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Dental Anatomy

and Occlusion
2009-2010
RESD 5004 (lecture portion) and 5005 (laboratory portion)

Course Director:
Edward Wright, D.D.S., M.S. (ext. 7-3697)
wrighte2@uthscsa.edu
Restorative Dentistry Faculty, Room# 3.592U
This material falls under the copyright laws and can only be reproduced within these
restrictions.
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Table of Contents
Page
Course Syllabus, RESD 5004 (Lecture Portion) ...........................................................

Course Syllabus, RESD 5005 (Laboratory Portion) ..................................................... 13


Introduction ................................................................................................................... 20
Chapter 1. Human Dentition I ...................................................................................... 21
A. Tooth Numbering Systems ................................................................................. 31
1. Universal Numbering System ........................................................................ 31
B. Terms of Orientation .......................................................................................... 33
1. Tooth Surfaces ............................................................................................... 34
2. Combining Terms of Tooth Surfaces To Describe Angles............................ 36
3. Division of Tooth Surfaces ............................................................................ 41
Chapter 2. Human Dentition II ..................................................................................... 42
A. Crown Elevations ............................................................................................... 48
B. Crown Depressions ............................................................................................ 53
C. Embrasures ......................................................................................................... 55
D. Proximal Contacts .............................................................................................. 58
Chapter 3. Anterior Teeth ............................................................................................. 60
A. Overview ............................................................................................................ 60
1. Lobes .............................................................................................................. 60
2. Tooth Outlines ............................................................................................... 62
B. Incisor ................................................................................................................. 63
1. Line Angles .................................................................................................... 63
2. Proximal Contacts .......................................................................................... 70
3. Embrasures..................................................................................................... 71
4. Contours ......................................................................................................... 74
C. Summary Maxillary Anterior Teeth ................................................................... 76
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1. Maxillary Central Incisors ............................................................................. 76


2. Maxillary Lateral Incisors .............................................................................. 79
3. Maxillary Canines .......................................................................................... 82
D. Review Maxillary Anterior Teeth ...................................................................... 85
E. Summary Mandibular Anterior Teeth ................................................................ 88
1. Mandibular Central and Lateral Incisors ....................................................... 88
2. Mandibular Canines ....................................................................................... 91
F. Review Mandibular Anterior Teeth .................................................................... 94
Chapter 4. Introduction to Your Articulator ................................................................. 97
Chapter 5. Occlusal Contact Relationships and Basic Mandibular Movements .......... 107
A. Static Occlusal Relationships ............................................................................. 108
1. Cusp-to-Marginal Ridge and Cusp-to-Fossa Occlusion ................................ 109
2. Cusp-to-Fossa Occlusion ............................................................................... 111
B. Mandibular Movements ..................................................................................... 112
Chapter 6. Posterior Teeth ............................................................................................ 115
A. Lobes and Associated Structures ....................................................................... 115
B. Angulations of Teeth ......................................................................................... 118
C. Occlusal Table .................................................................................................... 121
D. Vertical Line Angles .......................................................................................... 122
E. Marginal Ridges ................................................................................................. 124
F. Summary of Premolars ....................................................................................... 125
1. Maxillary First Premolar ................................................................................ 125
2. Maxillary Second Premolar ........................................................................... 128
3. Mandibular First Premolar ............................................................................. 131
4. Mandibular Second Premolar ........................................................................ 134
G. Review of Premolars .......................................................................................... 138
H. Summary of Molars ........................................................................................... 142

1. Maxillary First Molar..................................................................................... 142


2. Maxillary Second Molar ................................................................................ 145
3. Mandibular First Molar .................................................................................. 148
4. Mandibular Second Molar ............................................................................. 150
I. Review of Molars ................................................................................................ 153
Chapter 7 Primary Dentition ....................................................................................... 158
A. Formation and Calcification of the Primary Teeth ............................................ 158
B. Number of Teeth ................................................................................................ 158
C. Designation of the Primary Dentition ................................................................ 159
D. Comparison of Primary and Permanent Teeth ................................................... 159
E. Morphology of Individual Primary Teeth .......................................................... 161
F. Norms of Primary Dentition Occlusion .............................................................. 165
G. Drawings of Primary Teeth ................................................................................ 166
Chapter 8 Pulp Chambers and Canals ......................................................................... 169
A. Pulp Chambers ................................................................................................... 169
B. Root Canal System ............................................................................................. 170
C. Specific Teeth ..................................................................................................... 171
Chapter 9 Articulators ................................................................................................. 174
A. Non-adjustable Articulator ................................................................................ 174
B. Semi-adjustable Articulators ............................................................................. 176
C. Fully-adjustable Articulator ............................................................................... 180
D. Summary of Articulators .................................................................................... 184
Chapter 10. Mandibular Positions and Movements ..................................................... 185
A. Mandibular Positions ......................................................................................... 185
1. Rest Position .................................................................................................. 185
2. Maximum Intercuspation (MI) ...................................................................... 187
3. Centric Relation (CR) .................................................................................... 187

B. Mandibular Border and Functional Movements ................................................ 188


1. Sagittal Plane ................................................................................................. 189
2. Frontal Plane .................................................................................................. 192
3. Horizontal Plane ........................................................................................... 196
Chapter 11. Dynamic Occlusal Relationships.............................................................. 201
A. Horizontal Plane ................................................................................................ 202
B. Frontal Plane ...................................................................................................... 206
C. Sagittal Plane ...................................................................................................... 211
Chapter 12. Principles of Anterior Guidance of Occlusion ......................................... 212
Chapter 13. The Temporomandibular Joint ................................................................. 215
Chapter 14. Masticatory Muscles................................................................................. 220
Appendix:
Dental Anatomy Waxing Instruments........................................................................... 227
Drip Wax Block Exercise ............................................................................................. 230
Disinfect Extracted Teeth.............................................................................................. 232
Self Test 1 ..................................................................................................................... 234
Self Test 2 ..................................................................................................................... 235
Progressive Wax Block Exercise .................................................................................. 236
Self Test 3 ..................................................................................................................... 238
Cast Landmark Exercise ............................................................................................... 240
#10 Mesial Half Exercise .............................................................................................. 242
#8 Full Crown Exercise................................................................................................. 244
#8 Class 4 and 5 Composite Exercises .......................................................................... 245
#8 Full Crown Practical Exam ...................................................................................... 247
Comparing Occlusal Contacts Exercise ........................................................................ 248
#8 Maximum Intercuspation Exercise .......................................................................... 250
#6 Maximum Intercuspation Exercise .......................................................................... 251
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#4 Full Crown Exercise................................................................................................. 252


#4 Maximum Intercuspation Exercise .......................................................................... 254
Identify Extracted Teeth................................................................................................ 255
#29 Maximum Intercuspation Exercise ........................................................................ 256
#4 Full Crown Practical Exam ...................................................................................... 257
#3 Full Crown Exercise................................................................................................. 259
#3 Maximum Intercuspation Exercise .......................................................................... 261
#3 Full Crown Practical Exam ...................................................................................... 262
#30 Full Crown Exercise............................................................................................... 264
#30 Full Crown Practical Exam .................................................................................... 266
#30 Canine Guidance Exercise ..................................................................................... 268
Analysis of Mandibular Movements Exercise .............................................................. 270
Articulator Exercise ...................................................................................................... 282
#30 Canine Guidance Practical Exam ........................................................................... 285
#6-11 Anterior Guidance Exercise ................................................................................ 287
#11-14 Group Function Exercise .................................................................................. 290
Evaluating the Masticatory System............................................................................... 293
Masticatory and Cervical Palpations............................................................................. 294
#11-14 Group Function Practical Exam ........................................................................ 296
Dental Anatomy Quick Reference ................................................................................ 299

Course Syllabus, RESD 5004


(Lecture Portion)

List of Topics
Disinfecting Extracted Teeth
Human Dentition I & II
Anterior Teeth I, II, III
Restoring Contours with Composite
Introduction to Your Articulator
Occlusal Contacts and Basic Mandibular Movements
Posterior Teeth I & II
Tooth Identification
Primary Dentition
Pulp Chambers and Canals
Articulators
Mandibular Positions and Movements
Dynamic Occlusal Relationships
Your Articulator
Anterior Guidance of Occlusion
The Temporomandibular Joint
The Masticatory Muscles
Evaluating the Masticatory System

Chapter 1. Human Dentition I


As the mouth or oral cavity is viewed from the front, it must be noted that the right
side of the mouth is to the viewer's left and the left side of the mouth to the viewer's right.
The teeth are in two arches - an upper and a lower. The upper arch, or maxillary
arch, of teeth is set in the upper, immobile jaw (Figure 1-1).

The lower arch, or

mandibular arch, of teeth is set in the dynamic or movable member of the jaws, the
mandible (Figure 1-2).

Later as the individual teeth are discussed, maxillary and

mandibular teeth will be described as moving across each other; however, it must always
be remembered that only the mandibular arch is the movable member.

Figure 1-1 Maxilla (left side)

Figure 1-2 Mandible (left side)

There are three planes of orientation utilized in anatomical descriptions of the


skull. These are the frontal plane (parallel to the face), horizontal plane (parallel to the
floor), and sagittal plane (parallel to the sides of the head), Figure 1-3.

Figure 1-3 Planes of orientation


Each arch is divided in half, as is the remainder of the head, at the mid-sagittal
plane (midline). Each half arch is termed a quadrant. There are, therefore, two quadrants
per arch and a total of four quadrants.
There are 16 permanent teeth in each arch. There are eight permanent teeth in each
quadrant or half arch. Therefore, there are 32 teeth in the permanent dentition or in a
complete set of permanent teeth.
Humans also have another set of teeth called the primary dentition, or deciduous
teeth (baby teeth). Each of these two sets have characteristics that are unique to each set
(primary or permanent) of teeth. Set traits are used to distinguish between the two
dentitions. These will be discussed later.
Throughout the mouth, the teeth vary in size and shape, providing differing
functions. The various teeth may be separated by characteristics termed class traits. The
four classes of teeth are:
1.

Incisors - These are eight teeth whose crowns are designed for cutting or incising
(Figure 1-4). Their "biting" edges are termed incisal edges. These are the first two
teeth closest to the midline in each quadrant, and are named the Central Incisor
(first) and Lateral Incisor (second). Therefore, there are two incisors in each
quadrant (a central and a lateral incisor); four incisors in each arch (two central
incisors and two lateral incisors); and eight incisors in each set.
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2.

Canines (Cuspids) - These are four teeth with long pointed crowns designed for
piercing, tearing or holding food (Figure 1-5); they also have incisal edges. They
are the third teeth from the midline in each quadrant. There is, therefore, one
canine in each quadrant; two canines in each arch; and four canines in each set.

Figure 1-4

Figure 1-5

Maxillary and mandibular incisors

Maxillary and mandibular canines

3.

Premolars (Bicuspids, older terminology) - These eight teeth are holding and
grinding teeth (Figure 1-6). The premolars make the transition from the thinner,
sharper incisors and pointed canines, to the large grinding surfaces of the molars,
which are the largest teeth in the "back" of the mouth. The premolars are the
fourth and fifth teeth from the midline in each quadrant and are termed the first

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premolar and second premolar, respectively. Therefore, there are two premolars in
each quadrant, four premolars in each arch, and eight premolars in each set.
4.

Molars - These are the 12 large grinding teeth (Figure 1-7). They are the 6th, 7th
and 8th teeth from the midline in each quadrant. Named from "front" to "back",
(anterior to posterior), they are the first molar (or 6 year molar), second molar (or
12 year molar), and the third molar (or "wisdom" tooth).

Figure 1-6

Figure 1.7

Maxillary and mandibular premolars

Maxillary and mandibular molars

NOMENCLATURE:
When naming a specific tooth, the dentition or set is identified first, then the arch,
quadrant, and specific tooth name are identified - IN THAT ORDER, i.e., permanent
(set), maxillary (arch), right (quadrant), second premolar (tooth).

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The primary or deciduous set of teeth will not be covered at this time. In this course, if
"permanent" is omitted in naming a specific tooth, it should be understood to be a
permanent tooth, i.e., mandibular left second molar.
A visual tour (Figure 1-8) of the maxillary and mandibular dental arches from the
midline permits us to observe the various forms of the working surfaces of the teeth.
Tooth form varies from having simple cutting edges (incisors), to having single cusps
(canines), to a more complex makeup (premolars), and finally to the most complex of all
teeth (molars), with their multi-cusp occlusal surfaces.

Figure 1-8 A. Incisors; B. Canines; C. Premolars; and D. Molars.


INCISORS
As can be seen in Figure 1-9, the incisors have horizontal cutting blades. The function of
the incisors is to cut the food that is passed into the mouth. Figure 1-10 demonstrates
how the blades cut into the food, permitting the rest of the dentition to continue the
process of mastication as the food is transported by the tongue to the posterior teeth.

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Figure 1-9 Incisors in slight open

Figure 1-10 Incising food

and closed positions


CANINES
The canines (or cuspids) have colloquially been called "eye teeth." Each canine
has two blades which incline towards each other to form the cusp.
The function of canines in mastication is to pierce, tear, and rip the food as it is
introduced into the mouth. These teeth are able to handle great physical stress, since they
are extremely strong and well anchored in the corners of the arches. The cusp of the
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canine is called a "guiding cusp." According to some concepts of occlusion, its purpose
is to separate the posterior teeth during chewing.
PREMOLARS
The premolars are characterized by two cone-shaped cusps. The noted exception is
the mandibular second premolar, which often has a sharp lingual developmental groove
dividing the lingual cusp. The premolars functions as millers, mincers, and mullers of
food.
These teeth have cusps on the cheek (buccal) and tongue (lingual) sides. Based
upon how the teeth occlude with the opposing teeth, the cusps are classified as either a
supporting cusp (also called centric holding, functional, and stamp cusp) or a guiding
cusp (also called non-functional and shear cusp). Note that opposing teeth are in opposite
arches occluding each other, while adjacent teeth are in the same arch next to each other.
When teeth are in correct alignment and the posterior teeth are occluding, the
supporting cusp of the posterior teeth (Figure 1-11) is located between a supporting and
guiding cusp of an opposing tooth. Conversely, the guiding that is located buccal or
lingual to the occlusal table and forms one side of a fossa.

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Figure 1-11 Supporting and Guiding Cusps


The premolars mull food through the movement of the mandibular supporting cusp
along the maxillary supporting and guiding cusps of their opposing teeth, while the
maxillary premolar supporting cusps simultaneously mull the food in a similar manner.
MOLARS
The molars are large, milling teeth with anatomical differences that are related to
each molar's specific location within the dental arch. The maxillary molars consist of: 1)
right and left first molars (six-year molars), each with three large cuspids, a small cusp
located at the distolingual corner, and a fifth cusp on the lingual surface of the
mesiolingual cusp (termed cusp of Carabelli); 2) right and left second molars (twelveyear molars), each of which follows the same pattern as the first molar but is smaller and

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does not have the cusp of Carabelli; and 3) right and left third molars (wisdom teeth),
each of which follows a similar pattern as the second molar but is smaller (Figure 1-12).
The mandibular molars consists of: 1) right and left first molars (six-year molars),
each of which is a large five-cusp tooth; 2) right and left second molars (twelve-year
molars), each of which is usually a four-cusp tooth; and 3) right and left third molars
(wisdom teeth), each of which is usually also a four-cusp tooth (Figure 1-12).

Figure 1-12 The maxillary and mandibular molars


The molars have as their specific function the mastication of food.

They

principally accomplish this through the action of the supporting and guiding cusps. The
sharp ridges and grooves of the guiding cusps are responsible for the shearing, and the
movement of the supporting cusps in and out of their respective opposing fossae provides
the milling action. Both the supporting cusps and the guiding cusps of all the posterior
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teeth, particularly the molars, participate in the final mulling of the food before the bolus
enters the digestive tract.
If we were to choose which teeth are the most important, we would select the
canines and first molars. The maxillary and mandibular canines are firmly buttressed in
the corner of the arches, and the maxillary first molars are anchored in the zygomatic
processes of the maxilla (Figure 1-13).

Figure 1-13 Locations of the canine and the first molar

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A. Tooth Numbering Systems


A tooth numbering system enables us to rapidly identify the teeth and speeds our
dental communication. The ability to rapidly associate each number with the specific
tooth must be developed as soon as possible.
There are three prominent numbering systems, the Universal, Palmer
(Zsigmondy/Palmer), and International Numbering Systems. The Universal Numbering
System is the most common system used in the United States. The Palmer Numbering
System uses brackets around the number to designate in which quadrant the tooth is
located. Since this is not conducive to typewriters or computers, it has fallen from favor.
The International Numbering System uses two numbers, one identifies the tooth as
either primary or permanent and the quadrant in which the tooth is located, and the other
number designates the tooth's location in the quadrant. This numbering system has been
adopted by some international organizations, such as the World Health Organization. So
you may encounter this system if you provide dental care in a foreign country. Examples
of these numbering systems are provided in the review sections for the various teeth.

1. Universal Numbering System


In 1968 the American Dental Association recommended the use of the Universal
Numbering System. It designates one letter (A through T) for each primary tooth and one
number (1 through 32) for each permanent tooth (Figure 1-14).

The Universal

Numbering System will be utilized throughout this course and in your predoctoral dental
education.
Numbering begins in the maxillary right quadrant with the third molar being #1
and the second molar #2, the first molar #3, and so forth around the maxillary arch to the
maxillary left third molar, which is #16. Numbering then drops to the mandibular left
third molar (#17) and continues from left to right around the mandibular arch to the

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mandibular right third molar (#32). The tooth need not be present in the oral cavity to
receive its number. The maxillary right first molar is always #3 - whether present or not.

Figure 1-14 Universal Numbering System


It is good to learn the numbers of certain "key" teeth or groups of teeth such as the
canines, which are numbered 6, 11, 22, and 27 and the first molars which are numbered
3, 14, 19, and 30, (Figure 1-15). Then one may count from those points to number the

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adjacent teeth (teeth next to each other) until sufficient practice has been accomplished to
have rapid association of each tooth with its specific number.

Figure 1-15 Key tooth numbers

B. Terms of Orientation
In orienting oneself between front and back, structures toward the front of the
mouth are anterior, and structures toward the back are posterior. Anterior teeth are
incisors and canines, while posterior teeth are premolars and molars (Figure 1-16). The
term medial is used to orient structures toward the middle of the head and the term lateral
indicates structures or movements away from the mid-sagittal plane (Figure 1-17).
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Figure 1-16 Anterior and

Figure 1-17 Mid-sagittal plane

posterior teeth

1. Tooth Surfaces
The crown of the tooth can be thought of as having five sides or surfaces (Figure 118) and the various surfaces of the teeth have names (Figure 1-19). The surfaces of the
anterior teeth are named as follows:
a. Labial or facial - surface of a tooth toward the lips.
b. Lingual - surface of a tooth toward the tongue. For the maxillary teeth only, the
term palatal surface is used interchangeably with the term lingual surface; the
bone and soft tissue forming the "roof of the mouth" is the palate.
c. Mesial - surface of a tooth toward the midline of the arch.
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d. Distal - surface of a tooth away from the midline of the arch.


e. Incisal edge - the biting or incising edge.
The mesial surface of one tooth normally contacts the distal surface of the tooth
anterior to it. In the case of the central incisors, the mesial surface of the right central
incisor contacts the mesial surface of the left central incisor since they meet or contact at
the midline. The place where two adjacent teeth touch is termed the contact area.
The posterior teeth also have 5 surfaces, named as follows:
a. Buccal or facial - the surface of the tooth toward the cheek (corresponds to the
labial surface of anterior teeth). Facial may be used when speaking of the outer
surface of anterior or posterior teeth and is interchangeable with labial or
buccal.
b. Lingual - surface toward the tongue (same as anterior teeth). For the maxillary
teeth only, the term palatal surface is also used interchangeably with the term
lingual surface.
c. Mesial - surface of a tooth toward the midline of the arch (same as anterior
teeth).
d. Distal - surface of a tooth away from the midline of the arch (same as anterior
teeth).
e. Occlusal - the biting or chewing surface.

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Figure 1-18 Sides of teeth

Figure 1-19 Surface names

Proximal surfaces are surface between two teeth. All proximal surfaces are mesial
or distal surfaces, but not all mesial and distal surfaces are proximal surfaces.

2.

Combining Terms of Tooth Surfaces To Describe Angles

(Corners)
Terms for the tooth surfaces are often combined to indicate an area which includes
or is formed by two or more surfaces.

For example, the mesiolabial line angle is

understood to be the junction of the mesial and labial surfaces forming a line and angle.
There are two types of tooth angles: line angles and point angles. Two surfaces
make up a line angle, while three surfaces make up a point angle. When the type of angle
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is not specified, the number of surfaces combined indicates the type of tooth angle, i.e.,
mesiolabio-incisal angle is a point angle.
a. Tooth Line Angles
Line angles are corners or angles formed by the junction of two surfaces which
form it. There are eight line angles for each tooth (Figures 1-18 and 1-20 to 1-22). The
line angles for the anterior teeth are:
1. Mesiolabial (or labiomesial) - the angle where the mesial and labial surfaces
join.
2. Distolabial (or labiodistal) - the angle where the distal and labial surfaces join.
3. Mesiolingual (or linguomesial) - the angle where the mesial and lingual surfaces
join.
4. Distolingual (or linguodistal) - the angle where the distal and lingual surfaces
join. (It gets a little obvious by now!!)
5. Labio-incisal (or incisolabial) - the angle where the labial and incisal surfaces
join.
6. Linguo-incisal (or incisolingual) - the angle where the lingual and incisal
surfaces join.
7. Mesio-incisal (or incisomesial) - the angle where the mesial and incisal surfaces
join.
8. Disto-incisal (or incisodistal) - (guess what?) The angle where the distal and
incisal surfaces join.

