with more supplemental grooves
(compared with maxillary first premolar).
permanent teeth 158
The maxillary first molar is the largest tooth in the maxillary arch and
also has the largest crown in the permanent dentition.
All maxillary molars are wider buccolingually than mesiodistally; in
comparison, the mandibular molars are wider mesiodistally.


M a xillary R ight First M olar
Facial Lingual Occlusal Mesial Distal
Crown: It is the largest maxillary tooth. From the occlusal, all maxillary molars are
rhomboidal, with obtuse angles at the ML and DB (the other two angles are acute - MB and
DL). Like all maxillary posterior teeth, the crown outline is trapezoidal from each proximal view.
In addition, the crown is also centered over the root and shows no lingual inclination, like all
maxillary molars and unlike mandibular molars.
Roots: Three; MB root often has two canals (MB and ML). These pulp horns are often higher
than the distal and palatal.
Cusps: Four, two buccal (MB is usually longer and wider than DB) and two lingual (ML and DL).
ML is always the largest and highest on any posterior tooth. The cusp of Carabelli (when
present) is seen lingual to the ML cusp.
Occlusal pattern: It has an oblique ridge (as do all maxillary molars) which runs from the ML
cusp to the DB cusp and meets near the center on a level with the marginal ridges.
Note: The distal surface has a pronounced cervical concavity that needs special attention
when root planing. It is the second permanent tooth to erupt (after the mandibular first molar).
These two teeth form the corner stone of the arch. It has a long lingual groove which has a pit.
permanent teeth 159
T h e________ are the only teeth in the permanent dentition with a

vertical and centrally placed labial ridge.
• canines
• premolars

• canines
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Labial Mesial Distal
Crown: It has a prominent labial ridge. The cingulum is large and centered mesiodistally. It
represents a transition from anterior to posterior teeth; the mesial resembles the incisors and
the distal resembles the premolars. It is wider labio-lingually than mesiodistally. From the
proximal view, it appears to be positioned vertically in the arch.
Root: One root with one canal. It is the longest root. The heavy root results in a bony labial
ridge called the canine eminence.
Cusp: When viewed from the incisal, the cusp tip is located on the mesiofacial of the crown.
The mesial cusp ridge is shorter than the distal cusp ridge.
Surface: The lingual surface contains all of the following: a pronounced cingulum, lingual
ridge (located between mesio and distolingual fossa), mesio and distolingual fossa, and mesial
and distal marginal ridges.
Pits and grooves: It has a shallow lingual groove. This groove may contain a lingual pit near its
center.
Distinguishing features: least often extracted (together with the mandibular canine).
permanent teeth 160
A linguogingival groove may be present on the root (and possibly on

the crown) of the maxillary lateral incisor.
A maxillary lateral incisor has a single conical root that is relatively
smooth and straight but may curve slightly to the distal.


M a x illa r y R ig h t
L a te ra l In cis o r
Crown: It resembles the maxillary central incisor; however, it is smaller in all dimensions
except the root (root lengths are equal). The mesiodistal measurement is greater than the
labiolingual measurement.
Root: A single conical root that is relatively smooth and straight but may curve slightly to the
distal.
Surfaces: lingual pit is common (more pronounced than mandibular lateral). Lingual surface is
the most concave of any of the incisors (maxillary and mandibular). The linguoincisal ridge is
well developed. The distoincisal corner or angle is more rounded (convex) than that of the
central incisor.
Pits and grooves: a linguogingival groove may be present on the root (and possibly on the
crown). Note: It is prone to decay and also may complicate root planing.
Occlusion: In the intercuspal position, it opposes the incisal edge of the mandibular lateral and
the canine. It is the tooth that is most often in an abnormal relation and contact with adjacent teeth
in the same arch.
Distinguishing features: may be congenitally absent (most often of the permanent anterior
teeth). It is the last anterior tooth to begin calcification (10 months). Displays greater
variation in form than any other permanent tooth, except the third molars. It may appear “peg-
shaped" or manifest as “dens in dente.”
permanent teeth 161
When filling a Class II amalgam you are having trouble fitting the
matrix band perfectly and keep getting an overhang in the cervical
area. What surfaces are you preparing?
• mesio-occlusal of a maxillary first premolar

• disto-occlusal of a maxillary first premolar
• mesio-occlusal of a maxillary second premolar
• disto-occlusal of a maxillary second premolar
• mesio-occlusal of a mandibular first premolar
• disto-occlusal of a mandibular first premolar
DENTAL ANATOMY & OCCLUSION H|*dentaldecl<S

• mesio-occlusal of a maxillary first premolar (the mesial surface has a pronounced mesial
concavity that can be hard to adapt to with a matrix band)
" ’ Immediately cervical to the mesial contact area, centered on the mesial surface, is a marked depression,
called the mesial developmental depression, which continues up to and includes the cervical line.
A
\ Mesial developm ental ,
depression . | , '% M a x illa r y R ig h t
ll F ir s t p r e m o l a r
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Buccat L in g u a l O c c lu s a l M e s ia l D is t a l
Crown: widest of all premolars (maxillary and mandibular). The oblong crown outline is greater
buccolingually than mesiodistally. They are longer cervico-occlusally than the second premolar, first molar,
or second molar.
Roots: two roots, one buccal and one lingual, each with one canal. This is the only premolar that has two
roots. When viewed from the proximal, the axial inclination of the roots appears vertical.
Cusps: two; the lingual cusp is shorter than the buccal cusp. The buccal cusp tip is sharp and is placed
slightly to the distal. The mesial buccal cusp ridge is longer than the distal buccal cusp ridge. The lingual
cusp tip is located toward the mesial half of the lingual surface. Cusp inclines are very steep.
Surfaces: Mesial surface has a pronounced (deep) cervical concavity (developmental depression) that
requires special consideration when performing periodontal maintenance. Has a prominent buccal ridge.
Occlusal pattern: It has a deep sulcus and long central groove. Also has a mesial marginal developmental
groove. Usually few supplemental grooves and no pits.
Comparison: resembles the second premolar, except it is larger and more angular; the MBCR is longer than
the DBCR, the buccal ridge is more prominent and it has a longer central groove.
permanent teeth 162
A mandibular canine is wider labioiingually and mesiodistally than a

maxillary canine.
The crown of the mandibular canine can be as long or even longer
than that of a maxillary canine.


The mandibular canine is narrower labiolingually and mesjodistally than a maxillary canine.
M andibular Right
Canine
Crown: Labial surface is smooth and convex. Labial ridge is not as prominent as the maxillary
canine. The greatest faciolingual measurement is greater than the greatest mesiodistal
measurement.
Root: One; may be bifurcated into labial and lingual parts. A developmental depression may
appear on the mesial root surface. In cross-section, the root is ovoid, but wider
mesiodistally at the labial.
Cusps: The cusp tip is displaced lingually. The mesial cusp ridge is shorter than the distal
cusp ridge (more so than on maxillary canines).
Surfaces: The mesial surface of the crown is almost parallel to the long axis of the tooth. The
cingulum is less bulky and less prominent than the maxillary canine.
Comparisons: It appears more slender and is smoother than the maxillary canine in all
respects; the labial and lingual ridges are less well developed. This feature allows them to be very
caries resistant.
***AII canines have a mesiolabial developmental depression that is found on the labial crown
surface in the incisal third, just mesial to the labial ridge.
permanent teeth 163
Which tooth has two forms: the three-cusp type and the two-cusp
type?


'"Remember: The three-cusp type shows the Y-shaped groove pattern and the two-cusp type
shows either the U- or H-shaped groove pattern.
M a n d ib u la r Right Second Prem olar
Occlusal Mesial Distal
Crown: three-cusp type occurs most often (one buccal and two lingual cusps). From the buccal,
it is shorter and wider than the first premolar. From the occlusal, it has a square outline. It
resembles other premolars from the buccal aspect only.
Root: One; apex approximates the mental foramen. It is thicker and longer than the root of
the mandibular first premolar.
Cusp: Buccal cusp is shorter, not as sharp, and the cusp slopes are less steep than the
mandibular first premolar. Mesiolingual cusp is always larger than the DL cusp which may be
absent. Lingual inclines of the buccal cusps are functional. From a distal view, it is usually
possible to see the outline of all three cusps.
Pits and grooves: Central developmental groove is sometimes “U”-shaped or looks like a
crescent. It ends in the mesial and distal fossae, where it often joins a MB and a DB supplemental
groove.
Occlusal pattern: larger occlusal surface than first premolar. General shape is more nearly
square, especially three-cusp type, than the first premolar. Most frequently has a single central
pit. There is no mesiolingual groove or transverse ridge (both are common on first premolar).
permanent teeth 164
The outline of the crown of a maxillary second molar is narrower

mesiodistally than that of a maxillary first molar but is about the same
width buccolingually.
Two crown outline types are possible on the maxillary second molar
when viewed from the occlusal: rhomboidal and heart-shaped.


