Human Dentition

Handouts
Semester II
2021/ 2022

2022

By
Prof. Reham Magdy
 Index:

Item Pages
The Molars 1
Maxillary First Molar 2-9
Maxillary Second Molar 10-14
Maxillary Third Molar 15-16
The permanent mandibular Molars 17
The permanent mandibular first molar 18 -24
The permanent mandibular second molar 25-30
The permanent mandibular Third molar 31-33
Geometric outline Form (Semester I) 34-36
Mandible at different ages ( Semester I) 37-40
The Deciduous teeth 41-43
The Deciduous anterior teeth 44-46
The Deciduous posterior teeth 47-56
Physiologic tooth form protecting the periodontium 57-65

Compensating curvatures of the dental arches 66-72

& the arrangement of teeth

Phases of eruption of the permanent teeth into dental arches 73

Occlusion 74-89
 References

Recommended:

1. S. J. Nelson 'Wheeler's Dental Anatomy, Physiology and Occlusion', 9th

edition. Ash, Nelson, 2009

2. R. W. Brand, D. I. Isseland, Anatomy of Orofacial Structures, Mosby

Company, 1990.

3. J. N. Woelfel, R. C. Scheid, Dental Anatomy. Its Relevance to Dentistry.

Baltimore, Philadelphia, 2002.

4. B. K. Berkovtz et al Oral Anatomy, Histology and Embryology. 3rd ed. Mosby,

2002

5. Lounch K.”3rd Tooth Atlas” Brown and Herbanson, 2009

6. R. C. Schneid, G. Weiss 'Woelfel's Dental Anatomy' 8th edition. Philadelphia,

Lippincott Williams & Wilkins, 2011

7. B. Liebgott 'The Anatomical Basis of Dentistry' 3rd edition. Mosby, 2009

Optional:

1. James R. Hupp, Thomas P. Williams, F. John Firriolo „Dental Clinical Advisor”.

Mosby, 2006

2. S. Kumar 'Dental Anatomy and Tooth Morphology' 1st edition. Jaypee

Brothers Medical Publishers, 2007
 THE MOLARS

General features

 There are three permanent molars in each quadrant (12 permanent molars in oral cavity)

 The molars have no deciduous predecessors, so they are not considered successors.

 Generally the permanent molars are formed from four lobes, except the lower first molar
and lower third molar in cases when it resembles lower first molar, may have five lobes .
Each cusp of a molar is formed from its own lobe.

 The most developed molars are the first molars while the third molars are the most
variant.

 In the upper molars, the cronal buccolingual dimension is more than the mesiodistal
dimension ,

but in the lower molars the mesiodistal dimension is more than buccolingual.

- Molars are multirooted , the upper molars usually have at least three roots and lower ones
have at least two roots .

- Molars’ main function is grinding of food to be ready for swallowing.

1
 MAXILLARY FIRST MOLAR

Chronology

Appearance of dental organ 4 m.I.U.

First evidence of calcification at birth

Enamel completed 3-4 years

Eruption 6-7 years

Root completed 9-10 ears

General features:

- It is the largest tooth in maxillary arch.

- It has four well developed cusps (two buccal and two lingual) and a fifth elevation which
is called Tubercle of Carabelli. This fifth cusp ( as named) is a characteristic feature in
maxillary first molar.

- As the maxillary molars, the crown of this tooth is wider buccolingually than mesiodistally.

- It is formed of four lobes of calcification, correspondent to each cusp.

- This tooth has three well developed and widely separated roots, two buccal and one palatal
(lingual). They give this tooth the maximum anchorage against occlusal forces in the
dental arch.

2
Buccal aspect
Geometrical outline form:

- The crown is trapezoid, the shortest of the uneven

sides cervically .
- Buccal cusps and cusps tips of lingual ones can
be seen from this aspect. M D

- Part of the distal side is seen due to distobuccal

convergence.

The outline:

- The mesial outline of the crown is nearly straight downward and curving occlusally as
it reaches the height of contour which is the mesial contact area. The contact area is at
the junction of the occlusal and middle thirds. Then, the mesial outline curves
corresponding with the outline of the mesial slope of the mesiobuccal cusp. Both of the
mesiobuccal cusp slopes meet at an obtuse angle so the cusp appears less sharp .

- The distal outline is convex; from the cervical line to the contact area which is in the
center of the middle third then it a curve to the distal slope of the distobuccal cusp.
The mesial slope of the distobuccal cusp slopes meet at right angle so it appears
sharper and longer.

- The buccal groove is shifted more disally so the mesiobuccal cusp is broader than
the distobuccal cusp

The cervical line:

The cervical line is slightly curved root wise. This line is not as smooth and regular as
found in some other teeth

Elevations and depressions:

The cervical ridge is convex areas which is present cervically .

The buccal surface is characterized by buccal ridges on each buccal cusp.

Buccal developmental groove separates the two buccal cusps .

3
Roots:

- The three roots appear from this aspect , two buccal roots and a palatal root.

- The mesiobuccal root starts slightly concave outline at the cervical third then curves
convex at the middle third to the apex. Its apex is on line with the tip of the mesiobuccal
cusp. The distobuccal root is straighter and it has a tendency toward curvature mesially at its
middle third.

This pattern gives them both the "Cow horns appearance".

- The point of bifurcation of the two buccal roots is located approximately 4 m.m. away from
the cervical line.

- Palatal root is the largest & longest , appears conical and seen in the background between
the two buccal roots.

- There is a deep developmental groove on the buccal root trunk .

Lingual aspect
Geometrical outline form:

- It is trapezoid in shape with short side cervically.

- There is No lingual convergency

Outline :

- The outline is as that of the buccal aspect. The mesial outline is straight and
the distal outline of the crown is smoothly curved. The two cusp slopes meet
at obtuse angle (i.e less sharp).

- The lingual cusps are the only ones to be seen from this aspect.

The Cervical line :

- The cervical line is irregular and slightly convex root wise

Lingual anatomical landmarks:

- The high of contour is located in the middle third of the surface.

4
 - The lingual developmental groove separates the two lingual cusps . The mesiolingual cusp
is much larger. Its mesiodistal width is about 3/5th (or 2/3) of the mesiodistal diameter of the
crown, the distolingual cusp making up the remaining 2/5th ( 1/3).

- The Tubercle of Carabelli appears on the lingual surface of the mesiolingual cusp. It is
separated from the mesiolingual cusp by an irregular developmental groove. This is called the
fifth cusp developmental groove.

Roots:

-The three roots appear from the lingual aspect. The lingual root is conical with blunt rounded
apex. The apex of the 1ingual root is on line with the lingual groove of the crown. The two
buccal roots appear on the sides of the palatal root.

Mesial aspect
Geometrical outline:

It is trapezoid in shape with short side Occlusally.

Outline:

- Only the mesiobuccal, mesiolingual and Tubercle of Carabelli are seen.

- The buccal outline of the crown starting from the cervical line is curved with the
crest of curvature within the cervical third ( cervical ridge) then it progresses
downward till the mesiobuccal cusp.

- The lingual outline is curved with the crest of curvature located near the middle third. The
lingual outline dips inward outlining the tubercle of Carapelli that could be either found
overdeveloped or undeveloped in other cases. Then the lingual outline continues to the tip of
the mesiolingual cusp.

- The mesial marginal ridge, located mesially between the mesiobuccal and mesiolingual cusp
ridges, is irregular in outline and located about at the junction of the occlusal and middle
third.

The cervical line

- The cervical line is irregular, slightly concave rootwise.

Surface anatomy:

- The mesial contact area is at the junction of the middle and occlusal thirds of the
crown and somewhat toward the buccal side.
5
 The roots:

- Only two roots are seen, the mesiobuccal and the palatal roots.

- The mesiobuccal root is broad and flattened on its mesial surface. The outline of this
root is more or less straight to end at a blunt apex.

The palatal root is longer than the mesiobuccal root by 1.0 mm but it is narrower from
this aspect. Its buccal outline is concave and its lingual outline is convex specially at itsmiddle
half, giving it the "banana shape".

The root trunk is a little shorter than that buccaly. . There is smooth depression extends
from the bifurcation to the cervical line.

Distal aspect
This aspect is similar to that of the mesial aspect, but it differs in the following:

- The measurement of the crown is less than that of the mesial aspect
- The distal marginal ridge is located more cervically , so the four cusps can be
seen.
- The contact are is broader and located buccally more cervically.
- The cervical line is less curved and almost straight.
- The distobuccal root is narrow and shorter.
- The bifurcation is found more apical. The root trunk is about 5 mm..

Occlusal aspect
- It is Rhomboidal in outline.

- The crown is narrower distally due to the presence of distobuccal

convergence, and wider lingually than buccaly due to absence of lingual
convergency.

 The obtuse angles of the rhomboidal shape occlusal aspect is at the

mesiolingual and distobuccal line angles .

Elevations:

- There are four major cusps which are:

The mesiolingual cusp is the largest cusp, followed by the mesiobuccal , distobuccal,
then the smallest distolingual, and each cusp has a triangular ridge.

6
 - The oblique ridge traverses the occlusal surface joining the triangular ridges of
mesiolingual cusp and distobuccal cusp.

- The tubercle of Carabelli on the lingual surface of the mesiolingual cusp is small and
nonfunctional. It may be well defined or may be not distinct.

- The mesial marginal ridge is longer than the distal one.

Depressions:

- There are two major fossae:

A central fossa which is triangular concave area with a developmental pit at its depth
found mesial to the oblique ridge and a distal fossa which is linear and distal to the oblique
ridge.

