Ebook Textbook of preclinical conservative dentistry (2/E): Part 1

Part 1 book “Textbook of preclinical conservative dentistry” has contents: Introduction to preclinical conservative dentistry, morphology of permanent teeth, morphology of primary teeth, structure, nomenclature and tooth physiology, chair position and dental operatory, dental caries, armamentarium.

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Textbook of

Preclinical Conservative Dentistry

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New Delhi | London | Philadelphia | Panama

The Health Sciences Publisher

Editors

Nisha Garg

BDS MDS (Conservative Dentistry and Endodontics)

Professor Department of Conservative Dentistry and Endodontics

Bhojia Dental College and Hospital Baddi, Himachal Pradesh, India

Amit Garg

BDS MDS (Oral and Maxillofacial Surgery)

Associate ProfessorDepartment of Oral and Maxillofacial Surgery Sri Sukhmani Dental College and Hospital Dera Bassi, Mohali, Punjab, India

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or otherwise, without the prior permission in writing of the publishers

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is not associated with any product or vendor mentioned in this book.

Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons

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Textbook of Preclinical Conservative Dentistry

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Dedicated to

Prisha

and

Vedant

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Ajay ChhabraMDS

Principal, Professor and Head

Department of Conservative Dentistry

and Endodontics

Bhojia Dental College and Hospital

Baddi, Himachal Pradesh, India

Ashu Jhamb MDS

Reader

and Endodontics

Bhumika Ahuja MDS

Reader

Department of Pedodontics

KD Dental College and Hospital

Mathura, Uttar Pradesh, India

Damanpreet MDS

Reader

and Endodontics

Daminder Singh MDS

Medical Officer (Dental)

Government Dental College and

Hospital

Patiala, Punjab, India

Gurkirat Singh Grewal MDS

Senior Lecturer Department of Conservative Dentistry and Endodontics

Harleen Kaur Gill MDS

Jaidev Singh Dhillon MDS

Principal, Professor and Head Department of Conservative Dentistry and Endodontics

Gian Sagar Dental College and HospitalPatiala, Punjab, India

JS Mann MDS

Associate Professor Department of Conservative Dentistry and Endodontics

Government Dental College and Hospital

Madhu Garg MDS

Professor Department of Pedodontics and Preventive Dentistry

JCD Dental College Sirsa, Haryana, India

KD Dental College and Hospital Mathura, Uttar Pradesh, India

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Textbook of Preclinical Conservative Dentistry

viii

Navjot Singh Khurana MDS

Lecturer Department of Conservative Dentistry and Endodontics

Nidhi Rani MDS

Senior Resident Department of Conservative Dentistry and Endodontics

Postgraduate Institute of Medical Education and Research

Chandigarh, India

Poonam Bogra MDS

Senior Professor Department of Conservative Dentistry and Endodontics

DAV Dental College Yamuna Nagar, Haryana, India

Priya Verma Gupta MDS FPFA

Professor Department of Pedodontics and Preventive Dentistry

Divya Jyoti College of Dental Sciences and Research

Ghaziabad, Uttar Pradesh, India

RS Kang MDS

Former Associate Professor Department of Conservative Dentistry and Endodontics

Sanjay Miglani MDS

Associate Professor Faculty of Dentistry Jamia Millia Islamia New Delhi, India

Savita Thakur MDS

Shital Kumar MDS

Medical Officer (Dental)Government Dental College and Hospital

Simran Pal Singh BindraMDS

Department of Conservative Dentistry and Endodontics

Sunila Sharma MDS

Reader Department of Pediatric and Preventive Dentistry

Gian Sagar Dental College and Hospital Jansla, Punjab, India

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It gives me immense pleasure to introduce you to the second edition of the Textbook of Preclinical

Conservative Dentistry Since conservative dentistry is backbone of the dentistry, it is mandatory

to train the undergraduate students for restorative procedures before entering the clinics For

the second time, Dr Nisha Garg and Dr Amit Garg present their well-known book of preclinical

conservative dentistry, best described in simple and easy language with plenty of diagrams,

keeping in mind the syllabus prescribed by many universities of India Written by the two

prominent authorities on this important aspect of dentistry, Dr Nisha Garg and Dr Amit Garg

have accumulated a incredible amount of knowledge to summarize this important information

into easy-to-read chapters

From the introduction to preclinical conservative dentistry in chapter one highlighting the importance of preclinical conservative dentistry, going through dental anatomy, nomenclature, physiology of tooth form, armamentarium, dental caries, dental materials, adhesive dentistry, basic fundamentals of tooth preparation and step-by-step tooth preparation for amalgam and composites make this edition a must have preclinical guide for dental students before entering their clinics This edition has plenty of line diagrams and photographs for better understanding of the concept The authors have also included the too often neglected aspect of conservative dentistry, i.e importance, anatomy and tooth preparation of primary teeth, making it understandable how morphology of teeth affect the tooth preparation

I am pleased to introduce and recommend this book as an excellent guide for students to understand the subject of conservative dentistry

AP Tikku

BSc BDS MDS FICD

Dean Faculty of Dental Sciences King George’s Medical University Lucknow, Uttar Pradesh, India

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Preface to the Second Edition