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Figure 1-20 Anterior line angles

Figure 1-21 Anterior line angles

The line angles for the posterior teeth are:


1. Mesiobuccal (or buccomesial)
2. Distobuccal (or buccodistal)
3. Mesiolingual (or linguomesial)
4. Distolingual (or linguodistal)
5. Bucco-occlusal (or occlusobuccal)

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6. Linguo-occlusal (or occlusolingual)


7. Disto-occlusal (or occlusodistal)
8. Mesio-occlusal (or occlusomesial)

Figure 1-22 Posterior line angles


NOTE: Some texts list only six line angles for anterior teeth, because the mesial and
distal incisal angles of anterior teeth are rounded, the mesio-incisal and disto-incisal line
angles are considered to be non-existent. They are spoken of as mesial and distal incisal
angles only.
BUT: Eight line angles for each tooth will be utilized in this course; however, one
should have an understanding of variations in terminology.
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b. Tooth Point Angles


Point angles are corners formed by the junction of three surfaces. The point angle
takes its name from the surfaces which formed it. There are four "point angles" for each
tooth (Figures 1-18 and 1-23).
The point angles of the anterior teeth are:
1. Mesiolabio-incisal
2. Distolabio-incisal
3. Mesiolinguo-incisal
4. Distolinguo-incisal
The point angles of the posterior teeth are:
1. Distobucco-occlusal
2. Mesiobucco-occlusal
3. Distolinguo-occlusal
4. Mesiolinguo-occlusal
Note that the order of the surfaces within the word describing the point angle may
vary; e.g. mesiolabio-incisal may also be mesio-incisolabial, labiomesio-incisal, labioincisomesial, incisolabio-mesial, or incisomesiolabial.

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Figure 1-23 Posterior point angles

3. Division of Tooth Surfaces


Tooth surfaces, a portion of a tooth, or contacts of teeth can be divided into
sections, commonly in thirds. The labial surface is routinely divided into cervical or
gingival third, middle third, and incisal third (Figure 1-24).

The buccal surface is

similarly divided into cervical or gingival third, middle third and occlusal third.

Figure 1-24 Division of facial surface with adjacent tooth contacts marked
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Chapter 2. Human Dentition II


The bone that surrounds the teeth is termed the alveolar bone (also referred to as
the alveolar process), Figure 2-1. The tooth socket is termed the alveolus (plural alveoli).

Figure 2-1 Alveolar bone or alveolar process


Each tooth is attached to the alveolus (boney socket) by fibers, which are
collectively termed the periodontal ligament. This fibrous tissue extends from the walls
of the alveolus to the layer of bone-like tissue called cementum, which covers the root of
the tooth. The remaining portion of the tooth not covered by cementum is covered by the
hardest mineralized tissue in the body called enamel. The portion of tooth covered by
enamel is the anatomical crown (Figure 2-2). The junction of the enamel and cementum
is the boundary between anatomical crown of the tooth and the root of the tooth and is
termed the cementoenamel junction (CEJ) or cervical Line. The CEJ is not a distinct
structure, but merely a distinct location. Cervical lines have great importance in dentistry
and will be covered later and in other courses.

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Figure 2-2 Crown, roots, and supporting tissues


The tissue covering the bone and surrounding the teeth is called gingiva (gingival
tissue), and patients often refer to it as the gums. The gingiva may be divided into
attached gingiva and free gingiva. The portion of the gingiva adjacent to the teeth and
firmly attached to the alveolar bone is termed the attached gingiva. Gingiva that extends
coronally (toward the crown) from the attached gingiva is the free gingiva or marginal
gingival. The tissue covering the bone apical to the attached gingiva is a thin vascular
tissue, not attached firmly to the underlying bone called the alveolar mucosa (Figure 2-3).
The linear junction of the attached gingiva with the free gingiva is termed the free
gingival groove. The junction of the attached gingival with the alveolar mucosa is
termed the mucogingival junction.
The most occlusal or incisal extent of the gingiva on a tooth is called the gingival
margin. It varies considerably according to many factors such as age, health of tissue,

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tooth location, etc.

You will need to understand the difference between the terms

marginal gingiva (free gingiva) and gingival margin.

Figure 2-3 Free and attached gingiva


There is a very small space or potential space between the free gingiva and the
tooth. This small space encircling the crown is the gingival sulcus. It is bounded by the
tooth (usually the enamel of the crown) and the epithelium covering the free gingiva. The
"bottom" of the gingival sulcus is the most occlusal extent of the epithelial attachment
(Figure 2-4). This epithelial attachment is a bond around the tooth where the gingival
epithelium forms a union with the tooth. This attachment is extremely important and will
be discussed in many succeeding courses.

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Figure 2-4 Gingival sulcus and epithelial attachment


Periodontium is a collective term referring to all the tissues (bone, gingiva, etc.)
that surround and support the teeth. When one views healthy gingiva (collective term for
the gingival tissues), it should be noted that the gingiva covers a portion of the anatomical
crown. The portion of the crown visible in the mouth (not covered by the gingiva) is
termed the clinical crown. It is important to distinguish between the clinical crown and
the anatomical crown.
The main inner bulk of the tooth is hard tissue termed dentin.

The dentin

surrounds the "nerve" or pulp of the tooth and is covered by enamel in the anatomical
crown and by cementum in the root. The junction of the enamel and dentin (inside the
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crown of the tooth) is termed the dentinoenamel junction (DEJ). This would be visible as
a line in cross sections of the anatomical crown.

The junction of the dentin and

cementum (inside the root of the tooth) is termed the cementodentinal junction, (CDJ),
Figure 2-4.
The soft pulp tissue containing the tooth's vascular as well as the nerve supply,
occupies an irregular central cavity inside the tooth termed the pulp cavity. The pulp
cavity can be divided into 3 general portions, 1) the central portion in the anatomical
crown is termed the pulp chamber, 2) the thin channel(s) extending from the pulp
chamber down the center of the root(s) is (are) termed the pulp canal(s), and 3) the small
projections extending occlusally or incisally within the pulp chamber are termed pulp
horns (Figure 2-5).

33

Figure 2-5 Pulp cavity


Anatomical areas of the crown are often separated into crown elevations and crown
depressions. Many surfaces of crowns are described as concave or convex. Concave
surfaces are depressions. Convex surfaces bulge outward or are elevated from the surface
(Figure 2-6).

34

Figure 2-6 Convex and concave surfaces

A. Crown Elevations
a. Cusps - Elevated projections or points on the crowns of teeth. They are the peaks of
the occlusal surfaces of posterior teeth and the incisal portion of canine crowns.
Incisors do not possess cusps, while canines normally exhibit one cusp, premolars
two or three cusps, and molars four or five. The cusp tip is the most occlusal
termination of the cusp (Figure 2-7).
b. Mamelons - Small, rounded projections of enamel on the incisal ridges of newly
erupted anterior teeth. They are the incisal terminations of the three labial lobes.
They are usually worn away soon after eruption (Figure 2-8).

35

Figure 2-7 Cusps and cusp tips

Figure 2-8 Mamelons

c. Tubercles - Small bumps or cusp-like projections found on the crowns of teeth. They
are variable in size and shape. Tubercles are often thought of as mini-cusps. They are
not a consistent characteristic of teeth.
d. Lobes - One of the primary anatomical divisions of the tooth crown, usually
separated by identifiable developmental grooves (discussed under Crown
Depressions). Lobes are represented by cusps and mamelons and cingula.
e. Cingulum (Plural: cingula) - The rounded eminence in the cervical third of the
lingual surface of anterior teeth (Figure 2-9).
f.

Marginal ridges - The linear elevations found at the mesial and distal terminations
of the occlusal surface of posterior teeth. They are also found on anterior teeth, but
are less prominent, forming the lateral margins of the lingual surface (Figures 2-10
and 2-11).

36

Figure 2-9 Cingulum

Figure 2-10 Marginal ridges of maxillary


anterior teeth

Figure 2-11 Marginal ridges of posterior teeth

37

g. Triangular ridges - Linear ridges on posterior teeth, which run from the cusp tips to
the central area of the occlusal surface. In the mesiodistal cross-section, they tend to
have a triangular shape (Figure 2-12).
h. Transverse ridge - A combination of two triangular ridges which cross the occlusal
surface on a posterior tooth, one from the buccal and one from the lingual. Thus a
transverse ridge is simply a union of two triangular ridges (Figure 2-12).
i.

Oblique ridge - A special type of transverse ridge (composed of two triangular


ridges), only present on maxillary molars. It crosses the occlusal surface in an
oblique direction from the distobuccal cusp tip to the mesiolingual cusp tip (Figure 212).

Figure 2-12 Triangular, transverse, and oblique ridges


j.

Cusps ridges - Each cusp has four cusp ridges extending in different directions
(mesial, distal, facial and lingual) from its tip. They vary in size, shape and sharpness
(Figure 2-13). The cusp ridge which extends toward the central portion of the
occlusal surface is a triangular ridge. The cusp ridges are named by the direction
38

toward which they extend from the cusp tip. Mesial and distal cusp ridges are also
termed mesial and distal cusp arms (Figure 2-13). In this course, the cusp ridge(s) on
the occlusal table will always be referred to as a triangular ridge. The cusp ridge on
the buccal or lingual surface will be referred to as the buccal or lingual ridge. The
ridges on the facial and lingual surfaces of the teeth are rounded and not precise
ridges.

Figure 2-13 Posterior cusp ridges


k. Inclined plane - The sloping area partially bordered by the crests of two cusp ridges.
Normally, each cusp has four inclined planes, two on the occlusal table (form the
triangular ridge) and two form the buccal or lingual surfaces of the cusp. Inclined
planes are named by combining the names of the two cusp ridges between which they
lie (Figure 2-14).

39

Figure 2-14 Inclined Planes and Occlusal Table

B. Crown Depressions
a. Fossa (Plural - fossae) - An irregular concavity, on the surface of a tooth. There is
normally a rather large, shallow fossa on the lingual surface of an anterior tooth
(Figure 2-10), while each posterior tooth exhibits two or more fossae of varying size
and shape on the occlusal surface. There are no distinct borders to locate a fossa.
Fossae are just deeper portions of the occlusal surface, separated by various ridges
(Figure 2-15). It is important to note that all of the fossae on the tooth's occlusal
surface are the same depth. This is a very important feature to remember when you
begin to wax posterior teeth.

40

Figure 2-15 Posterior Tooth Fossae and Grooves


b. Sulcus (Plural - sulci) - A long, narrow depression, usually V-shaped in cross section,
located on the occlusal surface of each posterior tooth. A primary developmental
groove is found at the bottom of the sulcus and the sides are inclined planes of
triangular ridges.
c. Primary Developmental Groove - A groove or line which denotes the border where
the primary parts, or lobes, of the tooth crown have coalesced.

The primary

developmental groove that travels mesiodistally along the center of the tooth is called
the central developmental groove (Figure 2-15).
d. Supplemental (secondary) Developmental Groove - An auxiliary groove that
branches from the primary developmental groove. Its location is not related to the
junction of primary tooth parts. All grooves that are not primary developmental
grooves are considered supplemental developmental grooves for this course (Figure
2-15).
e. Triangular fossa - A depressed area that is formed by the joining of three
developmental grooves. A pit is normally the deepest portion of a fossa.
f.

Pit - A small depressed point that is formed by two or more grooves. The premolars
generally have mesial and distal pits at the base of the triangular fossae. Molars

41

generally have mesial and distal pits at the base of the triangular fossae in addition to
a central pit formed by the convergence of developmental groves.

C. Embrasures
The contact area is the area of interproximal contact between two adjacent teeth.
Since the proximal surfaces of the teeth (mesial and distal) are considerably larger in area
than the proximal contact area, there is a space between the two teeth that surrounds the
interproximal contact where the teeth do not touch. This space is termed an embrasure.
This space is actually a continuous space that surrounds the contact area and
increases in width, as one moves facial, cervical, lingual or occlusal from the
interproximal contact. Embrasures form an irregular area similar to a "doughnut" with
the "hole" at the contact area (Figure 2-16).

Figure 2-16 Anterior Teeth Embrasures


Portions of this space (embrasure) are given several names according to location.
The openings or spaces between the teeth, facial and lingual to the contact area, are
termed the facial embrasure and lingual embrasure, respectively. The small V-shaped
area between the teeth that is occlusal or incisal to the contact area is termed the occlusal
or incisal embrasure.
The embrasure space cervical to the contact area is termed the interproximal
embrasure, interproximal space, gingival embrasure, or cervical embrasure.
42

This

triangular area between the crest of the alveolar bone and the contact area is normally
filled by a pointed projection of the free gingiva termed the interdental papilla or gingival
papilla (Figure 2-17).

Figure 2-17 Interdental papilla or gingival papilla


Embrasures serve as spillways for the food during mastication and allow for proper
protection and stimulation of the periodontium necessary to maintain healthy tissues. If
an imaginary line were drawn in a faciolingual direction bisecting any embrasure space,
the two portions (a mesial portion and a distal portion) should be approximately equal in
size and shape. It should follow from this that the portion of each tooth that forms the
sides of the embrasures must be nearly mirror images of each other. This is necessary to
provide our symmetrical embrasures.

1. Facial or Lingual View.


a. The contact evenly divides the embrasure space mesiodistally.
b. Gingival embrasures decrease in size (mainly occlusogingival height) from anterior
to posterior. They increase in width (buccolingually) from anterior to posterior
(Figures 2-18 and 2-19).

43

Figure 2-18 Maxillary anterior tooth embrasures, labial view. (This photo is of a
typodont; note that gingival embrasures would be filled with gingival papillae in a
healthy patient).

Figure 2-19 Maxillary posterior tooth embrasures, buccal view.

2. Incisal or Occlusal View.


a. The interproximal contacts of the anterior teeth are approximately centered
labiolingually for the thickness of the tooth at that height. Lingual embrasures are
generally wider than labial embrasures (Figure 2-20).

44

Figure 2-20 Maxillary central incisors reduced to expose contact, incisal view.
b. The interproximal contacts of posterior teeth are generally buccal to the buccolingual
center (Figure 2-21).

The lingual embrasures are also wider than the buccal

embrasures of the posterior teeth.

Figure 2-21 Maxillary posterior tooth embrasures, occlusal view.

D. Proximal Contacts
The contacts between adjacent teeth (interproximal contacts) are very important for
arch stability and the health of the periodontium. Their buccolingual and occlusogingival
location, in addition to their size (surface area) are critical. In a mesiodistal direction,
they should be centered over the interproximal space.

45

This allows the proximal

embrasures to be divided into equal halves and allows a symmetrical gingival papillae to
occupy the space.
Contact areas become more gingivally located from anterior to posterior in each
quadrant when viewed from the facial or lingual. The majority of this occlusogingival
effect is due to the crowns becoming shorter. On each tooth, the distal contact area is
generally more cervical than the mesial contact area.
The surface area of the proximal contacts increases in size from anterior to
posterior. Anterior teeth have relatively small proximal contact areas that are centered
labiolingually, while posterior teeth have larger contact areas that are generally located
buccal to the buccolingual center (Figures 2-18 through 2-21). The contact areas become
larger with function (as an individual ages), because as one chews, the adjacent teeth rub
against each other, causing contact areas to wear, and proximal contact areas to increase
in size.

46

Chapter 3. Anterior Teeth


A. Overview
When someone smiles or talks, the anterior teeth are the most noticeable of the
dentition and their shape, alignment, and color are generally extremely important to our
patients. It is tremendously difficult to make a single anterior tooth or all of the anterior
teeth look natural and pleasing. Since esthetics is so important to our patients, throughout
your dental career you will probably continually take classes on how to improve your
anterior restorations.
When calipers are used to compare the mesial to distal dimensions for the
maxillary central incisor and the maxillary lateral incisor, this naturally occurring ratio
was found to be 1.2 to 1.0. There are other ratios that are used by viewing the anterior
teeth from the front and other areas of the body. Additional information can be obtained
by reading Chapter 3 of your Operative Dentistry Textbook.

1. Lobes
Lobes are major anatomical divisions of the tooth and understanding their extent
will help one better visualize the developmental grooves or depressions that separate
them. The lobes are named according to their location, similar to the way in which
surfaces and line angles are named.
All anterior teeth have four lobes: three labial lobes, termed the mesiolabial,
middle labial (or simply labial) and distolabial lobe. The fourth lobe is represented by the
cingulum and termed the lingual lobe (Figure 3-1).

47

Figure 3-1 Maxillary anterior teeth lobes


In incisor teeth, mamelons are the rounded incisal terminations of the three labial
lobes. Remember, these mamelons are usually worn away shortly after the teeth erupt
into the mouth.
The separation of the three facial lobes creates two slight vertical depressions in
the labial surface of anterior teeth. These are termed the mesiolabial and distolabial
developmental depressions. The canines have larger, vertical labial surface depressions
with a fairly prominent ridge (the middle labial lobe) between them (Figure 3-2). The
lingual lobe of each anterior tooth forms the cingulum, and there are only very subtle
depressions from its junction with the rest of the tooth.

Figure 3-2 Labial depressions on maxillary anterior teeth

48

2. Tooth Outlines
Geometric shapes (Figures 3-3 to 3-7) are used to roughly describe the tooth shape
from various views. These shapes should be known for the National Board Dental
Examination Part I that you will take next year.

Figure 3-3 General tooth outlines

Figure 3-4 Geometric shape for

Figure 3-5 Geometric shape for

incisal view of lateral incisor

occlusal view of mandibular first molar

49

B. Incisors
Looking at a smiling mouth, one observes the facial surfaces of the eight incisors.
The facial surface of each incisor crown has a trapezoidal outline with the shorter of the
parallel sides at the gingival aspect and the longer at the incisal (Figure 3-6). From a
proximal view (mesial or distal), all incisors have a triangular outline (Figure 3-7). Try
to visualize this triangular-trapezoidal shape in three dimensions to begin to form a visual
image of the incisors.

Figure 3-6 Trapezoidal facial outline

Figure 3-7 Triangular proximal outline

1. Line Angles
All teeth have four vertical line angles (two facial and two lingual). These form
the mesial and distal "boundaries" of the labial and lingual surfaces. Surfaces and line
angles in the vertical plane are also described as axial surfaces and axial line angles,
respectively. Examine the vertical line angles on the labial surface (mesiolabial and
distolabial line angles) of the maxillary incisors.
50

a. Labial Line Angles


From a facial view, the mesiolabial line angles of the maxillary central incisors are
relatively long and straight when compared to the distolabial line angles which are
somewhat shorter and more curved. The same relationship is true for the maxillary
lateral incisor, although the lateral incisor shows more curvature of both line angles
(Figure 3.8).

Figure 3-8 Maxillary anterior teeth's facial line angles


Viewing the incisal edges of these teeth, the maxillary central incisor at the
mesiolabial line angle appears square or close to 90. The maxillary central incisor at the
distolabial line angle is more rounded (greater than 90 angle), Figure 3-9. Mesiodistally
along the facial surface between these boundaries, the incisal one-third is relatively flat
except for two very slight vertical depressions.
If the teeth are tipped slightly to the lingual, and the middle and gingival thirds of
the facial surface are observed, mesiodistally incisors have a greater convexity as the
gingival margin is approached. The line angles also become slightly more rounded (less
distinct) as the gingival line is approached (Figure 3-10). The labial surface of the
51

maxillary lateral incisor has a similar form to the maxillary central incisor except the
lateral incisor is more round or more convex in all locations.

Figure 3-9 Incisal edges

Figure 3-10 Labial contours

When the mesiolabial and distolabial line angles of the mandibular incisors are
observed from the facial aspect, they are fairly uniform and straight (Figure 3-11). When
these line angles are observed from the incisal aspect, they are very near 90. The labial
surfaces between these line angles are also relatively flat with only slight rounding as the
dentinoenamel junction (DEJ) is approached.

Figure 3-11 Mandibular incisor facial line angles

52

b. Lingual Line Angles


On the lingual surfaces of the maxillary incisors, observe how the mesiolingual and
distolingual line angles coincide fairly well with the mesial and distal marginal ridges
(Figure 3-12). Marginal ridges of anterior teeth were defined previously as the mesial
and distal terminations of the lingual surfaces of anterior teeth. Some maxillary central
incisors will have very prominent marginal ridges, while other teeth have less distinct
marginal ridges.
The incisal one-third of the lingual surface between the marginal ridges is flat to
slightly concave. In the middle and gingival thirds of the lingual surface, this concavity
between the marginal ridges changes into a convexity, the cingulum. The cingulum does
not lie in the center of the tooth, but is displaced distally. The lingual surface of the
maxillary lateral incisor is similar except the marginal ridges, fossa, and cingulum may
be slightly more distinct than for the central incisors (Figure 3-12).

Figure 3-12 Maxillary incisor lingual surfaces


The marginal ridges of some mandibular incisors are distinct, while others are not
well defined. When well formed, the marginal ridges are only distinct in the incisal third.
They blend into the cingulum as slight depressions in the middle and gingival thirds. The

53

remainder of the mandibular incisors lingual surface is less concave and the cingulum is
less convex in comparison to the maxillary incisors (Figure 3-13).

Figure 3-13 Mandibular incisor lingual surfaces


c. Incisal Line Angles
When incisors erupt, they have mamelons, which rapidly wear away.

The

mandibular incisors often occlude with the lingual surfaces of the maxillary incisors near
the incisal edges. As an individual protrudes and retrudes the mandible, the incisal edges
rub across each other, forming a distinct wear pattern.

The incisal surfaces of the

maxillary incisors wear with an incline toward the lingual surface, while the incisal
surfaces of the mandibular incisors wear with an inclination toward the labial surface
(Figure 3-14).
The labio-incisal and linguo-incisal line angles are the incisal boundaries of the
labial and lingual surfaces, respectively. Mesiodistally, these line angles form fairly
parallel arcs (Figure 3-15).