_ /% Jr/
M a x i ll a r y R ig h t S e c o n d M o la r
\ s fit
i M
w
\
J g •
| ; \
\ J
i .
Buccal L in g u a l O cclu sal M e s ia l D is ta l
Crown: Second molar is smaller than first molar, particularly in its width on the lingual
side, which has a smaller or nonexistent DL cusp (tooth may only have three cusps) and
is also smaller mesiodistally. When viewed from the occlusal, the mesiobuccal line angle
is the most acute. Buccal is broader than lingual due to absence of the fifth cusp
(Carabelli). It is more angular than the first molar.
Roots: Three; they are as long as first molar but are less spread apart mesiodistally and
faciolingually. They bend more to the distal and have a longer root trunk (as compared
to the first molar).
Cusps: Cusp of Carabelli is absent. The ML cusp is the largest, DL cusp is the smallest
(same as maxillary first molar). The primary cusp triangle is formed by the ML, MB, and
DB cusps (same for all maxillary molars). Note: The DL cusp is not a part of this triangle.
Occlusal pattern: sm aller oblique ridge and a more varied pit and groove pattern
compared to first molar. The transverse groove of the oblique ridge connects the central
and distal pits (same for all maxillary molars).
Note: The lingual groove is shorter and does not have a pit (compared to first molar).
DL cusp may also be absent on maxillary third molars.
permanent teeth 165
You buy a batch of pre-fabricated temporary crown restorations for
your office for the first time. Your assistant drops the entire box on
the ground and they all get mixed up. The hardest tooth to distinguish
left from right will be the:


• m andibular second molar (it is the most sym m etrical molar)
M a n d ib u la r R ig h t S e c o n d M o la r
Crown: resembles the mandibular first molar except, it has no fifth cusp and it is
smaller. Occlusal outline can be rhomboidal (most common) or heart-shaped. The
greatest faciolingual diam eter is located in the mesial third of the crown.
Root: two; they are closer to gether and straighter than the first molar roots and are
inclined more distally. Mesial root is not as broad faciolingually compared to first
molar. It has a longer root trunk.
Cusps: four (two buccal and two lingual). This contributes to symmetry.
Occlusal pattern: looks like plus sign (+). Facial and lingual grooves form right
angles with the central groove. Central groove is straight. Has m ore secondary
developmental grooves (three of them) than the first molar. Has two transverse
ridges and three fossae with pits.
Distinguishing features: has only one buccal groove and one buccal pit.
permanent teeth 166
The mandibular central incisors are the smallest and simplest teeth of
the permanent dentition.
The mandibular central has a simple root, which is very narrow
labiolingually and wide mesiodistally.


• th e f i r s t s ta te m e n t is tr u e , th e s e c o n d is fa ls e
M andibular Right Central Incisor
i if *1i§
1vM 11
W
Lingual
W
***The mandibular central incisor is the least variable tooth in the mouth. It is also the smallest tooth in
the dentition. It is smaller than the mandibular lateral which is not the case in the maxillary arch.
C r o w n : very smooth; lacks anatomical features. The incisal outline is straight and perpendicular to the
long axis. The mesial and distal incisal angles are almost 90°.
R o o t: one: tapers evenly to a sharp apex. V e ry n a rro w m e s io d is ta liy , w id e la b io lin g u a lly , and
concave on both the mesial and distal surfaces.
S u r fa c e s : lingual surface (concave) and lingual fossa are very smooth. The cingulum, MMR, DMR,
and incisal ridge come together, forming a shallow lingual fossa. The cingulum is centered. The labial
surface is convex.
P its a n d g r o o v e s : few if any developmental lines and grooves.
in the intercuspal position, each one occludes with only one tooth, the opposing maxillary
O c c lu s io n :
central incisor. Only tooth in the dentition that occludes with a single tooth (all others occlude with two).
Im p o r ta n t: In an ideal intercuspal position, the d is t o in c is a l aspect of the mandibular central incisor
opposes the lin g u a l fo s s a of the maxillary central incisor.
permanent teeth 167
A permanent maxillary central incisor usually has how many

mamelons and developmental lobes?
• two mamelons and two developmental lobes

• two mamelons and three developmental lobes
• three mamelons and two developmental lobes
• three mamelons and four developmental lobes

• three mamelons and four developmental lobes
The permanent maxillary central incisor is generally considered to have 3
mamelons and 4 developmental lobes. Each of the 3 mamelons develops from a
separate center of calcification. The cingulum is thought to arise from the fourth
developmental lobe.
Tooth development begins with increased cell activity in growth centers in the
tooth germ. A growth center (lobe) is an area of the tooth germ where the cells
are particularly active. These lobes are primary centers of calcification and are
primary sections of formation in the development of the crown of a tooth. They
are represented by a cusp on posterior teeth and mamelons and cingula on
anterior teeth. They are always separated by developmental grooves, which
are very prominent in the posterior teeth and form specific patterns. With
anterior teeth, their presence is much less noticeable and these lobes are
separated by what are known as developmental depressions.
Summary of number of lobes:
• All anterior teeth: three labial and one lingual (cingulum)
• Premolars: three buccal and one lingual
Exception: The mandibular second premolar has three buccal and two
lingual lobes.
• First molars: maxillary - four lobes (or five if Carabelli); mandibular - five
lobes
• Second molars (maxillary and mandibular): four lobes, one for each cusp
• Third molars: at least four lobes, one for each cusp. Variations are seen.
Important: The minimum number of lobes from which any tooth may develop
is four.
Remember: The presence of mamelons in a 14-year-old usually indicates a
malocclusion. Generally, mamelons wear off within a few years of eruption
through normal excursive movements of the dentition.
pictures of teeth 168
Which permanent tooth is shown below?
• the permanent mandibular right first molar

• the permanent maxillary right first molar
• the permanent maxillary right first premolar
• the permanent mandibular right first premolar
DENTAL ANATOMY & OCCLUSION d^dentaldecks

the permanent maxillary right first molar
Remember:
• It is the largest permanent tooth in the maxillary arch (mesiodistal diameter of crown =
10.0 mm; buccolingual diameter of crown = 1 f .0)
• Although the crown is relatively short (7.5 mm), it is broad both mesiodistally and
buccolingually
• Cusp of Carabelli is found lingual to the ML cusp
• The total number of pits on the occlusal surface of the maxillary first molar is the
same as found on the occlusal surface of the mandibular second premolar (three-
cusp type)
• From a buccal view, the buccal roots present a “plier handle” appearance with the
large lingual root centered between them
• Occlusally, the tooth outline is somewhat rhomboidal, with four distinct cusps. The
cusp order according to size is: mesiolingual, mesiobuccal, distobuccal, and
distolingual
The picture below is:
/
>
• the mesial view of a maxillary right first molar

• the distal view of a maxillary right first molar
• the mesial view of a maxillary right second molar
• the distal view of a maxillary right third molar

• th e m e s ia l v ie w o f a m a x illa r y r ig h t f i r s t m o la r
*** The k e y to the photo is that the only two cusps of the maxillary first molar that are seen from the
m e s ia l are the mesiobuccal cusp and the mesiolingual cusp. A mesial marginal groove usually notches
the mesial marginal ridge about midway along its length. From a d is ta l view, the mesial cusp tips are
seen projecting beyond the outline of the distobuccal cusp and distolingual cusp.
N o te : The distal facial root is the s h o r te s t; therefore when viewed from the distal, the mesiofacial root
is sometimes visible. The mesial facial root is flattened mesiodistally and has r o o t d e p r e s s io n s on both
mesial and distal surfaces.
Maxillary Right First Molar
Pulp cavity
Mesiodlstal Buccollngual
Distal view o f maxillary

rig ht first molar
Cervical Midroot

• the permanent maxillary right second molar
• the permanent mandibular right second molar
DENTAL ANATOMY & OCCLUSION (H M entaldecks

• the permanent maxillary right second molar
Remember: This tooth resembles the maxillary first molar except:
• It is smaller: mesiodistal diameter of crown = 9.0, buccolingual diameter of crown = 11.0
• The buccal is broader than the lingual due to the absence of the fifth cusp (of Carabelli)
• It is more angular
• DL cusp may be absent. When this occurs, the occlusal outline takes on a "heart shape” as
opposed to the more common rhomboidal occlusal outline (true for all maxillary molars)
M a x illa ry R ig h t Second M o la r
Distal
0
Midroot
cross-section

• the permanent mandibular right second premolar
• the permanent mandibular right second molar

the permanent mandibular right second molar
Remember:
• It is the most symmetrical molar (two buccal and two lingual cusps)
• Occlusal pattern looks like a plus sign (+)
• Cervico-occlusal length of crown = 7.0; mesiodistal diameter of crown =
10.5 mm; buccolingual diameter of crown = 10.0 mm
• The buccolingual dimension is broader at the mesial than at the distal
• The lingual height of contour is located in the middle third
Mandibular Right Second Molar
Buccal Lingual Mesial Distal

• the buccal viewof a permanent mandibular right second molar

• the lingual viewof a permanent mandibular right second molar
• the buccal view of a permanent mandibular right first molar
• the lingual viewof a permanent mandibular right first molar

• the buccal view of a permanent mandibular right second molar
Keys to distinguish between the buccal aspect and lingual aspect:
On the buccal, there is a slight cervical dip of the CEJ; there is no dip at all on the lingual
The buccal developmental groove extends almost halfway down the buccal surface and
ends in a pit; on the lingual, the groove only extends slightly onto the lingual surface
Buccal developmental
groove
Slight
cervical
dip of
the CEJ 1
- Mandibular Right
Second Molar
i
J J w
The picture below is a facial view of what permanent mandibular

tooth?
• the permanent mandibular left canine

• the permanent mandibular right canine
• the permanent mandibular left premolar
• the permanent mandibular right premolar

To distinguish aright m andibular canine from a left m andibular canine; remember:
• The distal cusp ridge is longer than the m esial cusp ridge
• The mesial surface of the crow n is alm ost parallel to the long axis of the tooth
Occlusion: The cusp tip opposes the incisal em brasure betw een the m axillary canine
and the lateral incisor, w hile the facial surface opposes the ir m arginal
ridges. Important: In a Class II relationship, during a protrusive m ovem ent they
contact the m axillary canines and lateral incisors.
1. The cingulum of a canine is sim ilar to the lingual cusp of a m andibular
first prem olar.
2. W hen view ed from eith er proxim al surface, the facial outline from cusp tip
to root apex is m ade up of one continuous arc (from the facial, the
proxim al surfaces from the contact to apex look like a straight line).
3. O ne variation of this tooth is that on occasion, the root is bifurcated (facial
and lingual roots) near its tip. The double root m ay or m ay not be
accom panied by deep depressions in the root.
Lingual Mesial Distal

