Dental Anatomy

Challenge 2010
Propound

Lecture Notes
Lecture Title: Morphology of molars(3)& Deciduous Dentition Professor Name: Dr. Ashraf AlShawesh Done By: Dental Anatomy Scripts Team

MORPHOLOGY OF PERMANENT MOLARS

Last time we finished everything related to first molar and today we will talk about the second permanent molar. Mandibular permanent 2nd molar Buccal aspect This tooth from the buccal aspect is smaller than the first molar, but still larger than the third molar in all dominions, and this is a type trait which is similar to the type trait in maxillary molars , we said as we go posteriorly; the size of the tooth becomes smaller and smaller. The other difference when we look from the buccal aspect we only see two cusps instead of three, for this reason we only have one buccal groove not two, if you remember in the mandibular first molar we have two grooves buccally ( mesiobuccal and distobuccal ) here we have only one buccal groove, the lingual cusps are more prominent from the buccal aspect.

Roots We see tow roots that are more closer one to the other and distally inclined, as we go posteriorly the roots become closer to each other and also distally inclined. Lingual aspect The crown is short occlusocervically, little of the proximal surface is visible and this is important, because this tooth is squire in shape, Mesial and distal are parallel but in the first molar these surfaces converge lingually. Mesial and distal profiles are less converges cervically, also as we go from the height of contour toward the cervical margin the convergence is less compared with the first molar which has big convergence; this tooth is almost parallel and straight.

Mesial aspect The root is narrower buccolingually and the apex tends to be sharp. Distal aspect Distal cusp is missing, we only see two cusps which are the distobuccal and distolingual but we dont see the distal cusp that existed on the distobuccal corner of the first molar, and also less of the buccal surface is visible and this is also a type trait. Distobuccal angle is less rounded because we dont have a cusp here, for this reason if you look at the tooth from the distal aspect you dont see any part of the buccal, because this corner is less rounded than the same corner in the mandibular first molar. Distal root is much narrower buccolingually with a pointed apex. Occlusal aspect The crown is rectangular, we have four cusps of equal size, the buccal profile is equal to the lingual profile in length and the mesial profile equal to the distal profile in length, and this means this tooth is a typical tooth. The most prominent of the buccal profile is the mesobuccal cusp (the most prominent part), buccolingual width and the mesial half are greater than the distal half, while in first molar the distal half is greater than the mesial half. The maximum buccolingual dimension is just mesial to the buccal groove; the mesial cusps are wider mesodistaly than distal cusps. The marginal ridges We see two marginal ridges located at the same level, the mesial marginal ridge is still slightly higher than the distal marginal ridge.

These marginal ridges are not crossed by grooves, they are intact, and if you remember we said in the first mandibular molar they tend to be crossed by groove. The groove pattern is cross like plus sign +, so the buccal groove is continuous in the lingual groove at the center groove goes perpendicular of that making plus sign. We see many Supplementary grooves compared to the first molar.

Pulp
The pulp is similar to that of the first molar but we have one difference that we need to remember; in the first molar we have two canals but in the second mandible molar in 90% of the cases we have two canals in the mesial root and in 40% of the cases we have two canals in the distal root. The percentage of extra canal tends to be less, most commonly we see two canals in the mesial but its very rare to see two canals in the distal, so there is a possibility 60% of having two canals in the distal root in the first molar but this possibility is very rare in the second molar, so the second molar in most of the cases has only one canal on distal root.

Mandibular 3rd molar Buccal aspect Third molar its highly variable, roots are short, fuse and distally inclined. Lingual aspect Short crown of highly bulbous outline, and the cusps tip tend to be rounded.

Mesial aspect The buccal and lingual profiles are highly convex, the distance between the apices of mesial cusp is short, so as you go toward the third molar the distance between the tips of the cusp become smaller, this means the occlusial table become smaller.