54

Figure 3-14 Incisal edge wear

Figure 3-15 Incisal line angles

Mesio-incisal and disto-incisal line angles are used to describe the two incisal
"corners" as seen in a facial view. The mesio-incisal line angle of the maxillary central
incisor is approximately a right angle, while the lateral incisor's line angle is slightly
more rounded (Figure 3-16).
The disto-incisal line angle of the maxillary central incisor is obtuse or more
rounded than its mesio-incisal line angle. Similarly, the disto-incisal line angle of the
maxillary lateral incisor is more rounded than in the central incisors (Figure 3-17).

Figure 3-16 Maxillary incisor

Figure 3-17 Maxillary incisor

Mesio-incisal line angles

disto-incisal line angles

The mesio-incisal and disto-incisal line angles of the mandibular incisors are all
acute or approach 90. The disto-incisal angle of the mandibular lateral incisors is the
only line angle that is slightly rounded (Figure 3-18).
55

Figure 3-18 Mandibular incisor mesio-incisal and disto-incisal line angles


The teeth tend to have a faciolingual taper (or lingual convergence), which is
especially prevalent among the anterior teeth. In architecture, if stone blocks are used to
build an arch, they must be wider on the outer surface than on the inner surface (Figure 319). This arch of blocks may be used to simulate an arch of teeth. All but one of the
teeth are wider on their facial than on their lingual surfaces (Figure 3-20). The one
exception: the maxillary first molar, which is wider on the lingual aspect than on the
facial aspect.

Figure 3-19 Faciolingual taper

Figure 3-20 Lingual convergence of


maxillary teeth

56

2. Proximal Contacts
Proximal contacts must be observed from two different views. From an incisal
view of anterior teeth, all contacts are centered labiolingually in the incisal and middle
thirds of the teeth, depending on the location of the tooth in the arch (Figure 3-21). From
a facial view, the contact between the maxillary central incisors is near the incisal edge.
In the anterior teeth, the more distal the contact is from the midline, the more cervical it is
located (Figure 3-22).

Figure 3-21 Maxillary incisor proximal

Figure 3-22 Maxillary incisor proximal

contacts, incisal view

contacts, facial view

Although the exact location of proximal contacts vary, the "average" dentition has
the contacts in the following locations and these will be used in this course and may be
seen on your National Board Dental Examination Part I:
Maxillary Tooth
Central Incisor
Lateral Incisor
Canine

Mesial Contact

Distal Contact

I 1/3
I & M 1/3
I & M 1/3

I & M 1/3
M 1/3
M 1/3

Definitions:
I 1/3 - Incisal one-third of proximal surface
M 1/3 - Middle one-third of proximal surface
I & M 1/3 - Junction of incisal and middle thirds of proximal surface

57

In the mandibular arch, the proximal contacts of the anterior teeth are near the
incisal edge. In general, the proximal contacts move slightly more gingival the more
distal the tooth's location. The middle one-third is not reached until the distal of the
canine (Figure 3-23).

Figure 3-23 Mandibular incisor proximal contacts, frontal view


Mandibular Tooth
Central Incisor
Lateral Incisor
Canine

Mesial Contact

Distal Contact

I 1/3
I 1/3
I 1/3

I 1/3
I 1/3
M 1/3

3. Embrasures
Place a large rubber band around the facial surfaces of the maxillary dentiform
(Figure 3-24). It should be near the incisal edges of the anterior teeth. This will make the
facial embrasures easier to visualize from an incisal view. Note the curvature of the
rubber band around the anterior segment.

The rubber band will make the facial

embrasures appear as small triangular shaped spaces. Note the shapes and relative sizes
of these embrasures. Note especially the shape of the portions of the teeth that form the

58

other two sides of this triangular space. Note the "regular" or uniform appearance of the
embrasures (Figure 3-25).

Figure 3-24 Rubber band on typodont

Figure 3-25 Rubber band bordering


embrasures

For the embrasures to have this symmetrical form, the portions of the two adjacent
teeth that form each embrasure must be of very similar form. These adjacent parts of the
two teeth forming the embrasure are approximate mirror images of each other.
Remove one of the maxillary central incisors from the dentiform. Place a mouth
mirror against the mesial surface of the central incisor remaining in the dentiform (Figure
3-26).

59

Figure 3-26 Embrasures should "mirror image" each other


Study the embrasures formed between the central incisor and its image. When
forming a tooth in wax, the borders of the wax pattern that form the embrasure with the
adjacent tooth can be shaped to form an ideal embrasure. These border positions can then
act as landmarks in forming the remainder of the tooth. This ability to form the border
portions of teeth in proper relationship to adjacent structures will be a skill vital to
success in carving teeth to correct form.
The incisal and gingival embrasures should also be studied at this time. Review
the mesial and distal incisal angles of the incisors; these angles are the "sides" of the
embrasures. Study the characteristics of each embrasure individually, i.e., the incisal
embrasure between the two maxillary central incisors is a very small, V-shaped area
(Figure 3-27). The characteristic shape is dictated by the nearly square form of the
mesio-incisal angles and the location of the proximal contact in the incisal one-third.
Compare the incisal embrasures among the other anterior teeth. The incisal embrasures
in both arches generally become slightly wider (more open) the more distal their location
is in the arch. Incisal embrasures also become slightly taller as the proximal contacts
move gingivally.
60

Figure 3-27 Incisal and gingival embrasures

4. Contours
The tooth's contours are its convexities and concavities. The height-of-contour is
the tooth's maximal bulge on the facial, lingual, mesial, or distal surface, measured in the
incisocervical or occlusocervical direction. The height-of-contour is usually expressed as
being in the cervical, middle, or occlusal third of the tooth. These heights of contour
must be memorized for the facial and lingual surfaces and the interproximal contacts for
the mesial and distal surfaces. These will be asked in test questions for this course and
the National Board Dental Examination Part I.
In Figure 3-28, observe the tooth's contour coronal to the gingival tissue and think
about the tooth's height-of-contour locations.

61

Figure 3-28 Height-of-contour


Using the typodont, view the contour of the anterior teeth immediately adjacent to
the gingiva on the facial and lingual surfaces. Note that the tooth does not have a bulge
above the gingiva. Each height-of-contour is the convexity incisal to the CEJ. It must be
noted that in an ideal gingiva to tooth relationship, the undercut area (area cervical to the
height-of-contour) of the tooth is covered by the gingiva.
The angulations of the teeth in the arch also influence the tooth contour. This is
best illustrated by removing a maxillary central incisor from the arch and noting the bulge
of the cingulum when the tooth is positioned vertically. Replace the tooth firmly into the
typodont and note the relationship of the lingual gingiva to the cingulum. The height of
the gingiva and the tooth's labial angulation result in a tooth that does not have undercuts
that would tend to retain plaque.

62

C. Summary Maxillary Anterior Teeth


1. Maxillary Central Incisor
Labial View (Figure 3-29)
1. Anatomical crown length is greater than width.
2. Facial crown outline is trapezoidal with shorter parallel side at the cervical.
3. Incisal outline (edge) is relatively straight.
4. Mesial outline is only slightly convex (relatively straight).
5. Mesial contact area is in incisal one-third.
6. Distal outline is more convex (more rounded) than mesial outline.
7. Distal contact area is at junction of incisal and middle thirds.
8. Mesio-incisal angle is acute or near right angle.
9. Disto-incisal angle is more rounded than mesio-incisal.
10. Single root is basically cone shaped with a blunt apex.
11. Apex of root is usually slightly distal to long axis of tooth.
Lingual View (Figure 3-30)
1. There is shallow lingual fossa in the incisal and middle one-third of the lingual
surface.
2. Lingual fossa boundaries are the incisal ridge, mesial and distal marginal ridges and
the cingulum.
3. Cingulum is located slightly to the distal of center, or it can be said that the mesial
side of the cingulum is longer than the distal side.
4. Crown and root taper lingually, therefore some of mesial and distal surfaces can be
seen from a lingual view.

63

Figure 3-29 Maxillary central incisor,

Figure 3-30 Maxillary central incisor,

facial view

lingual view

Mesial View (Figure 3-31)


1. The crown is triangular in outline with the base at the cervical.
2. The labial outline is just slightly curved.
3. The lingual outline is slightly convex in the cingulum area and reverses to be
slightly concave in the incisal two-thirds.
4. The anatomical crown is widest labiolingually in the cervical one-third.
5. A line drawn through the long axis of the tooth will bisect the apex of the root and
the incisal edge.
6. The cervical line is curved more incisally than on any other tooth.

64

Distal View (Figure 3-32)


Note: The distal view characteristics that are the same as the mesial view are
not repeated, i.e., triangular outline, etc.
1. The incisal one-third of the crown appears to be thicker than from a mesial view due
to the more rounded curvature of the distolabial area.
2. Curvature of cervical line is less than on mesial.

Figure 3-31 Maxillary central incisor,

Figure 3-32 Maxillary central incisor,

mesial view

distal view

Incisal View (Figure 3-33)


1. The outline is roughly triangular with the base being the broad labial surface and the
tooth converging lingually.
2. Incisal edge is relatively straight mesiodistally and bisects labiolingual diameter.
3. Crest of cingulum is located slightly to the distal of the center of the lingual surface.
4. Mesial and distal contact areas are located near the centers of the proximal surfaces
labiolingually.
65

5. Distolabial line angle is more obtuse than mesiolabial line angle.


6. Slight developmental depressions are on the labial surface.

Figure 3-33 Maxillary central incisor, incisal view

2. Maxillary Lateral Incisor


Labial View (Figure 3-34)
1. Crown is smaller than the central incisors crown and the difference between the
crowns length and width is more apparent than with the central incisor.
2. Crown outline is trapezoidal.
3. Incisal outline is more curved than the central incisor's outline.
4. Mesial outline is slightly rounded.
5. Mesial contact area is in the incisal one-third.
6. Distal outline is very convex or rounded.
7. Distal contact area is in the middle one-third.
8. Mesio-incisal line angle is slightly rounded.
9. Disto-incisal line angle is distinctly curved or rounded.
10. Root is pointed and as long or longer than the central incisors root.
11. Root apex is most often curved sharply to the distal.

66

Lingual View (Figure 3-35)


1. Lingual fossa is usually deeper than the central incisors fossa.
2. Mesial and distal marginal ridges are more prominent than the central incisors
marginal ridge.
3. The cingulum is more rounded than the central incisors cingulum.
4. There is often a linguogingival fissure on the distal side of the cingulum, that can
run below the CEJ and cause localized periodontal problems.

Figure 3-34 Maxillary lateral incisor,

Figure 3-35 Maxillary lateral incisor,

facial view

lingual view

Mesial View (Figure 3-36)


1. The crown is triangular in outline with the base of the triangle relatively narrower
than the central incisors.
2. The labial outline is slightly curved.
3. The lingual outline is slightly concave in the middle and cervical thirds.
4. The incisal edge and apex of the root are on a line through the long axis of the tooth.
67

Distal View (Figure 3-37)


1. As in the central incisor, the incisal one-third of the crown appears thicker than in
the mesial view due to the curvature of the distolabial line angle to the lingual.

Figure 3-36 Maxillary lateral incisor,

Figure 3-37 Maxillary lateral incisor,

mesial view

distal view

Incisal View (Figure 3-38)


1. The outline is similar to, but shows more convexity labially and lingually than the
central incisor. This provides more of an ovoid outline compared to the central
incisor's triangular outline.
2. The incisal edge is slightly convex to the labial. The incisal ridge is more prominent
(curved more lingually) than with the central incisors.
3. The crest of the cingulum is slightly to the distal of the center of the tooth.
4. Mesial and distal contact areas are centered labiolingually.

68

Figure 3-38 Maxillary lateral incisor, incisal view

3. Maxillary Canine
Labial View (Figure 3-39)
1. The cusp tip of is slightly mesial to center of crown.
2. Mesial outline is slightly convex.
3. Mesial contact area is at the junction of incisal and middle one-third.
4. Distal outline is very convex at contact area with a concave outline in the cervical
third.
5. Distal contact area is in the center of the middle one-third of the distal surface of the
crown.
6. The mesial cusp arm (cusp arms are the length from the cusp tip to the respective
incisoproximal angle) is shorter than the distal cusp arm. Both have slight
developmental depressions.
Lingual View (Figure 3-40)
1. Has the most prominent cingulum in the mouth.
2. There is a well-developed lingual ridge in the center running incisocervical from the
cusp tip to the cingulum. It is most prominent in the incisal one-third near the cusp
tip and blends into the lingual surface toward the cingulum.
3. Mesial and distal marginal ridges are well developed.
4. There are sometimes slight concave mesial and distal fossae, bordered by the lingual
ridge and the mesial and distal marginal ridges.

69

Figure 3-39 Maxillary canine,

Figure 3-40 Maxillary canine,

facial view

lingual view

Mesial View (Figure 3-41)


1. The outline of the crown is triangular.
2. The labial outline is slightly convex.
3. Lingual outline is a fairly straight slope in the incisal one-half and very convex in
the cingulum area.
4. When wear has taken place, the worn cusp tip and cusp arm will face lingually.
5. The cusp tip is labial to the root apex.
Distal View (Figure 3-42)
1. There is a definite concavity in the distal surface of the crown between the contact
area and the CEJ.
2. The distal marginal ridge is heavier than its mesial counterpart.

70

Figure 3-41 Maxillary canine,

Figure 3-42 Maxillary canine,

mesial view

distal view

Incisal View (Figure 3-43)


1. Mesial and distal contact areas are centered labiolingually.
2. The cusp ridges (mesial & distal cusp arms) are approximately centered
labiolingually or slightly labial to the center.
3. There are two developmental depressions on the labial surface. The mesial
developmental depression is very slight and confined mainly to the incisal portion,
while the distal is more concave and extends more cervically than the mesial.

Figure 3-43 Maxillary canine, incisal view

71

D. Review Maxillary Anterior Teeth

Figure 3-44 Review maxillary anterior teeth, labial, incisal and lingual views

72

Figure 3-45 Review maxillary anterior teeth, mesial and distal views

1. Maxillary Central Incisor


Right
Universal Code:
8
International Code: 1-1
Palmer Notation:
1|

Left
9
2-1
|1

No. of terminal roots:


1
No. of pulp horns (facial view): 3
No. of cusps:
none
No. of developmental lobes:
4

Proximal Contact locations:


Mesial: incisal third
Distal: junction of incisal and middle thirds
Height-of-Contour:
Facial: cervical third
Lingual: cervical third

Identifying characteristics: The largest and most prominent incisor. Disto-incisal angle
is more rounded than mesio-incisal. Prominent lingual features are cingulum, lingual
fossa, and marginal ridges. It may have lingual pit. Has a large, simple pulp cavity with
one root canal. It is not likely to have longitudinal grooves on root.

73

Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

10.5 mm

13.0 mm

8.5 mm

2. Maxillary Lateral Incisor


Right
Universal Code:
7
International Code: 1-2
Palmer Notation:
2|

Left
10
2-2
|2

Proximal Contact locations:


Mesial: junction of incisal and middle thirds
Distal: middle third

No. of terminal roots:


1
No. of pulp horns (facial view): 2
No. of cusps:
none
No. of developmental lobes:
4

Height-of-Contour:
Facial: cervical third
Lingual: cervical third

Identifying characteristics: Is similar to, but smaller than the maxillary central incisor.
Has more prominent marginal ridge and lingual fossa than central incisor and
occasionally has a DL developmental groove along the distolingual aspect that may travel
through the gingival attachment and sometimes along the root. Usually has two rather
than three pulp horns. Has apical accessory canals more frequently than other incisors.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

9.0 mm

13.0 mm

6.5 mm

3. Maxillary Canine
Right
Universal Code:
6
International Code: 1-3
Palmer Notation:
3|

Left
11
2-3
|3

No. of terminal roots:


No. of pulp horns (facial view):
No. of cusps:
No. of developmental lobes:

Proximal Contact locations:


Mesial: junction of incisal and middle thirds
Distal: middle third
1
1
1
4

Height-of-Contour:
Facial: cervical third
Lingual: cervical third

74

Identifying characteristics: Is the largest single rooted tooth in the mouth. Its cingulum
is centered mesiodistally. Its prominent facial ridge is off-center, toward the mesial. It
has a distinct lingual ridge running incisocervical, two lingual fossae on both sides of the
ridge, and a prominent cingulum.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

10.0 mm

17.0 mm

7.5 mm

E. Summary Mandibular Anterior Teeth


1. Mandibular Central and Lateral Incisors
Labial View (Figure 3-46)
1. The crowns appear to be approximately twice as long as they are wide. The lateral
incisor is wider (about 0.5 mm) than the central incisor, with most of the extra width
on the distal surface.
2. The crown outline is trapezoidal.
3. Incisal outline is straight.
4. Mesial and distal outlines are straight.
5. The distal side of the lateral is often shorter than the mesial side causing the incisal
edge (which is straight) to slope downward in a distal direction.
6. Mesial and distal contact areas are in the incisal one-third near the incisal angles.
The distal contact area of the lateral incisor is slightly more cervical than the other
three contact areas.
7. The mesio-incisal angles of central and lateral incisors are sharp.
8. The disto-incisal angle of the central is sharp and the disto-incisal angle of the
lateral is slightly rounded.
9. There are no developmental depressions on the labial surface.
10. Roots are thin and tapered and often curved slightly to the distal.

75

Lingual View (Figure 3-47)


1. Lingual surfaces of both central and lateral are smooth and rounded with no distinct
lingual fossae.
2. Mesial and distal marginal ridges are only very minor elevations.
3. Some mandibular incisors have distinct mesial and distal marginal ridges. They are
prominent only in the incisal one-third.
4. The cingulum (or cingula) are much less distinct than in their maxillary
counterparts.

Figure 3-46 Mandibular central and

Figure 3-47 Mandibular central and

lateral incisors, facial view

lateral incisors, lingual view

Mesial and Distal Views (Figures 3-48 and 3-49)


1. The crowns have a very pointed triangular outline.
2. The labial outline of the crowns is curved in the cervical one-third and is then
straight from the crest of this curvature to the incisal edge.
3. The incisal edge is lingual to the long axis of the tooth.

76

4. The incisal surface, when worn, angles to the labial.


5. The cervical lines extend about 1 mm more apically on the lingual side than on the
labial side.
6. The roots taper evenly to a blunt apex and have mesial and distal depressions in the
proximal root surfaces.

Figure 3-48 Mandibular central

Figure 3-49 Mandibular lateral

incisor, mesial view

incisor, distal view

Incisal View (Figure 3-50)


1. The incisal edge of the central incisor is lingual to the center of the tooth and
straight.
2. The incisal edge of the lateral incisor is lingual to the center of the tooth, but slants
to the distolingual to start the curve of the arch.
3. Both teeth converge lingually.
4. The proximal contacts are centered labiolingually.
5. The lateral incisor appears twisted on its axis in a distolingual direction in
comparison to the symmetrical central.

77

Figure 3-50 Mandibular central and lateral incisors, incisal view

2. Mandibular Canine
Labial View (Figure 3-51)
1. Compared to the maxillary canine, the crown is narrower and as long or longer.
2. The mesial outline is straight and in line with the mesial outline of the root.
3. The mesial contact area is in the incisal one-third.
4. The distal outline is concave cervical to the contact area, but not to the degree of that
in the maxillary canine.
5. The distal contact area is at the junction of incisal and middle one-third.
6. The mesial cusp arm is shorter and more horizontal than the distal cusp arm. The
distal cusp arm slopes apically.
Lingual View (Figure 3-52)
1. The lingual surface is relatively flat and smooth.
2. The cingulum is poorly developed.
3. The marginal ridges are only very slight elevations.
4. The root narrows more lingually than the root of the maxillary canine.

78

Figure 3-51 Mandibular canine,

Figure 3-52 Mandibular canine,

facial view

lingual view

Mesial and Distal Views (Figures 3-53 and 3-54)


1. The labial outline is fairly straight incisal to the slight cervical curvature.
2. The lingual outline is slightly more concave and slopes more apically than the
maxillary lingual outline due to the less prominent cingulum in the mandibular.
3. The cusp tip is lingual to the root apex.

79

Figure 3-53 Mandibular canine,

Figure 3-54 Mandibular canine,

mesial view

distal view

Incisal View (Figure 3-55)


1. The labial outline is less convex than the maxillary canine.
2. The cusp tip and mesial cusp arm are inclined slightly to the lingual.

Figure 3-55 Mandibular canine, incisal view

80

F. Review Mandibular Anterior Teeth

Figure 3-56 Review mandibular anterior teeth, labial, incisal and lingual views
81

1. Mandibular Central Incisor


Right
Universal Code:
25
International Code: 4-1
Palmer Notation:

___

1|

Left
24
3-1

Proximal Contact locations:


Mesial: incisal third
Distal: incisal third

___

|1

No. of terminal roots:


1
Height-of-Contour:
No. of pulp horns (facial view): generally 1 Facial: cervical third
No. of cusps:
none
Lingual: cervical third
No. of developmental lobes:
4
Identifying characteristics: The mesio-incisal and disto-incisal angles are very similar
and acute. Has less prominent lingual features than on maxillary incisors. From a
proximal view, the incisal edge is displaced toward the lingual. The root is flat and the
faciolingual wider than the mesiodistal.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

9.0 mm

12.5 mm

5.0 mm

2. Mandibular Lateral Incisor


Right
Universal Code:
26
International Code: 4-2
Palmer Notation:

___

2|

Left
23
3-2

Proximal Contact locations:


Mesial: incisal third
Distal: incisal third

___

|2

No. of terminal roots:


1
Height-of-Contour:
No. of pulp horns (facial view):generally 1 Facial: cervical third
No. of cusps:
none
Lingual: cervical third
No. of developmental lobes:
4
Identifying characteristics: Compared to the mandibular central incisor, its crown is
slightly wider mesiodistally. The distal end of the incisal edge is rotated toward the
lingual. Its root is larger than the mandibular central incisor root.