In presenting the second edition of Textbook of Preclinical Conservative Dentistry, we would like to express our appreciation

in the kindly manner in which the first edition was accepted by dental students across the country We once again thank Almighty God for His blessings in all our endeavors

The scope of the second edition of this book is as earlier to be simple yet comprehensive which serve as an introductory for dental students This book covers basic tooth anatomy, cutting instruments, principles of tooth preparation, dental materials and their manipulation so as to have fundamental knowledge before handling patients in the clinics

Emphasis is laid upon the language which is simple, understandable and exclusively designed for beginners in conservative dentistry

The line diagrams are in an expressive interpretation of tooth preparation procedures, which are worked upon and simplified to render them more comprehensive and comparable with real photographs

In an attempt to improve the book for better clarification of the subject, many eminent personalities were invited

to edit, write and modify the important chapters in form of text and photographs We are grateful to Dr Manoj Hans,

Dr Daminder Singh, Dr Shital Kumar and Dr Varun Jindal for providing us photographs related to preclinical and clinical work for better understanding of the subject

We fall lack of words to thank Dr RS Kang, Dr JS Mann, Dr Navjot Singh Khurana, Dr Ankur Vats, Dr Ashu Jhamb and

Dr Savita Thakur for critically evaluating the chapters and bringing them in the best form

We offer our humble gratitude and sincere thanks to Mr Vikram Bhojia (Secretary, Bhojia Trust) for providing healthy and encouraging environment for our work

We would like to express our thanks to our colleagues for their ‘ready to help’ attitude, constant guidance and positive criticism which helped in improvement of the book

We are grateful to Hu-Friedy, GC Fuji, Coltene Whaledent and Dentsply for using their images in our book

It is hoped that all these modifications will be appreciated and render the book still more valuable basis for preclinical dentistry

We thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–Publishing), Dr Priya Verma Gupta (Editor-in-Chief, Dentistry), Dr Abha Bedi (Development Editor), Seema Dogra (Cover Designer), Nitesh Jain (Graphics Designer), Deep Kumar Dogra (Operater) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for showing personal interest and trying to the level best to bring the book in present form

We shall be grateful to our readers if they critically analyze the text and send us useful suggestions to improve quality

of the book for next edition

Nisha Garg Amit Garg

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Preface to the First Edition

Operative dentistry is one of the oldest branches of dental sciences forming the central part of dentistry as practiced in primary care It occupies the use of majority of dentist’s working life and is a key component of restorative dentistry The subject and clinical practice of conservative dentistry continues to evolve rapidly as a result of improved understanding

of etiology, prevention and management of common dental diseases The advances and developments within the last two decades have drastically changed the scope of this subject But before taking professional training, gathering basic knowledge along with operating skill is mandatory

The main objective of this book is to provide students with the knowledge required while they are developing necessary clinical skills and attitude in their undergraduate training in conservative dentistry and endodontics We have tried to cover wide topics like morphology of teeth, cariology, different techniques, instruments and materials available for restorations of teeth along with the basics of endodontics

So we can say that after going through this book, the student should be able to:

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1 Introduction to Preclinical Conservative

Dentistry 1

Nisha Garg

Causes of Loss of Tooth Substance 1

Objectives of Operative Dentistry 3

Objectives of Preclinical Conservative Dentistry 3

Armamentarium 3

Preclinical Tooth Preparations 4

2 Morphology of Permanent Teeth 6

Amit Garg, Mannat Dhillon

Definitions 6

Maxillary Teeth 7

Mandibular Teeth 15

3 Morphology of Primary Teeth 26

Priya Verma Gupta, Sunila Sharma

Tooth Notation Systems 42

Nomenclature of Tooth Surfaces 46

Physiology of Tooth Form 46

5 Chair Position and Dental Operatory 51

Amit Garg, Gurkirat Singh Grewal

Common Positions for Dental Procedures 51

7 Armamentarium 70

Nisha Garg, Amit Garg

Nomenclature 70 Parts 71

Instrument Formula 72 Different Instrument Designs 73 Exploring Instruments 74 Hand Cutting Instruments 76 Restorative Instruments 79 Instrument Grasps 81 Finger Rests 82 Rotary Cutting Instruments 84 Matrix Retainers and Bands 89 Wedges 94

8 Principles of Tooth Preparation 101

Nisha Garg

Purpose of Tooth Preparation 101 Classification 101

Definitions 104 Number of Line and Point Angles 105 Steps 108

Initial Stage 108 Final Stage 112

9 Tooth Preparation for Amalgam and Composite Restorations 122

Nisha Garg, Poonam Bogra

Preparation for Amalgam Restoration 122 Tooth Preparation for Composite Restoration 129

10 Tooth Preparation for Primary Teeth 135

Madhu Garg, Priya Verma Gupta, Bhumika Ahuja

Rationale for Tooth Preparation 135 Principles of Tooth Preparation 135 Classification of Dental Caries 137 Tooth Preparation 137