D >y. M

• the permanent maxillary right canine
DENTAL ANATOMY & OCCLUSION H^dentaldecks

***The key to determining right from left is the mesial marginal groove. It
extends onto the mesial surface, but first it crosses the mesial marginal ridge.
Remember:
• This tooth has a pronounced cervical concavity on the mesial surface of
its crown.
• This tooth is the premolar that has a mesial buccal cusp ridge (MBCR)
that is longer than its distal buccal cusp ridge (DBCR).
• When viewed from the lingual, the lingual cusp is inclined mesially.
M a x illa r y R ig h t F ir s t P r e m o la r M a x illa r y R ig h t F ir s t P r e m o la r
M eslodlstal Buccollngual
B uccal L in g u a l M e s ia l P u lp c a v it y

DENTAL ANATOMY & OCCLUSION (IM e n ta ld e c k s

the permanent mandibular right first premolar
Remember:
• This tooth has a mesio-lingual developmental groove.
• This tooth has a large buccal cusp that occupies almost two-thirds of the occlusal surface.
• This tooth has a very prominent transverse ridge with no central groove, but may have mesial
and distal pits.
• It is the only posterior tooth in which the occlusal plane is tilted lingually in relation to the
horizontal plane.
Distinguishing features: Has an extreme lingual taper for a posterior tooth. It has the greatest
lingual inclination of the crown from its root of all mandibular teeth. Has a mesiolingual
developmental groove. The mesial marginal ridge is shorter in length and less prominent in height
than the distal marginal ridge.
Occlusion: The buccal cusp contacts the mesial marginal ridge area (specifically the mesial
triangular fossa) of the maxillary first premolar and the distal marginal ridge of the canine.
Note: The attached gingiva is very narrow on the facial (compared to any other mandibular tooth).
M a n d i b u l a r R ig h t F ir s t P r e m o ia r
M r |
J
Buccal L in g u a l
J
M e s ia l

DENTAL ANATOMY & OCCLUSION (i^dentaldecks

• the permanent m andibular right first molar
***This tooth presents a pentagonal “home plate” occlusal outline that is distinctive for
this tooth. There are five cusps. Of them, the mesiobuccal cusp is the largest, the distal
cusp is the smallest.
Remember:
• This tooth is the largest of the mandibular teeth; cervico-occlusal length of crown is
7.5 mm.
•T h e mesial-distal dimension (11.0 mm) is slightly greater than the faciolingual
dimension (10.5 mm) of the crown.
• It is the first permanent tooth to erupt (6-7 years).
• It has five cusps (three buccal, two lingual).
Note: When a protrusive m andibular movement is achieved, the mandibular first molar
has the potential to contact the maxillary second premolar and the first molar.
Mandibular Right First Molar Mandibular Right First Molar
Pulp Cavity
Carvlccl M ktoo t
c ro n -i« tllo n CfOM'.tOCtlcMl
Mesial Distal
• the permanent mandibular right second premolar (two cusp type)

• the permanent mandibular right second premolar (three cusp type)
DENTAL ANATOMY & OCCLUSION l*dentaldecl<S

• the permanent mandibular right second premolar (three cusp type)
Remember:
• This tooth most frequently has a single central pit
• Resembles other premolars from the buccal aspect only
• From the occlusal aspect, the three-cusp type appears square, the two-cusp type
appears round
• To determine the right from the left for this tooth, the occlusal view will show a
slight mesial concavity
1. The lingual surface is much wider mesiodistally than the lingual
surface of the first premolar.
2. The interdental papilla between the mandibular second premolar and
the first molar is shorter (cervico-occlusally) than any other in the mouth.
Mandibular Right Second Premolar

Pulp Cavity
Occlusal view of the two-cusp type of permanent mandibu

lar right second premolar, showing the U- and H-shaped
groove patterns.
• the mesial view of a permanent mandibular right first molar

• the distal view of a permanent mandibular right first molar
• the mesial view of a permanent mandibular left second molar
• the distal view of a permanent mandibular left second molar

• the distal view of a permanent mandibular right first molar
The key to the sketch is the distobuccal developmental groove on the facial.
You need to know this tooth from every view (mesial, distal, facial, and lingual).
M a n d ib u la r R ig h t F irs t M o la r
Mesial
;V
Buccal Lingual

• the permanent maxillary right second premolar
DENTAL ANATOMY & OCCLUSION (Dtdentaldecks

th e p e rm a n e n t m a x illa r y r ig h t s e c o n d p r e m o la r
R e m e m b e r:
• The crown is smaller than the first premolar. From the occlusal, it is much m o re symmetrical and
le s s angular (more ovoid) than the first premolar. The crown is w id e r b u c c o lin g u a lly (9.0 mm)
than mesiodistally (7.0 mm).
• The buccal and lingual cusp are a lm o s t e q u a l in height. T h e re is m e s ia l in c lin a t io n of the lingual
cusp (same as first premolar). The distobuccal cusp ridge (DBCR) is lo n g e r than the mesiobuccal
cusp ridge (MBCR) the opposite of the maxillary first premolar.
Maxillary Right Second Premolar
1r,
I
Buccal Lingual Mesial Distal
Maxillary Right Second

Premolar
Pulp Cavity
The picture below is a facial view of what permanent maxillary tooth?

• the permanent maxillary right second premolar

the permanent maxillary right canine
Remember:
• The crown has a prominent labial ridge. The cingulum is large and centered
mesiodistally. It is wider labiolingually (8.0 mm) than mesiodistally (7.5 mm).
From the proximal view, they appear to be positioned vertically in the arch.
• It is the longest root (17.0 mm). The heavy root results in a bony labial ridge
called the canine eminence. Note: Mandibular canine root is 16.0 mm long.
• When viewed from the incisal, the cusp tip is located on the mesiofacial of the
crown. The mesial cusp ridge is shorter than the distal cusp ridge.
• Cervicoincisal length of crown is 10.0 mm; for the mandibular canine it is 11.0
mm.
Maxillary Right Canine

Pulp Cavity
Meilodlittri loblofinguoi
crois-iacllon croj»-»ccHon
Distal
The picture below is a lingual view of what permanent maxillary

tooth?
• the permanent maxillary right central incisor

• the permanent maxillary right lateral incisor

• th e p e rm a n e n t m a x illa r y r ig h t la te ra l in c is o r
R e m e m b e r:
• The crown resembles the maxillary central incisor; however, it is s m a lle r in all dimensions except
the root (root lengths are equal - 13,0 mm). The mesiodistal measurement (6.5 mm) is g re a te r
than the labiolingual measurement (6.0 mm).
• A lin g u a l p it is common (more pronounced than mandibular lateral). The lingual surface is the
m o s t c o n c a v e of any of the incisors (maxillary and mandibular).
Maxillary Right Lateral Incisor

Pulp Cavity
The picture below is a facial view of what permanent maxillary tooth?
• the permanent maxillary right lateral incisor

• the permanent maxillary right central incisor
• the permanent maxillary left lateral incisor
• the permanent maxillary left central incisor
DENTAL ANATOMY & OCCLUSION (Dtdentaldecks

• th e p e rm a n e n t m a x illa r y r ig h t c e n tr a l in c is o r
R e m e m b e r:
• The crown is the lo n g e s t (10.5 mm) and w id e s t (8.5 mm) incisor tooth. It is the m o s t p r o m in e n t
to o th in the mouth. The crown outline is w id e r m e s io d is ta lly (8.5 mm) than fa c io lin g u a lly (7.0
mm).
• The mesial curvature of the cervical line is la rg e r (3.5 mm) than any other tooth. The cingulum is
well-developed and is located o ff- c e n te r to w a r d th e d is ta l.
• The maxillary central incisors have the n a rro w e s t in c is a l e m b ra s u re s .
The picture below is a buccal view of what permanent mandibular
tooth?

• the permanent mandibular left canine

the permanent mandibular right second premolar
Remember:
• This tooth resembles other premolars from the buccal aspect only.
• The apex of the root approximates the mental foramen.
• Most frequently has a single central pit. There is no mesiolingual groove or
transverse ridge (both are common on the first premolar).
The picture below is a iabiolingual section of the pulp cavity of which

permanent mandibular tooth?
• the permanent mandibular right central incisor

• the permanent mandibular right lateral incisor

the permanent mandibular right canine
Remember:
• It may be bifurcated into labial and lingual parts. A developmental
depression may appear on the mesial root surface. In cross-section, the
root is ovoid, but wider mesiodistally at the labial.
M a n d ib u la r R ight C anine
P ulp C avity
M e sio d ista l L a b lo lin g u a l

cro ss-se ctio n cro ss-sectio n
The picture below is a facial view of what permanent mandibular
tooth?

• the permanent mandibular left lateral incisor
• the permanent mandibular left central incisor

th e p e rm a n e n t m a n d ib u la r r ig h t la te ra l in c is o r
R e m e m b e r:
• The crown is not a s b ila te ra lly s y m m e tric a l as the mandibular central incisor. The crown is tilte d
d is ta lly on the root. The distoincisal angle is m o re r o u n d e d than the mesioincisal angle. It is
b ro a d e r la b io lin g u a lly (6.5 mm) than mesiodistally (5.5 mm).
• The lingual surface is smooth. The c in g u lu m is slightly off-center to the distal. The mesial marginal
ridge is s lig h tly lo n g e r than the distal marginal ridge.
M a n d ib u la r R ight Lateral Incisor

The picture below is a lingual view of what permanent mandibular

tooth?