82

Average Anatomic
Crown Height
9.5 mm

Average
Root Length
14.0 mm

Average Mesiodistal
Crown Width
5.5 mm

3. Mandibular Canine
Right
Universal Code:
27
International Code: 4-3
Palmer Notation:

___

3|

Left
22
3-3

Proximal Contact locations:


Mesial: incisal third
Distal: middle third

___

|3

No. of terminal roots:


1 or 2
No. of pulp horns (facial view): 1
No. of cusps:
1
No. of developmental lobes:
4

Height-of-Contour:
Facial: cervical third
Lingual: cervical third

Identifying characteristics: Compared to the maxillary canine, its crown is longer,


narrower, and has with less prominent lingual features. The cusp tip is inclined to the
lingual and the distal end of the incisal edge is rotated to the lingual. It has the longest
root in the mandibular arch with longitudinal grooves on the root.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

11.0 mm

16.0 mm

7.0 mm

83

Chapter 4. Introduction to Your Articulator


Your articulator (Figure 4-1) articulates casts to simulate the manner in which the
teeth occlude (Figure 4-2) and the movements of the mandible. This enables the dentist
and dental laboratory technician to fabricate appliances without the patient being present
and provides outstanding visibility of the dental structures.

Figure 4-1 Whip Mix Model 4641Q

Figure 4-2 Articulator with articulated

articulator

casts

The articulator is designed such that the casts can be mounted so the location of the
hinge axis of the articulator corresponds to the location of the patient's TMJ hinge axis.
This enables the articulator to provide mandibular movements similarly to those your

84

patient would make. The upper frame of the articulator simulates the maxilla and the
lower frame simulates the mandible (Figure 4-3).
Figure 4-3 Components of your articulator
Support Pin

Condylar Guidance Knob


Progressive Side-shift Guide

Upper Frame

Condyle Locking Tab


Condylar Guide

Incisal Guide Pin

Condylar Element
Support Pin Storage Compartment
Mounting Plate

Incisal Guide Table

85

Lower Frame

Your articulator is classified as a semi-adjustable articulator, enabling you to


provide a moderate number of adjustments for condylar movements and anterior
guidance. You will use this articulator during your entire predoctoral training; as you
progress through this course and other courses, your understanding of your articulators
ability to simulate your patient's movements will also progress.

Memorize the

components of your articulator; it would be best to do this while viewing your articulator
along with the labeled drawing (Figure 4-3).
Your articulator's upper and lower frames, each have mounting plates, onto which
the dental casts are attached or mounted. The upper and lower frames are connected by a
condylar element that can move forward along the condylar guide to provide condylar
guidance (Figures 4-4 and 4-5).

Figure 4-4 Condylar element (ball)

Figure 4-5 Condylar element in

against centric stop

anterior position

The condylar element (the ball) is generally against the centric stop (the most
posterior aspect of the condylar guide) (Figure 4-4).

When a protrusive or lateral

mandibular movement is made, one or both of the condylar elements move forward.
Casts are mounted in the articulator while the condylar elements are against the centric
stops. To ensure the elements do not inadvertently move while mounting casts or during
86

other procedures, the articulator has a condyle locking mechanism with tabs and when
these condyle locking tabs are placed in the up position the mechanism secures the
condylar elements against the centric stops. With the condylar elements in this position,
rotate the condyle locking tabs so the condylar elements cannot move away from the
centric stops. They are rotated in the other direction to enable the articulator to simulate
protrusive and lateral mandibular movements.
If the condylar guidance knob is loosened, the guidance angle can be changed.
Just below the condylar guidance knob along the side of the upper frame are graduated
markings (Figure 4-6). These markings indicate the angle at which condylar guidance
may be set.

Once the desired angle is set, the condylar guidance knob should be

tightened so this angle does not inadvertently change. Clinically, a wax record of the
patient in a protrusive position is used to enable setting the articulator's condylar
guidance.
In humans, the condyle also has the ability to shift medially and laterally. During
mandibular movements, the lateral pterygoid muscle pulls the condyle forward and
medially, providing a bodily medial side-shift of the mandible. This is called the Bennett
movement and is simulated in the articulator with the progressive side-shift guidance
(Figures 4-7). There is a thumbscrew above the progressive side-shift guide that is
loosened to change the progressive side-shift guidance (or Bennett angle) setting. Once
the desired guidance is set, the thumbscrew should be tightened so guidance does not
inadvertently change. Throughout this course, we will use the arbitrary progressive sideshift setting of 15.

87

Figure 4-6 Condylar guidance

Figure 4-7 Progressive side-shift guide

numbers
The condylar guidance and progressive side-shift numbers are generally marked on
the casts with a felt tip marker. This is helpful in case one of the adjustable components
moves and must be reset or the casts are removed from the articulator and later need to be
remounted.
Most articulators are slightly different from each other, and changing casts from
one articulator to another generally results in errors in articulation. In this situation the
articulator's serial number is also placed on the casts. Since your Whip Mix articulator
has been calibrated to be compatible with any Whip Mix 4000 series articulator and has
the quick mounting plates, it is probably not necessary to record the articulator type used.
The incisal pin establishes the distance the anterior aspects of the upper and lower
frames will be apart, and changing its length simulates changing the vertical relationship
of the maxillary and mandibular arches. One end of the incisal pin has a beveled surface
and the other has a rounded surface. In this course we will generally use the beveled end.

88

Both ends of the incisal pin have graduated markings. In the middle of these
markings is a thick black line that runs around most of the pin. When casts are mounted,
this thick black mark is generally aligned with the top of the metal projection on top of
the upper frame (called the boss), so the upper and lower frames are parallel to each other
(Figure 4-8).
The lower tip of the incisal pin will contact the incisal table. Your articulator came
with three forms of incisal tables. They are 1) a clear plastic incisal block (Figure 4-9),
2) an adjustable incisal guide table (Figure 4-10), and 3) a dovetail incisal block (Figure
4-11). In this course you will use the adjustable incisal guide table and dovetail incisal
block.

Figure 4-8 Properly set incisal pin

Figure 4-9 Incisal block

In the center of the adjustable incisal guide table is a line, and the adjustable incisal
guide table should be positioned on the articulator so this line is towards the anterior
portion of the articulator (Figure 4-10). The incisal guide table should be positioned
(anterior-posteriorly) so the beveled end of the incisal pin rests on this line (Figure 4-12).
With the pin set to this position, you can change the angle or inclination of the incisal
guidance without changing the vertical dimension of your articulator.

89

Figure 4-10 Adjustable incisal

Figure 4-11 Dovetail incisal block

guide table
There are three thumbscrews projecting to the sides of the adjustable incisal guide
table. The shorter one is loosened to change the angulation, or inclination, of the table.
Along the thumbscrew side of the table are graduated markings with numbers that
correspond to the setting for the table's angulation (Figure 4-13); a setting of 0
positions the table flat, or in a horizontal position. After the correct angulation is set, the
thumbscrew should be tightened so the setting does not inadvertently change.

Figure 4-12 Properly aligned (A-P)

Figure 4-13 Angulations for adjustable

adjustable incisal guide table

incisal guide table


90

On each side of the incisal guide table are lateral wings that can be adjusted by the
other two thumbscrews. The anterior surface of the incisal table has graduated markings
with numbers that correspond to the setting for the wings' angulations (Figure 4-14); a
setting of 0 positions the wing flat. After the correct angulation is set, the thumbscrew
should be tightened so the setting does not inadvertently change.

Figure 4-14 Angulations for lateral wings


The adjustable incisal guide table is used to simulate guidance by the anterior
teeth. Its inclination and the inclination of the lateral wings are set to replace the tooth
guidance in order to prevent wear of the stone casts and to provide guidance when tooth
structure or teeth are absent.
The anterior teeth are generally used to set the adjustable incisal guide table. Its
inclination is set first by moving the lower member of the articulator, with its mounted
mandibular cast, forward and adjusting the table inclination. This lets the table and
incisal pin touch in such a way that the teeth only very lightly brush against each other
during excursive movements (laterotrusive, mediotrusive, protrusive, and all movements
in-between these). The lateral wings are raised so the wings and incisal pin touch in such
91

a way that they similarly only allow the teeth to lightly brush against each other in lateral
movements (Figure 4-15).

Figure 4-15 Adjusting lateral wings of the incisal guide table


A: Anterior teeth and incisal pin positioned with casts in maximum intercuspation
position (MI).
B: Anterior teeth and incisal pin positioned with mandibular cast in left laterotrusion.
Note the right wing is raised, the pin is in contact with the wing, and the left
maxillary and mandibular canines are in contact.
C: Anterior teeth and incisal pin positioned with mandibular cast in right laterotrusion.
Note the left wing is raised, the pin is in contact with the wing, and the right
maxillary and mandibular canines are in contact.
The relationship between the incisal guidance and cuspal inclination is dramatized
in Figure 4-16, with an enlarged lower tooth form (broken line) superimposed upon
various degrees of incisal guidance. In Figure 4-16A, the incisal guide lateral wing
inclines are steep, so the posterior teeth can accommodate steep cuspal inclinations. In
Figure 4-16B, the incisal guide lateral wing inclines are shallow, so the posterior teeth
must have shallow cuspal inclines for the posterior teeth to be in harmony with the incisal
guidance.
92

Figure 4-16 Relationship between the incisal guidance and cuspal inclination

93

Chapter 5. Occlusal Contact Relationships and


Basic Mandibular Movements
Dentists routinely apply the principles of a patient's static occlusal relationships
and dynamic mandibular movements into their design of the patient's tooth surfaces.
Prior to discussing these concepts, a basic understanding about supporting and guiding
cusps is necessary. This chapter will introduce occlusal contact relationships that occur
in maximum intercuspation (centric occlusion) of the teeth and in mandibular movements
(excursive or eccentric movements).
The buccal and lingual cusps have different functions, and their functions are
opposite in the maxillary and the mandibular arches. As viewed from the frontal plane
(Figure 5-1), it can be visualized that, if the teeth are squeezed together in maximum
intercuspation, the maxillary lingual cusps and mandibular buccal cusps support the load
of the occlusal forces, and these cusps are termed supporting cusps (also called centric
holding, functional, and stamp cusps).

The maxillary buccal cusps and mandibular

lingual cusps do not support the occlusal load in maximum intercuspation, but they may
guide the mandible during excursive (or eccentric) movements and are termed guiding
cusps (also called non-functional and shear cusps).
Many use the pneumonic "BULL" to remember the guiding cusps with B = buccal,
U = upper, L = lingual, and L = lower. This may make it easier for you to remember that
the guiding cusps are the buccal of the upper and lingual of the lower.

94

Figure 5-1 Cusps of posterior teeth, frontal view

A. Static Occlusal Relationships


In the normal alignment of the teeth, each mandibular tooth is positioned both
lingual and mesial to its maxillary counterpart until the midline is reached (Figure 5-2).
In the maximum intercuspation position, occlusal contacts may occur in one of two
primary forms presented below. It should be noted that the following descriptions relate
to "ideal" contact relationships and healthy individuals often show variations from these
patterns.

Figure 5-2 Static occlusal relationships

95

Students find these relationships are easy to memorize by using the diagram in
Figure 5-3.

Figure 5-3 Static occlusal diagram

1. Cusp-to-Marginal Ridge and Cusp-to-Fossa Occlusion


This is the more common occlusal scheme, test questions more commonly refer to
this occlusal scheme, and it is sometimes referred to as the "normal" or "ideal" occlusal
scheme. From the occlusal view (Figure 5-4), observe that the mandibular buccal cusps
occlude as follows:
a. The mandibular first premolar buccal cusp contacts the marginal ridges of the
maxillary canine and maxillary first premolar.
b. The mandibular second premolar buccal cusp contacts the marginal ridges of the
maxillary first premolar and the maxillary second premolar.
c. The mesiobuccal cusp of the mandibular first molar contacts the marginal ridges of
the maxillary second premolar and the maxillary first molar.
d. The distobuccal cusp of the mandibular first molar contacts the central fossa of the
maxillary first molar.
e. The mesiobuccal cusp of the mandibular second molar contacts the marginal ridges of
the maxillary first and second molars.
f. The distobuccal cusp of the mandibular second molar contacts the central fossa of
maxillary second molar.

96

Figure 5-4 Cusp-to-marginal ridge and cusp-to-fossa occlusion


By referring to Figure 5-4, visualize the contact relationships of the maxillary
lingual cusps. A corresponding cusp-to-marginal ridge pattern occurs in addition to the
following two contacts:
a. The mesiolingual cusp of the maxillary first molar contacts in the central fossa of the
mandibular first molar.
b. The mesiolingual cusp of the maxillary second molar contacts the central fossa of the
mandibular second molar.
To further visualize the cusp-to-fossa and cusp-to-marginal ridge occlusion, the
buccal and lingual views are provided in Figures 5-4 and 5-5.

97

Figure 5-5 Cusp-to-fossa and cusp-to-

Figure 5-6 Cusp-to-marginal ridge and

marginal ridge occlusion, buccal view

cusp-to-fossa occlusion, lingual view

2. Cusp-to-Fossa Occlusion
While having some similarities with the cusp-to-marginal ridge and cusp-to-fossa
relationship, the cusp-to-fossa relationship locates the mandibular buccal cusps with
fossae of maxillary teeth and the maxillary lingual cusps with fossae of mandibular teeth
(Figure 5-7). The mandibular buccal cusps contact as follows:
a. The buccal cusp of the mandibular first premolar contacts the mesial fossa of the
maxillary first premolar.
b. The buccal cusp of the mandibular second premolar contacts the mesial fossa of the
maxillary second premolar.
c. The mesiobuccal cusp of the mandibular first molar contacts the mesial fossa of the
maxillary first molar.
d. The distobuccal cusp of the mandibular first molar contacts the central fossa of the
maxillary first molar.
e. The mesiobuccal cusp of the mandibular second molar contacts the mesial fossa of the
maxillary second molar.
f. The distobuccal cusp of the mandibular second molar contacts the central fossa of the
maxillary second molar.

98

Figure 5-7 Cusp-to-fossa occlusion


The maxillary lingual cusps will follow a corresponding pattern of contacts in
fossae as seen in Figure 5-7. Buccal and lingual views of the cusp-to-fossa relationships
are provided in Figures 5-8 and 5-9.

Figure 5-8 Cusp-to-fossa occlusion,

Figure 5-9 Cusp-to-fossa occlusion,

buccal view

lingual view

B. Mandibular Movements
The border movements are the maximal extent the mandible can move in any
direction. In normal function of the mandible (functional movements), we rarely go to
99

these border-movement positions but may do so, i.e., when we yawn or yell at maximal
opening. There are two primary movements that the temporomandibular joint (TMJ) is
capable of making; these are rotation (hinge movement) and translation (sliding
movement) (Figure 5-10).
The mandibular border movements in the sagittal plane are shown in the diagram
in Figure 5-11, with the following positions identified:
A.

Maximum protrusive

B.

Maximum intercuspation (MI), maximum intercuspation position (MIP), or


Centric Occlusion (CO)

C.

Retruded contact position (Centric Relation Contact)

C-F. Hinge axis movement [rotation in Centric Relation (CR)]


D.

Maximum opening

E.

Normal opening and closing pathway

Figure 5-10 Mandibular movements

Figure 5-11 Border movements

in sagittal plane

in sagittal plane

From the frontal view, individuals are able to move their mandible laterally to the
left and to the right. Visualize the mandible as an individual moves it to the right. As
100

this occurs, the right side of the mandible is moving laterally; the movement is termed
laterotrusive movement and the right side of the mandible is in laterotrusion. Again as
the mandible moves to the right, the left side of the mandible is moving medially; the
movement is termed mediotrusive movement and the left side of the mandible is in
mediotrusion. The side of the laterotrusive and mediotrusive movements reverse when
the mandible moves to the left.
The laterotrusive side is also termed the working side; this is because as an
individual chews, the mandible moves to the side of the food.

Conversely, the

mediotrusive side is termed the non-working or balancing side.

The laterotrusive

(working) and mediotrusive (non-working or balancing) sides reverse when the mandible
moves in the opposite direction.
Understanding tooth contacts that occur during the various movements is important
in most aspects of Dentistry. As a foundation, you will be required to know the ideal
contacts in maximum intercuspation (MI) of both occlusal schemes. These contacts will
be further studied in your Maximum Intercuspation Exercise.

Figure 5-12 Mandibular movements in frontal plane

101

Chapter 6. Posterior Teeth


The third molars (wisdom teeth) are often similar to the second molars, but vary
more from individual to individual. Therefore, in this course and the National Board
Dental Examination Part I, their anatomical form is not discussed. You need to know the
average ages for which they calcify and erupt.

A. Lobes and Associated Structures


Lobes of posterior teeth are discussed to help you understand the major
developmental grooves that separate the lobes. Posterior lobes, as anterior lobes, are
named by their location.
Most premolars have four lobes, three facial and one lingual - EXCEPTION there are two forms of the mandibular second premolar - one type has two cusps (one
buccal and one lingual), while the other has three cusps (one buccal and two lingual). In
the 3-cusp type mandibular second premolar, there are 5 lobes (Figure 6-1).

Figure 6-1 Lobe form of posterior teeth


102

The "average" maxillary and mandibular first molars have 5 lobes, while the
"average" maxillary and mandibular second molars have four lobes. The lobes are also
named by their location.
For the interrelationship with other areas of dentistry, it is necessary for you to
understand the terms groove, fissure, and pit. A groove, or a developmental groove, is a
linear channel on the surface of the tooth, usually the junction of the dental lobes. A
fissure is a developmental linear cleft, the result of incomplete fusion of the enamel of
adjoining dental lobes. A pit is a pinpoint fissure or the junction of several fissures.
The central developmental groove of the premolars is the demarcation between the
facial lobe and the lingual lobe(s). The mandibular second premolar that has two lingual
cusps, has a lingual developmental groove separating these cusps (Figure 6-2).
The premolars also have vertical developmental depressions on their facial
surfaces, which distinguish the three facial lobes. These are termed the mesiobuccal and
distobuccal developmental depressions (Figure 6-3).

Figure 6-2 Mandibular second

Figure 6-3 Facial developmental

premolar developmental grooves

depressions

The central developmental groove of maxillary molars separates the two buccal
and two lingual lobes (Figures 6-4). The buccal developmental groove separates the two

103

buccal lobes and the distal oblique and lingual developmental grooves separate the
mesiolingual and distolingual lobes (Figure 6-4).

Figure 6-4 Maxillary first molar developmental grooves


The mandibular first molars have five lobes, three on the buccal (Figure 6-5). The
most distal of the buccal lobes (called the distal lobe) is represented by the distal cusp and
separated from the distobuccal lobe (cusp) by the distobuccal groove. The distobuccal
lobe is separated from the mesiobuccal lobe by the mesiobuccal groove.

Most

mandibular second molars have four lobes, without the distobuccal developmental groove
and distal lobe.
The central groove of the mandibular molars, separates the buccal lobes from the
two lingual lobes. The two lingual lobes are separated by the lingual developmental
groove.

104

Figure 6-5 Mandibular first molar developmental grooves

B. Angulations of Teeth
If the various teeth are arranged in the arches according to an ideal pattern, each
tooth has a definite angulation away from the individual's vertical. When the teeth are
viewed from the side, there is a mesial angulation of the teeth (Figure 6-6). Observe that
the most vertical teeth are the premolars.
When the teeth are viewed from the anterior or posterior aspect, the crowns of the
maxillary posterior teeth have a buccal inclination, while the crowns of mandibular
posterior teeth have a lingual inclination (Figure 6-7). The amount of buccal and lingual
angulation increases the more distally the tooth is located in the arch.

105

Figure 6-6 Facial view of angulations

Figure 6-7 Proximal view of angulations

Viewing the maxillary buccal cusp tips from the buccal aspect, a gentle anterior to
posterior convexity is formed (Figure 6-8). This curvature is termed the curve of Spee or
anteroposterior curve and defined as the curve produced by a line connecting the cusp tip
of the maxillary canine and buccal cusp tips of the premolars and molars. The curve of
Spee also occurs in the mandibular arch as a concavity, corresponding to the maxillary
arch's convexity.
Viewing the posterior teeth from the anterior or posterior aspect, another curved
line is formed, termed the curve of Wilson or mediolateral curve. It is formed by the
lingual inclination of the mandibular posterior teeth and the buccal inclination of the
maxillary posterior teeth.

It forms a convexity on the maxillary arch and has a

corresponding concavity on the mandibular arch (Figure 6-9).

106

Figure 6-8 Curve of Spee

Figure 6-9 Curve of Wilson

Try to visualize these two curved lines combined to form a spherical plane. The
maxillary arch is convex like the outer surface of a sphere and the mandibular arch is
concave like the inner surface of the sphere (Figure 6-10). This spherical plane is termed
the Curve of Monson or compensating curve. It is sometimes compared with a mortar
and pestle, with the maxillary arch the convex pestle and the mandibular arch the concave
mortar (Figure 6-11).

Figure 6-10 Curve of Monson

Figure 6-11 Mortar and pestle

107

If the maxillary and mandibular casts are intercuspated (interdigitated) into MI, the
maxillary anterior teeth and buccal cusps slightly overlap the mandibular teeth on the
facial aspect (Figure 6-12). On the lingual aspect, the mandibular lingual cusps slightly
overlap the maxillary lingual cusps (Figure 6-13).

The amount of vertical overlap

decreases as the tooth is located more distally in the arch (Figure 6-14).