- There are two minor fossae:

The mesial triangular fossa just distal to the mesial marginal ridge and it is
surrounded by mesiobuccal groove extend buccaly and mesiolingual groove extend lingually.
The distal triangular fossa just mesial to the distal marginal ridge. It is surrounded by
distobuccal groove extend buccaly and distolingual groove extend lingually. Each fossa has a
pit .

- The central developmental groove joins between the central pit in the central fossa
and ends at the mesial triangular fossa. The buccal developmental groove radiates buccally
from the central fossa perpendicular to the central groove and goes between the two buccal
cusps.

- The distal groove that joins the distal triangular and distal fossa. The lingual groove
curves lingually separating between the two cusps.

- Another development groove may be seen radiating from the central pit distally and
crosses the oblique ridge to end at the distal fossa. This is called the Transverse groove of
the oblique ridge.

Thus , from the mesial pit in the mesial triangular fossa the following developmental
grooves radiate:

- The central developmental groove to the central fossa.

- The mesiobuccal groove
- The mesiolingual groove

From the distal pit in the distal triangular fossa the following developmental grooves
radiate:

7
 - The distal groove.
- The distolingual groove.
- The distobuccal groove.
- The distal marginal groove that may extends over the marginal ridge into the distal
surface ( may be found) .

Pulp cavity
It contains a pulp chamber, four pulp horns and mostly four root canals

( mesiobuccal root has 2 root canals).

Buccolingual section:

The chamber is broad and rectangular in shape and the two pulp
horns extend to the mesiobuccal and mesiolingual cusps.

The lingual canal is large and accessible, mostly the mesiobuccal

root has two root canals which either open in one or two apical foramina.

The disto buccal root has only one root canal.

Mesiodistal section:

The pulp chamber is not wide, and the pulp horns extend to the mesio-buccal and
distobuccal cusps. The mesiobuccal and distobuccal canals are narrow and tapering to the apex.

Cervical cross section:

The outline is rhomboidal in shape with rounded corners. The canals of this tooth
form a triangular pattern. A line drawn between the mesiobuccal and the palatal canals makes
the base of the triangle.

8
9
THE MAXILLARY SECOND MOLAR

10
Chronology

Appearance of dental organ one year

First evidence of calcification 2.5-3 years

Enamel comp1eted 7-8 years

Eruption 12-13 years

Root completed 14-16 years

This tooth help the maxillary first molar in function, and it has the same form with
some variations:

Buccal aspect

-The crown is a little shorter cervico- occlusally

(by about 0.5 mm) and narrower mesio-distally (by l mm.

- The buccal groove is located more dista1ly ( So the MB cusp is

larger than DB one).

- The buccal roots are inclined distally more than those

of the maxillary first molar .

11
Lingual aspect
- The mesiolingual cusp is smaller and not well developed as in the first
maxillary molar.

- No fifth cusp is present.

- The distolingual cusp is smaller, and in some

cases may be so much reduced( heart shaped occlusal form) .

- The apex of the lingual root is shifted more distally.

Mesial aspect
- No tubercle of Carabelli.

- The roots are less divergent

- It is similar to the mesial except that the distobuccal cusp is smal1er than in the first
molar.

Distal aspect

M D

12
Occlusal aspect
The crown is more constricted mesio-distally and has no tubercle of Carabelli. There
are two major types of crown form:

1- Rhomboidal:

- It is most frequent type resembling the maxillary first molar. Except that the
rhomboid form is more accentuated.

- The distobuccal and distolingual cusps are smaller.

2- Heart shaped:

Resembling the maxillary third molar. The distolingual cusp being poorly developed or
sometime missing. It has two buccal and one lingual cusp.

It is common to find supplemental grooves than in the maxillary first molar which
make the surface more wrinkled.

13
Pulp cavity
It is not common to find two root canals in the mesiobuccal root .Thus it is more
common to find four pulp horns and three root canals one in each root.

14
THE MAXILLARY THIRD MOLAR

15
Chronology
Appearance of dental organ 4 year

First evidence of calcification 7-9 years

Enamel completed 12-16 years

Eruption 17-21 years

Root completed 18-25 years

- This is the most variable tooth in the upper arch.

- The most common crown form is the heart-shaped which is generally smaller and
more rounded in all dimensions that the second molar. The distolingual cusp is very small and
poorly developed or may be absent presenting an occlusal table with three cusps.

- Sometimes it could be found in rhomboidal form resembling the upper 6.

- The crown is shorter and narrower mesio-distally than the maxillary second molar.

-Many supplemental grooves is found on the occlusal table.

- The root from and number extremely variable, but are smaller in all dimensions.

- The most common is the three root type where they are often fused.

Pulp cavity
Due to the variation in the shape of the upper third molars, there are variations in the
shape of their pulp cavities.

16
 THE PERMANENT MANDIBULAR MOLARS

General features:

-There are three permanent mandibular molars in each quadrant of the lower arch.

-They are the largest teeth in the mandibular arch .

-Their mesio-distal dimension larger than their bucco-lingual dimension.

- All mandibular molars are formed of four lobes of calcification except the lower first molar and the

third molar ( when it is 5 cusp type, resembling the lower first molar)

-Their buccal and lingual aspects are trapezoid with the shortest of uneven sides cervically and their
proximal aspects are rhomboid in shape.

17 Dr /Reham Magdy
 THE PERMANENT MANDIBULAR FIRST MOLAR

Chronology:

Appearance of dental organ 4 m.i.u.

First evidence of calcification at birth

Enamel completed 2.5 - 3 years

Eruption 6 - 7 years

Root completed 9 - 10 years

General Features:

- The lower 6 is the largest tooth in the mandibular arch.

- It has five cusps, two buccal, one distal and two lingual, and formed of five lobes of calcifications;
three buccal and two lingual.

- Its mesiodistal dimension(width) larger than its buccolingual dimension (contrary to upper First
molar).

- The crown has both lingual as well as distal convergence, so the distal side is narrower than the
mesial side (as all lower molars).

-Two widely separated roots present, one mesial and one distal

- In some exceptional cases of lower 6 , the mesial root could divide leading to the appearance of
thin slender root present on the lingual side so the tooth appears to have 3 roots .

18 Dr /Reham Magdy
 Buccal aspect:

The geometrical outline form of the crown:

-Trapezoid with the smallest of the uneven sides cervically.

The crown outlines:

- The mesial outline is straight or slightly concave from the cervical region to the contact area, which
is at the junction of the middle and occlusal thirds, then it terns convex in the occlusal third to the
mesiobuccal cusp tip.

- The distal outline is straight from the cervical line to the distal contact area, which is at the middle
third, and then the outline contiues more convex above the contact area than mesially till the distal cusp
tip.

- The buccal cusps are flat. The mesiobuccal cusp is the largest widest and highest; followed by the
distobuccal cusp, while the distal cusp is the sharpest and the smallest. The tips of the lingual cusps
could be detected from this aspect too.

The cervical line:

It is ir regularly curved rootwise.

The surface anatomy:

- The cervical ridge runs along the cervical third.

- The mesiobuccal developmental groove separates the mesiobuccal and the distobuccal cusps. It ends
at the center of the crown in a mesiobuccal pit.

- The distobuccal developmental groove- is longer- separates the distobuccal cusp from the distal
cusp .A distobuccal pit could be found at the terminal end of the groove.

NB: Fault pits could be detected at the terminal ends of buccal grooves of some lower molars and
could be carious.While in the upper molars it could be found lingually.

19 Dr /Reham Magdy
 The Roots:

- The roots appear narrow from this aspect. The mesial root is longer than the distal root.

- The root trunk is located approximately 3-4 mm below the cervical line and has a developmental depression.

- The mesial root in the middle third, and then end with tapered apex which is located below the
mesiobuccal cusp.

- The distal root is almost straight . Its apex is more pointed and located below or distal to the distal contact
area.

Lingual aspect:

- Smaller than the buccal aspect due to the lingual convergence.

- Occlusally, there are two pointed lingual cusps that are higher and more pointed than the buccal cusps. The
mesiolingual cusp is wider and higher than the distolingual cusp. The two lingual cusps are separated by
the lingual developmental groove extending till the junction between the occlusal and middle third.

The cervical line:

It appears irregular and curved sharply rootwise. The cervical line is located more occlusally than bucally,
leading the crown to appear shorter , and the root appears longer from this aspect.

No specific elevation are found on this aspect, except that the surface appears convex with its maximum
convexity in the middle third.

The roots:

- The root trunk lingually is longer than buccally by about 1mm( about 5mm long ) due to location of
cervical line .It shows deep developmental depression .

20 Dr /Reham Magdy
Mesial aspect:

The geometrical outline form of the crown:

-The crown is rhomboidal. It is wider cervically than the occlusally.

The outlines of the crown:

-The buccal outline is convex due to the presence of the cervical ridge, then becomes flat till the MB cusp
. The tip of this cusp is located above the buccal third of the root.

-The lingual outline is straight from the cervical line till the crest of curvature at the middle third and continues
convex till the tip of the mesiolingual cusp. The ML cusp is located on one line with the lingual third of
the root

The cervical line:

It is irregular and becomes more occlusally as it slopes lingually ( becomes higher lingually by about 1mm)
.

Crown surface:

- The contact area is large, rounded or ovoid and located more buccally at the junction of the middle and
occlusal thirds.

The roots:

-The mesial root is broader and longer than the distal root.