• the permanent mandibular left lateral incisor
• the permanent mandibular left central incisor

• th e p e rm a n e n t m a n d ib u la r r ig h t c e n tr a l in c is o r
R e m e m b e r:
• The mandibular central incisor is the le a s t v a ria b le to o th in the mouth. It is also the s m a lle s t
to o th in the dentition. It is smaller than the mandibular lateral, which is not the case in the maxillary
arch.
• The crown is very smooth and lacks anatomical features. The incisal outline is straight and
perpendicular to the long axis. The mesial and distal incisal angles are almost 90°.
M andibular Right Central Incisor
[} /A
y w'
Labial Incisal M esial D istal
Mandibular Right
Central Incisor
Pulp Cavity
temporomandibular joint 187
Which ligaments below are considered to be accessory ligaments of
the TMJ? Select all that apply.
• sphenomandibular ligament
• temporomandibular ligament
• stylomandibular ligament
• lateral discal ligament
DENTAL ANATOMY & OCCLUSION J^ d en tald ecks

• s p h e n o m a n d ib u la r lig a m e n t
• s ty lo m a n d ib u la r lig a m e n t
The s p h e n o m a n d ib u la r a n d s ty lo m a n d ib u la r lig a m e n ts are considered to be a c c e s s o r y
lig a m e n ts . The former is attached to the lingula of the mandible and the latter at the angle of the
mandible. These ligaments are responsible fo r lim ita tio n of mandibular movements (they limit
excessive opening).
The te m p o ro m a n d ib u la r lig a m e n t (also called the lateral ligament) runs from the articular eminence
to the mandibular condyle. It provides lateral reinforcement for the capsule. This ligament p r e v e n ts
p o s te r io r a n d in f e r io r d is p la c e m e n t of the condyle (it is the m a in s ta b iliz in g lig a m e n t of the TMJ).
C o lla te ra l lig a m e n ts (m e d ia l a n d la te ra l) also referred to as “d is c a l lig a m e n ts " are ligaments that
arise from the periphery of the disc. They are attached to the medial and lateral poles of the condyle
respectively, and stabilize the disc on the top of the condyle. These ligaments restrict m o v e m e n t o f
th e d is c a w a y from the condyle during function. N o te : They are composed of collagenous
connective tissue: thus they do not stretch.
A patient comes into your dental office complaining of chewing

difficulties. When you ask him to protrude his mandible, the mandible
markedly deviates to the right. Which muscle, which inserts fibers
into the capsule and articular disc of the TMJ, is most likely
damaged?
• right medial pterygoid muscle

• left medial pterygoid muscle
• right lateral pterygoid muscle
• left lateral pterygoid muscle

• r i g h t la t e r a l p t e r y g o i d m u s c le
***On protrusion, the mandible will deviate to the same direction as the damaged lateral pterygoid
muscle.
The la t e r a l p t e r y g o i d m u s c le is actually comprised of the superior belly and the inferior belly.
• The i n f e r i o r b e l l y originates from the lateral pterygoid plate and inserts on the neck of the
condyle.
• The s u p e r i o r b e l l y originates from the greater wing of the sphenoid and infratemporal crest,
and inserts on the joint capsule, the articular disc, and the neck of the condyle.
N o t e : Each belly has different functions. When the right and left i n f e r i o r b e l l i e s contract
simultaneously, the mandible is protruded, whereas unilateral contraction results in a lateral
movement of the mandible to the opposite side. When the right and left inferior bellies contract
along with the mandibular depressor muscles, the result is mouth opening. The function of the
s u p e r i o r b e l l y is to assist in stabilizing the position of the articular disc during mouth closure.
T h e M u scle s o f M a s tic a tio n w ith A sso cia ted M o v e m e n ts o f th e M a n d ib le
M u s c le s o f M a s tic a tio n M o v e m e n ts o f th e M a n d ib le
M asseter • E leva tio n o f the m andible (d u rin g ja w c losin g )
Te m p ora lis • E le va tio n o f the m andible (d u rin g ja w c losin g )

• R etraction o f the m a nd ib le (lo w e r ja w backw ard)
M e dia l p terygoid • E leva tio n o f the m a nd ib le (d u rin g ja w c lo s in g )
Lateral p terygoid • O n e m uscle: lateral d evia tio n o f the m andible (to

s h ift the lo w e r ja w to the opposite side)
• B o th m uscles: protrusio n o f the m a nd ib le (p ulls
a rtic u la r disc fo rw a rd )
A patient with constant, unexplained headaches is referred to a TMJ

specialist by his physician. In order to check for tenderness, the
specialist must palpate the joint. What is the best way to palpate the
posterior aspect of the mandibular condyle?
• intraorally
• externally over the posterior surface of the condyle with the mouth open
• through the external auditory meatus
• any of the above

• externally over the posterior surface of the condyle with the mouth
open
The temporomandibular joint should be evaluated for tenderness and noise.
When checking for joint noises (clicking and crepitus), the joint is palpated
laterally (in front of the external auditory meatus) while the patient opens and
closes the mandible.
Tenderness can be assessed by palpating the lateral aspects of the joints
when the mouth is closed and during opening of the mouth. The joint should
also be palpated for tenderness while the patient opens maximally, and the
fingertip should be positioned slightly posterior to the condyle to apply force to
determine if there is inflammation of the retrodiscal tissue.
Note: Placing fingertips in the patient's external auditory meatus, can produce
false joint sounds during mandibular function because of pressure against the
thin ear canal cartilage.
Remember:
1. The posterior aspect of the condyle is rounded and convex, whereas the
anteroinferior aspect is concave.
2. The condyles are neither symmetrical nor identical.
3. Sleep bruxism is characterized by episodes of massive bilateral clenching
that lasts up to 5 minutes; it often coincides with passage from deeper to
lighter sleep, not lighter to deep sleep; it occurs approximately every 90
minutes.
4. There is no single factor that is responsible for all bruxing. The most
common treatment for bruxing is a nightguard.
A 56-year-old man comes into the ER with his mouth wide open. His
wife explains that he can't close his mouth. The resident on-call
quickly diagnoses this as a bilateral dislocation of the TMJ and treats
it promptly with reduction. Dislocation of the TMJ is almost always:
• posteriorly and occurs while sleeping

• anteriorly and occurs while laughing or yawning
• anteriorly and occurs while chewing food
• posteriorly and occurs while laughing or yawning
DENTAL ANATOMY & OCCLUSION ^ d e n t a l decks

• anteriorly and occurs w hile laughing or yaw ning
Dislocation of either or both TMJs can occur when the condyle translates anterior to
the crest of the articular eminence, and the condyle becomes trapped in front of the
eminence, resulting in the patient's inability to close the mouth. When the mouth is
opened to its fullest extent, such as with laughing or yawning, the condyle will
translate to its anterior limit. Sometimes the mouth is opened beyond its normal limit,
and the mouth locks open because the condyle becomes trapped in front of the
articular eminence.
Dislocation is also called an open lock. Reduction of the dislocation is done by
standing behind the patient with the thumbs inside the mouth and the index fingers
below the chin. The thumbs depress the back of the mandible, and the chin is elevated
by the index fingers. The head of the condyle will then slide into the articular fossa.
Note: The term subluxation refers to hypermobility or hypertranslation of the
mandible. When there is natural laxity or looseness of the ligaments associated with
the TMJ, the mandible is able to open beyond the usual anterior limit and can appear
to be a dislocation, as previously described. However, with a subluxation, the patient
can seif-reduce, or return, the mandible to its normal position without the assistance of
a dentist.
C losed Po sitio n O p e n P osition A n te r io r D is lo c a tio n

Which component of the TMJ has the most vasculature and

innervation?
• articular fossa
• anterior band of the articular disc
• posterior band of the articular disc
• articular eminence
• retrodiscal tissue

• r e tr o d is c a l tis s u e
The a r tic u la r d is c (meniscus) is composed of d e n s e fib r o u s c o n n e c tiv e tis s u e , and it is positioned in
between the condyle and the fossa, thereby dividing the joint into superior and inferior joint spaces.
The a r tic u la r d is c (meniscus) varies in thickness; the thinner central intermediate zone separates the
th ic k e r p o r tio n s , which are the a n te r io r a n d p o s t e r io r b a n d s . The posterior band of the articular disc
is the thickest of the two bands, and it is attached with posterior loose connective tissues called
r e tr o d is c a l tis s u e s (bilaminar zone; posterior attachment). The less thick anterior band of the articular
disc is contiguous with the capsular ligament, the condyle, and the superior belly of the lateral pterygoid
muscle.
N o te : The r e tr o d is c a l tis s u e is h ig h ly v a s c u la riz e d and in n e rv a te d , whereas the articular disc for the
most part is not. Only the e x tre m e p e r ip h e r y of the articular disc is slightly innervated.
Inferior h e a d o f t h e la te ra l p te ry g o id
A relatively unsuccessful treatment option for individuals suffering
from osteoarthritis is to inject or implant hyaline cartilage into areas
of articular cartilage degeneration. If osteoarthritis were to involve the
TMJ, this treatment modality would definitely be unsuccessful
because the articular surfaces of the TMJ are covered with:
• dense fibrous connective tissue

• periosteum
• elastic cartilage
• periosteum and elastic cartilage

• dense fibrous connective tissue
Important: The most superficial layer of the articular surfaces of the TMJ
(condyle and fossa) consists of dense fibrous connective tissue not hyaline
cartilage. Underneath this superficial layer is a layer of fibrocartilaginous tissue
that offers resistance against both compressive and lateral forces. Articular
surfaces of most diarthrodial joints are covered by hyaline cartilage, but the TMJ
is an atypical diarthrodial joint in that its articular surfaces are covered with a
dense fibrous connective tissue.
The TMJ is the articulation between the condyle of the mandible and the
squamous portion of the temporal bone. The condyle is elliptically shaped with
its long axis oriented mediolaterally. The articular surface of the temporal bone
is composed of the concave articular fossa (which is the anterior three-fourths
of the larger mandibular or glenoid fossa) and the convex articular eminence
(tubercle).
The disc completely divides the TMJ into two compartments. These two
compartments are synovial cavities, an upper and a lower synovial cavity. The
synovial membrane lining the joint capsule produces the synovial fluid that fills
these cavities.
The disc is attached to the lateral and medial poles of the mandibular condyle.
The disc is not attached to the temporal bone anteriorly, except indirectly
through the capsule. Posteriorly, the disc is divided into two areas. The upper
division of the posterior portion of the disc is attached to the temporal bone's
postglenoid process, and the lower division attaches to the neck of the condyle.
The disc blends with the capsule at these points. Note: The posterior area of
attachment of the disc to the capsule is one of the places where nerves and
blood vessels enter the joint.
The disc consists of dense fibrous connective tissue. Few cells are present,
but fibroblasts and white blood cells are among these. The central area of the
disc is avascular and lacks innervation, and the peripheral region has blood
vessels and nerves.
A patient with chronic TMJ inflammation is being treated by a dental