Matrix Bands and Retainers 141

Steps for Amalgam Restoration for

Primary Teeth 143

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xvi

11 Dental Materials 145

Amit Garg, Vandana Chhabra

Dental Cements 145

Zinc Oxide Eugenol Cement 146

Zinc Phosphate Cement 149

Zinc Silicophosphate Cements 151

Calcium Hydroxide 152

Zinc Polyacrylate Cement/Zinc Polycarboxylate

Cement 152

Glass Ionomer Cement 154

Pulp Protection Materials 159

Dentin Bonding Agents 173

Evolution of Dentin Bonding Agents 173

Dental Composites 177

13 Basics of Endodontics 185

Nisha Garg, Sanjay Miglani

Etiology of Pulpal Diseases 186

Progression of Pulpal Pathologies 186

Endodontic Instruments 186 Access Cavity Preparation 188 Access Cavity of Anterior Teeth 189 Access Cavity Preparation for Premolars 190 Access Cavity Preparation for Maxillary Molars 190

Access Cavity Preparation for Mandibular

Molars 190 Working Length Determination 191 Significance of Working Length 191 Irrigation of Root Canal System 192 Cleaning and Shaping 192

Basic Principles of Canal Instrumentation 193 Techniques of Root Canal Preparation 193 Obturation of Root Canal System 194 Coronal Restoration 195

Common Errors During Endodontic Treatment 195

14 Examination Spotters 198

Nidhi Rani, Harleen Kaur Gill

Instruments 198 Materials 202

Glossary 209

Anamika Thakur, Simran Pal Singh Bindra

Index ��215

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“Operative dentistry is science and art of dentistry which

deals with diagnosis, treatment and prognosis of defects of

the teeth which do not require full coverage restorations for

correction Such treatment should result in the restoration

of proper form, function and esthetics while maintaining

the physiologic integrity of the teeth in harmonious

relationship with the adjacent hard and soft tissues, all

of which should enhance the general health and welfare

of the patient” It plays an important role in enhancing

dental health and now branched into dental specialties

But before practicing operative dentistry, one should

understand the concept of tooth preparation because

operative dentistry deals with diagnosis, prevention,

interception and restoration of the defects of natural teeth

Preclinical operative dentistry is a branch of operative

dentistry where practical training is given for tooth

preparation and restoration of teeth with various materials

on dummy models in simulated oral environment

need for Preclinical conservative dentistry

As we know oral cavity is a small area which consist of

lips, cheeks, palate and a mobile tongue To do tooth

preparation in this area, a great skill is required So in

order to have proper understanding of anatomical and dimensional considerations, it is always recommended

to do tooth preparations on artificial acrylic teeth called typhodont teeth Typhodont teeth are screwed on to the phantom head By doing tooth preparation in dummy models, a person is able to juxtapose his acquired skill

in clinical patient easily Repeated tooth preparations in extracted natural teeth increase the skill and efficiency

of the person Moreover this training increases the confidence and psychomotor skills for handling tissues Basic purpose of preclinical conservative dentistry

is to make the students to gain expertise for restorative procedures before handling the patient This develops confidence in the student before they manage the patient

cAuSES oF LoSS oF tootH SuBStAncE

• Dental caries (Fig 1.1)

• Noncarious loss of tooth structure – Attrition (Fig 1.2)

1

Introduction

Causes of Loss of Tooth Substance

Objectives of Operative Dentistry

Objectives of Preclinical Conservative Dentistry

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2

Figure 1.1: clinical picture showing pit and fissure caries in premolar

Figure 1.2: clinical picture showing generalized attrition of

mandibular anterior teeth

Figure 1.3: clinical picture showing generalized abrasion of teeth

Figure 1.4: clinical picture showing generalized erosion of

maxillary anterior teeth

Figure 1.5: clinical picture showing fractured central incisor

which can be corrected by esthetic treatment

Figure 1.6: clinical picture showing spacing between teeth which

can be corrected by restorative procedures

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oBjEctIvES oF oPErAtIvE dEntIStry

Following are the objectives of operative dentistry:

diagnosis

Diagnosis is determination of nature of disease, injury or

other defect by examination, test and investigation

Prevention

It includes the procedures done for prevention before the

manifestation of any sign and symptom of the disease

Interception

It includes the procedures undertaken to prevent the

disease from developing into a more serious or full extent

Preservation

Preservation of the vitality and periodontal support of

remaining tooth structure is obtained by preventive and

After restoration is done, it must be maintained for

providing service for longer duration

Figure 1.7: clinical picture showing fractured amalgam restoration

requiring replacement Figure 1.8: clinical picture showing intrinsic discoloration of teeth

which can be corrected by esthetic restorations

oBjEctIvES oF PrEcLInIcAL conSErvAtIvE dEntIStry

• To gain expertise for manipulation of different dental materials

• To have knowledge of different instruments used in restorative dentistry

• Excavating instrument: Spoon excavator

• Cutting instruments: Chisel, hatchet, gingival marginal

trimmer and hoes

• Mixing instruments: Cement mixing spatula, mortar

and pestle

• Filling instrument: Plastic filling instrument, amalgam

carrier, teflon-coated instruments

• Condensers: Round and parallelogram condenser

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• Contrangle micromotor hand piece, round, straight,