-The root outline is straight buccally and lingually then tapers to a blunt apex which is located below the
mesiobuccal cusp ( as the crown is tilted ligually), with a developmental depression in the middle. The
mesial root could be bifid ( divided apically into two apexes)

21 Dr /Reham Magdy
Distal aspect:

- Similar to the mesial aspect, except for:

- The crown is shorter, narrower and tipped distally so occusal aspect details could be seen .

-The distal marginal ridge is curved and located more cervically than the mesial. It appears irregular and it
could be crossed with a developmental groove or depression.

- The distal contact area is larger than the mesial and is located in middle third cervicoocclusally, under
the distal cusp.

-The cervical line is straight buccolingually, than the mesial.

-The distal root is narrower and more rounded bucco-lingually than the mesial root with a pointed apex. So
part of mesial root can be seen from the distal aspect.

-The distal suface of the root shallows a developmental depressions.

Occlusal aspect:
The geometric outline:

It is hexagonal from the occlusal aspect.

- The crown is greater mesio-distally than bucco-lingually.

-The crown is broader on the buccal than on the lingual side (lingual convergence),

and broader on the mesial than on the distal side (distal convergence).

Thus the crown owes a disto-lingual convergence.

22 Dr /Reham Magdy
The elevations:

-The mesiobuccal cusp is larger than the lingual cusps which are almost equal, then followed by the
distobuccal cusp and the distal cusp is the smallest .Each cusp has its triangular ridge.

- The mesial marginal ridge is longer than the distal marginal ridge.

The depressions:

-The mesial and distal triangular fossa lie just distal and mesial to the marginal ridges respectively. The
distal fossa is smaller and shallower than the mesial fossa. Each fossa has a developmental pit. The fosse
are surrounded with bucal and lingual groove. .

-The central fossa is placed in the center between the buccal and lingual cusp ridges, with a central pit at its
depth.

-From the central fossa the central developmental groove runs mesially and distally in zigzag course ending
in the triangular fossae.

- A short distance mesially from the central pit, the mesiobuccal developmental groove originates in a
mesiobuccal direction and passes between the mesiobuccal and distobuccal cusps.

-The lingual developmental groove is irregular and originates from the central fossa directed lingually .

-The distobuccal developmental groove starts from the central groove pass between the distobuccal and distal
cusps.

Pulp cavity:
The tooth has 5 pulp horns and most probably 3 root canals (2 in mesial root, and 1 in distal)

Bucco-lingual section:
-The pulp chamber is wide with prominent pulp horns.
-The mesial root may show broad root canal which becomes
narrow at the apical end of the root to a pointed apical foramen.
More likely this root present two separate canals which join in
a common apical opening, or the two canals open in two separated apical
foramina.
-The distal root presents shorter has root canal

Mesiodistal section:
-Buccally appears with 3 pulp horns and 2 root canal

- Lingually, appears with two pulp horns and two root canals.

23 Dr /Reham Magdy
Cervical cross section:
At the cervical part the pulp chamber is rectangular in shape.

24 Dr /Reham Magdy
 THE MANDIBULAR SECOND MOLAR

Chronology:

Appearance of dental organ 1 year

First evidence of calcification 2.5 - 3 years

Enamel completed 7 - 8 years

Eruption 11 - 13 years

Root completed 14 - 15 years

General Features:

-It supplements the first molar in function.

-It is slightly smaller than the first molar in all dimensions.

-The crown has four well developed cusps, two buccal and two lingual as well as two roots one mesial and
one distal.

- It has supplemental grooves on its occlusal surface.

25

Dr /Reham Magdy
Buccal aspect:

* The geometrical outline form of the crown:

-Trapezoid with the shortest of the uneven sides cervically.

* The crown outlines:

-The crown is somewhat shorter cervico-occlusally and narrower mesiodistally than lower 6.

-The mesial outline is nearly straight to the contact area

(at the junction of middle and occlusal thirds) and then convex.

-The distal outline is convex to the distal contact area (at the center of the middle third) then convex to the
cusp tip.

Occlusally, two buccal cusps appear with blunt tips. From this aspect the two lingual cusp tips appear too.

* The cervical line:

-The cervical line is nearly straight, irregular and may point sharply towards the root bifurcation.

* The surface anatomy (Elevations and depressions):

-The less prominent cervical ridge is found occupying the cervical one third than lower 6.

-There is one buccal developmental groove which may ends in a buccal pit. The groove separates between
two buccal cusps , the mesiobuccal ( which appears longer )and distobuccal cusps ( diff. from lower 6).

* The Roots:

-The root trunk is longer than the lower 6 and has a deep developmental depression.

-The mesial and distal roots, are shorter and closer to each other compared to lower 6.

-The mesial root is slightly longer than the distal. Both roots are more inclined distally than in the lower 6.

26

Dr /Reham Magdy
Lingual aspect:

*The crown and root converge less lingually than the first molar.

* The geometrical outline form of the crown:

-Trapezoid with the shortest of the uneven sides cervically.

* The crown outline:

as the buccal aspect

* The surface anatomy (Elevations and depressions):

Only the lingual cusps are visible as they are more pointed than the buccal cusps.

-The pointed mesiolingual and distolingual cusps are nearly the same size but the mesiolingual cusp may be
slightly wider and longer than the distolingual.

- The Lingual developmental groove separates the two cusps .

-The cervical line is irregular in outline.

Mesial aspect:

27

Dr /Reham Magdy
* The geometric outline:

Rhomboidal with lingual inclination. It is narrower occlusally.

* The crown outline:

- The buccal is convex cervically due to the pronounced cervical ridge ( but less than lower 6) then the
buccal surface outline is straight till the mesiobuccal cusp tip.

- Lingually, the crest of curvature of the crown is in the middle third of the crown

- Occlusally, The mesial marginal ridge is sharply concave. Occlusal table appears more constricted than
lower 6.

* The cervical line:

- The cervical line shows less curvature and is located ore occlusally in its lingual side.

* Surface structures:

The mesial contact area is at the junction of the occlusal and middle thirds and located more buccally.

The Root:

- The mesial root is less broad and somewhat pointed apically than the first molar and has longitudinal
depression on its mesial surface.

Distal aspect:

The distal surface is shorter and narrower than the mesial aspect.

- The distobuccal cusp is the shortest cusp.

- The distal marginal ridge is more cervically located than the mesial marginal ridge; so much of the occlusal
surface is visible.

28

Dr /Reham Magdy
- The contact area is therefore centered on the distal surface buccolingually as well as cervico-occlusally.

- The distal root is narrow and slightly shorter than the mesial root.

Occlusal aspect:

* Geometrical outline:

- The geometric shape from the occlusal aspect is rectangular.

* Crown outline:

-The crown is larger mesiodistally than buccolingually.

-The distal side of the crown is narrower than the mesial side and the lingual side is narrower than the buccal
side.

* Elevations:

-The occlusal surface shows four cusps, the Mesiobuccal cusp, both lingual cusps (the lingual cusps are
almost equal) then the distobuccal cusp. Each cusp has a triangular ridge.

- The mesial marginal ridge is longer than distal marginal ridge.

* Depressions:

- There are, the central fossa, which is roughly circular and concave and is located in the center of the
occlusal surface containing pit at its depth.

- The mesial and distal triangular fossae, are located internal to the marginal ridges. The distal triangular
fossa is usually smaller than the mesial one .Each fossa has a pit .

-The buccal and lingual developmental grooves meet the central groove in the central fossa forming a
characteristic cross-shaped pattern and dividing the crown into four nearly equal parts.

- There are more supplemental grooves radiating from the central groove (than on the first molar).

29

Dr /Reham Magdy
* The pulp cavity:
- It is smaller in size than lower 6 , with four pulp horns beneath each cusp .
- This molar can have two root canals, one for each root.

- It may have three root canals similar to the lower first molar, two are together in the mesial root.

Cervical cross section: the pulp chamber is generally more or less triangular

because of the smaller dimension of this molar distally.

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Dr /Reham Magdy
 THE MANDIBULAR THIRD MOLAR

Chronology:

Appearance of dental organ 4 years

First evidence of calcification 8 - 10 years

Enamel completed 12 - 16 years

Eruption 17 - 21 years

Root completed 18 - 25 years

General features:

- The mandibular third molars are extremely variable in size and shape of both crown and root portions.

- The occlusal surface has irregular groove pattern with numerous supplemental grooves that produce a
wrinkled appearance.

- These roots are usually shorter than those of first or second molars and may be excessively distally curved.

- The roots may be slightly separated or fused for all or part of their length.

* This tooth could be found with the following crown forms variations:

Type I ( 4 cusps type):

- 50%.resembles the permanent second molar with four cusps and rectangular outline form of the crown.

31

Dr /Reham Magdy
Type II ( 5 cusps type):

- 40% resembles the permanent first molar with five cusps and hexagonal crown form

Type III:

- In 10% of cases it may have more than five or less than four cusps.

Pulp cavity:

- It follows the general outline of the tooth, though it is variant.

32

Dr /Reham Magdy
To summarize:
Number of Lobes Teeth Distribution of lobes

Four lobes -The anterior teeth Three labial and one

1igua1
- The maxillary premolars and the mandibular
first premolar
-The mandibular second premolar ( if two-
cusped type)

-The maxillary molars Two buccal and Two lingual

- The mandibular second molar
- The mandibular third molar ( if resemble lower
7)

Five lobes -The lower second premolar

( three cusp type) Three buccal and two
lingual
-The lower first molars.