Distal aspect Almost entire buccal surface is visible because the angle between the buccal and distal surface is very rounded, the distal root is narrowest bucculingualy and shortest of all mandibular molars, these details are similar to the pulp in the mandibular second molar. Occlusial aspect The tooth is ovoid in outline, the mesial half is wide bucculingually than the distal half, buccal and lingual profiles converge distally, that means the distal portion of the crown is narrower than the mesial portion.

Highly restricted occlusal table, occlusal surfaces are very small and the distance between the tips of the cusps is small, the cusps are narrow and conical in shape, the marginal ridges are very highly convex, the roof and pit system are very irregular, and this tooth is very irregular, the grooves tend to be short, and its very possible that this tooth have four, five or six cusps, but its impossible or very rare to see less than 4 cusps, in general for mandibular molar teeth its extremely rare to see less than 4 cusps in any mandibular molars teeth, but in maxillary its possible to see 3 cusps.

**Backward to premolars**

Curves of occlusion
When our teeth are in occlusion, they do not occlude in a flat surface.

Curves of occlusion
Curve of Spee Curve of Wilson Sphere of Monson
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3 2
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The curve of Spee :( Picture # 1) An anterio-postrior curve caused by drawing a line from all buccal cusps of mandubular teeth starting from the tip of the canine to premolars then molars, Imaginary curvature passing through the tips of all mandinular teeth ( Mandibular posterior teeth and canine ). The curve of Wilson :( Picture # 2) An imaginary curvature line passing through the buccal and lingual cups of one molar on one side and then to the same molar on the other side. Sphere of Monson :( Picture # 3) Integrating the two previous curves, this sphere should touch all the cusps of all posterior teeth plus the incisal edges of anterior teeth. The center of this sphere is the area between the two eyebrows which is called the glabular point, Glabella.

Why do we need these curvatures and these spheres?

The teeth of the upper and the lower jaws are going to articulate. Lets imagine that theyre flat, keeping in mind that the mandible opens like a hinge. While you close your mouth the posterior teeth of the upper and the lower jaws will come in contact but the anterior teeth wont and thats not what we want. We want when closing the mouth a full and perfect contact of the two arches. Mandible closes in a curvature, not brought up vertically, it rotates. Because the mandible has to rotate while closing the mouth our teeth should be organized this way. Otherwise, if our teeth were organized where all the cusps and the incisal edges are on a flat plane then when you close your mouth you wont get a perfect contact with all teeth, youll get a good contact on only the most posterior teeth and this is not good at all. This is one of the basics of the occlusion of teeth and thats why our teeth arent organized in flat surfaces.

Molar Occlusal Relationship

Lets talk about the Molar Occlusal relationship. A question on the practical exam will be on this so make sure you understand it very well.

Previously, we covered the incisal relationships (3 classes and 2 divisions for class 2) and the canine relationships (Also 3 classes). In Molar Occlusal relationships there are also 3 classes that are called Angles Molar relationships after the American orthodontist who were the first to present them, Edward Hartley Angle.

Angles Classes: Class I: When the mesiobuccal(MB) cusp of the upper first molar bites exactly at the mesiobuccal(MB) groove of the lower first molar.

Class II: When the mesiobuccal(MB) Cusp of the upper first molar bites anterior to the mesiobuccal(MB) groove of the lower first molar.

Class III: When the mesiobuccal(MB) cusp of the upper first molar bites posterior to the mesiobuccal(MB) groove of the lower first molar.

[Q]: If you have class II molars, is it necessary for you to have canines and incisors of class II also? [A]: In most of the cases yes but not necessarily for all cases, it is possible that you have very nice incisal relationship, a perfect class I, but your molars are not in a good contact. [Remember]: any problem in occlusion is called Malocclusion. Its when the teeth are not class I teeth (class I is always the normal). [Remember]: the normal, healthy class is when we have the upper incisors overlapping the lower incisors (class I).