tapered, inverted cone diamond points

PrEcLInIcAL tootH PrEPArAtIonS

tooth Preparations on Plaster Models

Before going for tooth preparation on typhodonts or

extracted teeth, it is advisable to practice on plaster models

These plaster models are prepared by pouring plaster

of paris in readymade tooth moulds Students practice

class I to V tooth preparations on these models Working

on plaster models have many advantages Students can

understand concept of tooth preparation better on bigger

models Outline form, line and point angles, convergence

of walls, and carving can be understood in a better way on

plaster models (Figs 1.10A to C) By these, student can

easily replicate tooth preparations on typhodonts and

extracted teeth

tooth Preparations on typhodonts

Before going for tooth preparation in patient’s mouth, it is

always advisable to practice all types of tooth preparations

on typhodonts and extracted teeth Typhodonts are artificial acrylic teeth mounted on maxillary and mandibular arches which can be fixed to human-shaped rubber faces to simulate the oral cavities Typhodonts can also be mounted separately on plaster moulds or blocks

(Fig 1.10D) Typhodonts are advantageous because of

their easy accessibility, availability in anatomical forms But these have disadvantages like:

• There is no separation between enamel and dentin

• Because of their softness they get cut very fast

tooth Preparations on Extracted teeth

After performing tooth preparations on plaster models and typhodonts, students are advised to practice on extracted natural teeth These teeth should be mounted in plaster blocks or phantom jaws These teeth have advantages over typhodonts because being natural, these show differentiation of enamel and dentin But these teeth carry risk of contamination and they are not easily available

Shortcomings of Preclinical Practice

• Knowledge of saliva control and isolation can not be experienced in preclinical work

• One can not be familiar with tongue interference which

is common while working on mandibular arch

• Retraction of soft tissues is completely different in patients

• Patient anxiety and apprehension can not be experienced with mannequins

Figures 1.9: Photograph showing armamentarium required for restorative procedures

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Scope of operative dentistry

return to health and function and increase the overall

well being of the patient

• Thorough knowledge of dental materials which can be

used to restore the affected areas

• To understand the biological basis and function of

various tooth tissues

• To maintain the pulp vitality and prevent occurrence of

pulpal pathology

vIvA QuEStIonS

Q.1 What is preclinical operative dentistry?

Ans Preclinical operative dentistry is a branch of

operative dentistry where practical training is given

for tooth preparation and restoration of teeth with

various materials on dummy models in simulated

oral environment

Q.2 Define Operative dentistry?

Ans According to Sturdvent, “Operative dentistry is

defined as science and art of dentistry which deals

with diagnosis, treatment and prognosis of defects

of the teeth which do not require full coverage restorations for correction.” Such corrections and restorations result in the restoration of proper tooth form, function and aesthetics while maintaining the physiological integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues

Q.3 Why is subject preclinical operative dentistry important?

Ans Since oral cavity is a small area which consist

of lips, cheeks, palate, and a mobile tongue To

do tooth preparation in this area, a great skill is required Repeated tooth preparation in extracted natural teeth increases the skill and efficiency of the person

Q.4 Why should one practice on dummy models before doing patients?

Ans By doing tooth preparation in dummy models,

a person is able to juxtapose his acquired skill

in clinical patient easily Moreover this training increases the confidence and psychomotor skills for handling tissues

Q.5 What are different causes of loss of tooth structure?

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As we know there are 32 teeth in permanent dentition

and 20 teeth in deciduous dentition A tooth has crown

and a root portion Crown part of the tooth is covered

with enamel and root portion of tooth is covered by

cementum The crown and root join at cementoenamel

junction (CEJ)

DEFINITIONS

Cervical line: Each tooth has a crown and root portion

The crown is covered with enamel and the root portion is

covered with cementum The crown and root join at the

CEJ This junction is also called the cervical line

Cingulum: It is enlargement or the bulge on the cervical

third of lingual surface of the crown in anterior teeth

(incisors and canines)

Ridge: It is linear elevation on the surface of a tooth Its

named according to its location

Marginal ridges: These are rounded borders of enamel

that form the mesial and distal margins of occlusal surfaces

of posterior teeth (premolars and molars) and mesial and

distal margins of the lingual surfaces of anterior teeth (incisors and canines)

Triangular ridges: These descend from the tips of the

cusps of molars and premolars toward the central part of occlusal surfaces

Transverse ridge: When both buccal and lingual triangular

ridges join, they combine to form a transverse ridge

Oblique ridge: It is a ridge obliquely crossing the occlusal

surfaces of maxillary molars It is usually formed by the union of triangular ridge of distobuccal cusp and distal cusp ridge of the mesiolingual cusp

Fossa: It is an irregular depression or concavity on lingual

surface of anterior and occlusal surface of posterior teeth Its named according to its shape or location

Lingual fossae: Occur on lingual surface of incisors Central fossae: Occur on occlusal surface of molars Sulcus: It is a long depression on the surface of tooth

ridges and cusps

Developmental groove: It is shallow groove between the

primary parts of the crown or root

Morphology of Permanent Teeth

Viva Questions

CHAPTER OUTLINE

Amit Garg, Mannat Dhillon

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Pits: These are small pinpoint depressions located at the

junction of developmental grooves or at ending of those

grooves

Lobe: It is one of the primary sections of formation in the

development of the crown

Mamelons: These are three rounded protuberances found

on the incisal edges of newly erupted incisor teeth

Cusp: Elevation on the crown portion of a tooth making up

a divisional part of the occlusal surface

Tubercle: Smaller elevation on some portion of crown

produced by an extra formation of enamel Its commonly

found on palatal surface of maxillary first molar It differs

from cusp as it is formed by enamel only while cusp is formed

of pulp horn covered by dentin and enamel (Fig 2.1).