- Lower third molar if it resemble the lower 6

- Deciduous lower

Chonology permenanent teeth

33

Dr /Reham Magdy
The Geometric Concept of Crown Outline ( Semester 1)
The geometric outline forms that could be detected cronally in all teeth aspects, facial,
lingual and proximal (except the incisal or occlusal) could be either triangle, trapezoid,
or rhomboid

* Facial and Lingual aspects of all teeth:

Is Trapezoid, with the shortest of the uneven sides cervically and the longest sides
incisally or occlusally.

The significance of this geometrical form:

1. Each tooth occludes with two of the opposing arch; (except the mandibular incisor
and the maxillary 3rd molar) this would help, If a tooth has single antagonist the
other tooth would prevent elongation of its antagonists in the opposing arch and
helps to stabilize the remaining teeth for a longer period .

2. Provides contact between teeth , thus Distribution and reduction of the forces exerted
on the teeth which could be transmitted to the periodontium which if harmed tooth
could be lost.

3. Allow the presence of interproximal spaces that accommodate gingival tissues where
the contact between the teeth help to protect this tissue which prevent food
accumulation.

34 Dr /Reham Magdy
 4. Spacing between roots which allows sufficient bone and periodontal ligaments support
for teeth and allow the presence of proper blood circulation and nourishment
provided through surrounding capillaries .

* Mesial and Distal aspects of the anteri or teeth:

Is Triangle, the base of the triangle is represented by the cervical

portion of the crown, and the apex by the incisal ridge.

This design provides:

1. Wide base to the crown for more strength and support .

2. A tapered to a thin incisal ridge facilitate the cutting and

penetration of food material.

* Mesial and Distal aspects of maxillary posterior teeth:

Is Trapezoid, with the shortest of the uneven sides occlusally and the longest
cervically. This design provides the following:
1. Because the occlusal surface is constricted, the tooth can be forced into food
material more easily.
2. The wide base cervically, allows stabilize the tooth and decrease the forces upon it.

NB. If the occlusal surfaces were as wide as the bases of the crowns, excessive forces
would be transmitted to the roots during mastication.

3. This form helps self cleaning of the teeth.

35 Dr /Reham Magdy
Mesial and Distal aspects of mandibular posterior teeth

Is Rhomboid, the occlusal surface is constricted in comparison to the bases. The

rhomboid design provides the following:

1. This outline inclines the crown lingual on the root, bringing the cusps into proper

occlusion with their maxillary antagonist and prevents clash of the cusps with one

another .

2. To keep the axis of the crowns and roots of the teeth of both jaws parallel, help

dissipate the forces away from the long axis of the tooth.

3. Permits the prominence of the cervical ridge, leads to deflection of food which

promote self cleaning of teeth and proper gingival massage.

36 Dr /Reham Magdy
 Mandible At Different Ages ( Semester 1)

**Mandible at birth:

-The mandible size is too small.

-Consists of two separate halves that unite at the midline by fibrous tissue (the area of union
called symphisis menti.)
-The chin bone is underdeveloped
- Contains the deciduous and permanent tooth germs in crypts .
- No teeth erupted at that age.
-The mental foramen opens below the crypt of lower D ( or between crypts of lower D&E) .
-The mandibular canal runs near the lower border of the mandible.
-The Mandibular angle170◦.
-The condyle is present at one line with the upper border of the mandible.
-The sigmoid notch is shallow
-The coronoid process present at higher level than the condyle

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Dr /Reham Magdy
** At 3 years (after the eruption of all deciduous teeth):

- The size increased a bit and the body elongates especially behind mental foramen to
accommodate for the developing permanent molars tooth germs. It increase in height due to
deciduous teeth eruption .
-The two halves of mandible joint at the symphysis menti area from down to upward by bone
at the end of 1st year.
-Still the chin bone not well developed.
-The mental foramen is below the socket of the deciduous lower first molar (D) (or between
the socket lower D &E) .
- The mandibular canal higher than the mylohyoid line level ( a bit higher due to bone
formation at the base of the mandible)
- Mandibular angle is 140◦
-The condyle still is at a lower level than the coronoid process.
-The sigmoid notch becomes deeper than at birth, but still shallow .

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Dr /Reham Magdy
**Mandible at adult age:

- Appearance of mental protuberance, which gives the characteristic, chin appearance of the

adult.

-The mandible increases in length and height due to the eruption of the permanent teeth and

growth of their alveolar process.

-The mental foramen is present below the socket of lower 4 or in-between both sockets of

lower 4&5 and present at the midway between upper and lower borders.

-The mandibular canal runs parallel to the mylohyoid Line ( due to bone remodeling)

-The mandibular angle becomes 110-120◦

-The condyle present at a higher level than that of the coronoid process.

-The sigmoid notch becomes deeper.

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Dr /Reham Magdy
Mandible in old age:

- The mandible is reduced in height due loss of teeth and resorption of the alveolar bone

As the individual tries to bring the upper an lower jaws near to each other during mastication

this leads to most of the changes that occurs in the old age mandible. .

-The mandibular canal and the mental foramen are close to the upper border of the body of

mandible.

-The mandibular angle (140º).

-The condylar head is more or less bent backward till it becomes in a lower level than the

coronoid process .

- The sigmoid notch is shallower than in adult.

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Dr /Reham Magdy
.

THE DECIDUOUS TEETH

- There are other names for those teeth as primary, milk, baby, and temporary teeth.
- There are twenty deciduous tooth , 5 in each quadrant (2 incisors, 1 canines, and 2 molars).

* Eruption and shedding of deciduous teeth:

-The first deciduous tooth (mandibular central incisors) starts to erupt at the age of six months
( beginning of deciduous dentition) . At about 2 years old, the last deciduous tooth; (second molar),
emerges. At three years the deciduous dentition teeth are completely erupted .

 The sequence of deciduous teeth eruption is: A, B, D, C, E

A B D C E
- About one year after complete root formation, resorption begins at the root apex until resorption
of the entire root has taken place and the crown is lost (shed) from lack of support.
- At 6 years, shedding of the first deciduous tooth begins (lower central incisor)
(Beginning of mixed dentition and end of deciduous dentition ), in order to make way for their
permanent successors. In sequence, shedding continues till age of twelve years. At that age all the
deciduous teeth are shed and replaced by their successors ( beginning of permanent dentation age
end of mixed dentition) .
- The anterior deciduous teeth are replaced by the anterior permanent teeth, while the deciduous
molars are replaced by the permanent premolars.

Periods of human dentition:

- Deciduous dentition: From 6 months to 6 years the oral cavity contains only deciduous teeth.

- Mixed dentition: From 6-12 years, the oral cavity contains mixed dentition.

- Permanent dentition: From 12 years, the oral cavity contains only permanent teeth.

41 Dr /Reham Magdy
Functions of deciduous teeth:
*Efficient mastication of food.
*Maintenance of a normal facial appearance.
*Formulation of clear speech.
*Growth of jaws.
*Maintenance of space for the emergence of permanent teeth.
General differences between deciduous and permanent teeth:
Deciduous teeth
1. Smaller in size.
2. Their crown is whiter in color, as enamel is less
translucent
3. The enamel of the deciduous teeth is less
mineralized.
4. More root/ crown ratio (2:1).
5. The crowns have a marked constriction at the
neck.
6. The enamel seems to bulge close to the cervical
line (well-developed cervical ridge) as neck
constricted and enamel ends abruptly.
7. The enamel and dentin are thinner with wider
pulp chamber.
8. The crown on deciduous teeth appears bulbous.
9. Deciduous teeth shed
10. Deciduous teeth have less angulations in their
orientation in jaw
42
permanent teeth
Larger in size
Their crown is yellowish in color, as enamel is more
translucent
The enamel of the permanent teeth is more
mineralized compared to deciduous.
Less root /crown ratio (1.5:1)
Less constricted neck.
Less developed cervical ridge as neck less
constricted and enamel ends gradually.
The enamel and dentin are thicker and pulp chamber
less wide in comparison to deciduous teeth.
The crowns appear less bulbous.
Permanent teeth don’t shed
Permanent teeth oriented with specific angulations in
the jaw
Dr /Reham Magdy
 Concerning the POSTERIOR TEETH
Deciduous teeth Permanent teeth
1. The molars have narrow occlusal table with Wider occlusal table with longer and blunt cusps
short, sharper cusps and ill-defined ridges &well developed ridges.
2. There are fewer grooves or depressions in all Deeper grooves and depressions.
surfaces of the crowns.
3. There is little- if any- root trunk, Well developed root trunk
widely divergent roots ( to occupy underlying less divergent roots.
developing permanent tooth).

Concerning the ANTERIOR TEETH

Deciduous teeth Permanent teeth
1. The labial surface of the crowns of the Developmental grooves could be found
incisors is smooth.
2. The cervical ridge on the facial surface is Less prominent
prominent.
3. There are no well developed mamelons on Well-developed mamelons could be seen on newly
the incisal edges. erupted teeth incisal edges.
4. The cingulum is prominent and occupy about Less prominent cingulum
one third of the crown.
5. The root is narrow. The roots are wider in comparison.

43 Dr /Reham Magdy
 THE DECIDUOUS ANTERIOR TEETH
 Shapes are very similar to the permanent successors.
 Incisal angles follow the same trend.
 Cervical lines follow the same trend.

MAXILLARY CENTRAL INCISOR:

Itresembles its permanent successor except for the following:
- It is smaller in all dimensions.

Lab. Ling.

- Labial surface : Greater crown width than length, almost its length equal to its width ( differ from
permanent).
- Constricted neck, and well developed cervical ridge.
- Root is narrow.
- The lingual surface: shows well developed marginal ridges and cingulum, so from the proximal
aspects, the crown appears thick in relation to its total length.
- A lingual ridge is present on the full length of the root.

