ANATOMY
FOR THE ENT
RESIDENT
Hedyeh Javidnia, PGY2 November 7, 2008
. .
Objectives
Dental Anatomy Odontogenesis Types of Dentition Tooth Surfaces Mandibular & Maxillary Anatomy
Dental Anatomy
Anatomy of a tooth. a. Anatomical crown- portion of tooth covered with enamel
Anatomic crown
Dental Anatomy
b. Clinical crown- visible part of tooth above the gum line.
Clinical crown Anatomical crown
Dental Anatomy
c. Root
(1) Part of tooth embedded in the alveolar process and covered by cementum.
Dental Anatomy
d. Apex- tapered end of root tip.
e. Apical foramenopening at the root tip.
Dental Anatomy
Tissues of the tooth.
a. Enamel (1) Makes up anatomic crown. (2) Hardest material in the human body (3) Incapable of remodeling and repair.
Enamel
Dental Anatomy
b. Dentin (1) Makes up bulk of tooth. (2) Covered by enamel on crown and cementum on the root. (3) Not as hard as enamel. (4) Exposed dentin is often sensitive to cold, hot, air, and touch (via dentinal tubules).
Dental Anatomy
c. Cementum (1) Covers root of tooth. (2) Overlies the dentin and joins the enamel at the cemento-enamel junction (CEJ). (3) Primary function is to anchor the tooth to the bony socket with attachment fibers.
Dental Anatomy
d. Pulp (1) Made up of blood vessels and nerves entering through the apical foramen. (2) Contains connective tissue, which aids interchange between pulp and dentin.
Dental Anatomy
4. Periodontium
a. Alveolar process. (1) Bone extensions of the maxillae and mandible that supports the teeth. (2) Cortical plate is the dense outer layer of bone covering the spongy (cancellous) bone
Enamel Dentin Dentinal Tubules Cementum Pulp Alveolar Process Cortical Plate Spongy Bone
Dental Anatomy
b. Periodontal ligaments. (1) Dense connective fibrous tissues that connect teeth to the alveolar bone. (2) One end is embedded in cementum and other end in bone. (3) Supports and protects the tooth from normal shock.
Periodontal Ligaments
Enamel Dentin Dentinal Tubules Cementum Pulp Alveolar Process Cortical Plate Spongy Bone
Dental Anatomy
c. Gingiva - surrounds the teeth and covers the alveolar process.
Periodontal Ligaments
Enamel Dentin Dentinal Tubules Cementum Pulp Alveolar Process Cortical Plate
Gingiva
Spongy Bone
Odontogenesis
A. Bud Stage B. Cap Stage C. Bell Stage D and E. Dentinogenesis and amelogenesis F. Crown formation G. Root Formation H. Eruption
A. Bud Stage
Bud stage is characterized by rounded, localized growth of epithelium surrounded by proliferating mesenchymal cells, which are packed closely beneath and around the epithelial buds
B. Cap Stage
Vestibular lamina
When the appropriate depth is reached, the basal layer at the tip of the dental lamina thickens, forming a concavity.
C. Bell Stage
Dental lamina
Continued growth leads to bell stage, where the enamel organ resembles a bell with deepening of the epithelium over the dental papilla Continuation of histodifferentiation (Inner dental epithelium - ameloblasts and Dental papilla - odontoblasts)
D. Amelogenesis
Dentin
Odontoblasts
At the same time or soon after the first layer of dentin (mantle dentin) is formed, the inner dental epithelial cells differentiate into ameloblasts and secrete enamel proteins. The ameloblasts will then start laying down organic matrix of enamel against the newly formed dentinal surface. The enamel matrix will mineralize immediately and form the first layer of enamel. The formation of enamel is called amelogenesis.
E. Dentinogenesis
Dentin is formed by odontoblasts that differentiate from ectomesenchymal cells of dental papilla with influence from the inner dental epithelium Differentiation of odontoblasts is mediated by expression of signaling molecules and growth factors in the inner dental epithelial cells
F. Crown Formation
Growth areas of developing crown. Growth at cusp tip, intercuspal region, and cervical region
G. Root Formation
Development of root begins after the enamel and dentin formation has reached the future cementoenamel junction Epithelial cells of the inner and outer dental epithelium proliferate from the cervical loop of the enamel organ to form the Hertwigs epithelial root
sheath. The root sheath determines if a tooth has single or multiple roots, is short or long, or is curved ir straight
Stratum intermedium
Eventually the root sheath will fragment to form several discrete clusters of epithelial cells known as epithelial cell rests of malassez. These will persist in adults within the periodontal ligament The epithelial rests appear as small clusters of epithelial cells which are located in the periodontal ligament adjacent to the surface of cementum. They are cellular residues of the embryonic structure known as Hertwig's epithelial root sheath.
REVIEW: Odontogenesis
A. Bud Stage B. Cap Stage C. Bell Stage D and E. Dentinogenesis and amelogenesis F. Crown formation G. Root Formation H. Eruption
Types of Dentition
1. Deciduous (baby) teeth a. Twenty ( 20) primary teeth. b. Arches - maxillary and mandibular. c. Quadrants - each arch divided in half. (1) Maxillary right and left. (2) Mandibular right and left.
Enamel is thinner, pulp is thicker
Deciduous Teeth
d. Teeth in each quadrant. (1) Central incisor (2) Lateral incisor (3) Cuspid (4) 1st molar (5) 2nd molar
Deciduous Teeth
f. Numbering system. (1) Alphabetical. (2) Maxillary - patients right to left, A through J. (3) Mandibular - patients left to right, K thru T.
D
C B A MAXILLARY E F G H I J
R
T S K
MANDIBULA R L
R
Q P O N
Types of Dentition
2. Permanent teeth. a. Thirty-two (32) permanent teeth. b. Arches - maxillary & mandibular.
Permanent Teeth
c. Quadrants. (1) Maxillary right and left.
(2) Mandibular right and left.
R L
Permanent Teeth
d.
Permanent Teeth
(4) (5) (6) (7) (8) 1st bicuspid 2nd bicuspid 1st molar 2nd molar 3rd molar (wisdom tooth)
Tooth Surfaces
1. Facial - next to cheeks & lips. a. Labial- anterior facial. b. Buccal - posterior facial. 2. Lingual- next to tongue. 3. Mesial - towards midline, an imaginary line between central incisors. 4. Distal- away from midline. 5. Incisal- cutting edge of anterior teeth. 6. Occlusal- chewing surface of the posterior teeth.
Tooth Surfaces
7. Proximal surfaces - mesial or distal surface of a tooth lying next to another tooth.
8. Interproximal space (embrasure) - spaces between teeth, filled with hard and soft tissue (interdental papilla).
Tooth Surfaces
9. Cusps- pronounced elevations on the occlusal surfaces of a tooth terminating in a conical or rounded surface.
The End!!