MAXILLARY TEETH

Central Incisor

Labial Aspect

with almost square or rectangle shape

r FEJBM PVUMJOF JT TUSBJHIU PS TMJHIUMZ DPOWFY XIFSFBT

the distal outline is more convex

r %JTUPJOJDJTBMBOHMFJTOPUBTTIBSQBTNFTJPJODJTBMBOHMF

teeth may show mamelons

r $FSWJDBM PVUMJOF GPMMPXT B TFNJDJSDVMBS TIBQF XJUI

convexity towards root surface (Fig 2.2A).

of curvature at cingulum After this it becomes concave and then slightly convex again when it approaches linguoincisal ridge

Box 2.1: Special features of maxillary lateral incisor

t Most commonly found missing tooth t Peg-shaped lateral—Common finding t Palatogingival groove.

Labial Aspect

curvature, rounded incisal edge and rounded incisal

angles, mesially and distally (Box 2.1)

r FTJPJODJTBM BOHMF DBO CF BT TIBSQ BT UIBU PG DFOUSBMincisor

r %JTUBMPVUMJOFJTNPSFSPVOEFEUIBODFOUSBMJODJTPSr $SFTU PG DPOUPVS NFTJBMMZ JT BU QPJOU PG KVODUJPO PGmiddle and incisal third and on distal side, it lies more towards cervical aspect

r -BUFSBM JODJTPS JT OBSSPXFS NFTJPEJTUBMMZ BOE TIPSUFS

cervicoincisally than central incisor (Fig 2.3A).

Figures 2.1A and B: Schematic representation showing

cusp and tubercle

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8

Lingual/Palatal Aspect

r 1BMBUBMBTQFDUJTOBSSPXFSUIBOMBCJBM

r $JOHVMVN JT QSPNJOFOU XJUI BŁOJUZ UPXBSET EFFQ

developmental grooves within lingual fossa

r 8JEUI PG DSPXO BQQFBST NPSF UIBO PO NFTJBM TVSGBDF

because of placement of crown on the root

r $VSWBUVSF PG DFSWJDBM MJOF JT VTVBMMZ MFTT UIBO UIBU PG

mesial surface (Fig 2.3D).

Incisal Aspect

r BZSFTFNCMFDFOUSBMJODJTPSPSDBOJOFr -BCJBMTVSGBDFJTNPSFDPOWFYXJUIQSPNJOFOUDJOHVMVNr -BCJPMJOHVBM EJNFOTJPOT NBZ CF HSFBUFS UIBO

mesiodistal dimensions (Fig 2.3E).

Canine

Labial Aspect

r FTJPEJTUBMEJNFOTJPOTBSFTIPSUFSUIBODFOUSBMJODJTPSr -BCJBMTVSGBDFJTTNPPUIXJUITMJHIUTIBMMPXEFQSFTTJPOT

seenr FTJBMPVUMJOFJTDPOWFYGSPNDFSWJYUPNFTJBMDPOUBDUarea

r %JTUBM PVUMJOF JT VTVBMMZ DPODBWF GSPN DFSWJDBM MJOF UPdistal contact area

r *ODJTBMFEHFDPNFTUPBEJTUJODUQPJOUJOGPSNPGDVTQ

*UIBTNFTJBMBOEEJTUBMTMPQFT.FTJBMTMPQFJTTIPSUFSthan distal slope

Figures 2.2A to E: Schematic representation showing (A) Labial aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Incisal aspect of maxillary central incises

A

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below cingulum and between marginal ridges It

divides lingual fossa in mesial and distal lingual fossa

(Fig 2.4B).

Mesial Aspect

r 0VUMJOF JT XFEHF TIBQF XJUI HSFBUFTU NFBTVSFNFOUT

towards cervical third

r -BCJBM TVSGBDF BQQFBST DPOWFY GSPN DFSWJDBM MJOF

towards cusp tip

straight at middle third and again convex at incisal third

third of the crownr $VTQ UJQ BOE DVTQ TMPQFT MJF MBCJBM UP MPOH BYJT PG UIFroot

r %JTUBM DVTQ SJEHF JT MPOHFS UIBO UIF NFTJBM DVTQ SJEHF

(E) Incisal aspect of maxillary lateral incises

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difference places buccal cusp tip distal to long axis of

the tooth (Figs 2.5A).

Palatal Aspect

palatal side than on buccal side

buccal cusp

r FTJBMBOEEJTUBMTMPQFTPGQBMBUBMDVTQNBLFSPVOEFE

angle at cusp tip

of both cusps with their mesial and distal slopes can be

seen from palatal aspect (Fig 2.5B).