- On the mesial and distal surfaces :

- The well developed cervical ridge and cinglum appear.
- In the root, there are central developmental depressions for about the whole length of the root.
From the incisal view, the crown appears much wider mesiodistally than labia-lingually.

M D

44 Dr /Reham Magdy
MAXILLARY LATERAL INCISOR:

It is similar to the neighboring deciduous central incisor with some

variation:
- The length of crown is greater than its mesiodistal width.
- The root is as long as the central incisor but it looks longer
in proportion to its crown than the central.
- The lingual anatomy more prominent.

MANDIBULAR CENTRAL INCISOR:

Similar to their successors ( permanent lower central incisor) except that:

- From the mesial aspect, the incisal ridge is centered over the root
(contrary to permanent).
- The labial and lingual cervical contours are more convex.
- The root is twice the crown length and taper down to a pointed
apex. It is very narrow and conical in shape.

MANDIBULAR LATERAL INCISOR:

- Similar to the deciduous central incisor except for:

- It is some- what larger in all measurements except labio-lingually
where the two teeth are identical in measurement.
- The cingulum, marginal ridges and lingual fossa are more developed.
- The incisal ridge slopes downwards distally, and its distal margin is
more rounded.

MAXILLARY CANINE:

Similar to the permanent maxillary canine except for:

- The neck is more constricted.

- The contact areas at about the same level nearly at the center of the
crown cervico- incisally.
- The cusp is much longer and sharper than the permanent.
- The mesial slope of the cusp is longer than the distal slope (contrary to
permanent canine), so the tip of the cusp is distal to the long axis.
- The root is about twice as long as the crown and more slender than that
of its permanent successor.
45 Dr /Reham Magdy
MANDIBULAR CANINE:

- Similar to the permanent mandibular canine except for the general

differences.

- Also it differ from the deciduous upper canine that it is thinner and longer
and its mesial slop is shorter than the distal slop.

46 Dr /Reham Magdy
 Posterior Deciduous Teeth

Deciduous Maxillary first molar Teeth

Upper D
*It is the predecessor for the maxillary first premolar.
* It more resembles the maxillary first premolar.
*This tooth mostly have:
- four-cusp, two buccal or two lingual cusps and three roots.
- The Disto-lingual cusp could be so much reduced or even missing in some D s.

Buccal Aspect :

M D

-Trapezoid geometrical outline form.

-The border of the occlusal surface is scalloped

With no definite cusp ridge form.

*There are two cusps, a large mesiobuccal cusp and

a small distobuccal cusp separated with a buccal depression..

*Cervical line is convex towards the root with the crest of

curvature is present mesially to outline the most bulging part of the cervical ridge.

*There is marked constriction of the crown cervically (at the neck).

There is a prominent cervical ridge with more prominence on the mesial half of the buccal
surface, forming mesiao cervical protuberance or mesiocervical ridge.

The three roots (MB, DB & L) are thin and widely spread and the root trunk is very short or even
missing .The distal root is considerably shorter than the mesial root while the palatal root is the
longest.

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Dr /Reham Magdy
Lingual Aspect:

D M

*The crown has a lingual convergence

and its surface is very convex.

*Two cusps present, well developed mesiolingual cusp and the distolingual cusp is
poorly defined.

*The lingual root is the largest of them and both buccal roots appear
divergent on both sides .

Mesial aspect:

L B

Outline form is trapezoid with the shortest of the uneven

sides is present occlusally.

The buccal outline of the crown is broadly convex cervically

representing the prominent mesiobuccal cervical ridge then
it becomes straight from the ridge and converges to the narrow occlusal margin.

Lingual outline it is more gradually convex in the cervical and middle

thirds and straight in the occlusal third.
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Dr /Reham Magdy
Occlusal outline: the mesiolingual cusp is sharper and larger than the mesiobuccal cusp.

The mesial marginal ridge is wide buccolingually.

Cervical line: slightly curved occlusally.

The root, there is a short root trunk, the wide mesiobuccal root, which hide the distobuccal root
and the palatal root appears curved.

Distal aspect:

B L

The crown is narrower and shorter on the distal side than on the mesial side.

The distal marginal ridge is more cervically oriented.

The distolingual cusp, is poorly developed and shorter than the distobuccal cusp.

All three roots are seen from this aspect, as the distobuccal root is narrower than
the mesiobuccal root.

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Dr /Reham Magdy
Occlusal Aspect:

M D

Rectangular geometrical outline form, with B side and M sides are broader than the L and D
sides.

Elevations:
There are two large buccal cusps (MB & ML) and
two small lingual cusps (DB & DL)
(ML> MB>DB>DL), The DL cusp may be missing in some molars types.

Sometimes an oblique ridge connects the ML and DB cusps

Mesial marginal ridge > distal marginal ridge.

Depressions:

-Central groove joins between Central fossa & mesial triangular fossa ( surrounded with
mesiobuccal grooves directed bucally and mesiolingual groove directed lingually) .

-Distal groove joins between Central fossa & disal triangular fossa ( surrounded with
distobuccal supplemental groove directed bucally and distolingual groove directed lingually) .

Mesial, distal and central pits in the deepest point of the mesial, distal and central fossa
respectively.

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Dr /Reham Magdy
 Deciduous Maxillary second molar Teeth

Upper E
-This molar is considerably larger than the deciduous maxillary first molar and its roots are
noticeably shorter.

-It greatly resembles the permanent maxillary first molar .

So the differences between these two teeth are the general differences that mentioned
before between the permanent and deciduous posterior teeth.

Buccal aspect:

M D

-2 Buccal cusps.
-Well defined cervical ridge.
-Crown narrow at cervix
-Crown longer M>D
-Three Roots appears & short root trunk.

Lingual aspect:

-Ling. Convergency
- 2 lingual Cusps & Tubercle of Carabelli on ML cusp.
-CL Straight
-3 Roots appear , palatal and 2 buccal roots.
M
D

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Dr /Reham Magdy
Mesial aspect:
M D

- The buccolingually appears thick and the crown appear short

-Root bifurcation: about 2mm, and both MB and palatal
root appear from his aspect .

Distal aspect:
As upper 6

Occlusal aspect:

M D

-Rhomboidal in shape. It appears as upper 6 but with lingual convergence.

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Dr /Reham Magdy
 Deciduous Mandibular first molar Teeth
This tooth does not resemble any of the other teeth, deciduous or permanent. Because it varies so
much from all others, it appears strange and primitive. It has 4 Cusps 2 Roots

Buccal aspect:

M
D

*Outline form: trapezoid

*The neck is constricted.
*The buccal surface has a very prominent cervical ridge with the
most prominent part is present mesially(mesiobuccal cervical ridge) .
*The cervical line is convex towards the root and slopes occlusally from
mesial to distal. Thus the mesial portion of the crown is longer than
the distal.
The mesial outline is straight.
The Distal side is convex and converges markedly toward the cervix

*The mesiobuccal cusp is much wider than the distobuccal cusp with
no groove between them, just a depression.

*The mesial root is often wider and longer than the distal root.

*The roots are widely spread and slender, and the furcation is
close to the cervical line.

Lingual Aspect:

The Crown & root are converging Lingually

*The mesiolingual cusp is larger, longer, and sharper than the other cusp.

*The mesial marginal ridge is so well developed that it resembles a cusp.

*The cervical line is nearly straight. *The roots are narrower lingually.

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Dr /Reham Magdy
Mesial Aspect:

B
L

*Outline form: rhomboidal.

*Buccal outline: the buccal outline is extremely convex at the cervical

third representing the most prominent mesiobuccal cervical ridge
then the buccal outline becomes straight till the tip of the mesiobuccal cusp.

*The buccal outline of the crown is longer than the lingual

*The lingual outline is convex with the maximum
convexity is present in the middle third. It extend lingually
beyond the confines of the root base.
*Occlusal outline: the occlusal table is small buccolingually.

*Both the mesiobuccal and the mesiolingual cusps are

seen from this aspect, as is the well-developed mesial marginal ridge.

*The cervical line is convex toward the occlusal .

It slopes occlusally from buccal to lingual.

Root: The mesial root outlines are straight from the neck till the apical third then it tapers to end
in a flat and broad apex as a square form . The buccal outline longer than the lingual outline
leading to an inclined root apex. The root has a depression on most of its length

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Dr /Reham Magdy
Distal Aspect:

L B

The crown has an almost equal length buccally and lingually.

The distobuccal and distolingual cusps are nearly the

same height but much shorter than the mesial cusps. Yet the distolingual
cusp is smaller than distobuccal.

The distal marginal ridge is short buccolingually,

is less prominent than the mesial marginal ridge,
and is located more cervically so more of the occlusal surface is seen.

The cervical line is almost straight.

The two roots appear from this aspect as, the distal root is more rounded,
less broad, thinner, and shorter than the mesial root.

Oclussal aspect:
Outline form: rhomboid.

M
D

The crown is much wider mesiodistally than buccolingually

Mesial and distal marginal ridges are well developed

with the mesial is more prominent than the distal one.

*The occlusal anatomy is shallow.

*There is central fossa is shallow , appears with a central pit.
*There is a short buccal groove and a short lingual
groove extending from the central pit separating the
cusps but do not extend on the surfaces buccaly and lingually.