Figure 6-12 Facial overlap

Figure 6-13 Lingual overlap

Figure 6-14 Variations in overlap

C. Occlusal Table
The facio-occlusal (occlusofacial) line angles are formed by the junction of the
facial and occlusal surfaces of the teeth, and the linguo-occlusal (occlusolingual) line
angles are formed by the junction of the lingual and occlusal surfaces. The facio-occlusal
and linguo-occlusal line angles in both the maxillary and mandibular quadrants form a
fairly straight continuous imaginary line along the posterior teeth (Figure 6-15). The
108

central developmental grooves of the posterior teeth are also aligned in a more or less
continuous groove from anterior to posterior (Figure 6-16).
The facio-occlusal and linguo-occlusal lines are the facial and lingual extent of the
occlusal table (occlusal surface).

Even though the molar teeth are much wider

(faciolingually) than the premolar teeth, notice the occlusal tables of the molars are only
slightly wider than the occlusal tables of the premolars (Figure 6-15). The maxillary
molars additional bulk is primarily on the lingual aspect, lingual to the cusp tips, while
the mandibular molars additional bulk is primarily on the buccal aspect.

Figure 6-15 Facio-occlusal and

Figure 6-16 Central grooves

linguo-occlusal line angles

D. Vertical Line Angles


As described earlier, the term line angle is defined as the line formed by the
junction of two surfaces. All teeth have four vertical line angles formed by the junction
of facial, lingual, mesial, and distal surfaces (Figure 6-17). Viewing the posterior teeth
from the occlusal, the facial line angles of the premolars are fairly distinct, the facial line

109

angles of the molars are rounded, and the lingual line angles of the premolars and molars
are more rounded and not as delineated (Figure 6-18).

Figure 6-17 Vertical line angles

Figure 6-18 Line angle prominence

Closely view the facial line angles of the premolars from the facial aspect and
observe that the line angles in the occlusal one-third are very distinct and angular, while
the line angles in the gingival one-third are quite round (Figures 6-19). Also note the
mesiofacial and distofacial line angles converge as they move cervically.

The

mesiodistal distance is smaller at the CEJ than at the contact areas for all teeth, so all
mesiofacial and distofacial line angles converge as they move cervically. This rounding
and converging of the line angles occurs for all vertical line angles, but is most easily
visualized in the facial line angles of the premolars and anterior teeth, due to their
prominence.

110

Figure 6-19 premolar line angles

Figure 6-20 Marginal ridges

E. Marginal Ridges
Marginal ridges were previously defined as the mesial and distal terminations of
the occlusal surfaces in posterior teeth (Figure 6-20). It is very important that adjacent
marginal ridges be the same height. In other words, the crest of the distal marginal ridge
should be the same height as the crest of the mesial marginal ridge of the next tooth distal
to it (Figure 6-21).
It is also important to note that the two adjacent teeth do not contact at the crest of
these ridges, but there is a small embrasure occlusal to the proximal contact.

The

occlusal embrasure is formed by the curved sides of the marginal ridges from the
proximal contact to the crests of the marginal ridges.
It is also important to observe that the crests of the marginal ridges are level for
their entire buccolingual distance. As the marginal ridge surface slopes from its crest
toward the center of the tooth, the surface flows into the respective mesial or distal
triangular fossa (Figure 6-21).

111

Figure 6-21 Characteristics of posterior marginal ridges

F. Summary of Premolars
1. Maxillary First Premolar
Buccal View (Figure 6-22)
1. The crown outline is trapezoidal.
2. The mesial cusp arm of the buccal cusp is fairly straight and longer than the distal
cusp arm. The distal cusp arm is shorter and more curved.
3. The mesial outline is concave from below the CEJ to the mesial contact area; this is
a fairly broad concavity.
4. The mesial contact area is just cervical to the junction of the occlusal and middle
thirds (contact is in the middle third)
5. The distal outline is straighter from the CEJ to the distal contact area than the mesial
outline, although still slightly concave.
6. The distal contact area is located in the middle third as is the mesial contact area.
7. The buccal cusp tip is pointed and located slightly distal to the center of the buccal
surface.
8. There is a prominent buccal ridge on the buccal surface and the mesiobuccal and
distobuccal line angles are very distinct in the occlusal third of the buccal surface.
9. The vertical developmental depressions are seen in the occlusal one-third of the
buccal surface. The mesial depression is the more concave.

112

Lingual View (Figure 6-23)


1. The lingual portion of the crown is narrower mesiodistally than the buccal portion.
2. The lingual cusp tip is pointed and located mesial to the buccal cusp tip so that the
distal cusp arm is longer than the mesial cusp arm.

Figure 6-22 Maxillary first premolar,

Figure 6-23 Maxillary first premolar,

buccal view

lingual view

Mesial View (Figure 6-24)


1. The crown outline is trapezoidal, with the short parallel side of the trapezoid at the
occlusal aspect.
2. The buccal height-of-contour (greatest convexity of the buccal outline) is in the
cervical third.
3. The lingual height-of-contour is usually near the center of the middle one-third.
4. The lingual cusp tip is about 1 mm shorter than the buccal cusp tip.
5. The cusp tips are located within the confines of the root surfaces.
6. Approximately half the maxillary first premolars have 2 roots (1 buccal and 1
lingual); the other half have a single root.

113

7. A distinguishing feature of this tooth is the mesial developmental depression. It is a


marked concavity just cervical to the contact area and centered on the mesial surface
of the crown. This concavity extends onto the mesial root surface.
8. There is also a well-defined developmental groove that crosses the mesial marginal
ridge just lingual to the mesial contact area and ends just cervical to the crest of the
marginal ridge.
9. When the root is bifurcated, it is only bifurcated for about one-half its total length;
therefore, there is a long root trunk (the distance from the CEJ to the bifurcation.
Distal View (Figure 6-25)
1. There is no developmental depression on the distal surface of the crown.

Figure 6-24 Maxillary first premolar,

Figure 6-25 Maxillary first premolar,

mesial view

distal view

Occlusal View (Figure 6-26)


1. The occlusal outline is roughly hexagonal.
2. The crown is wider in the buccal third than in the lingual third.

114

3. On the buccal surface, there is a prominent buccal ridge, the buccal developmental
depressions are prominent, and the mesiobuccal and distobuccal line angles are very
distinct in the occlusal third.
4. The mesiobuccal cusp arm meets the mesial marginal ridge at nearly a right angle,
while the distobuccal cusp arm meets the distal marginal ridge at an acute angle.
5. The mesiolingual cusp arm is shorter than the distolingual cusp arm. Both are
smoothly curved and blend uniformly into the mesial and distal marginal ridges
respectively.
6. The central developmental groove divides the occlusal table into buccal and lingual
halves.
7. Two distinct grooves extend from the mesial and distal pits toward the mesiobuccal
and distobuccal line angles. They are termed the mesiobuccal and distobuccal
developmental grooves, respectively.
8. The buccal triangular ridge is distinct, while the lingual triangular ridge is less
prominent.

Figure 6-26 Maxillary first premolar, occlusal view

2. Maxillary Second Premolar


NOTE: Many characteristics from each view will be similar to those of the maxillary
first premolar and will not be repeated here. Only differences and distinctive features
will be listed.

115

Buccal View (Figure 6-27)


1. It is similar to first premolar, but more symmetrical.
2. The mesiobuccal and distobuccal line angles are less prominent than in the first
premolar.
3. The mesial cusp arm of the buccal cusp is shorter than the distal cusp arm; the
reverse of the maxillary first premolar.
4. The mesial and distal contact areas are in the middle thirds.

Figure 6-27 Maxillary second premolar, Figure 6-28 Maxillary second premolar,
buccal view

lingual view

Mesial View (Figure 6-29)


1. The buccal and lingual cusps are more nearly the same height than in the first
premolar.
2. There is no mesial marginal groove crossing the mesial marginal ridge.
3. The mesial surface does not have a marked concavity as does the first premolar.

116

4. The buccal and lingual cusp tips are slightly farther apart than those of the first
premolar.
5. The buccal height-of-contour is in the cervical third, while the lingual height-ofcontour is in the middle third.

Figure 6-29 Maxillary second premolar, Figure 6-30 Maxillary second premolar,
mesial view

distal view

Occlusal View (Figure 6-31)


1. The occlusal outline is ovoid rather than hexagonal (as is the first premolar).
2. The mesiobuccal and distobuccal line angles are slightly more rounded than those of
the first premolar.
3. There is less lingual convergence than in the first premolar.
4. Its occlusal surface has numerous supplemental grooves giving it a "wrinkled"
appearance.

117

Figure 6-31 Maxillary second premolar, occlusal view

3. Mandibular First Premolar


Buccal View (Figure 6-32)
1. The crown outline is "roughly" trapezoidal.
2. The mesial and distal outlines are similar except that the distal outline is slightly
more concave cervical to the contact area.
3. The mesial and distal contact areas are in the middle thirds.
4. The buccal cusp tip is large, pointed, and mesial to the tooths midline. There is
often a slight concavity (dip) in the distal cusp arm.
5. There is a prominent development of the middle-buccal lobe, termed the buccal
ridge, that extends from the cusp tip down the buccal surface of the tooth.
Lingual View (Figure 6-33)
1. The occlusal surface slopes dramatically toward the lingual, enabling most of the
occlusal surface to be visible from this view.
2. There are concavities between the CEJ and contact areas in the lingual portions of
the mesial and distal surfaces.
3. There is a very small lingual cusp in alignment with the buccal triangular ridge on
the occlusal surface.
4. The root is very narrow on the lingual side and tapers evenly to a pointed apex.

118

Figure 6-32 Mandibular first premolar, Figure 6-33 Mandibular first premolar,
buccal view

lingual view

Mesial View (Figure 6-34)


1. From a mesial view, the crown has a rhomboidal outline.
2. The tip of the buccal cusp is centered over the root, while the tip of the lingual cusp
is in line with the lingual border of the root.
3. The buccal outline is very convex from the CEJ to the buccal cusp tip, and its
height-of-contour is in the cervical third.
4. The mesial surface of the root is smooth and flat, often with deep developmental
grooves.
5. The lingual height-of-contour is in the middle third.
Distal View (Figure 6-35)
1. The distal marginal ridge is located more occlusally and is more horizontal than the
mesial marginal ridge.

119

Figure 6-34 Mandibular first premolar, Figure 6-35 Mandibular first premolar,
mesial view

distal view

Occlusal View (Figure 6-36)


1. The occlusal outline is usually diamond-shaped, but some may be more circular.
2. The mesiobuccal and distobuccal line angles are prominent but rounded.
3. The crown converges sharply to the center of the lingual surface from the mesial and
distal contact areas.
4. Marginal ridges are well-developed.
5. Due to the lingual tilt of the crown, the majority of the buccal surface is seen in this
view, but very little of the lingual surface may be seen.
6. There are mesial and distal fossae on the occlusal surface. The distal is larger and
has the more classic form of a fossa. The mesial fossa is linear and extends
lingually to become the mesiolingual developmental groove.
7. One of the distinctive features of this tooth is its prominent transverse ridge,
composed of the buccal triangular ridge and the lingual triangular ridge.

120

Figure 6-36 Mandibular first premolar, occlusal view

4. Mandibular Second Premolar


Buccal View (Figure 6-37)
1. The mesial and distal contact areas are relatively broad and located in the middle
third.
Lingual View (Figure 6-38)
1. There are two types of mandibular second premolars. One type has two lingual
cusps and the other has only one lingual cusp, see Figure 6-42. Your typodont has
two lingual cusps; the photographs in this section were taken of the type with only
one lingual cusp.
2. In this view of the two-cusp type (only one lingual cusp), there is a single large
lingual cusp that is mesial to the buccal cusp tip allowing the buccal cusp tip to be
observed (Figure 6-38). There is no lingual developmental groove, but a
development depression where the lingual cusps distal cusp arm joins the distal
marginal ridge.
3. In the lingual view of the three-cusp type, there is a mesiolingual and distolingual
cusp. The mesiolingual cusp is larger and longer than the distolingual. There is a
groove separating the two cusps that extends from the occlusal surface onto the
lingual surface.

121

Figure 6-37 Mandibular second

Figure 6-38 Mandibular second

premolar, buccal view

premolar, lingual view

Mesial View (Figure 6-39)


1. The crown and root are wider buccolingually than those of the first premolar.
2. The buccal cusp tip is located more to the buccal and shorter than in the first
premolar.
3. The marginal ridge is at right angles to the long axis of the tooth.
4. The buccal height-of-contour is in the cervical third; the lingual height-of-contour is
in the middle third.

122

Figure 6-39 Mandibular second

Figure 6-40 Mandibular second

premolar, mesial view

premolar, distal view

Occlusal View (Figure 6-41)


1. The crown of the two-cusp type has a rounded outline, while the three-cusp type has
a more square outline.
2. In the two-cusp type, the central developmental groove is most often U- or Hshaped, but may be straight. Its mesiolingual and distolingual line angles are more
rounded, and there is one well-developed lingual cusp tip mesial to the midline.
3. In the three-cusp type, the buccal cusp is the largest, the mesiolingual is the next
largest and the distolingual is the smallest cusp. Each cusp has a triangular ridge,
and cusps are separated by developmental grooves. The mesial and distal portions
of the central developmental groove and the lingual developmental groove form of a
"Y"; a central pit is at their intersection.

123

Figure 6-41 Mandibular first premolar, occlusal view

124

G. Review of Premolars

Figure 6-42 Review premolars, buccal, lingual and occlusal views


125

Figure 6-43 Review premolars, mesial view

126

1. Maxillary First Premolar


Right
Universal Code:
5
International Code: 1-4
Palmer Notation:
4|

Left
12
2-4
|4

Proximal Contact locations:


Mesial: middle third
Distal: middle third

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

2
2
2
4

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

Identifying characteristics: The mesial marginal groove extends onto the mesial surface
and the tooth commonly has a bifurcated root.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

8.5 mm

14.0 mm

7.0 mm

2. Maxillary Second Premolar


Right
Universal Code:
4
International Code: 1-5
Palmer Notation:
5|

Left
13
2-5
|5

Proximal Contact locations:


Mesial: middle third
Distal: middle third

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

1
2
2
4

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

Identifying characteristics: It is similar to maxillary first premolar except the two cusps
are more equal in length and has more supplemental occlusal grooves.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

8.5 mm

14.0 mm

7.0 mm

127

3. Mandibular First Premolar


Right
Universal Code:
28
International Code: 4-4
Palmer Notation:

Left
21
3-4

___

Proximal Contact locations:


Mesial: middle third
Distal: middle third

___

4|

|4

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

1
1
2
4

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

Identifying characteristics: It has two cusps, but the lingual cusp is small, does not
occlude, and has no or very small pulp horn. There is a very prominent transverse ridge
that separates the two occlusal fossae.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

8.5 mm

14.0 mm

7.0 mm

4. Mandibular Second Premolar


Right
Universal Code:
29
International Code: 4-5
Palmer Notation:

___

5|

Left
20
3-5

Proximal Contact locations:


Mesial: middle third
Distal: middle third

___

|5

No. of terminal roots:


1
No. of pulp horns:
2
No. of cusps:
2 or 3
No. of developmental lobes: 4 or 5

Height-of-Contour:
Buccal: middle third
Lingual: middle third

Identifying characteristics: Frequently has three cusps and a "Y" occlusal-groove pattern.
Other occlusal patterns are "H" and "U".
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

8.0 mm

14.5 mm

7.0 mm
128

H. Summary of Molars
1. Maxillary First Molar
Buccal View (Figure 6-44)
1. The crown has a trapezoidal outline.
2. Mesial outline is fairly straight from CEJ to curvature of contact area.
3. The mesial contact is in the middle third of the anatomical crown just cervical to the
junction with the occlusal third.
4. The distal outline is convex.
5. The distal contact is in the middle of the middle third.
6. There are two buccal cusps, the mesiobuccal cusp is broader and higher than the
distobuccal cusp.
7. The buccal groove separates the two buccal cusps.
8. All three roots can be seen from this view. The lingual root is the longest and the
two curved buccal roots are about the same length.
10. The root trunk (the area from CEJ to the bifurcation) averages 4 mm long.
11. The roots are about twice as long as the crown.
Lingual View (Figure 6-45)
1. There is a lingual depression that starts on the cervical third of the crown and
progresses down the lingual root.
2. The mesiolingual cusp is the longest and its mesiodistal width is about three-fifths
of the lingual surface.
3. There is often a fifth cusp (cusp of Carabelli) on the lingual surface of the
mesiolingual cusp about 2 mm cervical to the cusp ridges of the mesiolingual cusp.
Observe this cusp on the tooth in your typodont.

129

Figure 6-44 Maxillary first molar,

Figure 6-45 Maxillary first molar,

buccal view

lingual view

Mesial View (Figure 6-46)


1. The buccal outline is fairly straight with its height-of-contour in the cervical third.
2. The lingual outline is very curved from its height-of-contour in the middle third.
3. The mesial contact area is buccal to the buccolingual center of the crown, and there
is a slight concavity apical to the contact area that extends slightly onto the root
trunk.
4. The lingual root is the longest and diverges lingually from the crown.
5. The mesiobuccal root is broad buccolingually and hides the distal root from this
view.
Distal View (Figure 6-47)
1. The distal one-half of the crown is narrower buccolingually than the mesial half,
allowing some of the mesial half of the tooth to be visible.
2. All three roots are visible with the distobuccal smaller than the other two.

130

Figure 6-46 Maxillary first molar,

Figure 6-47 Maxillary first molar,

mesial view

distal view

Occlusal View (Figure 6-48)


1. The outline is rhomboid shaped.
2. The mesial contact area is buccal to the buccolingual center of the crown.
3. The mesial one-half of the crown is wider buccolingually than the distal one-half.
4. The crown is also mesiodistally wider lingual to the contact areas than buccal to the
contact areas; this is the only tooth that does not have faciolingual taper.
5. The mesiolingual cusp is the largest, followed in size by the mesiobuccal,
distobuccal, distolingual, and fifth cusp.
6. A triangle is formed by the cusp arms of the three major cusps, the mesial marginal
ridge, and the oblique ridge; this is characteristic of all maxillary molars.

131

Figure 6-48 Maxillary first molar, occlusal view

2. Maxillary Second Molar


Buccal View (Figure 6-49)
1. The crown is shorter and narrower than that of the maxillary first molar.
2. The roots are closer together and inclined more to the distal than in the first molar.
3. The mesial and distal contact areas are in the middle third.
Lingual View (Figure 6-50)
1. The distolingual cusp is smaller than in the first molar.
2. There is generally no fifth cusp (cusp of Carabelli).

132

Figure 6-49 Maxillary second molar,

Figure 6-50 Maxillary second molar,

buccal view

lingual view

Mesial View (Figure 6-51)


1. The buccolingual diameter is about the same as that of the first molar, but the crown
is shorter.
2. The roots do not have as great a buccolingual spread as in the first molar.
3. The buccal height-of-contour is in the cervical third, while the lingual height-ofcontour is in the middle third.

133

Figure 6-51 Maxillary second molar,

Figure 6-52 Maxillary second molar,

mesial view

distal view

Occlusal View (Figure 6-53)


1. The outline of the crown is more distinctly rhomboid-shaped than that of the first
molar.
2. The buccal half is larger than the lingual half, and the mesial half is larger than the
distal half.

Figure 6-53 Maxillary second molar, occlusal view


134

3. Mandibular First Molar


Buccal View (Figure 6-54)
1. The crown outline is roughly trapezoidal.
2. Mesial and distal contacts are in the middle third.
4. There are two developmental grooves - the mesiobuccal and distobuccal
developmental grooves
5. It has a mesial root, distal root, and approximately a 3 millimeter root trunk.
6. The mesial root is curved and angles distally, while the distal root is relatively
straight.
Lingual View (Figure 6-55)
1. Mesial outline is convex from CEJ to the broad contact area.
2. The mesiolingual and distolingual cusps are approximately the same size and
separated by the lingual developmental groove.

Figure 6-54 Mandibular first molar,

Figure 6-55 Mandibular first molar,

buccal view

lingual view

135

Mesial View (Figure 6-56)


1. The crown outline is rhomboidal, which is characteristic of mandibular posterior
teeth.
2. The buccal outline is convex with the height-of-contour in the cervical third.
3. The lingual height-of-contour is in the middle third with the lingual outline fairly
straight from the CEJ to the height-of-contour, then fairly rounded to the cusp tips.
4. The occlusal table appears to be displaced lingually.

Figure 6-56 Mandibular first molar,

Figure 6-57 Mandibular first molar,

mesial view

distal view

Occlusal View (Figure 6-58)


1. The crown outline is pentagonal.
2. The mesiobuccal cusp is the largest cusp, followed by the two lingual cusps, the
distobuccal cusp, and the distal cusp.
3. The crown is wider mesiodistally than buccolingually, which is the reverse in
comparison to the maxillary molars.

136

Figure 6-58 Mandibular first molar, occlusal view

4. Mandibular Second Molar


Buccal View (Figure 6-59)
1. There is a buccal developmental groove separating the mesiobuccal and distobuccal
cusps.
2. The roots are shorter and more parallel, but angle more acutely to the distal than
those of the mandibular first molar.
3. The mesial and distal contact areas are in the middle third.

137

Figure 6-59 Mandibular second molar,

Figure 6-60 Mandibular second molar,

buccal view

lingual view

Mesial View (Figure 6-61)


1. The buccal height-of-contour is in the cervical third, while the lingual height-ofcontour is in the middle third.

Figure 6-61 Mandibular second molar,

Figure 6-62 Mandibular second molar,

mesial view

distal view
138

Occlusal View (Figure 6-63)


1. Has a roughly rectangular outline that converges slightly to the lingual.
2. There are usually only four cusps, with the distobuccal cusp as large or larger than
the mesiobuccal cusp.
3. The developmental grooves divide the crown into four roughly equal parts.
4. The distal contact area is centered buccolingually.