(E) Incisal aspect of maxillary canine

Mesial Aspect

r 3PVHIMZUSBQF[PJEBMJOTIBQFXJUIMPOHFTUTJEFUPXBSETcervical portion, and shortest towards occlusal portionr #VDDBMBOEQBMBUBMPVUMJOFTBSFTNPPUIMZDVSWFEGSPNthe cervical line till the tips of buccal and palatal cuspsr FTJBM EFWFMPQNFOUBM EFQSFTTJPO JT GPVOE DFSWJDBM

to mesial contact area bordered by mesiobuccal and mesiolingual line angles This depression continues apically beyond cervical line and joins the deep developmental depressions of roots

r %FWFMPQNFOUBM HSPPWF JT GPVOE JO FOBNFM PG NFTJBMmarginal ridge This groove is usually continuous with central groove of occlusal surface of crown

r 5XPSPPUTPOFCVDDBMBOEPOFQBMBUBMBSFDMFBSMZWJTJCMF

from mesial aspect (Fig 2.5C).

Distal Aspect

It is almost similar to mesial aspect except that:

r $POWFY EJTUBM TVSGBDF XJUI OP EFQSFTTJPO BU DFSWJDBMthird

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r "OHMF GPSNFE CZ KVODUJPO PG NFTJPCVDDBM SJEHF JT

almost right angle Whereas angle formed by junction

of distobuccal cusp ridge and distal marginal is acute

(Fig 2.5E).

r $FOUSBM EFWFMPQNFOUBM HSPPWF EJWJEFT UIF PDDMVTBM

surface buccolingually This groove extends from distal

marginal ridge to mesial marginal ridge where it joins

mesial marginal developmental groove

r FTJPCVDDBM BOE EJTMPCVDDBM EFWFMPQNFOUBM HSPPWF

join the central groove just inside the mesial and

distal marginal ridges The junction of grooves are

deeply pointed and referred as mesial and distal developmental pits

r %JTUBM UP NFTJBM NBSHJOBM SJEHF JT B USJBOHVMBSdepression, called mesial triangular fossa

distal triangular fossa is presentr #uccal and lingual triangular ridges are visible extending from center of central groove to their respective cusp tips

Second Premolar

Buccal Aspect

premolarr *U JT MFTT QPJOUFE BOE NPSF PCMPOH JO TIBQF XIFOcompared to first premolar

r FTJBMTMPQFPGCVDDBMDVTQJTTIPSUFSUIBOEJTUBMTMPQF

(reverse is true for first premolar) (Figs 2.6A).

Figures 2.5A to E: Schematic representation showing (A) Buccal aspect; (B) Palatal aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Occlusal aspect of maxillary first premolar

Abbreviations: MBCR, mesiobuccal cusp ridge; MP, mesial pit; MTF, mesial triangular fossa; MMR, mesial marginal ridge; MMDG, mesial marginal

development groove; MLCR, mesiolingual cusp ridge; CDG, central development groove; DBCR, distobuccal cusp ridge; DTF, distal triangular fossa; DP, distal pit; DMR, distal marginal ridge; DLCR, distolingual cusp ridge

C

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r (SFBUFS EJTUBODF CFUXFFO DVTQ UJQT JODSFBTFT UIF

dimensions of occlusal surface buccolingually

(Fig 2.6C).

Distal Aspect

It is almost similar to mesial aspect except that distal

root depression is present which is deeper than mesial

depression (Fig 2.6D).

Occlusal Aspect

r 0VUMJOFJTSPVOEFEPSPWBMr $FOUSBM EFWFMPQNFOUBM HSPPWF JT TIPSUFS BOE NPSFirregular

r VMUJQMF TVQQMFNFOUBSZ HSPPWFT SBEJBUF GSPN DFOUSBMgroove These groves end in shallow depressions in the enamel of occlusal surface giving it a wrinkled

appearance (Fig 2.6E).

First Molar (Box 2.2)

Box 2.2: Important features of maxillary first molar

t 'JSTUQFSNBOFOUUPPUIUPFSVQU t .PTUDBSJFTQSPOF

also considered as “corner stones” of dental arches

Buccal Aspect

representing the shorter of uneven sides

(E) Occlusal aspect of maxillary second premolar

Abbreviations: DBCR, distobuccal cusp ridge; MBCR, mesiobuccal cusp ridge; DBTG, distobuccal triangular groove; DMR, distal marginal ridge; DTF,

distal triangular fossa; DP, distal pit; DPTG, distopalatal triangular groove; DPCR, distolingual cusp ridge; MBTG, mesiobuccal triangular groove; MMR, mesial marginal ridge; MTF, mesial triangular fossa; MP, mesial pit; MPTG, mesiopalatal triangular groove; MPCR, mesiopalatal cusp ridge

A

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It extends occlusoapically and terminates approximately

half the distance from its origin occlusally to the cervical

line At this point, a pit is present called buccal pit

r FTJBM PVUMJOF PG DSPXO JT BMNPTU TUSBJHIU XIFSF BT

distal outline is convex

cervically (Fig 2.7C).