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Dr /Reham Magdy
 Deciduous Mandibular second Molar

-The deciduous mandibular second molar is larger than the first one.
It resembles the permanent mandibular first molar in many ways such as:
The outline form of all aspects ( except occlusally) of the two teeth is the same.
The number of cusps (five cusps), the number of roots (two roots)is the same.
All the elevations and depressions that are present in the permanent mandibular first
molar are present in this tooth.

However, there are many differences that enable us to differentiate between these two teeth such
as:
The general differences between the deciduous and permanent teeth that were mentioned
before (e.g. size, color, bulbous crown, prominent cervical ridge, thin and divergent roots, and
absence of root trunk)

*The three cusps on the buccal surface of the deciduous first molar are of nearly equal size and
are named; mesiobuccal, buccal and distobuccal cusps. (Compare with cusps of the permanent
first mandibular molar).The central grove lacks the zigzag form as the lower 6.

*Oclussaly it is rectangular in form.

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Dr /Reham Magdy
 Physiologic tooth form protecting the periodontium
The teeth form and their arrangement are related to doing their function without causing damage
to their periodontium (supporting tissues )

Periodontium is : The investing and supporting attachment system of teeth.

Perio= around *Dontium=tooth
• It consists of:
*Two soft tissues: gingiva and periodontal ligament.
*Two hard tissues: cementum and alveolar bone.

The following factors help to:

- Maintenance of the teeth in the dental arch.

- Preventing disease, damage, bacterial invasion, and calculus buildup.

- Disperse the excessive occlusal trauma and biting forces.

-To protect the periodontium, (gingiva- cementum- Periodontal ligament- alveolar bone) and
therefore increasing the life span of the teeth within the dental arch.
These factors are either:

I) Direct Factors:
1- Proximal contact areas.
2- Size and location of interproximal spaces.
3- The embrasures or spillways.
4- Curvature of the cervical line on the mesial or distal surfaces.
5- Labial, buccal, and lingual contours of the crowns.
6- Self-cleaning qualities of the teeth.

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Dr/Reham Magdy
II) Indirect factors:

 Crown /root ratio

 Cusp form
 Root form
 Angle of tooth alignment in the dental arch

- Lingual angulations of the crown of lower

posterior teeth.

-  Distal angulations of crown and root of

Permanent molars.

Direct Factors

1- Proximal contact areas:

- The contact area is a flattened area, narrow in the anterior teeth, and broad in the posterior
teeth. Each tooth has a mesial and distal contact at the proximal maximal contour of each
surface except third molars ( has no distal contact area) .

- The contact begins after eruption as a point then contact is transformed into area of contact by
time due to continuous wear of the proximal maximal contour of adjacent teeth .

* Contact areas location:

The contact areas must be observed from two aspects in order to locate them:

The labial or buccal aspect:

To demonstrate the relative position of the contact areas cervico-incisally or cervico-occlusally.

-On a tooth :

The distal contact area has a more cervical location than the mesial one (except the case of upper
first premolar).

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Dr/Reham Magdy
-On all teeth :

Contact areas become more cervically located from anteriorly to posteriorly .

The size of the contact areas increases in the same quadrant

*The incisal or occlusal aspect:

To demonstrate the position of this contact areas labiolingually or
buccolingually.

-In anterior teeth: Contact areas are centered in the faciolingual

dimension.

-In posterior teeth : Contact areas are located slightly buccal to

the center of the faciolingual dimension.

** The actual proximal contact areas touch each other so that the surfaces are not large enough
to create a buildup of excessive amounts of bacterial or food debris, but are large enough to be
an effective barrier and prevent food from packing between the teeth. So, the proper contact
areas help the followings:

* Significances of contact areas:

1- Stabilize the dental arches by anchorage between the adjacent teeth.

2- Prevent food impaction between the teeth, which could harm the periodontium of teeth .

3- Protects the interdental gingiva from the frictional trauma of food during mastication
Resistance to teeth displacement.

Thus, the presence of non proper proximal contact relation could lead to:

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Dr/Reham Magdy
- Food impaction between the teeth with consequent gingival inflammation which leads to
destruction of the supporting tissues ( periodontiun ) and loss of the tooth.

- Separation of teeth causes a change in tooth alignment, which leads to applying excessive
forces of mastication on the tooth and occlusal trauma that the tooth can't withstand and could
lead to destruction of the supporting tissues and tooth loss.

2- Inter proximal spaces:

Interproximal spaces are v-shaped or triangular spaces between the teeth (The base of
the triangle is the alveolar process, the sides are the proximal surfaces of contacting teeth
and the apex of the triangle is the area of contact).It is formed by the proximal surfaces
and their contact areas. The space is wider cervically than occlusally and filled by the
gingival tissue.

Fequently , as a pathological consequence of periodontal or orthodontic treatment , the

interproximal gingival is affected and recession occurs between the teeth, the interdental papilla
and bone no longer fill the entire spaces, and then a void exists cervical to the contact area. This
void is called cervical embrasure. This offers a place in which bacteria and food debris can
accumulate.

The interproximal space helps the followings:

- Filled by the gingival tissue (Interdental papilla) which:

*keeps food from collecting cervical to the contact areas between the teeth.

*This tissue carries the blood vessels and nerve supply to all the investing tissue.

- Provides a bulk of bone, thus affording better anchorage ,nourishing and support of
teeth in their sockets.

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Dr/Reham Magdy
 3- Embrasures or (spillways):

-These are the open spaces between the proximal surfaces of two adjacent teeth which is
surrounding the contact areas .
-This space is triangular in shape. The apex of the triangular embrasure is towards the contact
and widen out from the contact area in all directions. The size of embrasure is determined by
the location of the contact area...

- The names of the embrasures are facial (buccal or labial), lingual, incisal, or occlusal.

** There are also cervical or gingival embrasure, but only if the interproximal space is
not occupied by gingiva or bone ( Remember that this embrasure only found in
pathological cases).

The embrasures have several purposes:

- They allow food to be shunted away from contact areas and thus keep food from being
packed between the teeth.
- The embrasures reduce the forces of occlusal trauma brought on the teeth; by offering an
escapement way for the food so, they dissipate and reduce occlusal forces.
- It allows self cleaning action of the teeth as it bring the friction action of the tongue,
cheeks and lips on he tooth surface allowing the food remains removal .
- They permit a slight amount of stimulation to the gingiva by the physiological frictional
massage of food and prevent its trauma by sliding food away of surface.

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Dr/Reham Magdy
4- Curvature of the cervical line:
The curvature of the cervical line on the mesial and distal surfaces of the teeth depends
on:

-The height of the contact area above the crown cervix.

-The diameter of the crown labiolingually or buccolingually.

***In individual teeth the curvature of the cervical line is greater mesially than distally.

***In different teeth, this curvature is greater in anterior than in posterior teeth.

The periodontal attachment follows the cervical line and connects the gingiva to the
tooth surface . The periodontal ligament attaches the cementum to the bone.

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Dr/Reham Magdy
 * The cervical line in the anterior teeth:

The maxillary anterior teeth show greater amount of curvature of the cervical line.
The more anterior the tooth, the greater the curvature.

The mandibular anterior teeth show less curvature (about 1 mm.) than do their
maxillary counterparts.

This great curvature because the anterior teeth are narrow labiolingually. So as the
supporting tissue level follow the curvature of cervical line , so it is appropriate
due to dimension of the anterior teeth to offer high cervical line curvature for more
support.

The cervical line in the posterior teeth:

Which is wider buccolingually have more bone support and therefore need not
have this raised portion of bone.

5- Facial and lingual contours on labial, buccal, and lingual surfaces

The degree of these contours vary from tooth to tooth, but the following concepts should
be considered:-

- The location of the buccal contour of anterior and posterior teeth is at the cervical
third of the crown.
- The lingual height of contour of anterior teeth is at the cervical third of the crown
(the cingulum).
- The lingual crest of curvature of posterior teeth is at or near the middle third.
- The normal amount of curvature found on most facial contours is approximately
0.5 mm. and somewhat less lingually on the anterior teeth.

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Dr/Reham Magdy
The correct degree of facial or lingual curvature is important because ( C) :

1- It allows for the proper deflection of food, so that the right

amount of tissue stimulation occurs and the gingival margins are
protected.
2- The contour on the lingual surface should allow the tongue to rest
against the tooth to promote the most efficient cleaning.
3- The facial height of contour allows for maximum cleaning by the
lips and cheeks.
4- It keeps the gingival margins under slight tension to keep it
healthy .

Wrong dental restorations replacing the normal contour of the teeth may
lead to the followings:

Too small or absent convexity (B):

The food will push the gingival tissue apically leading to gingival recession.

Too large convexity ( A) :

This will provide too much protection to the gingiva.

-Gingiva will lose its tone.

- Food will accumulate around the gingival region

--resulting in its inflammation.

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Dr/Reham Magdy
 6- Self-cleaning qualities of the teeth:

- The smoothness of the enamel that covers the crowns of the teeth helps food substances to slip
off the crown also aids greatly in the prevention of periodontal disease by stimulating and
cleaning the gingival tissue.

- It is evident that the teeth reflect their function as well as their self- cleaning ability.

- Pits and fissures do provide a method of dissipating the extreme occlusal forces that result
from the inter digitation of the cusps in the process of grinding up food, its smoothness allow
them to be self cleaning.
** When a tooth is :

- Well formed histologically and morphologically.

- Properly arranged in the dental arch.

- Has a normal relation to the opposing and adjacent teeth.

It is considered self-cleaning tooth.

II ) Indirect factors:
1- Crown form and cusp form: Which includes:

*Crown outline

*Proximal maximal contour.

*Facial and lingual maximal contour.