Figure 6-63 Mandibular second molar, occlusal view

139

I. Review of Molars
As you compare the maxillary and mandibular first, second, and third molars
(Figure 6-64), notice that from the first to the third molars the crowns are progressively
shorter, roots are progressively shorter, and roots are progressively less divergent. Note
(Figure 6-65) that the tallest cusps of the maxillary and mandibular molars are the
mesiolingual cusps and that the maxillary first molar has a lingual depression.

Figure 6-64 Molars, buccal view

Figure 6-65 Molars, lingual view

140

Notice in Figure 6-66, that the oblique ridges (distobuccal cusp triangular ridge and
mesiolingual distal cusp ridge) are present on all maxillary molars, the distolingual cusps
are progressively smaller from the maxillary first to the third molar, and the mesiodistal
and buccolingual dimensions are progressively smaller from the maxillary first to the
third molar.

Figure 6-66 Maxillary molars, occlusal view


Notice in Figure 6-67, that the mandibular first molar has five cusps, two buccal
grooves, and no transverse ridges. The second and third molars have four cusps, one
buccal groove, and the possibility of two transverse ridges. Also notice mesiodistal and
buccolingual dimensions are progressively smaller from the mandibular first to the third
molar.

Figure 6-67 Mandibular molars, occlusal view

141

1. Maxillary First Molar


Right
Universal Code:
3
International Code: 1-6
Palmer Notation:
6|

Left
14
2-6
|6

Proximal Contact locations:


Mesial: middle third
Distal: middle third

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

3
4
5
5

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

Identifying characteristics: It has five cusps, but the cusp of Carabelli may be very small
or absent. It has a prominent oblique ridge from distofacial to mesiolingual cusp and
distinct buccal and lingual grooves. It has three roots with the lingual being the largest
and spread to the lingual.
The mesiofacial root-tip is the most likely root-tip to be pushed into the sinus.
Since this root has 2 canals, a sectional view of this root is ribbon-shaped.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

7.5 mm

Buccal 12.0 mm
Lingual 13.0 mm

10.0 mm

2. Maxillary Second Molar


Right
Universal Code:
2
International Code: 1-7
Palmer Notation:
7|

Left
15
2-7
|7

Proximal Contact locations:


Mesial: middle third
Distal: middle third

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

3
4
4
4

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

Identifying characteristics: It is similar to maxillary first molar except the fifth cusp is
absent, the crown is shorter occlusocervically and narrower mesiodistally, the oblique
ridge is less prominent, and the three roots lie closer together (sometimes fused).
142

Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

7.0 mm

Buccal 11.0 mm
Lingual 12.0 mm

9.0 mm

3. Mandibular First Molar


Right
Universal Code:
30
International Code: 4-6
Palmer Notation:

Left
19
3-6

___

Proximal Contact locations:


Mesial: middle third
Distal: middle third

___

6|

|6

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

2
5
5
5

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

Identifying characteristics: It has five cusps (mesiofacial, distofacial, distal, mesiolingual


and distolingual), no oblique ridge (unlike maxillary molars), two grooves on the buccal
surface, and two roots (the mesial usually has two canals and the distal one canal). It is
the largest mandibular tooth.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

7.5 mm

14.0 mm

11.0 mm

4. Mandibular Second Molar


Right
Universal Code:
31
International Code: 3-7
Palmer Notation:

___

7|

No. of terminal roots:


No. of pulp horns:
No. of cusps:
No. of developmental lobes:

Left
18
4-7

Proximal Contact locations:


Mesial: middle third
Distal: middle third

___

|7
2
4
4
4

Height-of-Contour:
Buccal: cervical third
Lingual: middle third

143

Identifying characteristics: It has four cusps, each nearly in equal size. Compared to the
mandibular first molar, there is only one facial groove, the crown is smaller in most
dimensions, and the mesial and distal roots are closer together and curved toward the
distal.
Average Anatomic
Crown Height

Average
Root Length

Average Mesiodistal
Crown Width

7.0 mm

13.0 mm

10.5 mm

144

Chapter 7. Primary Dentition


By Lisa M. Abadeer, D.D.S.

A. Formation and Calcification of the Primary Teeth


You need to memorize the eruption and formation pictures of the primary teeth in the
back on your manual.

B. Number of Teeth
20 Primary Teeth
32 Permanent Teeth
Primary Teeth replaced by Succedaneous Teeth
Primary Central

Permanent Central

Primary Lateral

Permanent Lateral

Primary Canine

Permanent Canine

Primary 1st Molar

Permanent 1st Premolar

Primary 2nd Molar

Permanent 2nd Premolar

Succedaneous Teeth - The 20 permanent teeth which replace the primary teeth; they erupt
lingual to the primary teeth.
Accessional Teeth - The 12 permanent molars which erupt distal to the primary second
molars.

145

C. Designation of the Primary Dentition


Universal
Maxillary Right 2nd Molar
A
Maxillary Right 1st Molar
B
Maxillary Right Canine
C
Maxillary Right Lateral Incisor
D
Maxillary Right Central Incisor
E
Maxillary Left Central Incisor
F
Maxillary Left Lateral Incisor
G
Maxillary Left Canine
H
Maxillary Left 1st Molar
I
Maxillary Left 2nd Molar
J
Mandibular Left 2nd Molar
K
Mandibular Left 1st Molar
L
Mandibular Left Canine
M
Mandibular Left Lateral Incisor
N
Mandibular Left Central Incisor
O
Mandibular Right Central Incisor P
Mandibular Right Lateral Incisor Q
Mandibular Right Canine
R
Mandibular Right 1st Molar
S
Mandibular Right 2nd Molar
T

FDI
5-5
5-4
5-3
5-2
5-1
6-1
6-2
6-3
6-4
6-5
7-5
7-4
7-3
7-2
7-1
8-1
8-2
8-3
8-4
8-5

D. Comparison of Primary and Permanent Teeth


1. Crown
a. Smaller size
In general, the primary teeth are smaller in overall size and crown dimensions
when compared to the corresponding permanent teeth.
b. Crown proportions
Crowns of the primary anterior teeth are wider in their M - D dimensions relative
to their cervico-occlusal height when compared to their permanent counterparts.
Therefore, the crowns of the primary teeth seem short relative to their total crown
and root length when compared to the permanent teeth.
146

c. Occlusal convergence
The buccal and lingual surfaces of the primary molars converge toward the
occlusal surface and are flatter above the cervical curvatures than those of the
permanent molars. This yields an occlusal surface that is proportionally narrower
in the buccal - lingual dimension than the permanent molars.
d. Cervical ridges
1) Are more pronounced in the primary teeth (e.g. the buccal surface of the
primary 1st molar).
2) The labial and lingual surfaces of the primary anterior teeth have a conspicuous
bulge in the cervical third.
3) The pronounced cervical bulge must be considered in operative procedures
(Stainless steel crown preparation, Class 2 alloys.)
e. Cervical constriction
The primary teeth have a markedly constricted cervix because of the large cervical
bulge.
f. Enamel thickness
1) The enamel thickness of the primary teeth is thinner and more consistent (1
mm) throughout the entire crown than that of the permanent teeth.
2) The enamel thickness is an important consideration in the depth of the cavity
preparations, and in the progression of dental caries.
g. Enamel rods
The enamel rods in the cervical third of the primary crowns slope occlusally rather
than gingivally as seen in the permanent dentition. The occlusal orientation of the
enamel rods means that there is no need to bevel the gingival floor margin of a
primary cavity preparation.
h. Color
The primary teeth are usually lighter in color than the permanent teeth.

147

2. Pulp Morphology
The pulp chambers are proportionally larger in the primary dentition. There is
proportionally less tooth structure protecting the pulp in primary teeth. The pulp horns,
especially the mesial pulp horns, are higher in primary molars than in permanent molars.
Root canals of the primary molars are broad and "ribbon like" with numerous secondary
canals.

Pulp morphology modifies the design of cavity preparations, influences

restorative decisions, and affects pulp therapies in the primary dentition.

3. Root Structure
The roots of the primary teeth are narrower and longer in relative terms than the
roots of the permanent teeth. The roots of the primary molars are more slender and flared
to allow for development of the crowns of the succedaneous (permanent) teeth. There is
very little root trunk in the primary molars with the roots originating almost directly from
the crown. Root morphology is an important consideration in primary pulp therapies, and
may be problematic in oral surgical procedures.

E. Morphology of Individual Primary Teeth


Drawings of the primary teeth are displayed at end of this Chapter.

1. Maxillary Central Incisor


a. The only primary or permanent incisor with a mesiodistal dimension greater than its
cervico-incisal crown height.
b. Has a prominent labial and lingual cervical ridge.
c. Pulp chamber and canal resemble the exterior form of the tooth.

148

d. Root length is greater in comparison to crown length than that of the permanent
central incisor.

2. Maxillary Lateral Incisor


a. Similar morphology to the primary maxillary central incisor except that it is not as
wide mesiodistally, and the cervico-incisal height is greater than the mesiodistal
width.
b. Pulp chamber and canal follow the external contour of the tooth.

3. Maxillary Canine
a. Larger than the maxillary primary incisors in all dimensions.
b. The cervical third of the crown is markedly convex, especially on the labial and
lingual surfaces.
c. Proportionally, the cusp of the primary maxillary canine is much longer and sharper
than that of the permanent successor.
d. The root is more than twice as long as the crown.
e. From the incisal aspect, the crown is essentially diamond shaped with the cusp tip
being slightly distal.

4. Mandibular Central Incisor


a. Smaller in all dimensions than the primary maxillary central incisor. It is the smallest
tooth in the mouth.
b. Although it is a small tooth, the labiolingual dimension is only about 1 mm less than
that of the maxillary primary central incisor.
c. Pulp chamber and canal follow the external anatomy.

149

5. Mandibular Lateral Incisor


a. Similar in all dimensions to the primary mandibular central incisor, but slightly larger.
b. Tendency for the disto-incisal line angle to slope distally.
c. Pulp chamber and canal follow the external anatomy.

6. Mandibular Canine
a. Similar in form and function to the maxillary canine but slightly smaller.
b. The cusp tip is slightly mesial.

7. Maxillary First Molar


a. Intermediate in form between premolar and molar.
b. More nearly resembles the tooth that will replace it than any other primary molar.
c. Has a prominent cervical bulge which is characteristic of primary molars, and in
particular first primary molars.
d. Often not a definite ridge on the occlusal surface, but on some teeth an oblique ridge
will be seen from the mesiolingual cusp to the distobuccal cusp.
e. Pulp camber has three or four pulp horns with the largest being the mesiobuccal.
f. Has three roots: mesiobuccal, distobuccal, and lingual (largest).
g. Roots begin almost immediately at the cervical line, are long and slender, and widely
flared.

8. Mandibular First Molar


a. Unique morphology different than all other primary and permanent teeth.
b. Its chief differing characteristic is a large mesial marginal ridge that often resembles a
fifth cusp.
c. A heavy transverse ridge connects the mesiobuccal and mesiolingual cusps.

150

d. Prominent cervical bulge on the buccal surface that is most pronounced on the
mesiobuccal.
e. The mesial surface is relatively flat.
f. Sharp and prominent mesiolingual cusp.
g. Pulp chamber has four pulp horns with the mesiobuccal being largest.
h. Two roots, M and D, but often has three pulp canals, mesiobuccal, mesiolingual, and
distal.
i. Morphology has significant effects on restorative procedures.

This is especially

important in preparations for stainless steel crowns and MO alloys.

9. Maxillary Second Molar


a. Resembles a maxillary permanent first molar but smaller in size.
b. As is the case with all primary molars, has pronounced cervical bulge.
c. Usually four cusps, but a fifth cusp is possible on the mesiolingual.
d. Strong oblique ridge between the distobuccal and mesiolingual cusps, effectively
dividing the occlusal surface into two sections.
e. Pulp chamber has four pulp horns, the mesiobuccal is the largest.
f. Three flared roots, the lingual is the largest.

10. Mandibular Second Molar


a. Resembles the mandibular permanent first molar.
b. Has five cusps, three on the buccal and two on the lingual.
c. Cervical constriction with the accompanying cervical bulges.
d. The pulp chamber has five pulp horns, the largest are the mesiobuccal and
mesiolingual.
e. There are two roots (mesial and distal) and usually three root canals (mesiobuccal,
mesiolingual, and distal).
151

F. Norms of Primary Dentition Occlusion


1. Mesial surfaces of the maxillary and mandibular incisors are in alignment.
2. The maxillary central incisor occludes with the mandibular central incisor and the
mesial third of the mandibular lateral incisor.
3. The maxillary lateral incisor occludes with the distal two-thirds of the mandibular
lateral incisor and that portion of the mandibular canine which is mesial to its cusp tip.
4. The maxillary first molar occludes with the distal two-thirds of the mandibular first
molar and the mesial portion of the mandibular second molar.
5. The maxillary second molar occludes with the distal surface of the mandibular second
molar.
6. A "flush terminal plane relationship" (the distal of the maxillary second molar is in
alignment with the distal of the mandibular second molar) is also commonly seen in
the primary dentition.
7. Spacing is a common finding in the primary dentition.

152

G. Drawings of Primary Teeth

Figure 8-1 Tooth A

Figure 8-2 Tooth B

Figure 8-3 Tooth C

Figure 8-4 Tooth D


153

Figure 8-5 Tooth E

Figure 8-6 Tooth P

Figure 8-7 Tooth Q

Figure 8-8 Tooth R

154

Figure 8-9 Tooth S

Figure 8-10 Tooth T

155

Chapter 8. Pulp Chambers and Canals


The following are definitions that will be used in this chapter:
The pulp chamber consists of a roof, floor and four walls; the roof contains the pulp
horns. Its size and shape are determined by many factors.
The root canal extends from the pulp chamber floor to the apical foramen.
The apical foramen is the apical opening of the root canal, usually about one-half mm
from the anatomical apex.
The apical constriction is the narrowest point of the root canal, usually about one-half
mm from the apical foramen. Therefore the apical constriction is approximately one mm
from the anatomical apex.
Lateral canals are small branches of the main root canal that leave the main canal at
approximately right angles.
Accessory canals are very small branches of the main root canal in the apical third of the
root (angle apically rather than at right angles) and in the furcation of molars.

A. Pulp Chambers
1. Size and Shape
The pulp chambers size and shape are determined by the contour of the crown,
and the chamber follows the size and shape of the cusps. These also vary with:
1. Age - Increasing amounts of secondary dentin are continually deposited on the walls
of the pulp chamber and cause its size to diminish over time.
2. Caries and/or Restorations - Irritants to the pulp cause dentin to be deposited
reducing the size of the chamber.
3. Trauma Trauma can result in the deposition of dentin to the point of complete
obliteration of the pulp space.

156

2. Anterior Teeth
The pulp horns correspond with the developmental mamelons in the anterior teeth,
which are located under the incisal edges. During endodontic therapy, special care must
be taken to ensure pulpal tissue is not left in the pulp horns.
The dentinal tubules in the cervical region of anterior teeth have an S-shape,
enabling the tooth to transmit color that is below the cervical line in the canal region onto
the surface of the tooths anatomical crown. If this area of the pulp chamber is filled with
a dark filling material, it can darken the anatomical crown.

3. Posterior Teeth
Pulp chambers of posterior teeth appear as miniature versions of the crown. Their
size, in relationship to the thickness of the enamel and dentine, is important both in
endodontics and in operative dentistry.

B. Root Canal System


Teeth as well as their canal systems vary in length, but generally fall within an
average range.

Knowing the average length of the various teeth (e.g., the average

maxillary central incisor is 23 mm long) helps when performing endodontic procedures


on these teeth.
Root canals are rarely straight and generally have varying degrees of irregularities
throughout. Curves within the canals occur in anterior as well as posterior teeth, and
generally the greater the canal curvature, the greater the difficulty in performing the
endodontic procedure. In cross section, the canals are usually round, ovoid, or ribbon
shaped, but other shapes are possible.

157

The number of canals and foramina within one root will also vary. Some common
combinations are: 1 canal with 1 foramen, 2 canals with 1 foramen, 2 canals with 2
foramina, and 1 canal with 2 foramina.
Great variation may also be found in the apical third of the root. It may have the
following: 1) an apical delta, in which the main canal branches several times and the
branches exit through separate foramina; 2) accessory canals in which small branches of
pulp tissue angle apically into the dentine (also present in the furcations of molars); 3)
lateral canals, which are small branches of the main canal that leave the main canal at
approximately right angles, but are usually farther from the apex; 4) the apical foramen,
which is generally a series of openings rather than a single exit; 5) an apical constriction,
which is the narrowest part of the canal (usually located one-half mm from the apical
foramen) and, in endodontics, is the most apical point to which the canal is cleaned and
filled.

C. Specific Teeth
Maxillary Central Incisors
The average length is 23 mm.

The pulp chamber is wide mesiodistally and

somewhat triangular in shape. The canal is round in the apical third and then becomes
ovoid in the mesiodistal dimension at the cervical level. An apical root curve is present
in 25% of these teeth.
Maxillary Lateral Incisors
They are similar to central incisors, but smaller overall. Over 50% have a distal
root curvature. The root is slightly oval in a faciolingual direction and becomes more
round towards the apex. The canal form follows the same shape as the root with the
widest diameter in the cervical area.

158

Maxillary Canines
These teeth are the longest in the arch, averaging 27 mm, but may be as long as 35
mm. The maxillary canine only has one pulp horn, and its pulp chamber is broad
labiolingually and narrow in a mesiodistal dimension. In 60% of these teeth, the root
curves in one direction or another. The cross section of the root is oval in a faciolingual
direction in the cervical third and mid-root, then becomes round in the apical third.
Maxillary Premolars
The first premolar usually has two roots and two main canals. The root shape is
broad labiolingually and narrow mesiodistally, and the pulp chamber is broad
labiolingually and very thin mesiodistally.

When two roots are present, the shape

becomes more round toward the apex, and the roots may curve in any direction.
The second premolar is usually single-rooted, and the pulp-canal space and root
structure are similar to those of the first premolar.
Maxillary Molars
These teeth generally have three roots and a large pulp chamber. The mesiofacial
root is broad faciolingually and thin mesiodistally. Over 50% of the mesiofacial roots of
maxillary molars have a second canal. The mesiofacial pulp horn is located well coronal
under the mesiofacial cusp. The palatal root is the largest, generally round in shape, and
55% of the time curves toward the facial.
Mandibular Incisors
These are smallest teeth in the mouth and often have ribbon shaped pulp chambers
and root canals. Some have a second canal to the lingual of the main canal. The root is
very thin and may have a concavity on the mesial and on the distal surface when there are
two canals.
Mandibular Canines
This tooth usually has an ovoid-shaped root, more broad faciolingually. It usually
has a wide pulp chamber and a straight canal in the coronal and middle thirds.

159

Mandibular Premolars
The crown is set at a 30 angle with the long axis of the root and the root canal
system has a wide variety of canal configurations.
Mandibular Molars
The pulp chamber of this tooth corresponds to the shape of the crown. These teeth
generally have one mesial root and one distal root. The mesial root is broad in a
faciolingual dimension, and 75% of mandibular molars have two separate canals in this
root. If there are two separate canals, they may have separate foramina or may join to
exit via a common foramen. The mesial root usually has a gentle curve to the distal.
The distal root is broad and may contain a ribbon-shaped canal. The distal root
may have two separate canals or there may be two separate distal roots.

160

Chapter 9. Articulators
The dental articulator is for relating casts and replicating mandibular movements
during fabrication of dental appliances. The rigidity of its metal parts and the casts do
not allow for the movement or bending that occurs in the mouth. An example of this
difference is when an individual bites on a thin object between the molars on one side,
the teeth on the opposite side often touch; this does not occur with the articulator.
In general, there are three types of articulators: non-adjustable, semi-adjustable,
and fully-adjustable articulators. The more adjustable the articulator, the more accurate it
can reproduce an individual's condylar movements, but the more time it takes to set its
adjustments.

A. Non-adjustable Articulator
These articulators can range from a hinge articulators, which allow for no to
minimal excursive movements (Figures 9-1 to 9-3), to those that use preset guidances
(Figure 9-4).

When using these articulators, the casts are placed into maximum

intercuspation (MI), usually done by hand-articulating the casts. The casts are arbitrarily
mounted equidistant between the articulator's upper and lower members, and the
articulator is able to accurately reproduce MI. Typically, restorations fabricated in this
manner are adjusted to MI with the articulator. Then the excursive interferences are
identified during the try-in appointment by the patient making these movements and the
dentist removing the interferences at this time.

161

Figure 9-1 Hinge articulator

Figure 9-2 Hinge articulator

Figure 9-3 Hinge articulator that

Figure 9-4 Non-adjustable articulator

allows minimal excursive movements

that allows excursive movements

1. Advantages and Disadvantages


Advantages:
1. They are relatively inexpensive.
2. They are relatively small, so store and ship easily.

162

3. Neither a facebow nor an interocclusal record is used, so time is saved by not making
these.
Disadvantages:
1. Since the articulator does not reproduce accurate excursive movements, more chair
time is needed to intraorally adjust the excursive pathways on the restoration.
2. Poor anatomic form may result if considerable adjustment is required.

2. Recommendations
Consider using this articulator when fabricating single-tooth restorations for
patients with a stable occlusion in MI and an immediate anterior guidance (an anterior
guidance that immediately disoccludes the posterior teeth when mandible moves anterior
or lateral from MI).

B. Semi-adjustable Articulators
These articulators permit closer duplication of the patient's condylar movements
through adjustment of the condylar guide, progressive side-shift guide, and sometimes
the intercondylar distance (Figure 9-5).
Adjusting the condylar guide will allow the articulator to more closely approximate
the angle that the patient's condyle travels along the articular eminence in the sagittal
plane.