TMJ expert. To supplement his examination, the dentist wants to
image the soft tissues of this patient's TMJ. Which of the following is
the best imaging modality for identifying the position of the articular
disc in the temporomandibular joint?
• panoramic radiograph
• magnetic resonance imaging (MRI)
• computerized axial tomography (CAT Scan)
• lateral transcranial radiograph
DENTAL ANATOMY & OCCLUSION i * dental decks

• m agnetic resonance im aging (MRI)
Magnetic resonance imaging (MRI) is considered to be the gold standard for providing
an image of the soft tissue of the temporomandibular joint, especially the position of
the articular disc in relation to the condyle because sagittal cuts can be made at
different depths through the condylar head. Thus the medial pole can be clearly
differentiated from the lateral pole, one of the most important advantages in diagnosis
of intracapsular disorders. The MRI utilizes a magnetic field to alter the energy levels
of primarily the water molecules of the soft tissue, which results in good visualization
of the different soft tissues, including the articular disc.
Note: The m ajor advantage of the MRI technique is that there is no exposure of the
patient to x-ray radiation. Currently, no harmful effects of MRI have been
demonstrated. The other imaging modalities (i.e., panoramic radiograph, CAT Scan,
lateral transcranial radiograph) are best used for evaluating the bony structures of the
temporomandibular joint.
Reciprocal clicking is always a sign of damage to the ligaments that

fasten the disc in place.
A disc cannot click if the posterior and collateral ligaments are intact.

DENTAL ANATOMY & OCCLUSION ^ d e n ta ld e c k s

Part I • Volume 1 3 * © 2017
Reciprocal clicking is always a sign of damage to the ligaments that fasten
place. A disc cannot click if the posterior and collateral ligaments
the disc in
are intact. The variations in deformation of the ligaments and disc appear
unlimited. However, many clicking and deformed TMJs have adapted
sufficientlyso that they can comfortably accept loading.
Adapted centric posture is the manageably stable relationship of the
mandible to the maxilla that is achieved when deformed TMJs have adapted to
a degree that they can comfortably accept firm loading when completely
seated at the most superior position against the articular eminentiae.
Like centric relation, adapted centric posture is a horizontal axis position of
the condyles. It occurs irrespective of vertical dimension or tooth contact. It
is also a mid-most position, because even if a disc is completely displaced, the
medial pole of each condyle adapts to the concavity of the fossae and
maintains contact against the medial incline of each fossa wall.
The mandible is in adapted centric posture if five criteria are fulfilled:
1. The condyles are comfortably seated at the highest point against the
articular eminentiae.
2. The medial pole of each condyle is braced by bone (the disc may be
partially interposed).
3. The inferior head of the lateral pterygoid muscles have released contraction
and are passive.
4. The condyle-to-fossa relationship is manageably stable.
5. Load testing produces no sign of tension or tenderness in either TMJ.
A patient with temporomandibular disorder comes to the dental office
for treatment. He has bilateral “clicking” of the condyles upon
opening and tenderness on palpation of the joint. An MRI shows
damaged collateral ligaments. The most common direction in which
the articular disc in the TMJ will be displaced in this patient is:
• laterally
• medially
• posteriorly
• anteromedially
DENTAL ANATOMY & OCCLUSION 1 * dental decks

« anteromedially
In a healthy temporomandibular joint (TMJ), the articular disc is seated on the
condyle and is held in place by the collateral ligaments (medial and lateral,
also called “discal ligaments”) that are attached to the medial and lateral poles
of the condyle. Attached to the anterior portion of the articular disc are muscle
fibers from the lateral pterygoid muscle.
When the collateral ligaments become elongated or torn, they become loose
and this allows the lateral pterygoid muscle to pull the articular disc out of
place. When this occurs, it is called a disc displacement. Because of the
anteromedial direction of the lateral pterygoid muscle, the articular disc is
usually displaced anteromedially.
Note: When the articular disc is displaced anteromedially to the condyle, a
click sound is usually demonstrated when the mouth is opened and the
condyle moves past the thick posterior band of the articular disc. There can
also be a clicking sound when the mandible moves to the opposite side, as
the condyle again moves past the thick posterior band of the articular disc.
Often another reciprocal click will be demonstrated when the mouth is
subsequently closed and the condyle moves from the thin central area of the
disc and then past the thicker posterior band as the articular disc once again
becomes displaced. A crepitation sound (also known as crepitus) is usually
associated with a degenerative process (osteoarthritis) of the condyle, the dull
thud is usually associated with a self-reducing subluxation of the condyle, and
tinnitus is described as ear ringing.
The TMJ is a(n):
• arthrodial joint
• ginglymus joint
• ginglymoarthrodial joint
DENTAL ANATOMY & OCCLUSION (i^dentaldecks

Part I • Volume 1 3 * © 2017
• g in g ly m o a r th r o d ia l jo in t
The TMJ is a g in g ly m o a r th r o d ia l jo in t (meaning that it glides and rotates), permitting both h in g e -lik e
r o ta tio n a n d s lid in g (gliding) m o v e m e n ts . N o te : Ginglymus means rotation, and arthrodial means
freely movable.
C o m p o n e n ts o f th e T M J :
• M a n d ib u la r c o n d y le (sometimes called the condyloid process of the mandible) - the articulating
surface or functioning part of the condyle is located on the superior and anterior surfaces of the
head of the condyle. This surface is covered with a layer of dense f ib r o u s c o n n e c tiv e tis s u e .
• A r tic u la r fo s s a - this fossa is the anterior three-fourths of the larger mandibular fossa. It is
considered to be a n o n - fu n c tio n in g p o r tio n of the joint. R e m e m b e r: The mandibular fossa
(glenoid fossa) is the temporal component of the TMJ; it is bounded in front by the articular
eminence, and behind, by the tympanic part of the temporal bone, which separates it from the
external auditory meatus.
• A r tic u la r e m in e n c e (also called the articular tubercle) is a ridge that extends mediolaterally just in
front of the mandibular fossa. It is considered to be the fu n c tio n a l p o r tio n of the joint. It is lined
with a thick layer of dense f ib r o u s c o n n e c tiv e tis s u e .
• A r tic u la r d is c (also called the meniscus) is a biconcave fib r o c a r tila g in o u s d is c interposed
between the condyle of the mandible and the mandibular (glenoid) fossa of the temporal bone, which
provides the gliding surface for the mandibular condyle, resulting in smooth joint movement. The
central part is avascular and devoid of nerve tissue; only the extreme periphery is slightly
innervated.
Articular U p per synovial

fossa ^ cavity
Postglenoid_
— Joint disc
^ Lower synovial
cavity
Condyle
Lateral p terygoid muscle

All of the following structures make up the articulating parts of each
temporomandibular joint EXCEPT one. Which one is the EXCEPTION?
• mandibular condyle
• articular fossa and articular eminence
• articular disc (meniscus)

• r e tr o d is c a l tis s u e
The a r tic u la r d is c (m eniscus) is com posed of d e n s e f ib r o u s c o n n e c tiv e tis s u e , and it is positioned
in between the condyle and the fossa, thereby dividing the joint into superior and inferior joint spaces.
The a r tic u la r d is c (meniscus) varies in thickness; the thinner central intermediate zone separates the
th ic k e r p o r tio n s , which are the a n te r io r a n d p o s te r io r b a n d s . The posterior band of the articular
disc is the thickest of the tw o bands, and it is attached with posterior loose connective tissues called
r e tr o d is c a l tis s u e s (bilaminar zone; posterior attachm ent). The less thick anterior band of the articular
disc is contiguous with the capsular ligam ent, the condyle, and the superior belly of the lateral
pterygoid muscle.
N o te : The re tr o d is c a l tis s u e is h ig h ly v a s c u la riz e d and in n e rv a te d , w hereas the articular disc for
the most part is not. Only the e x tre m e p e rip h e ry of the articular disc is slightly innervated.
Superior head of the
A rtic u la r disc
Superior
compartment Superior lamina
Retrodiscal pad
Inferior Interior lamina
compartment
Inferior head of the lateral pterygoid m.