Distal Aspect

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Figures 2.7A to E: Schematic representation showing (A) Buccal aspect; (B): Palatal aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Occlusal aspect of maxillary first molar

Abbreviations: DBCR, distobuccal cusp ridge; CP, central pit; DTF, distal triangular fossa; DMR, distal marginal ridge; DPCR, distopalatal cusp ridge;

DBC, distobuccal cusp; DPC, distopalatal cusp; MPC, mesiopalatal cusp; MBCR, mesiobuccal cusp ridge; BDG, buccal development groove; MTF, mesial triangular fossa; CDG, central development groove; MMR, mesial marginal ridge; MPCR, mesiopalatal cusp ridge

C

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14

r 4JODF DSPXO JT OBSSPXFS PO UIF EJTUBM TVSGBDF UIBO

mesial surface, most of the palatal and buccal surfaces

can be seen from distal aspect

r "MMDVTQTBSFWJTJCMF(Fig 2.7D).

Occlusal Aspect

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four major cusp ridges and marginal ridges

r #VDDPMJOHVBMNFBTVSFNFOUPGDSPXOPONFTJBMTJEFJT

greater than distal side, i.e distal surface is narrower

buccolingually, than mesial surface

mesiobuccal, distopalatal, distobuccal and fifth cusp in

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r 3IPNCPJEBMTIBQFIBTUXPBDVUFBOHMFT.FTJPCVDDBM

and distopalatal and two obtuse angles, i.e mesiopalatal

and distobuccal

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of mesiopalatal and distobuccal cusp meet to form

oblique ridge

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triangular ridge of mesiobuccal cusp meet to form

transverse ridge

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groove, transverse groove and distal oblique groove

cusps (Fig 2.8A).

Palatal Aspect

It is mainly different from first molar in following respects:r 4IPSUFSEJTUPQBMBUBMDVTQ

r "CTFODFPGêGUIDVTQ

(E) Occlusal aspect of maxillary second molar

E D

Trang 32

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between mesiopalatal and distopalatal cusp (Fig 2.8B).

Mesial Aspect

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marginal ridge is located more occlusally than distal

marginal ridge (Fig 2.8C).

Distal Aspect

can be seen from this aspect

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mesial marginal ridge (Fig 2.8D).

Occlusal Aspect

It is almost similar to maxillary first molar except that:

r FTJPEJTUBMEJNFOTJPOTBSFTNBMMFSUIBOêSTUNPMBS

r FTJPCVDDBMBOENFTJPQBMBUBMDVTQTBSFTBNFBTUIBU

of first molar, but distobuccal and distopalatal cusps

are smaller and less well developed

r 'JGUIDVTQJTNJTTJOH

r PSF PG TVQQMFNFOUBSZ HSPPWFT BOE QJUT BSF QSFTFOU

than first molar (Fig 2.8E).

MANDIBULAR TEETH

Central Incisor

Box 2.3: Important features of mandibular central incisor

t 4NBMMFTUUPPUIJOBSDI t #JMBUFSBMMZTZNNFUSJDBM

Labial Aspect

r Crown is smooth, tapered from incisal ridge to cervical

portion (Box 2.3)

r Sharp mesial and distal incisal angles with straight incisal

edge perpendicular to long axis of the tooth (Fig 2.9A).

Lingual Aspect

r Smooth surface with slight concavity

lingual side

r Small and convex cingulum (Fig 2.9B).

(E) Incisal aspect of mandibular central incises

A

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16

Mesial Aspect

r Wedge shaped with incisal edge being lingual to long

axis of the root

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r -BCJBM TVSGBDF PG DSPXO JT XJEFS NFTJPEJTUBMMZ UIBO

lingual surface (Fig 2.9E).

r $VSWBUVSFPGDFSWJDBMMJOFJTEFFQ(Fig 2.10C)

(E) Incisal aspect mandibular lateral incisors

C

Trang 34

Distal Aspect

is placed more lingually than mesial portion

r $VSWBUVSF PG DFSWJDBM MJOF JT MFTT EFFQ UIBO PO NFTJBM

surface (Fig 2.10D).

Incisal Aspect

Incisal edge is twisted distolingually This twist corresponds

to the curvature of mandibular arch (Fig 2.10E).

Canine

Labial Aspect

r Crown is narrower than maxillary canine

r Crown appears longer because of its narrowness than

maxillary crown

r FTJBMPVUMJOFJTBMNPTUTUSBJHIU

r FTJBMTMPQFPGDVTQJTTIPSUFSUIBOEJTUBMTMPQF

r Crown appears to be tilted distally because there is

more of crown distal to long axis of root than mesial to

Figures 2.11A to B: Schematic representation showing (A) Labial aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Incisal aspect of mandibular canine

Trang 35

r $SPXO BQQFBST USBQF[PJEBM JO TIBQF XJUI DFSWJDBM

margin being the shortest of uneven sides

r " DIBSBDUFSJTUJD GFBUVSF PG UIJT UPPUI JT UIBU NFTJBMmarginal ridge is located more cervically than distal

marginal ridge (Fig 2.12B).

Mesial Aspect

r Crown is rhomboidal in shape with buccal tip centered

over the root

r Crown is tilted lingually

r #VDDBM PVUMJOF JT DPOWFY GSPN DFSWJDBM MJOF UP UIF

cusp tip

r -JOHVBMPVUMJOFTIPXTQSPNJOFOUNFTJPCVDDBMMPCF

Figures 2.12A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Occlusal aspect of mandibular first premolar

C

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r FTJBMNBSHJOBMSJEHFNFSHFTXJUINFTJPMJOHVBMGPTTB

This houses mesiolingual slopes

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marginal ridge It slopes cervically at 45°from cusp tip

towards center of occlusal surface (Fig 2.12C).