The patients occlusal anatomy is reconstructed based upon the articulators

movements, so the more accurate the movements, the more accurate the posterior tooths
grooves, ridges, and cusp height can be fabricated.
The distance between the rotational centers of the condyles has an effect on the
mediotrusive (non-working) and laterotrusive (working) pathways of the supporting
cusps across their opposing occlusal surfaces.

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In theory, the greater the patient's

intercondylar distance, the smaller the angle between laterotrusive (working) and
mediotrusive (non-working) pathways.
The patient with an intercondylar distance smaller than the articulator's will have a
larger angle between pathways than created by the articulator, and intraoral excursive
interferences are likely to occur. As long as the intercondylar distance of the articulator
is the same or smaller than the patient's, it will accommodate the patient's pathways.
Some semi-adjustable articulators have a fixed intercondylar distance. In those,
the intercondylar distance is set smaller than expected, in order to provide clinically
acceptable results. Your dental school articulator is a semi-adjustable articulator (Whip
Mix 4641Q Articulator), has the intercondylar distance fixed.

Figure 9-5 Semi-adjustable Articulator

Figure 9-6 Nonarcon Articulator

Semi-adjustable articulators are designed as either an arcon or nonarcon articulator.


Arcon is a contraction of: articulator-condyle. Arcon describes articulators that have
their condylar guides (simulating the patient's articular eminence) as part of the upper
member and condylar elements (simulating the patient's condyle) as part of the lower
member. Your articulator is constructed in this manner, so it is an arcon articulator,
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which is mechanically similar to the patient's anatomy. Instruments with the condylar
guides and condylar elements on the opposite members are called nonarcon articulators
(Figure 9-6).

1. Setting the Semi-adjustable Articulator


Three procedures are performed to obtain the information needed to accurately
adjust the Whip Mix semi-adjustable articulator. These are 1) the facebow transfer, 2) a
centric relation (CR) interocclusal record, and 3) a protrusive interocclusal record.
The facebow transfer (Figures 9-7 and 9-8) has two posterior references (the hinge
axis of each condyle) and one anterior reference. The anterior reference is generally the
nasion, which arbitrarily sets the maxillary cast to an appropriate position on the
articulator. The maxillary cast is mounted using the facebow's articular alignment.

Figure 9-7 Facebow adjusted to patient

Figure 9-8 Facebow transfer used to


position the maxillary cast for mounting

Most semi-adjustable articulators do not use the patient's actual hinge axis, but rely
on an arbitrary determined hinge axis. The most common reference used for the arbitrary
hinge axis is the external auditory meatus. Plastic tips of the facebow are generally
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placed in the external auditory meatus. The direction and distance (6 millimeters) to the
actual hinge axis is very similar for most individuals and an adjustment is made to
compensate for this difference. This generally provides clinically acceptable results. In
the Predoctoral Clinic, you will use an arbitrary hinge axis facebow with plastic ear
pieces, which are positioned into the patient's external auditory meatus (Figure 9-7).
The CR interocclusal record captures the relationship of the patient's maxillary
teeth relative to the mandibular teeth (or maxilla to mandible) and the mandibular cast is
mounted using this record. A protrusive interocclusal record is obtained by the patient
protruding the mandible 4-6 millimeters mm anterior from CR and then biting into a wax
record. This protrusive wax record is used to determine the condylar guide setting and
the progressive side-shift guide (Bennett angle) is arbitrarily set at 15.
When the articulator is properly set in this manner, the casts are mounted in CR
and the lower member of the articulator can be moved forward to provide MI and the
excursive movements.

2. Advantages and Disadvantages


Advantages:
1. Casts may be mounted in CR and the mandibular cast protruded to obtain MI. This
enables the practitioner to observe any CR-MI interferences and fabricate restorations
that are harmonious to the patient's occlusal scheme in both positions.
2. The semi-adjustable articulator more closely approximates the patient's true excursive
movements than the non-adjustable articulator. These more accurate movements may
help to minimize the intraoral adjustments.
Disadvantages:
1. It takes time to gather the patient information needed to set the semi-adjustable
articulator.
2. These articulators are more expensive than non-adjustable articulators.
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3. They are larger and more difficult to send in the mail.

3. Recommendations
This articulator will provide CR and MI occlusion, and relatively accurate
excursive movements. Consider using this articulator when you are evaluating a patient's
occlusion, fabricating several crowns, or fabricating a removable appliance that will
replace more than a few teeth.

C. Fully-adjustable Articulator
These articulators are capable of duplicating most of the precise condylar
movements that individuals make (Figure 9-9). One of the reasons it is more accurate
than the semi-adjustable articulator, is that the semi-adjustable articulator's condylar
guide's surface is flat, while a patient's articular eminence is curved. The fully-adjustable
articulator's condylar guidance surface can be adjusted to more closely approximate this
curvature. Another reason is that the fully-adjustable articulator uses the patient's actual
hinge axis.

1. Setting the Fully-adjustable Articulator


Three procedures are required to set the fully-adjustable articulator: 1) identify the
actual hinge axis, 2) obtain a pantographic recording, and 3) obtain a CR interocclusal
record.
A hinge axis locator (sometimes referred to as kinematic facebow) is used to
identify the actual hinge axis. It positions a grid divided into millimeters (similar to
graph paper) that is fixed to the patients skin over the condylar area (Figure 9-10). A
stylus attached to the mandibular teeth is positioned over the grid. The mandible is
arched along its hinge axis as the stylus is adjusted; it is adjusted until the stylus does not

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move from its location, but merely rotates about a point. This positions the stylus
directly over the exact hinge axis through the condyles. This point is marked by placing
a dot on the surface of the patient's skin.

Figure 9-9 Fully-adjustable articulator

Figure 9-10 Hinge axis locator

The pantographic recording (or tracing) records the exact pathway of the mandible
during border movements using 6 tables (Figures 9-11 and 9-12). The pantograph has 2
components: 1) a mandibular jig attached to the mandibular teeth containing 6 recording
tables and 2) a maxillary jig attached to the maxillary teeth containing 6 recording
styluses.
When the jigs are in place, the maxillary and mandibular arches contact only
through a central bearing point.

Consequently, movements are determined by the

patient's condyles moving against the discs and articular eminences.


There are two recording tables for each condyle. One records condylar movement
in the horizontal plane and the other records movement in the vertical plane. The
recordings scribe the path of the rotating (laterotrusive) condyle, orbiting (mediotrusive)
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condyle, and the condyle in protrusive, as the condyles move from the kinematically
determined hinge axis. There are also two anterior tables that record lateral mandibular
movement in the horizontal plane (Figure 9-11).

Figure 9-11 Pantographic recording

Figure 9-12 Pantographic recording unit

After the tracings are made (Figure 9-12), the pantographic jigs are stabilized and
removed from the patient.

The pantograph serves as a facebow to transfer the

relationship of the maxillary cast and hinge axis to the articulator. It also holds all the
information needed to adjust the articulator to the precise condylar movements made by
the patient. With the pantograph attached, the articulator is systematically adjusted until
each stylus reproduces the recorded condylar movements.

Most fully-adjustable

articulators required grinding the articulator's condylar guidance surface to duplicate the
patient's curved pathways (Figure 9-13).

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Figure 9-13 Contoured condylar guidance plate


The articulator now precisely reproduces the patient's pathways from CR and
restorations can be more accurately adjusted on the articulator.

1. Advantages and Disadvantages


Advantages:
Restorations can be fabricated to precisely fit the patient's occlusal movements;
therefore, minimal chair time should be needed for intraoral adjustments.
Disadvantages:
1. The articulator is expensive and it is very time consuming to gather and transfer this
information to the articulator.
2. Gathering and transferring this information to the articulator requires a high degree of
skill and most practitioners must use it regularly to maintain this expertise.

2. Recommendations
Few dentists have the training to use this articulator and it is most commonly used when a
patient needs the occlusal surfaces of all or most of their teeth restored.

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D. Summary of Articulators
1. Non-adjustable Articulators
These articulators are inexpensive, easy to ship, and hold casts of full or partial
arches in MI. Those with movable condylar elements are larger and generally provide
clinically acceptable excursive movements. The casts are mounted, usually by hand
articulation, in MI.
2. Semi-adjustable Articulators
They are more expensive and more difficult to ship, but they approximate condylar
pathways better than non-adjustable articulators. Casts may be mounted in CR and the
mandibular cast can be protruded to obtain MI. This enables the practitioner to observe
CR-MI interferences and provides more accurate excursive movements than the nonadjustable articulator. These may help to minimize the intraoral adjustments.
3. Fully-adjustable Articulators
They will accurately simulate the movements of the mandible, enabling
restorations to be fabricated to precisely harmonize with the patient's masticatory
movements. Properly setting this articulator is very time consuming and requires a high
level of operator skill. These articulators are expensive compared to the other types.
This articulator is most commonly used for full mouth reconstruction.

171

Chapter 10. Mandibular Positions and


Movements
In order to avoid injury to the teeth and the supporting structures when placing
tooth restorations and prostheses, a good understanding about mandibular positions and
movements is vital. It is additionally essential for diagnosis and treatment of pathological
conditions of the teeth, periodontium, masticatory muscles, and temporomandibular joints
(TMJs).

A. Mandibular Positions
There are three primary mandibular positions: the rest position, maximum
intercuspation (MI), and centric relation (CR).

1. Rest Position
This position is considered to be the postural position of the mandible when the
musculature is relaxed. To demonstrate the rest position we would ask a normal, healthy,
young individual with natural dentition to sit up straight in an ordinary chair, feet flat on
the floor, and hands at rest in the lap. Follow these instructions yourself as you read this.
We would ask the individual to moisten the lips with the tongue, let the mandible "relax,"
"go loose," or "sag," and let the lips lightly contact. Relax your mandible; your teeth
should be separated, and you should now be at rest position (Figure 10-1).

The

masticatory muscles are quite relaxed, but there is some muscle activity of the closing
muscles, just sufficient to overcome the pull of gravity on the mandible. The muscles are
in a state of minimum tonic contraction, the maxillary and mandibular teeth do not

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contact, and there is a space between them. This space is called the freeway space,
interocclusal clearance, or interocclusal space.

Figure 10-1 Rest position


The rest position is relatively constant. You could get up, walk around the room,
sit down again, and go through the same relaxing exercise and your mandible would
adopt approximately the same rest position.

Certain factors can interfere with the

consistency of this position, such as head posture. If you stretch your head backwards,
the resting relationship of the mandible to the maxilla will change.
The rest position is also affected by dentition. The loss of all teeth usually results
in a new rest position, with the mandible closer to the maxilla than when teeth were
present. Emotional states (i.e., nervousness, anxiety, etc.) have also been reported to
affect the rest position. In general, these altered postures and emotional states are not
considered normal conditions. The average individual will tend to show a relatively
constant rest position, unless they lose their teeth. Clinical rest position is often used in
making decisions, such as for construction of denture prostheses and full-mouth
rehabilitation.

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2. Maximum Intercuspation (MI)


Place your mandible in rest position as previously described, and close your teeth
together so they are fully interdigitated (intercuspated).

The mandible is now in a

position called maximum intercuspation (MI) or centric occlusion (CO) (Figure 10-2).

Figure 10-2 Maximum intercuspation (centric occlusion)

3. Centric Relation (CR)


This position is determined by the TMJs and independent of the manner in which
the teeth occlude. There are several techniques used to obtain this position that will be
taught to you later in your dental education.
To illustrate a position that approximates CR, tilt your head back as far as you can.
Place the tip of your tongue on the roof of your mouth as far posteriorly as you can. This
mandibular position is close to CR. Keeping this head and oral tissue position, slowly
close your mandible so your teeth just barely touch; this is an approximation of your
centric relation contact (Figure 10-3). Most individuals notice that their mandible is more
retruded in CR than in MI. Now slowly close your teeth together into MI. Most
individuals will notice a slide into MI, called the CR-MI slide or centric slide. The
average distance between CR and MI is 1.25 to 1.3 mm.
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Figure 10- 3 Centric relation

B. Mandibular Border and Functional Movements


Border and functional movements of the mandible are generally discussed in the
three planes: sagittal, frontal, and horizontal. The mandibles border movements are the
maximal limits the mandible can move. Functional movements of the mandible must
take place within these border movements.

Unlike functional movements, border

movements are defined and can be reproduced.


Rotation and translation are considered an integral part of the mandibles border
movements. Although pure rotation and translation are not observed in the normal
functional movements of the mandible, they occur with some border movements.
As a reference source, a point located at the incisal edge between the mandibular
central incisors is typically used in descriptions of mandibular movements.

The

displacement of this point during mandibular movements is simultaneously projected


against three planes in space, the sagittal, frontal, and horizontal planes. For clarity, the
mandibular movements will be described separately in each plane.

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1. Sagittal Plane
If you open your mandible from centric relation, you will probably observe that the
mandible first rotates in a pure hinge movement around a straight line or axis that extends
through the condyles. The condyles do not slide forward but simply rotate around this
axis. During this movement, a line formed by the movement of the mandibular central
incisors incisal embrasure is part of the circumference of a circle whose center lies on
the axis that extends through the condyles (Figure 10-4). It is called hinge movement
because it is a phenomenon of pure rotation about an axis that extends through both
condyles, as would occur with a hinge.

Figure 10-4 Hinge opening


As the mandible continues to open (Figure 10-5), it will reach a point where the
condylar movement changes from pure hinge rotation to a combination of condylar
rotation and forward movement of the condyles (known as translation). This results in a
different arc being drawn at the incisor point. As one continues to open as far as
possible, a point of maximum opening is reached. The mandible cannot open beyond this
position, and the condyles have made maximum rotation and translation.

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Figure 10-5 Maximum opening


Now close your mandible into the most forward position possible (Figure 10-6).
The incisal point has drawn an arc that illustrates the most anterior limit or border of
mandibular movement. This is the most protruded position of the mandible at any degree
of separation. In this position, the lower incisal point is usually higher than the incisal
edges of the maxillary anterior teeth.

Figure 10-6 Maximum protrusion

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Now retrude the mandible while maintaining the teeth gently in contact. When the
maxillary and mandibular incisors meet end-to-end, the mandible generally drops to
allow the teeth to cross each other. Continue retruding the mandible into MI (Figure 107).

Figure 10-7 Envelope of motion in the sagittal plane


The pattern which has now been traced by the incisal point is an outline of the
extreme limits of normal mandibular movements known as the envelope of motion. This
pattern of movement in the sagittal plane was first described by Posselt (Figure 10-8).
Of course, the mandible does not normally function at the extreme borders of the
envelope of motion. It moves freely within the envelope of motion in what is called
intra-border movements or functional movements. The normal functions of speaking,
eating, etc., involve intra-border movements. Border and functional movements are not
limited to the mandible, observe these with your shoulder and your wrist.

178

Review the mandibular border movements in the sagittal plane, shown in the
diagram in Figure 10-8, with the following positions identified:
A.

CR Contact

A-B. Hinge axis movement (rotation in CR)


C.

Maximum opening

D.

Maximum protrusive

E.

MI

F.

Normal opening/closing

Figure 10-8 Envelope of motion in the sagittal plane

2. Frontal Plane
Prior to discussing the envelope of motion formed in the frontal plane, the
fundamentals of the initial lateral movements need to be discussed. With your teeth in
light contact and in MI, slide your mandible to the right. Notice the condyle on the side
toward which the mandible moves (the right), remains in its position in the articular (or
glenoid or mandibular) fossa and only rotates. It is called the rotating condyle. The other
condyle (the left) moves (translates) forward, downward and inward along the articular
eminence. In this movement the left condyle is called the translating condyle (Figure 10-

179

9). Observe that lateral movement consists of unilateral (or "one-sided") translation of
the condyle.
During mandibular movement to the right, the teeth on the right move laterally and
the teeth on the left move medially.

The lateral movement is called laterotrusive

movement and is also known as working movement. The medial movement is called
mediotrusive movement, also known as non-working or balancing movement.
The tooth contacts that occur during the laterotrusive movement are called
laterotrusive contacts or working contacts. The tooth contacts that occur during the
mediotrusive movement, are called mediotrusive contacts, non-working contacts, or
balancing contacts.
Now that you understand these fundamentals, we will begin the envelop of motion
in the frontal plane. Start with the mandible in CR (MI is sufficiently close if you have
trouble placing your mandible in CR). Slide your mandible from CR to the right; notice
that the right condyle rotates while the left condyle moves forward, downward and
medially (Figure 10-9).

Figure 10-9 Right lateral movement

180

From the right lateral position move your mandible to maximum opening. To
achieve this, your right condyle must translate forward. When a position of maximum
opening has been reached, both condyles are fully rotated and translated to their
maximum limit. Maximum opening is therefore a position of bilateral condylar rotation
and translation (Figure 10-10). In this position there can be no lateral movement because,
the lateral movement is a unilateral translation while maximum opening is a bilateral
translation. Obviously, condyles which are bilaterally translated to the maximum extent
cannot translate unilaterally any further.

Figure 10-10 Maximum opening


Next, close your mandible from maximum opening to the left lateral position. This
is achieved by retruding (backward translating) the left condyle while the right condyle
remains in the translated position (Figure 10-11).

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Figure 10-11 Left lateral movement from maximum opening


Now move your mandible back to CR (Figure 10-12). This involves retrusion of
the right condyle and rotation of left condyle until the mandible comes into centric
relation.

Figure 10-12 Border movement in the frontal plane

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The movements scribed by the lower incisor point represent the mandibular border
movements in the frontal plane (Figures 10-12 and 10-13). Remember normal chewing
or speaking movements are intra-border.

Figure 10-13 Border movements

3. Horizontal Plane
In order to examine mandibular movements in the horizontal plane as related to
condylar rotation and translation, an imaginary writing pencil is attached to the
mandibular central incisors, and an imaginary plate on which the pencil can write is
attached to the occlusal surfaces and incisal edges of the upper teeth (Figure 10-14).

183

Figure 10-14 Imaginary pencil attached to mandibular central incisors


With the pencil in contact with the plate, a right lateral movement is made (Figure
10-15). The left condyle translates while the right condyle simply rotates. Note the line
scribed by the tip of the pencil as the result of this movement.
From this position, the mandible is next protruded to the maximum extent (full
protrusion) while maintaining the teeth in light contact (Figure 10-16). This is done by a
forward translation of the right condyle. Note that full protrusion consists of maximum
translation of both condyles and lateral movement consists of translation of only one
condyle. Similar to maximum opening, no lateral movement can be made from the
position of full protrusion.

184

Figure 10-15 Right lateral

Figure 10-16 Maximal protrusion

Next, move the mandible to the left lateral position by retruding the left condyle
(Figure 10-17). From there, move the mandible back to CR by retruding the right
condyle (Figure 10-18). These border movements in the horizontal plane produce a
diamond-shaped diagram on the plate (Figure 10-19).

Figure 10-17 Left lateral

Figure 10-18 Returning to CR

185

Figure 10-19 Horizontal plane border movements


The lines in this diamond shaped diagram represent the border movements of the
mandible in the horizontal plane. The mandible can move freely inside these lines in any
direction or pattern, making intra-border movements. However, the mandible cannot
move outside these borders.

Each apex of the diamond represents a particular

reproducible mandibular position. The most posterior apex approximates centric relation;
that is, the most unrestrained retruded relationship of the mandible to the maxilla. The
other apices are left lateral, protrusive, and right lateral positions.
Bennett Movement
During lateral movements pure rotation and translation of condyles do not occur,
but the entire mandible shifts towards the laterotrusive side; this shift is known as Bennett
movement or Bennett shift or side-shift (Figure 10-20). This movement was described by
Sir Norman Bennett in 1908 and is the lateral bodily movement of the mandible during
lateral movements.

186

Figure 10-20 Bennett movement


The amount of Bennett movement that occurs varies from person to person and
some articulators can be adjusted for this variation. An articulators capacity to vary the
Bennett movement (progressive side-shift guidance) enables the articulator to provide
lateral cuspal pathways more similar to the patients pathways.

187

Chapter 11. Dynamic Occlusal Relationships


The preceding chapter introduced basic biomechanical principles associated with
mandibular movements. Clinically, dentists must apply these principles to the design of
the tooths occlusal surface to ensure the reconstructed surfaces are compatible with the
mandible's functional movements throughout this dynamic range.
Up to this point in your education, we have only looked at occlusal contacts with
the articulator's condylar elements locked, so the articulator only provided MI contacts.
We will now expand your understanding of concepts of occlusal contacts to include other
positions in which individuals can occlude their teeth.
The subject of dynamic occlusal relationships is complicated, and this chapter is
merely an overview. You will obtain more in-depth knowledge later in your dental
education.
When an individual chews, the mandible moves toward the side where the bolus of
food is located. Thus, if food is on the right side of the mouth, the mandible will move in
a tear-drop pattern to the right (viewed in the frontal plane).
As the mandible moves to the right, the mandibular teeth on the right side are
moved laterally, and the right side is referred to as the laterotrusive side (also known as
the working side). If the teeth on the right side are engaged in laterotrusive movement
(working movement), the contacts that occur on these teeth are called laterotrusive
contacts (working contacts). As the mandible moves to the right, the mandibular teeth on
the left side move medially, so the left side is referred to as the mediotrusive side (nonworking or balancing side). If the teeth on the left side are engaged in mediotrusive
movement (non-working or balancing movement), the contacts on these teeth are called
mediotrusive contacts (non-working or balancing side contacts).
A forward movement of the mandible is termed protrusive movement and tooth
contacts during this movement are called protrusive contacts.
188

A. Horizontal Plane
Similar to the x, y, and z axes in mathematics, mandibular movement is often
analyzed using three planes: the horizontal, frontal, and sagittal.