Arch Occlusal Relationship

When we look at our teeth from a proximal view we can see how the teeth come in contact very well. Lets take this as an example (a mesial view of the upper and lower molars in full contact): Notice that the buccal cusp of the mandibular molars and also premolars bites in the area between the two cusps of the maxillary molars. So if you see that the buccal cusps of your lower molar or premolars are located in the fossa or the area between the two cusps of the maxillary molars or premolars then you have a healthy occlusion. Some people have something different, a cusp to cusp contact (cusps of the upper teeth bites against the lower teeth cusps) and this is of course a malocclusion. Some people have something that we call cross bite (buccal cusps of the lower teeth are not in between the cusps of the uppers but theyre very much buccally). Remember that in the healthy occlusion the buccal cusps of the mandibular posterior teeth should be biting in the area between the buccal cusps of the maxillary exactly. We can rephrase that and say this: the lingual cusps of the maxillary posterior teeth are biting in the area thats between the lingual cusps of the mandibular posterior teeth.

[Remember]: -Normal: Buccal cusp of the upper molar bites in the area between two cusps of the lower opposing molar. - Abnormal: Cusp-Cusp, Cross Bite. Cusps classification based on the occlusal relationship Because of the different classes of how the molars contact with the opposing molars theres a special classification for the cusps: Supporting Cusps: cusps that participate in the occlusion. Non Supporting Cusps: cusps that dont participate in the occlusion. This is extremely important when you do fillings because if youre going to restore any tooth you should make sure whether this certain cusp youre restoring is under occlusion and participating in it, a supporting cusp, or not. Knowing that its a supporting cusp; you should make the filling very strong because if you restored a supporting cusp with a weak filling it will break off easily.
Supporting cusps take the most of the load strong filling/restoration is a must!

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Deciduous Dentition
Set traits

How can we distinguish deciduous teeth from permanent teeth?

1. Deciduous teeth are smaller in size. 2. The crown height compared to the root length is smaller. For permanent central incisor the crown is about 10 mm and the root 13 mm so the root is still longer but the difference is not big. But when its for deciduous tooth we will find a smaller ratio, because it tends to have a smaller crown compared to the length of the root.
3. The crown width over height ratio (width/height) is greater.

For example; take width of the crown of the permanent central incisor = 8.5, and divide it by the height of the crown = 10.5, we will have something closed to one like 90%. Do the same for the deciduous teeth, here we will have something close to 100%.

4. Buccal and lingual cervical ridges are more bulgy, and the cervical line tends to be constricted.
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Its like the shape of the body of males and females, deciduous teeth look like females with a constriction, and permanent teeth look like males they are straight . 5. Buccal cervical ridges on deciduous molars are very prominent (the buccal HOC is very prominent), we dont have such prominent in permanent teeth. And as a result the occlusal table tends to be constricted in deciduous teeth.

6. Molar roots: within permanent molar the roots tends to be closer to each other compared to deciduous molar. [Q]: Why do we need a big distance between the roots of deciduous molars? [A]: Because of the successor tooth. Thats why the roots of deciduous molars are: -more slender (thin) -Relatively longer compared to the crown -more bowed (bent) -flared outward -root trunk is short *root trunk is the distance between the division of the root and the cervical line. But in a permanent tooth its about 1/3 of the root is in the form of root trunk.

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7. Deciduous teeth are milky (very white). 8. Enamel is thinner and the pulp is large. This is important because we have problems with our 4th and 5th year dental students, they start training on making filling in permanent teeth, so they know it's easy to go 3mm deep without reaching the pulp, they think that deciduous teeth the same, what they do ? When they have a child they go 3mm to do a filling and what happens that they end in the pulp, the pulp is very large you can only go 1.5 or 2 mm maximum. The other clinical important, it's very easy for deciduous teeth to have caries reaching the pulp very fast because the distance is very short, for posterior teeth we need long time between the initiation of caries until caries reaching the dental pulp. Deciduous incisors -Eruption: Mandibular incisors erupt before maxillary incisors and the central before lateral incisors. -No mamelons, labial grooves or lobes in deciduous incisors. Maxillary Central incisor The only incisor with mesiodistal (MD) breadth greater than crown height. Mesial and distal profiles overhang root profiles. (This isnt a feature in permanent incisor because they are in line with root profiles). No labial grooves, depressions or lobes.