Which of the following structures secretes the fluid which lubricates

the TMJ?
• internal synovial layer of the fibrous capsule
• outer fibrous layer of the fibrous capsule
• articular disc

■ internal synovial layer of the fibrous capsule
The fibrous capsule (joint capsule) is a sheet of fibrous tissue that covers the
temporomandibular joint. Think of it as a bag that contains the joint. It isolates
the contents of the joint and allows free movement of the condyle and articular
disc within a small “swimming pool” of synovial fluid. It is fairly thin except
laterally, where it forms the temporomandibular ligament (also called the lateral
temporomandibular ligament). Medially and laterally, the capsule is firm, to
stabilize the mandible during movement. Anteriorly and posteriorly, the
capsule is loose to allow mandibular movements. Usually, only a thin lining of
synovial fluid is present on the articular surfaces. Larger amounts of joint fluid
usually are associated with painful internal derangement. The joint capsule
and ligaments restrict excessive displacement of the mandible.
The fibrous capsule consists of two layers:
1. Internal synovial layer (synovial membrane) - this thin layer secretes
synovial fluid that lubricates the joint.
2. Outer fibrous layer - a thicker layer of fibrous tissue which is reinforced by
accessory ligaments (stylomandibular and sphenomandibular ligaments).
E x te rn a ! a c o u s t ic
m e a tu s
Translatory movements take place in which compartment of the

TMJ?
• upper (mandibular fossa-articular disc) compartment

• lower (condyle-articular disc) compartment
• both the upper and lower compartments

• upper (mandibular fossa-articular disc) compartment
The temporomandibular joints are considered the most complex joints in the
human body because they must provide for rotational movements, sliding
movements (translatory motion) and an infinite range of combined movements
and functions, unlike any other joint in the body.
When the mouth opens, two distinct motions occur at the joint. The first
motion is rotation around a horizontal axis through the condylar heads. The
second motion is translation. During these movements the condyle and
meniscus move together anteriorly beneath the articular eminence. In the
closed mouth position, the thick posterior band of the meniscus lies
immediately above the condyle. As the condyle translates forward, the thinner
intermediate zone of the meniscus becomes the articulating surface between
the condyle and the articular eminence. When the mouth is fully open, the
condyle may lie beneath the anterior band of the meniscus.
In the lower (condyle-articular disc) compartment, only a hinge-type or
rotary motion can occur. This rotational or terminal hinge-axis opening of
the mandible is possible only when the mandible is retruded in centric
relation with the conscious effort by the patient or by the dentist's control.
Note: During mouth opening, the articular disc moves anteriorly in relation to
the articular eminence.
In the upper (mandibular fossa-articular disc) compartment, only sliding
movements or translatory motion can occur. When the lateral pterygoid
muscles contract simultaneously, the discs and condyles can slide forward,
down over the articular eminence (protrusion).
Note: The inferior compartment (lower) allows for rotation of the mandible
corresponding to the first 20 mm or so of opening. After 20 mm the articular
disc and upper compartment become active and allow for forward translation of
the condyle.
primary dentition 200
All of the following statements are true EXCEPT one. Which one is the
EXCEPTION?
• the crowns of the primary anterior teeth are wider mesiodistally and shorter
incisocervically than their permanent counterparts
• the crowns of the primary molars are shorter and more narrow
mesiodistally at the cervical third as compared to the permanent molars
• the pulpal horns are lower in primary molars, especially the distal horns,
and the pulp chambers are proportionately smaller
• the roots of the primary anterior teeth taper more rapidly than do those of
the permanent anteriors
• the roots of the primary molars are longer and more slender than those of
the permanent molars
• the enamel ends abruptly at the cervical line on primary teeth, rather than
becoming thinner, which occurs on permanent teeth

• th e p u lp a l h o rn s a re lo w e r in p rim a ry m o la rs, e s p e c ia lly th e d is ta l h o rn s , a n d th e
p u lp c h a m b e rs are p ro p o rtio n a te ly s m a lle r
***The pulpal horns are higher in primary molars, especially the mesial horns, and the pulp chambers are
proportionately larger.
Comparison of maxillary, primary, and permanent second molars, linguobuccal cross section. A, The enamel
cap of primary molars is thinner and has a more consistent depth. B, A comparatively greater thickness of
dentin is over the pulpal wall at the occlusal fossa of primary molars. C, The pulpal horns are higher in primary
molars, especially the mesial horns, and pulp chambers are proportionately larger. D, The cervical ridges are
more pronounced, especially on the buccal aspect of the first primary molars. E, The enamel rods at the cervix
slope occlusally instead of gingivally as in the permanent teeth. F, The primary molars have a markedly
constricted neck compared with the permanent molars. G, The roots of the primary teeth are longer and more
slender in comparison with crown size than those of the permanent teeth. H, The roots of the primary molars
flare out nearer the cervix than do those of the permanent teeth.
Stainless steel crowns are often used in pediatric dentistry. Also
common in pediatric dentistry are kids throwing temper tantrums.
One day a 4-year-old patient throws a tantrum and knocks over your
case of stainless steel crowns. When picking out the primary
mandibular first molars you remember which of the following
statements?
• they resemble the permanent mandibular first premolar

• they resemble the permanent mandibular first molar
• they resemble the permanent maxillary second molar
• they resemble the primary mandibular second molar
• none of the above; their anatomy is unlike any other tooth in the mouth
(primary or permanent)

Part I • Volume 13 -© 2 0 1 7
• none of the above; their anatomy is unlike any other tooth in
the mouth (primary or permanent)
The general shape of the occlusal surface is oval (wider mesiodistally than
buccolingually). It has four cusps (Note: The primary mandibular second molar has five
cusps), with the mesiobuccal the largest and the mesiolingual next in size. The
distobuccal and the distolingual are much smaller. The buccal surface is longer than that
of the lingual and has a very prominent cervical ridge across the gingival area, directly
above where the tooth constricts at the cervix. The tooth has two roots: a mesial root,
which is much longer and wider, and a distal root. The apex of the mesial root is flattened
or squared off.
Looking at it from the occlusal, the mesiobuccal angle is acute and prominent because of
the mesial cervical ridge on the buccal surface. The DB angle is obtuse. The shape of the
occlusal table is that of a rhomboid.
Note: The primary first and second molars first show calcification at five to six months in
utero. In general, the root of a deciduous tooth is completely formed in just about one year
after eruption of that tooth into the mouth.
The Prim ary M an d ib u lar R ight First M olar

A frantic mother calls you on the phone asking what to do about her
child's first tooth. You want to impress her. Before she can say it, you
tell her what tooth it is. It is a:
• primary mandibular central incisor
• primary mandibular first molar
• primary maxillary central incisor
• primary maxillary first molar
You got that right, and now you really impress her and tell her how
old her child is. She is about:
• 4-Vz months old
• 6-y2 months old
• 10 -V2 months old
• 1 year old

• prim ary m andibular central incisor
• 6 -V2 m onths old
This tooth usually erupts at around Q-V2 m onths of age. The root is fully form ed and
calcified by about 18 m onths of age. Remember: This tooth is usually bilaterally
symm etrical w hen view ed from the facial and incisal.
The P rim ary M a n d ib u la r R ight Central Incisor
Labial Lingual Incisal Mesial Distal
1. The first perm anent tooth to erupt is the m andibular first m olar (“six year
m olars” ), follow ed shortly thereafter by the m axillary first molar.
2. The first perm anent tooth to begin calcifying is the m andibular first
molar (at birth).
3. The first succedaneous tooth to erupt is the m andibular central incisor
(around six to seven years old). (Remember: The m andibular first m olar
and the m axillary first m olar are not succedaneous teeth).
4. The perm anent m axillary central incisors erupt at approxim ately seven
to eight years of age. The perm anent m axillary lateral incisors erupt at
approxim ately eight to nine years of age.
A 10-V2-year-oid patient comes into your office. You are not sure
whether his maxillary canines are permanent or primary. Which of
the following statements will help you determine which they are?
• the cusp on the primary maxillary canine is much shorter than the cusp on
the permanent maxillary canine
• the mesial cusp ridge on the primary maxillary canine is shorter than the
distal cusp ridge; this is the opposite of all other canines
• the cusp on the primary maxillary canine is much longer and sharper than
the cusp on the permanent maxillary canine
• the primary maxillary canine is much narrower and longer than the
permanent maxillary canine

• the cusp on the primary maxillary canine is much longer and
sharper than the cusp on the permanent maxillary canine
The most significant differences between the primary maxillary canine and the
permanent maxillary canine are:
1. The cusp on the primary canine is much longer and sharper.
2. The mesial cusp ridge is longer than the distal cusp ridge (this is the opposite of ail
other canines).
***Obviously they differ in other ways, but these two differences are the most significant.
Note: The primary maxillary canine also appears especially wide and short.
Prim ary M axillary

Right Canine I Prim ary M an d ib u lar
Facial view R ight Canine
\ Facial view
1
I P erm anent M axillary P erm anent M an d ib u lar
Right Canine Right Canine
1
f \
Facial view Facial view
The picture below is the buccal view of which primary molar?

Part I • Volume 1 3 * © 2017
the primary mandibular right first molar
Primary right molars, buccal aspect. A, Maxil Primary right molars, lingual aspect. A, Maxil
lary first molar. B, Maxillary second molar. C, lary first molar. B, Maxillary second molar. C,
Mandibular first molar. D, Mandibular second Mandibular first molar. D, Mandibular second
molar. molar.
Occlusal views of the Primary Right Molars
Maxillary first molar Maxillary second molar Mandibular first molar Mandibular second molar
When attempting a MO Class il amalgam preparation and filling on a
primary tooth, you encounter a very large mesial marginal ridge that
resembles a cusp. You also notice a transverse ridge that runs from
the mesiolingual cusp to the mesiobuccal cusp that is rather large.
This tooth often proves difficult to restore, which tooth is it?