Distal Aspect

r %JTUBM NBSHJOBM SJEHF JT IJHIFS BCPWF UIF DFSWJY UIBO

mesial marginal ridge

r ǔFSF JT OP EFWFMPQNFOUBM HSPPWF PO EJTUBM NBSHJOBM

because of short buccal cusp (Fig 2.13A).

Figure 2.13A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Occlusal aspect of mandibular second premolar

C

Trang 37

When compared with first premolar, second premolar

shows following differences:

One buccal cusp and two lingual cusps.

followed by mesiolingual and distolingual

separated by grooves

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appearance

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lingual cusps and ends on lingual surface of crown

just below convergence of lingual cusp ridges

(Fig 2.13E).

First Molar

Buccal Aspect

r 5SBQF[PJEBMJOTIBQFr 5XPCVDDBMDVTQTBOEUISFFMJOHVBMDVTQUJQTBSFTFFOCFDBVTFCVDDBMDVTQTBSFVTVBMMZëBUUFOFEBOEMJOHVBMcusps are higher

grooves are found which demarcate mesiobuccal and distobuccal cusp, distobuccal and distal cusp, respectively

r FTJPCVDDBM DVTQ JT XJEFTU NFTJPEJTUBMMZ BOE EJTUBMcusp is smallest of all

r 5wo roots, one mesial and one distal are seen from CVDDBM BTQFDU FTJBM SPPU JT NPSF DVSWFE UIBO UIF

distal root (Fig 2.14A).

Lingual Aspect

portion of distal cusp is seenr FTJPMJOHVBMDVTQJTXJEFTUNFTJPEJTUBMMZXJUIJUTDVTQtip placed higher than distolingual cusp

r -JOHVBM EFWFMPQNFOUBM HSPPWF EFNBSDBUFTmesiolingual and distolingual and distolingual cuspr 4VSGBDFPGDSPXOMJOHVBMMZJTTNPPUIBOETQIFSPJEBMPOeach cusp

r esial and distal roots are seen from lingual aspect

(Fig 2.14B).

Mesial Aspect

r 3PVHIMZSIPNCPJEBMJOTIBQFseen

of tooth cannot be seen mesial aspectr $SPXOIBTMJOHVBMUJMUXJUISFTQFDUUPMPOHBYJTPGSPPUr ǔFSFJTBDVSWBUVSFPWFSUIFDFSWJDBMUIJSEPGUIFDSPXObuccally termed as buccal cervical ridge

Trang 38

between buccal and lingual cusp ridges

r 5XP NJOPS GPTTBF QSFTFOU BSF NFTJBM BOE EJTUBM

USJBOHVMBSGPTTB.FTJBMUSJBOHVMBSGPTTBJTQSFTFOUEJTUBM

to mesial marginal ridge and distal triangular fossa is present mesial to distal marginal ridge

mesiobuccal distobuccal and lingual development

groove (Fig 2.14E).

r 5wo roots, one mesial and one distal are seen from

buccal aspect (Fig 2.15A)

Lingual Aspect

r FTJPMJOHVBMBOEEJTUPMJOHVBMDVTQTBSFTFFOr $SPXOTMJHIUMZDPOWFSHFTPOMJOHVBMTJEF

Figure 2.14A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Occlusal aspect of mandibular first molar

C

Trang 39

r 4JODFOPEJTUBMDVTQJTQSFTFOUEJTUPCVDDBMHSPPWFJTOPUthere

r 5SBOTWFSTF SJEHF JT GPSNFE CZ USJBOHVMBS SJEHFT PGmesiobuccal and mesiolingual cusps, triangular ridges

of distobuccal and distolingual cusps

groove and the lingual groove (Fig 2.15E).

Figures 2.15A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;

(E) Occlusal aspect of mandibular second molar

C

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Q.4 Which tooth is named as corner stone of mouth?

is more on mesial side than on distal side

Q.10 Differentiate between right and left first maxillary

Q.11 How can you differentiate between right and left

maxillary lateral incisor?

Ans r %JTUBM PVUMJOF JT NPSF SPVOEFE UIBO NFTJBM

than on distal side

Q.13 What are the differences between right and left

maxillary first molar?

the cervical line

Q.16 What are the differences between right and left mandibular canine?

r 1SFTFODF PG NFTJPMJOHVBM HSPPWF XIJDI FYUFOET

into mesial fossa of occlusal surface

Q.18 Differentiate right and left second premolar.

Ans One buccal and one lingual cusp.

r $VSWBUVSFPGDFSWJDBMMJOFJTNPSFPONFTJBMTJEF

than on distal

r %JTUBM NBSHJOBM SJEHF JT QMBDFE NPSF DFSWJDBMMZ

than mesial marginal ridge

r FTJBMGPTTBJTTNBMMFSUIBOEJTUBMGPTTB

One buccal and two lingual cusps

r %JTUPMJOHVBM DVTQ JT TNBMMFS UIBO NFTJPMJOHVBM

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