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 Cingulum: -the cingulum is very bulging and more incisally located, it occupies one half () of the crown but in permanent it occupies one third (1/3) of the crown. -May extend further toward the incisal edge and in this case its called the lingual ridge. - Its rare to find pits or grooves. Marginal ridges are clearly evident. Constricted cervix from all aspects. In proximal surfaces the cervical line is more convex incisally. Conical root with rounded apex. Diamond-shaped from incisal aspect.

Maxillary lateral incisor Much smaller than central incisor. Mesial and distal profiles are more in line with root profiles; they are not bulge like in the central incisor. Distal incisal angle is more rounded than the mesio incisal angle which is similar to the same feature in permanent incisor. The labial surface is more convex mesiodistally. Lingual fossa is deep. Marginal ridges are more prominent. Cervical line is similar to that of the central. The tooth is rounded from incisal aspect.

Mandibular central incisor Bilaterally symmetrical. The mesioincisal and the distoincisal angles are 90 degree. Incisal margin is horizontal.

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 Prominent cingulum with lingual margin extending incisally separating the lingual fossa into two fossae. Marginal ridges are less marked than those of maxillary incisors. (Its similar to the same feature in the permanent teeth). Lingual fossa is shallower. The labial surface is flat mesiodistaly(MD). Cervical line is similar to that of the maxillary incisors. The root is three times the height of the crown; the apex is Narrow, conical and pointed.

Mandibular lateral incisor The incisal edge slopes distally. The distoincisal(DI) angle is rounded. The distal profile is more rounded than the mesial profile. Crown height over mesiodistal ratio (height/MD) is greater than mandibular central. The labiolingal(LL) diameter is greater than mesiodistal. The cingulum, fossa and marginal ridges are similar to those of the mandibular Central. Root: -Tends to be narrow and conical. -Apex has distal inclination. -The distal surface has narrow vertical depression.

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Top 5 point! 1- In mandibular 2nd molar we only have one buccal groove not two like in the
mandibular 1st molar.

2- The crown of the mandibular 2nd molar is rectangular and we have four
cusps of equal size, this tooth is a typical tooth.

3- In the first molar we have two canals but in the second mandible molar in
90% of the cases we have two canals in the mesial root and in 40% of the cases we have two canals in the distal root.

4- We have many set trait to distinguish between deciduous teeth and

permanent teeth, For example: the size of the tooth, the color, the height and the width of the crown.

5- The root of deciduous molars are more slender and longer & more bowed
& flared outward.

Test your self

Q1) The mandibular 1st molar is smaller than mand. 2nd molar buccly? a- True. b- False. Q2) What cusp is missing in mand. 2nd molar? a- Buccal cusp b- Lingual cusp. c- Distal cusp.
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Q3) When the MB Cusp of the upper first molar bites anterior to the MB groove of the lower first molar, this is what class of molar relationship? a- Class I b- Class II c- Class III Q4) As we go from 1st to 3rd molar the roots become closer to each other and more buccaly inclined? a- False. b- True. Q5) 1st ,2nd ,3rd molars , the smallest tooth between these teeth is? a- 1st molar. b- 2nd molar. c- 3rd molar. 1 2 3 4 5 B C B A c

Noha Ghazal Hadeel Jaradat Hebah Ramadnah Sundos Abu Zaid Salam Bataineh Eman Nazzal Asmaa Almawas Eman idkaidek

Rawda Najjar Baraah Alslamat A9eel Ghawanmeh Ahmed Al Shamary Hadeel sumrain Hibah Jarrah Abeer M. derawi

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