This transverse ridge separates the mesial portion from the remainder of the
occlusal surface.
Other characteristics of the primary mandibular first molar:
• It does not resemble any other primary or permanent tooth.
• The mesiobuccal cusp is always the largest and longest cusp, occupying
nearly two-thirds of the buccal surface.
• The mesiolingual cusp is larger, longer, and sharper than the distolingual
cusp.
• The crown is wider mesiodistally than high cervico-occlusally.
• The mesial marginal ridge is very well developed and resembles a cusp.
• It has a prominent mesiobuccal cervical ridge.
•Class II cavity preparations are difficult due to morphology and a high
mesial pulp horn.
• It has no central fossa.
P rim a ry M a n d ib u la r R ig h t F irst M o la r
Buccal Lingual O c c lu s a l M e s ia l D istal

How many lobes develop to form a primary canine tooth?
•2
•3
•4
•5

•4
All canines (permanent and primary) have four lobes, three on the facial (mesiofacial, midfacial,
and distofacial) and one on the lingual. The cusp tip is located on the midfacial (central facial)
lobe.
1. The pulp cavities of canines when viewed in a mesiodistal section normally
appear pointed at the incisal tip.
2. When viewed from the facial, primary canines resemble a pentagon (five-sided).
Primary right anterior teeth, facial aspect. A, Max Primary right anterior teeth, lingual aspect. A,
illary central incisor. B, Maxillary lateral incisor. C, Maxillary central incisor. B, Maxillary lateral incisor.
Maxillary canine. D, mandibular central incisor. E, C, Maxillary canine. D, mandibular central incisor.
Mandibular lateral incisor. F, Mandibular canine. E, Mandibular lateral incisor. F, Mandibular canine.
A 10-year-old patient comes into your office with his mother. They are
concerned about affording orthodontic treatment for his slightly
crowded anterior teeth. He has not lost his primary molars yet. From
this information alone, you tell his mother...
• don't worry, the premolar teeth that replace these primary molars take up
less space in the arch, so we can expect to see more room in a few years
• get a second job, the premolar teeth that replace these primary molars
take up more space in the arch so we can expect to see even less room
than there is now
• the premolar teeth that replace these primary molars take up the same
amount of space in the arch. Based on this we cannot tell at this point
whether your son will need orthodontic treatment

• d o n 't w o r r y , th e p re m o la r te e th th a t re p la c e th e s e p r im a r y m o la r s ta k e u p le s s
s p a c e in th e a rc h , s o w e c a n e x p e c t to s e e m o r e ro o m in a fe w y e a rs
R e m e m b e r: The sum of the mesiodistal widths of the primary molars in any one quadrant is greater
than the permanent teeth that succeed them (premolars). Roughly 2-5 mm greater.
S o m e d iffe r e n c e s b e tw e e n p r im a r y a n d p e rm a n e n t m o la rs :
• Primary molars have c r o w n s that are s h o r t e r and more b u lb o u s , with p r o n o u n c e d buccal and
lingual cervical ridges and a c o n s t r ic t e d cervical area.
• Primary molars have an o c c lu s a l ta b le that is n a r r o w e r faciolingually.
• Primary molars have anatomy that is s h a llo w (i.e., the cusps are short, the ridges are not
pronounced, and the fossae are not as deep).
• Primary molars have a p r o m in e n t mesial cervical ridge (makes it easy to distinguish rights from
lefts).
• Primary molars have ro o ts that are lo n g e r and more s le n d e r than the roots of the permanent
molars. The roots are e x tr e m e ly n a r r o w mesiodistally and v e ry b r o a d buccolingually.
• Primary molars have r o o t s that are v e ry d iv e r g e n t and less curved. There is little or n o root
trunk.
Prim ary r ig h t molars, m e s ia l aspect. A , M a xillary first

A B m olar. B, M a xillary second m olar. C, M a n d ib u la r first
molar. D, M and ib ula r second molar.
Although it usually isn't much of a problem, which of the following

criteria would NOT be used to distinguish primary maxillary central
incisors from their permanent counterparts?
• they are shorter incisocervically

• they are wider mesiodistally than incisocervically
• there are no mamelons present
• the incisal edge is straighter
• the distal flare of the root is greater

• the distal flare of the root is greater
The primary incisors (centrals and laterals) are very similar to the permanent
incisors, but differ in one important trait, the newly erupted primary incisors do
not show mamelons. The most characteristic feature of the primary
maxillary incisor is the mesiodistal width of the crown. It is the only
primary or permanent incisor with a mesiodistal diameter (6.5 mm) greater
than its crown height (6.0 mm).
1. The primary maxillary central incisor has a shorter length
incisocervically (6.0 mm) than the permanent maxillary central
incisor (10.5 mm).
2. Also, compared to the permanent central incisor, the incisal edge
of the primary central incisor is straighter.
3. Labial and lingual cervical ridges are prominent on all primary
central and lateral incisors.
4. Remember: When extracting primary incisors (centrals and
laterals) where the roots have been partially resorbed due to
pressure from the developing permanent teeth, the facial part of the
remaining primary root will usually be the longest and the most
securely attached to the gingiva.
The crowns of all 20 primary teeth begin to calcify between:
• 1 to 2 months in utero

• 4 to 6 m o n th s in u te ro
D e c id u o u s F i r s t E v id e n c e o f A m o u n t o f E nam el F .n a m e l C o m p le te d R o o t C o m p le te d
T e e th C a lc if ic a tio n F o r m e d a t B ir t h ( M o n t h s a f t e r B ir t h ) (M o n th s)
M a x illa ry
C e n tr a l in c is o r 4 m o n th s in u te ro F iv e -s ix th s 1.5 1.5
L a te ra l in c is o r 4 .5 m o n th s in u te ro T w o - th ird s 2.5 2
C a n in e 5.5 m o n th s in u te ro O n e -th ir d 9 3 .2 5
F ir s t m o la r 5 m o n th s in u te ro O c c lu s a l c o m p le te ly 6 2.5
c a lc ifie d p lu s 1/2 to
.V4 c ro w n h e ig h t
S e c o n d m o la r 6 m o n th s in u te ro O c c lu s a l c o m p le te ly 11 3
c a lc ifie d ; c a lc ifie d
tiss u e c o v e rs 1/5 to
1 4 c r o w n h e ig h t
M a n d ib u la r
C e n tra l i n c is o r 4 .5 m o n th s in u te ro T h re e -f ifth s 2.5 1.5
L a te ra l in c is o r 4 .5 m o n th s in u te ro T h re e -f ifth s 3 1.5
C a n in e 5 m o n th s in u tero O n e -tliird 9 3 .2 5
F ir s t m o la r 5 m o n th s in u te ro O c c lu s a l c o m p le te ly 5.5 2 .5
c a lc ifie d
S e c o n d M o la r 6 m o n th s in u te ro O c c lu s a l c o m p le te ly 10 3
c a lc ifie d
1. On a vera g e p rim a ry te e th take 10 months for completion of calcification.

2. The primary teeth begin to form in utero at about s ix w eeks. Hard tissue formation occurs in all
primary teeth by the 18th w e e k in utero.
3. The p e rm a n e n t te e th begin to develop at approximately fo u r m o n th s o f age in ute ro .
Maxillary and mandibular first molars begin to c a lc ify a t b irth . They are the first to begin
calcification. The mandibular third molars are generally the last teeth to begin calcifying. This
happens at about 8-10 years of age.
Sally and Annie, ages six and eight respectively, come into your
office and get their picture put up on the “Cavity-Free Board.” On the
back of each picture, your assistant writes how many baby teeth they
have lost and how many adult teeth they have. Which numbers are
correct?
• Sally (0, 4); Annie (2, 6)

•S ally (2, 6); Annie (4, 10)
• Sally (2, 6); Annie (2, 6)
• Sally (0, 4); Annie (8, 12)

•Sally (0, 4); Annie (8, 12)
*** Sally will have lost no teeth yet and have all her permanent first molars.
Annie will have lost her maxillary and mandibular incisors (centrals and
laterals) and have all permanent first molars and permanent maxillary and
mandibular centrals and laterals.
Ordinarily, a 6-year-old child would have the following teeth clinically visible in
the mouth: All (20) primary teeth and four permanent first molars - (“6
year molars”).
Remember:
• Mandibular centrals erupt between the age of 6 and 7 (usually closer to age
7).
• Maxillary centrals erupt between the age of 7 and 8.
Ordinarily, a 8-year-old child would have the following teeth clinically visible in
the mouth: 12 primary and 12 permanent teeth.
The 12 permanent teeth include the:
• Mandibular first molars (2) - right and left
• Maxillary first molars (2) - right and left
• Mandibular central incisors (2) - right and left
• Maxillary central incisors (2) - right and left
• Mandibular lateral incisors (2) - right and left
• Maxillary lateral incisors (2) - right and left
The primary teeth include the maxillary and mandibular canines along with the
maxillary and mandibular first and second molars (12 total).
1. The largest primary tooth is the mandibular second molar.
2. The mandibular central incisor is the smallest primary tooth.
3. The largest permanent tooth is the maxillary first molar.
4. The mandibular central incisor is the smallest permanent tooth.
The mesiolingual cusp is the most prominent cusp on the primary

maxillary first molar.
The mesiolingual cusp is the longest and sharpest cusp on the
primary maxillary first molar.


Characteristics of the prim ary m axillary first molar:
• In all dimensions except labiolingual diameter it is the sm allest molar. Note:
The length of the crown is 5.1 mm; the M-D diameter of the crown is 7.3 mm and
the labiolingual diameter of the crown is 8.5 (the mandibular first molar is smaller
at 7.0 mm labiolingually).
• The DL cusp is poorly defined; it is small and rounded when it exists at all.
• The cervical line is higher mesially than distally.
• The cervical ridge stands out very distinctly on the m esiobuccal portion of this
tooth.
• The occlusal pit-groove pattern is most frequently H-shaped.
• The number of roots (three) and the form of the roots closely resembles the
permanent maxillary first molar; they are slender and long, spread widely and have
a very small root trunk.
• On the crown, the mesial surface normally is larger than the distal surface.
D is ta l
A preschool child is shown below with a normal dentition. Note the

spaces between the maxillary lateral incisor and canine and the
mandibular canine and first primary molar. These spaces are termed
_______ spaces, and their presence allows for the space to be filled
by permanent teeth as they erupt.
• primitive
• private
• primate
• hawley