*Relation of cusps of opposing teeth

2- Crown to root ratio:

*Length, number and distribution.

*Root to crown ratio.

3- Angulation of crown and root:

*Lingual angulations of the crown of lower posterior teeth.
* Mesial and Distal angulations of crown and root of permanent molars.

4- The self-cleansing ability of the tooth.

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Dr/Reham Magdy
 Compensating curvatures of the dental arches
& the arrangement of teeth

- The maxilla and mandible are curved arches which may be U shaped, square or tapered, where the teeth are
arranged on them.

- The teeth in the arches are arranged in curves to achieve their function properly and in harmony.

I- Parabolic curve:

The curve is inspected from the facial surfaces, the teeth are arranged in curve described as a parabolic curve. The
curve is divided into three segments; anterior, middle and posterior.

- The anterior segment:

- For the upper arch, it is represented by a curved line includes the anterior teeth, ending at the labial ridge of the
canines.

-For the lower arch , the anterior segment is a bit smaller than the maxillary anterior segment.

- The middle segment :

For the upper arch, is represented by a straight line including the distal portion of the canines, the buccal surface
of premolars and the mesiobuccal cusp of the first molars.

-The middle segment of the mandibular arch extends distally, to the distobuccal cusp of the first molar,

note that the maxillary middle segment ends at the mesiobuccal cusp of the first molar.

- The posterior segment:

- For the maxillary arch, is represented by a straight line passing buccaly from mesio obuccal cusps of the first
molar , second and third molars.

- The posterior segment of the maxillary arch may be inclined palatally. For the mandibular arch, this segment
begin from distobuccal cusp of lower 6 and is always parallel to the median plane.

NB:
The lines describing the segments of the curve overlap slightly at the canines and first molar regions. This
arrangement indicates that the canines and first molars serve as anchor that supports both dental arches.

66
 Anterior segment

Middle segment

posterior segment

So again to summarize differences in segments between upper and lower arch:

The mandibular arch has the same segments but they differ from the maxillary ones in :

-The anterior segment of the mandibular arch is a bit smaller than the maxillary segment.

-The middle segment of the mandibular arch extends distally to the distobuccal cusp of the first molar, whereas the
maxillary middle segment ends at the mesiobuccal cusp of the first molar.

-The posterior segment of the maxillary arch may be inclined palatally for the lower arch, the posterior segment is
parallel to the median plane.

67
The arrangement of teeth in this curve allow the dental arch size to be more buccaly
than lingually which help in ( i.e significance of arrangement of teeth in this curve ) :

1- Extension of the direction of the mandibular movements.

2- Protection of the cheeks, lips and tongue from being clipped during closure of the teeth.
3- Avoiding the clashing of the incisal edges and cusps of the teeth during function.

* Bonwill Triangle
The mandible was described as being adapted to a 4 inch equilateral
triangle.
The angles of the triangle are placed at the centers of each of the condyles
and
at the mesial contact areas of the mandibular incisors. Thus Bonwill's
theory
did emphasize bilateral symmetry of the mandibular arch.

* The occlusal surfaces of dental arches do not follow a flat plane. The mandibular arch confirms generally to
one or more curved planes which appear concave, while the opposing maxillary arch conforms to curvature
which appear convex. When the two arches are brought together in centric occlusion, these curved planes
become identical.

II) Curve of Spee:

- This curve is seen within the sagittal plane.

- The curve is observed when the upper and lower dental arches are seen
from a point opposite to the first molars.

-The curve passes on the incisal ridges of the anterior teeth and the buccal
cusps of the posterior teeth follow a curve that end at the anterior surface of
the condyles.

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The importance of this curve:

Allow harmony between teeth during movement of the mandible antro posteriorly

III) Curve of Wilson:

- This curve is inspected in coronal plane.

- The crowns of the mandibular teeth must incline to the lingual, while the crowns of the maxillary teeth
incline toward the buccal adapting to the curve. Because of these inclinations, the buccal cusps of the
mandibular molars and the lingual cusps of the maxillary molars appear to be longer.

- The curve becomes deeper posteriorly, so that, the molars inclination is greater than that of the premolars.

- The curve is convex on the occlusal surfaces of maxillary arch teeth , and concave on the mandibular arch
teeth,

- The importance of this curve : is to complement the paths of the mandibular condyles during
side to side movements, and allow teeth to move in harmony.

Concave on mandibular
teeth arch

Convex on
maxillary

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IV) Sphere of Monson:
-It is a three dimensional curvature of the occlusal plane; which is the combination of the curve of Spee and
curve of Wilson.

-The mandibular arch was originally described as adapting itself to the curved surface of a sphere 4 inches
radius with the center of the sphere is at the glabella. Note that the radius of the sphere varies considerably in
different individuals.

- The mandibular teeth are the one that establish compensating curvatures, and the maxillary teeth have to
adapt themselves to the mandibular teeth.

Compensating curvatures of the individual teeth

(Curved tooth axis)
It is important to know that the axes of the teeth are not at right angles to their occlusal surfaces, and that the
force of occlusion does not act upon the teeth in straight lines.

Accordingly the long axes of the teeth are all curved; these axial curvatures tend to be parallel with each other
in centric occlusion and during jaw opening regardless the extent of the opening.

Importance of the curved tooth axis:

1- It .is necessary to stabilize each tooth in its location in the arch.It allows the mandibular teeth to strike the
maxillary teeth (specially the molars) with a mesial inclination of force, thus promote the tendency of
molars to drift mesial. So the teeth of the two jaws are not separated in the arch , and always achieve
proper contact .
2- It enables the teeth to withstand the occlusal forces to establish occlusal balance and does not harm the
periodontium
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Angulations of the individual teeth in relation to various planes

-Each tooth is positioned in the dental arch with an angle that best withstand the forces applied to it during
function.
-These angulations are normally described in mesiodistal and faciolingual directions.

Faciolingual inclination
Sections through the jaws with the teeth in centric occlusion show the mesial aspects of each tooth in either
arch, reflecting the faciolingual inclination of the teeth as follows:

1- The incisors are placed with their axes at about (60 degrees) to the horizontal plane.
2- The canines are less inclined (80 degrees).
3- The mandibular first premolar owes the most lingually inclined tooth.

Mesiodistal inclination
From the labial and buccal aspects, the axial inclinations appear as follows:

1- Most of the teeth exhibit moderate to great inclination of crown medially and root distally.
2- The mandibular incisors are nearly the only tooth which is almost straight .
Importance of the axial inclination
1- The faciolingual inclination provides:
a) Protection of the soft tissues by preventing their biting during mastication.
b) Adequate physiologic space for tongue movement during function.
c) Proper occlusal and incisal function of teeth.

2- The mesiodistal inclination favors the stabilization of the contact relation of the teeth.

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72
 Phases of eruption of the permanent teeth into dental arches

FIRST PHASE

*The first permanent molars erupts at 6 years of age (cornerstones).

*They serve to back up the deciduous teeth.

Second phase

The permanent central and then lateral incisors

*The permanent location of the incisors cannot established until development of the dental arch form is
complete
Third phase

The 1st and 2nd premolars s take the places of the deciduous molars.

Fourth phase

The canines (Keystones) force themselves between the lateral incisors and first premolars in both jaws.

Also the second molars emerge distally to the first molars backing them up during the wedging.

Fifth phase

Eruption of the wisdom tooth

73 Dr/Reham Magdy
 Occlusion

Definition:

Occlusion is the term used to describe the contact of teeth in opposing dental arches when the jaws
are:

1. Closed " static occlusal relation"

2. During various jaw movements "Dynamic occlusal relationships"

Various jaw movements (dynamic occlusal relationships) could be divided according to

the two condyles movements as the following :

1) Bilateral symmetrical movement: both condyles perform the same action movement.
A. Opening & closing (Elevation and depression of the mandible)
B. Forward movement (Protrusive)
C. Backward movement (Retrusive) which is limited movement.

2) Bilateral asymmetrical movement: both condyles do not perform the same action movement.

Right and left lateral movement in such movement one condyle act as pivot.

There are groups of functional relations presented by the mandibular movements:

1. Centric occlusion (static).

2. Protrusive occlusal relation(dynamic ).
3. Retrusive occlusal relation(dynamic ).
4. Lateral occlusal relation (Right and left) (dynamic ).

Ideal occlusion is important for the following:

1. Important for mastication, as the masticatory loads are evenly distributed over the teeth in
the dental arches during function.
2. Helps to bring about symmetry of facial bones and muscles and good apperance.
3. Promotes good pronunciation of letters during speech.
4. It helps in the stability of the jaw relations.

74 Dr/Reham Magdy
 Factors affecting Occlusion:

Some factors are involved in the development and affect occlusion which are:

1. Dental arch form and alignment of teeth.

2. The associated musculature.
3. Neuromuscular patterns developed with mastication.
4. The development and function of the temporomandibular joint.

Improper occlusion leads to undue occlusal stresses placed on teeth resulting in occlusal disharmony
which eventually leads to changes in the periodontium and weakening of the masticatory apparatus.

Classifications of Occlusion
Ideal tooth relationships were described and classified in the early 1900s by Edward H. Angle. ln
centric occlusion there are three relationship that can exist between the first molars.

He classified ideal occlusion as Class I Centric Occlusion and defined it based on the relationship
between the maxillary and mandibular first permanent molars as follows:

1. Class I occlusal relation (orthognathic relation)

It is normal relation in which the permanent maxillary fist molar is slightly posterior to the
permanent mandibular first molar. The mesiobuccal cusp of the maxillary first molar is directly in
line with the mesio-buccal groove of the mandibular first molar.