• p rim a te
Primate spaces appear in the d e c id u o u s dentition. The spaces appear between the m a x illa ry lateral
incisors and the maxillary canines. They also appear between the m a n d ib u la r canines and the
mandibular first molars.
"'Spacing is normal throughout the anterior part of the primary dentition, b u t is m o s t n o tic e a b le in
these two locations.
These primate spaces are normally present from the time the teeth erupt. Developmental spaces
between the incisors are often present from the beginning, but become somewhat larger as the child
grows and the alveolar processes expand. Generalized spacing of the primary teeth is a requirement
for proper alignment of the permanent incisors. This spacing is m o s t fr e q u e n tly c a u s e d by the
g r o w th o f th e d e n ta l a rc h e s .
c
B A
A
F E D
Primary right anterior teeth, mesial aspect.
Primary right anterior teeth, incisal aspect. A, Maxillary central A, Maxillary central incisor. B, Maxillary lat
incisor. B, Maxillary lateral incisor. C, Maxillary canine. D, eral incisor. C, Maxillary canine. D, Mandibu
Mandibular central incisor. E, Mandibular lateral incisor. F, lar central incisor. E, Mandibular lateral
Mandibular canine. incisor. F, Mandibular canine.
A neophyte dental student, only about two weeks into the program,
gets scared when her 10-year-old cousin gets hit in the face and loses
a tooth. She calls you up and says that her cousin lost his permanent
mandibular first molar. Once she tells you more about the root
morphology of the tooth, you realize it is primary and the child simply
lost his...
• primary mandibular first molar

• primary mandibular second molar
• primary maxillary first molar
• primary maxillary second molar

• p rim a r y m a n d ib u la r s e c o n d m o la r
“ *The p e r m a n e n t m a n d ib u la r f ir s t m o la r has a morphology that closely resembles the p rim a ry
m a n d ib u la r s e c o n d m o la r.
The d iffe r e n c e s include:
• Relative size of the d is ta l c u s p . The primary molar has its mesiobuccal, distobuccal, and distal
cusp almost equal in size. The distal cusp of the permanent molar, however, is smaller than the
other two cusps.
• From the b u c c a l a s p e c t, the primary mandibular second molar has a narrow mesiodistal
calibration at the cervical portion of the crown when compared with the calibration mesiodistally of
the crown at the contact level. The mandibular first permanent molar, accordingly, is wider at the
cervical portion.
• G r o o v e p a tte r n s are different on the occlusal surface.
• The primary tooth has more divergent roots to allow for the eruption of the permanent second
premolar.
• The primary tooth has a more prominent facial crest of contour.
P r im a r y A /la n d fb u la r R ig h t S e c o n d M o la r
B uccal L in g u a l O c c lu sa l M e s ia l D is ta l
1. Primary second molars have the g r e a te s t fa c io lin g u a l diameter of all primary teeth.
The maxillary second molar measures 10 mm faciolingually and the mandibular second
molar measures 8.7 mm. The first molars measure 8.5 mm (max.) and 7.0 mm (mand.),
respectively.
2. The primary teeth that present the most noticeable morphologic d e v ia tio n s from
permanent teeth are the f ir s t m o la rs .
Morphologically, the primary maxillary second molar strikingly

resembles the:
• permanent maxillary third molar

• permanent maxillary second molar
• permanent maxillary first molar
• permanent mandibular second molar

• p e r m a n e n t m a x il l a r y f i r s t m o la r ( b u t i t is s m a lle r )
In general, the primary second molars a r e l a r g e r t h a n the primary first molars and resemble the
form of the permanent first molars. N o t e : Isomorphy is the term used to describe this close
resemblance.
Other characteristics of the p r im a r y m a x il l a r y s e c o n d m o la r :
•T h e faciolingual measurement (1 0 .0 mm) of the crown is g r e a t e r than the mesiodistal
measurement (8.2 mm)
• May have a fifth cusp (of Carabelli)
• Has a p r o m i n e n t mesiobuccal cervical ridge
• Has an o b l i q u e r i d g e
• From the largest to smallest cusp: ML cusp, MB cusp, DB cusp, and DL cusp
• The l a r g e s t and l o n g e s t p u l p h o r n is the mesiobuccal
Prim ary M axillary P erm an ent M axillary

R ight Second M olar Right First M o la r
D G
C H K
II
A « M
Q P O N
Universal numbering system for primary dentition. I, Maxillary arch. II, Mandibular arch
Primary molar relationships are known as:
• class relationships
• step relationships
• primitive relationships
• occlusion relationships
DENTAL ANATOMY & OCCLUSION d^dentaldecks

Part I •Volume 13*© 2017
• step relationships
In these cases (the flush-terminal-plane), the first permanent molars do not erupt immediately into
a normal relationship. As you can see, the first permanent molars are in a Class II relationship.
The Class II relationship usually is temporary until the second primary molars are lost and the
permanent molars move into a Class I relationship. This occurs at approximately age ten or
eleven and is called the late mesial shift. Both the mesial-step and flush-terminal-plane
relationships usually result in the development of a Class I permanent molar occlusion, although
the flush-terminal-plane relationship can result in a Class II relationship if the late mesial shift
does not occur. Another step relationship involves a situation where the distal surface of
themandibular primary second molar is located to the distal of the distal surface of the maxillary
primary second molar. This is termed a distal-step relationship. In these cases, the permanent
molars erupt into a Class II relationship. Important: The terminal plane relationship of primary
second molars determines the future anteroposterior positions of permanent first molars.
Both the mesial-step and flush-terminal-plane relationships usually

result in the development of a:
• class I permanent molar occlusion

• class II permanent molar occlusion
• class III permanent molar occlusion

Part I 'Volum e 13 *©2017
•class I permanent molar occlusion
***Although the flush-terminal plane relationship can result in a Class II
permanent molar relationship if the late mesial shift does not occur.
Another step relationship involves a situation where the distal surface of the
mandibular primary second molar is located to the distal of the distal surface of
the maxillary primary second molar. This is termed a distal-step relationship.
In these cases, the permanent molars erupt into a Class II relationship.
The primary molar relationships are as follows:
A B
A. Flush-terminal-piane relationship
B. Distal-step relationship
C. Mesial-step relationship
> rst i fs?f 'r m

The Angle Classification of permanent molar relationships are as follows:
A. Class I molar relationship

B. Class II molar relationship
C. Class III molar relationship
t ei N r r - s t •i
A B C
Note: Primary molars should be assigned term inology according to step relationships, and per
m anent molars should be assigned term inology according to the Angle Classification system.

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DENTAL ANATOMY & OCCLUSION LEGEND

Topic Cards Topic Cards

anterior teeth information 1-8 occlusion terms 94-101

canine teeth information 9-14 periodontal 102-113

eruption sequence 15-26 prem olar teeth information 114-120

heights of 27-38 tooth components 121-137

miscellaneous 39-49 tooth terms 138-150

mandibular 50-61 perm anent teeth 151-167

molar teeth information 62-73 pictures of teeth 168-186

muscles 74-80 tem porom andibular joint 187-199

occlusion information 81-93 primary dentition 200-216

A stray crown is found in your office. It is an anterior tooth and has a

DENTAL ANATOMY & OCCLUSION IM e n ta ld e c k s

Which characteristic below is common to all mandibular anterior

• distinct cingula with grooves and pits

DENTAL ANATOMY & OCCLUSION i^ d e n ta ld e c k s

Mesial Distal Mesial Distal Mesial Distal

A clinical examination of your patient reveals two lower incisors

• difference in root length

DENTAL ANATOMY & OCCLUSION ifrd e n ta ld e c k s

• both statements are true

DENTAL ANATOMY & OCCLUSION ifrd e n ta ld e c k s

Summary of Schematic Outlines of the Tooth Crowns:

Which of the following statements best describes the pulp canal of

• an elliptical shape, consistently wider in the mesiodistal direction

DENTAL ANATOMY & OCCLUSION IM e n ta ld e c k s

Which of the following line angles is least "square"?

• mesioincisal of the mandibular lateral incisor

DENTAL ANATOMY & OCCLUSION Ifrd e n ta ld e c k s

• maxillary central incisor

DENTAL ANATOMY & OCCLUSION IM e n ta ld e c k s

Th e cervical cross sections o f th e p u lp o f p e rm a n e n t a n te rio r te e th

M a x . C en tra l Incisor M a x. Lateral Incisor M a x . C an ine

M a n d . C en tral Incisor M a n d . L a teral Incisor M a n d . C anine

DENTAL ANATOMY & OCCLUSION l^ d e n ta ld e c k s

Remember (from card #4):

M esial v ie w o f th e Lingual v ie w o f th e M esial v ie w o f th e

In maximum intercuspation, which anterior tooth is unique in that it

• maxillary first premolar

DENTAL ANATOMY & OCCLUSION l*d e n ta ld e c l< s

L in g u a l aspect D e e p e r lin g u a l fo ssa e

ln c is a l/P r o x im a l aspects C u s p ti p m a y b e a t o r la b ia l t o r o o t a x i s lin e

• the root always curves to the distal in the apical one-third

DENTAL ANATOMY & OCCLUSION ifrd e n ta ld e c k s

Which of the following terms is specific to canines?

DENTAL ANATOMY & OCCLUSION i^ d e n ta ld e c k s

• the middle child is 11 and has no adult canine teeth

DENTAL ANATOMY & OCCLUSION i^ d e n ta ld e c k s

Permanent Teeth Eruption Chart

DENTAL ANATOMY & OCCLUSION l*d e n ta ld e c k s

Maxillary Right Canine Mandibular Right Canine

Facial Lingual Incisal Incisal Facial Lingual

Which cusp ridge is the longest on the permanent canines?

DENTAL ANATOMY & OCCLUSION Ifrd e n ta ld e c k s

M e sia l asp e c t N a r r o w e r , lo n g e r t h a n m a x illa r y c a n in e

I n c i s a l P r o i i m . i l asp e ct* : C u s p tip lin g u a l to r o o t a x is lin e

• permanent mandibular first molars

DENTAL ANATOMY & OCCLUSION IM e n ta ld e c k s

• mandibular incisors only

DENTAL ANATOMY & OCCLUSION l^ d e n ta ld e c k s

Upper Teeth Erupt Shed

First molar 13-19 mos. 9-11 yrs.

Second molar 25-33 mos. 1 0 -1 2 yrs.

Lower Teeth Erupt Shed

Outline drawings of the m axillary teeth in contact, with dot