75 Dr/Reham Magdy
2. Class II occlusal relation (retrognathic relation)
Where the mandible is retruded backward in which the buccal groove of the mandibular molar
is posterior to the mesio-buccal cusp of the maxillary first molar.

3. Class III occlusal relation (prognathic relation)

Where the mandible is protruded anteriorly the buccal groove of the mandibular first molar is more
anterior than normal to the mesio-buccal cusp of the maxillary first molars.

76 Dr/Reham Magdy
Key of Occlusion:

The key to the intercuspal relationships between the teeth in the centric occlusal position is described
as the relative position of the maxillary and mandibular first permanent molars.

The location of the mesio-buccal cusp of the maxillary first permanent molar in relation to the mandibular first
molar is used as indicator in Angle's classification occlusion.

The permanent first molars are considered the key of occlusion since;

— They are the first permanent teeth to develop and erupt in the oral cavity.
— They are guided by the presence of the second deciduous molars.
— They are the largest teeth in the dental arch.
— Their entption is not disturbed since they have no deciduous predecessors.
— The maxillary first molars are preferred, as they erupt in the maxilla which is fixed to the skull.

77 Dr/Reham Magdy
 CENTRIC OCCLUSION

Definition:

It is the relation of the upper and lower teeth when they are in maximum intercuspation and the condyles are
resting in the most retrusive unstrained position in the glenoid fossa.

The centric occlusal position is the start and the terminal position of all physiologic mandibular movement.

In Class I centric occlusion, the following general relationships are found :

1. Opposing teeth:
Each tooth in a dental arch occludes with two teeth in the opposing arch, except the mandibular central incisor and the
maxillary third molar.

This serves to:

-Equalize the forces of contact in occlusion, thereby distributing the work.

-It preserves the integrity of the dental arch in case of losing a tooth, since the second antagonist prevents the
elongation and displacement of the opposing tooth.

2- Long axes of the maxillary teeth is distal to those of mandibular ones.

78 Dr/Reham Magdy
3- Maxillary anterior teeth overlap mandibular teeth:

-Horizontal overlap: “Overjet” Incisal edges of maxillary anterior teeth are labial to incisal edges of mandibular teeth
so it is the horizontal distance between lingual surface of upper anterior teeth
and labial surface of lower anteriors.

-Vertical overlap: “Overbite” it is the vertical distance where Incisal

edges of the maxillary teeth extend below the incisal edges of
mandibular teeth

3- Posterior teeth relations:

For the maxillary posterior teeth:

*Free cusps are the buccal cusps.
*Functioning cusps are the lingual cusps

For the mandibular posterior teeth:

*Free cusps are the lingual cusps.
*Functioning cusps are the buccal cusps.

79 Dr/Reham Magdy
 Relationship of Individual Teeth in
Centric Occlusion

Relations of Incisors:
Facial
- 1 & 2 overlap 1, 2 , 3
- Mesial outlines of upper 1 & lower 1 meet at the median line.
- Their incisal ridges are free of contact.
Lingual
- Lower 1, 2 strikes the mesial 2/3 of upper 1 , 2 near the junction of the incisal and middle

Relation of canines:

Facial
- Upper 3 cusp tip is free of contact
- it lies in the facial embrasure between lower 3 & 4,
Lingual -
- Lower 3 cusp tip is free of contact
- The cusp tip of 3 canine is directly below lingo-incisal embrasure between
2& 3

Labial Lingual

80 Dr/Reham Magdy
 Relation of PREMOLARs

Facial
- Buccal cusps of max. premolars are free of contact.
They lie in the buccal embrasures bet. their antagonist teeth & the distal tooth.
- Buccal cusps of mandibular premolars contact the MMR of their antagonists.
Lingual -
Lingual cusps of mandibular premolars are free of contact. They lie in the lingual embrasures bet. their
antagonist teeth & the mesial tooth.
- Ling. cusp of maxillary premolar contacts the DMR of there antagonist.

Buccal Lingual

81 Dr/Reham Magdy
 Upper and lower 6
Facial relation:
*Buccal cusps of max. first molars are free of contact.

-MB cusps lie in in one line with the buccal grooves of lower 6.

-DB cusps lie in the buccal Embrasure between lower 6 and 7.

*Buccal cusps of mandibular first molars contact the occlusal surfaces of max. first molar:

- MB cusps of 6 contact the MMR of their antagonist( upper 6) and the DMR of the upper 5

-DB cusps of lower First molars rest in the central fossae of their antagonist ( upper 6)

-The D cusp of lower 6 rests in the D ∆ fossa of upper 6

82 Dr/Reham Magdy
Lingual relation:

Maxillary molars:

Lingual cusps of max. molars contact the occlusal surface of mandibular molars

ML cusp of upper 6 rest in the central fossae of their antagonists.

DL cusps of upper 6 contacts the MMR of lower 7.

Mandibular molars:

Lingual surfaces and ling cusps of mand. molars are free of contact.

ML cusps of mand. First molars lie in the ling embrasures bet antagonist tooth( upper 6) and the upper 5.

DL cusps of lower 6 lie in the ling groove of the upper 6 .

NB read the centric occlusal relations of the other group of teeth from the
lecture presentation.

83 Dr/Reham Magdy
Centric occlusal relation of the deciduous teeth

The normal occlusion of the deciduous teeth is established at the age of three years as follows

1. The mesial outline of the upper and lower central incisors are in line with each other at the median line.
2. The upper central incisors have a labial position to the lower and the lower anterior teeth strike the upper teeth
lingually above the level of the t incisal ridge.
3. The upper central incisor occludes with the lower central incisor and the mesial third of the lower lateral
incisor.
4. The upper lateral incisor occludes with the distal two-thirds of the lower lateral incisor and the portion of the
lower canine which is mesial to the tip of its cusp.
5. The upper canine occludes with the portion of the lower canine distal to the cusp tip and the portion mesial to
the tip of the mesiobuccal cusp of the lower first molar (about one third of the molar).
6. The upper first molar occludes with the distal two-thirds of the lower first molar and the mesial portion of the
lower second molar represented by the mesial marginal ridge and the mesial triangular fossa.
7. The upper second molar occludes with the remainder of the lower second molar. The distal surface of the
upper molar projects slightly over the distal portion of the lower second molar (distal step).

84 Dr/Reham Magdy
 1. PROTRUSTIYE OCCLUSAL RELATION

When the mandible moves forward from centric occlusion, the only teeth that should touch are the anterior. The
mandibular tour incisors should glide across the maxillary four incisors. The canine may touch slightly, but no
posterior teeth should touch in a mandibular protrusive movement.

The occlusal cycle of anterior teeth

Occurs during the protrusive movement

Steps:

— Starting from centric occlusion the mandible moves downward to free the cusps.
— The mandible moves forward for biting by the anterior teeth, while the balancing side at the posterior teeth.
— Then the mandible moves backward and upward to centric occlusion.
— This alternating protrusion to working and back to centric is called occlusal cycle of anterior teeth.

2. RETRUSTIVE OCCLUSAL RELATION

The mandibular teeth show posterior relation to centric occlusion with the maxillary arch. Actually retrusion is

very limited and not performed during mastication. It is a reference mandibular movement used by dentists.

85 Dr/Reham Magdy
 3. LATERAL OCCLUSAL RELATION

In lateral occlusal relation, the mandible moves toward the right or left side until the canines on that side are in
cusp to cusp relationship. The side to which the mandible moves is referred to as working side. The side away from
which the mandible is moving is referred to as Non-working side. On artificial teeth this non working side is referred
to as balancing side.

The occlusal cycle of posterior teeth

Occurs during lateral movements of the mandible, it starts from centric occlusion and ends also in
centric occlusion.

Steps:

— From centric occlusion the mandible moves down word to free the cusps.
— The mandible moves to lateral side (e.g. Right); this side is the working side. The other side is the non working
or balancing side.
— In the working side the buccal cusps of the maxillary and mandibular teeth are in contact.
— In the non working side, the lingual cusps of the maxillary teeth contact with the buccal cusps of the
mandibular teeth.
— Then the mandible moves to centric occlusion.
— Alterations from one side to the other were performed.
— These lateral movements are known as the occlusal cycle of posterior teeth.

86 Dr/Reham Magdy
 Forms of malocclusion
Three common form of malocclusion are: crowding, anterior open bite and cross bite.

— Crowding:

Is the term used to describe the condition where the teeth are markedly out of the line of the dental arch
because there is disproportion between the size of the arch and the size of the teeth.

Anterior open bite

Occurs where there is no incisor contact and no incisor overbite. It may be caused by thumb sucking habit, by
abnormal swallowing patterns or because of skeletal deformities.

87 Dr/Reham Magdy
 — Cross bite: is a transverse abnormality of the dental arches where there is an asymmetrical bite. It maybe
unilateral or bilateral. Cross bites are usually related to discrepancies in the widths of the dental bases and
may involve displacement of the mandible to one side to obtain maximum intercuspation.

The mandibular teeth have focial relation to the maxillary teeth.

It is of two main forms:

1. Anterior Cross bite: usually associated with class 3 occlusal relation with large mandible or it may occur clue
to improper faciolingual inclination of the whole segment or an individual tooth.

2. Posterior cross bite: usually related to discrepancies in the width of the dental base and my involve
displacement of the mandible to one side. It can be unilateral or bilateral.

1 2

88 Dr/Reham Magdy
Good luck

89 Dr/Reham Magdy