In this chapter,

mandibular movement will be first discussed in the horizontal plane. For simplicity, the
discussion will be primarily limited to the first molar teeth. Once the cuspal movements
are understood for the first molar, this understanding can be easily applied to the
remaining teeth. The basic principles for the first molars are:
a.

In a normal alignment of the dentition, the mesiolingual cusp of the maxillary first
molar contacts and functions in the central fossa of the mandibular first molar.

b.

During a normal laterotrusive (working) movement, the mesiolingual cusp of the


maxillary first molar leaves the central fossa of the mandibular molar, passing
through its lingual groove (Figure 11-1). The size and position of the maxillary
first molar's mesiolingual cusp and the mandibular molar's lingual groove may
influence potential contact of these surfaces during this movement.

For this

movement to occur, the mandible moves to the right, the right condyle rotates in its
fossae and the left condyle translates (or moves forward along the articular
eminence) (Figure 11-1). At the tooth level, the mesiolingual cusp of #3 leaves the
central fossa of #30 through the lingual groove.
c.

During normal mediotrusive (non-working or balancing) movement, the


mesiolingual cusp of the maxillary first molar travels along the distobuccal groove
of the mandibular first molar. As the mandible moves to the left, the right condyle
translates, the left condyle rotates, and the mesiolingual cusp of #3 leaves the
central fossa of #30 along the distobuccal groove (Figure 11-2).

189

Figure 11-1 Right laterotrusive path

Figure 11-2 Right mediotrusive path

along #30

along #30

d.

During protrusive movement, the maxillary first molar's mesiolingual cusp travels
along the central groove of the mandibular first molar. As the mandible protrudes,
the right and left condyles translate, and the mesiolingual cusp of #3 leaves the
central fossa of #30 through the central groove (Figure 11-3).

e.

The mandibular progressive side-shift guidance (Bennett movement or mandibular


lateral side-shift) further influences the path of the condyles movements and the
desired locations of the occlusal grooves in teeth.

f.

The sum influence these functional activities have on #30, will generally occur
distal to #3's mesiolingual cusp contact, within the area scribed by the translation
from both TMJs (Figure 11-4). Thus, #30's anatomical form throughout this area
will be directed by these movements.

190

Figure 11-3 Protrusive path along #30

Figure 11-4 Sum of the functional


activities along #30

The mandibular movements are similarly related to maxillary dental anatomy:


a.

The distobuccal cusp of the mandibular first molar contacts and functions in the
central fossa of the maxillary first molar.

b.

During normal laterotrusive (working) movement, the mandibular first molar's


distobuccal cusp will travel along the maxillary first molar's buccal groove. The
size and position of the mandibular first molar's distobuccal cusp and the maxillary
buccal groove may influence potential contact of these surfaces during this
movement. As the mandible moves to the right, the distobuccal cusp of #30 will
travel along the buccal groove of #3 (Figure 11-5).

c.

During normal mediotrusive (non-working or balancing) movement, the


mandibular first molar's distobuccal cusp travels along the maxillary first molar's
mesiolingual cusp (Figure 11-6).

191

Figure 11-5 Laterotrusive path along #3 Figure 11-6 Mediotrusive path along #3
d.

During protrusive movement, the mandibular first molar's distobuccal cusp travels
along the maxillary first molar's central groove (Figure 11-7).

e.

The mandibular lateral side-shift (progressive side-shift guidance) will further


influence the path of the movements and the desired locations of these grooves.

Figure 11-7 Protrusive path along #3

Figure 11-8 Sum of functional


activities along #3

192

f.

The sum influence these functional movements have on #3, will generally direct
anatomy mesial to #30's distobuccal cusp contact, within the area scribed by the
translation from both TMJs (Figure 11-8).

g.

These functional movements take place simultaneously over all of the posterior
teeth. Questions concerning these movements will be on your National Board
Examination, Part I, and a nice way to remember them is to realize the three lines
from each centric contact look similar to bird's footprint (Figure 11-9). So think of
these as footprints left by a bird walking into the mouth on the mandibular arch and
out of the mouth on the maxillary arch.

Figure 11-9 Bird's footprints

B. Frontal Plane
When the teeth are in maximum intercuspation in a normally aligned occlusion, the
maxillary lingual and mandibular buccal cusps occlude in the central fossae of the
opposing arches, supporting the occlusal forces (Figure 11-10). These cusps are called
the supporting cusps (also called functional, centric holding, and stamp cusps).

193

Figure 11-10 Maximum intercuspation


On the laterotrusive side during mandibular movement, the teeth may contact and
guide along the maxillary buccal and/or mandibular lingual cusps. These cusps are called
the guiding cusps (also called non-functional, non-centric holding, idling, and shearing
cusps). A common pneumonic that is used for the guiding cusps is "BULL," which
stands for the buccal of the upper and lingual of the lower.
The laterotrusive contact may only be with the maxillary and mandibular buccal
cusps (Figure 11-11), the maxillary and mandibular lingual cusps, or all four cusps could
touch at once, which is referred to as cross-tooth balancing contacts (Figure 11-12).

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Figure 11-11 Laterotrusive contacts

Figure 11-12 Cross-tooth balancing


contacts

Posterior teeth may also contact during mediotrusive (balancing) movements of the
mandible. These contacts occur between the maxillary lingual and mandibular buccal
cusps (supporting cusps), Figure 11-13.
It is also possible during excursive movements to have simultaneous tooth contacts
on both sides of the mouth (laterotrusive and mediotrusive contacts). This occlusal
scheme is referred to as cross-arch balancing (Figure 11-14) and is sometimes utilized in
complete dentures because these contacts help stabilize the dentures.
In the natural dentition, however, all mediotrusive contacts (including cross-arch
balancing contacts) and laterotrusive contacts on lingual cusps (including cross-tooth
balancing contacts) are generally to be avoided.

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Figure 11-13 Mediotrusive contacts

Figure 11-14 Cross-arch and cross-tooth


balancing

There are two occlusal relationships for which laterotrusive contacts are considered
acceptable in the natural dentition:
a.

Canine Guidance Occlusion


Contact only on the maxillary and mandibular canine teeth, which causes all
posterior teeth to separate on the laterotrusive and mediotrusive sides.

This

relationship is referred to as canine guidance, canine rise, canine-guided


disocclusion, or canine-protected occlusion. In this relationship, canines guide the
mandible in lateral movements, disoccluding and protecting the posterior teeth
from lateral forces (Figure 11-15). As demonstrated in Figure 11-15, the adjacent
incisors may also contact.

196

From McNeil C. Science and Practice of Occlusion. 1997


Figure 11-15 Canine guidance occlusion
b.

Group Function Occlusion


Contact between the maxillary and mandibular buccal cusps without contact of the
lingual cups.

This relationship is called group function occlusion and the

laterotrusive contacts are evenly distributed among several teeth (includes posterior
teeth), Figure 11-16.

From McNeil C. Science and Practice of Occlusion. 1997


Figure 11- 16 Group function occlusion

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c.

Mutually Protected Occlusion


This is the occlusal scheme you will probably use throughout your dental career.
The anterior teeth protect the posterior teeth and the posterior teeth protect the
anterior teeth in the following manner.
1. In MI, the posterior teeth protect the anterior teeth, because the anterior teeth do
not contact so masticatory forces are transferred through the posterior teeth.
2. In all excursive positions, the anterior teeth protect the posterior teeth, because
the posterior teeth do not contact so masticatory forces are transferred through the
anterior teeth, as demonstrated in Figure 11-15.

C. Sagittal Plane
Protrusive Occlusal Relations
As the mandible protrudes, contact will generally occur along the lingual surface of
the maxillary anterior teeth and the incisal edges or facial surfaces of the mandibular
anterior teeth (Figure 11-17).

Most restorative natural dentition occlusal concepts

recommend that anterior contacts separate the posterior teeth during protrusive
movements. This relationship is referred to as anterior guidance.

Figure 11-17 Anterior guidance


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Chapter 12. Principles of Anterior Guidance of


Occlusion
Anterior guidance is the guidance provided to the movements of the mandible by
the maxillary and mandibular anterior teeth. It is an important factor in mandibular
movement but is commonly overlooked in the study of occlusion and in restorative
dentistry. The concept of anterior guidance includes: 1) separation of the posterior teeth
during excursive movements, especially protrusive and mediotrusive (non-working or
balancing) movements and 2) incision of food.
It is recommended that the steepness of the anterior guidance allow for an
unrestricted movement in any excursive direction from MI without traumatizing the
involved anterior teeth or other structures of the masticatory system. If the anterior teeth
are to be reconstructed, it is generally advisable to record the individual's anterior
guidance prior to tooth preparation, so it can be reestablished with the new restorations.
Ideally, anterior guidance occurs from the incisal edges of the six mandibular
anterior teeth traveling along the lingual surfaces of the six maxillary anterior teeth
(Figure 12-1). All twelve anterior teeth are not necessarily required to contact for proper
anterior guidance.
For some individuals, anterior guidance is only provided by the four canines. For
other individuals, all twelve teeth will engage in these movements. If the individual has a
severe morphologic malocclusion, anterior guidance may not be present and may be
impossible to develop. These situations make treatment planning a challenge. It should
be apparent that without proper anterior guidance, it may be impossible to develop an
occlusion free of excursive interferences. This may lead to problems associated with
occlusal trauma.

199

Figure 12-1 Anterior guidance


On the articulator, the incisal guide table helps the dentist or technician simulate or
develop a patients anterior guidance. Simulation is performed by adjusting the incisal
guide table to "track" an existing anterior guidance of mounted casts. Development of
anterior guidance is accomplished by adjusting the table to a pre-determined setting prior
to waxing the anterior teeth or if a patient requires prosthodontic reconstruction of the
anterior teeth, has the incisal guide table set with a cast of the preexisting teeth that is

200

used in waxing the final restorations. An acrylic customized incisal guide table may be
formed and used if more precision is desired.
One must realize that changing the steepness of the anterior guidance has an effect
on the rest of the dentition. For instance, if the anterior guidance is made more shallow
without regard for the posterior cusp heights, this could cause new occlusal interferences
to occur among the posterior teeth.
Anterior guidance is not limited to the laterotrusive and protrusive paths across the
maxillary anterior teeth but also involves the entire area between these pathways (the
shaded areas in Figure 12-2). This area is termed the functional envelope for the anterior
guidance, and when the anterior teeth are reconstructed, this area must be developed so
guided movements occur in all directions without causing trauma or forcing the mandible
to move in an uncharacteristic manner.

Figure 12-2 Maxillary anterior guidance

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Chapter 13. The Temporomandibular Joint


The anatomical features of a temporomandibular joint (TMJ) are annotated in
Figure 13-1 and 13-2. Features are labeled with letters that will be matched to the
features in the paragraphs below.
The glenoid (or mandibular) fossa and articular eminence of the temporal bone (A)
and condyle (B) are covered by dense fibrous connective tissue. The functional surface
of the temporal bone is along the articular eminence, while the functional surface of the
condyle is its anterior-superior aspect. The condyle is approximately two and one-half
times as wide mediolaterally as in the other directions.
Interposed between these structures is an articular disc (C). It is a biconcave
(concave on both sides) structure, shaped to accommodate the contours of the condyle
and the articular eminence. It has a thick posterior band, a thinner anterior band, and a
thin central zone, composed of dense collagenous connective tissue. The central zone is
avascular and not innervated in adults, while the peripheral areas are innervated and
vascular.

Figure 13-1 TMJ, sagittal view

Figure 13-2 TMJ, frontal view

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The superior and inferior heads of the lateral pterygoid muscle both insert into the
pterygoid fovea in the condylar region, and a part of the superior head inserts into the
disc and capsule. The disc is bound to the sides of the condyle by medial (E) and lateral
(D) collateral (discal) ligaments. The posterior discal region is called the retrodiscal
tissue or bilaminar zone (F) and is highly vascular and innervated. Its superior lamina
contains elastic fibers, while the inferior lamina consists primarily of collagen fibers.
As the mandible opens and the condyle translates forward, the central zone of the
disc remains interposed between the condyle and articular eminence. The morphology of
the disc causes the disc to move anterior with the condyle. As the condyle translates, the
retrodiscal tissue expands to fill the posterior space that develops from this movement.
When masticatory muscles retrude the condyle, the elastic fibers within the retrodiscal
tissue's superior lamina retrude the disc (Figure 13-3).
These structures form an superior joint space (K) bordered by the glenoid fossa
and disc, while the inferior joint space (L) is bordered by the disc and condyle. Observe
in Figure 13-3 that condylar translation occurs in the superior joint space and condylar
rotation occurs in the inferior joint space, rotation alone can allow an individual to open
20 to 25 millimeters.
These joint spaces do not joint together and are filled with synovial fluid, which
provides lubrication and nutrition for adjacent structures. If the disc did not completely
separate the two joint space, then the disc would be called a meniscus. The capsular
ligaments (G & H) help to hold the synovial fluid within the TMJs.
Pressure within the synovial fluid varies, as people clench their teeth, the pressure
increases, and as they relax their masticatory muscles the pressure decreases. These
pressure gradients help circulate the synovial fluid.

203

Figure 13-3 TMJ, sagittal view of opening


The synovial fluid lubricates the TMJ through two mechanisms, boundary
lubrication and weeping lubrication.

Boundary lubrication occurs from condylar

movements, which cause the synovial fluid to circulate from the recesses of the joint
spaces. Weeping lubrication occurs from loading and unloading of the condyle. This
compresses and releases the fibrocartilage, enabling synovial fluid to circulate in and out
of the articular cartilage, similar to how a sponge would release and suck up water from
its repeated loading and unloading.

204

The TMJ is enclosed in a capsule (Figure 13-4) that is attached at the borders of
the articulating surfaces of the articulating eminence, and to the neck of the condyle. The
anterolateral side of the capsule is often thickened to form a band referred to as the
temporomandibular ligament (or temporomandibular joint ligament).

The dense

collagenous connective tissue in this ligament does not stretch, and, with the masticatory
muscles, bilaterally these ligaments act like a "hammock" to suspend the condyles within
the TMJs.
The stylomandibular and sphenomandibular ligaments (Figure 13-5) are not
directly involved with mandibular movement but help to stabilize the TMJ and limit
excessive movement.

Figure 13-4 Temporomandibular

Figure 13-5 Stylomandibular and

Ligament

sphenomandibular ligaments
Source: Nelson SJ, Ash MM.

The temporomandibular joint is a ginglymoarthrodial joint, meaning it performs


both hinge and glide movements. The hinge (rotation) occurs in the inferior joint space,
while the glide motion (translation) occurs in the superior joint space.

Mandibular

movements are generally a combination of both rotation and translation, and both are
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maximally utilized during maximum opening. Since the mandible is connected with both
TMJs, mandibular movements simultaneously cause movement in both TMJs.
TMJ

sensory

innervation

(not

shown)

is

primarily

provided

by

the

auriculotemporal nerve (innervates the posterior and lateral TMJ) and a branch from the
deep temporal nerve (innervates the anterior TMJ).

206

Chapter 14. Masticatory Muscles


Masseter Muscle
The masseter muscle (Figure 14-1) extends from the zygomatic arch to the ramus
and the body of the mandible. The insertion of this muscle is broad, extending from the
region of the second molar to the posterior lateral surface of the ramus. The masseter
muscle has a distinct superficial and deep layers and is primarily a closure muscle. The
innervation is by the mandibular division of the fifth cranial (trigeminal) nerve.

Figure 14-1 Extra-oral muscles of mastication

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Temporalis Muscle
The temporalis muscle (Figure 14-1) is fan-shaped, originates in the temporal
fossa, passes medial to the zygomatic arch, and forms a tendon that inserts into the
anterior and medial surfaces of the coronoid process and anterior border of the ascending
ramus. The directions of the muscle fibers in the fan-shaped portion vary from verticallydirected fibers to posteriorly-directed fibers, enabling this muscle to exert forces in
various directions. This has caused many to divide the muscle into anterior, middle and
posterior regions, with various functions performed by each, i.e., the anterior region
primarily assists with mandibular closure, while the posterior region assists with
retrusion. The innervation is by the mandibular (third) division of the fifth cranial nerve.

Medial Pterygoid Muscle


The medial pterygoid muscle (Figure 14-2) arises from the medial surface of the
lateral pterygoid plate and palatine bone. Its insertion extends from the angle of the
mandible and along the ramus to approximately the area of the mandibular foramen. The
principal functions of the medial pterygoid muscle include mandibular closure and, to a
minor degree, lateral movements. The innervation is by the mandibular division of the
fifth cranial nerve.

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Figure 14-2 Intra-oral muscles of mastication; Source: Nelson SJ, Ash MM.

Lateral Pterygoid Muscle


This muscle (Figure 14-3) has two locations of origin, the outer surface of the
lateral pterygoid plate and the greater sphenoid wing. It inserts on the anterior surface of
the condylar neck, and generally some fibers also insert into the TMJ capsule and anterior
aspect of the disc.
The superior head of the lateral pterygoid is only active during various mandibular
closing movements, whereas the inferior head is active only during condylar protruding
movements. It is thought the superior head stabilizes the TMJ complex during biting
(closure) and mandibular retrusion. The inferior head assists in the translation of the
condyle during mandibular opening and excursive movements. The innervation is by the
mandibular division of the fifth cranial nerve.
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Digastric Muscles
The anterior digastric muscle (Figure 14-3) is attached at or near the lower border
of the mandible and near the midline. The anterior and posterior digastric muscles are
connected by a tendon that slides along a loop-like strip of fascia attached to the hyoid
bone.

The anterior digastric, mylohyoid, and geniohyoid muscles are active during

various phases of mandibular opening. The anterior digastric muscle is innervated by the
mandibular division of the fifth cranial nerve and the posterior digastric muscle is
innervated by the seventh cranial nerve.

Figure 14-3 Neck muscles; Source: Nelson SJ, Ash MM.


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Summary of Muscles
The primary closure muscles are the temporalis, masseter, and medial pterygoid
muscles.

The superior head of the lateral pterygoid is only active during various

mandibular closing movements and is thought to help stabilize the disc within the TMJ's
articular assembly during these movements.
The primary opening muscles are the anterior digastric, posterior digastric, and
mylohyoid muscles. The infrahyoid muscles also contract during opening to stabilize the
hyoid bone.
The primary mandibular protrusive muscle is the inferior body of the lateral
pterygoid muscle.

The primary retrusive muscles are the posterior region of the

temporalis, the anterior digastric, the posterior digastric, and the mylohyoid muscles. The
infrahyoid muscles also contract during retrusion to stabilize the hyoid bone.
The temporalis, masseter, medial pterygoid, lateral pterygoid, anterior digastric,
and mylohyoid muscles are innervated by the mandibular (third) division of the fifth
cranial (trigeminal) nerve, while the posterior digastric muscle is innervated by the
seventh cranial (facial) nerve.
Chewing movements involve a complex integrative neural processes of the central
nervous system that includes a large amount of proprioceptive (i.e., muscle "sense") and
exteroceptive (i.e., tactile "sense") innervation. Rhythmic movements such as chewing
are generally preprogrammed (by learning), which reduces the need for peripheral
sensory input. However, input from muscles, tendons, TMJs, and periodontal receptors
still have important functions, especially in relation to learning, new experiences, and
protective reflexes.
The masticatory muscles, TMJs, and occlusion of the teeth work together in a
marvelous complex system. The masticatory system is remarkably adaptable, but it is
possible to exceed its adaptive capacity by placing a non-harmonious restoration, over
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stretching the muscles or TMJs during a dental procedure, etc. There is currently no
system for predicting how well an individual will adapt to a dental procedure, and it is the
dentist's challenge to prevent or minimize such adverse events. It is never appropriate for
a dentist to tell a patient that a non-harmonious restoration he or she placed is fine and "it
will work itself in."

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Appendix
Self Tests
Laboratory Exercises
Laboratory Evaluation Forms
Laboratory Practical Evaluation Forms
Dental Anatomy Quick Reference

213

Dental Anatomy Waxing Instruments


Your Dental Anatomy waxing instruments are kept in a blue plastic box (Figure A1). These instruments will also be used for other courses, so there are a few waxing
instruments in the cassette that you will probably not use for Dental Anatomy.

Figure A-1 Freshmen waxing cassette


The instruments have their names written on them, but to help you more easily
identify the instruments you will probably use in Dental Anatomy, these are listed below.
The PKT #1 instrument, PKT #2 instrument, and PKT #3 instrument are shown in
Figure A-2, and are arranged in this order from top to bottom. The PKT #1 and #2
instruments are usually used to carry melted wax to the object being waxed. The PKT #1
instrument tips are larger than the PKT #2 instrument, enabling it to hold heat longer and
carry more wax, but it cannot provide the detail as can be achieved with the thinner PKT
#2 instrument. The PKT #3 instrument tips looks like cones and are often used for
burnishing wax.

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Figure A-2 PKT #1 instrument, PKT #2 instrument, and PKT #3 instrument


One tip of the spatula #7 instrument (Figure A-3) is sharp and is used for carrying
warmed wax to the object being waxed, carving grooves in the tooth's wax occlusal
surface, or burnishing wax. Its other tip is spoon shaped for carrying a large amount of
wax or smoothing a large area of wax; you probably will not use this tip in Dental
Anatomy.

Figure A-3 Spatula #7 instrument


Both tips of the Hollenback #3 carver (Figure A-4) are sharp blades that are used to
carve wax. The blades are orientated differently from the handle, so you will usually find
one tip more convenient to use than the other.

Figure A-4 Hollenback #3 carver


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The SA37 instrument (Figure A-5) is a combination of the most commonly used
tips from the spatula #7 instrument and the Hollenback #3 carver. It provides you with
the convenience of having these in one instrument.

Figure A-5 SA37 instrument


Two additional instruments that are primarily used to carve the occlusal grooves of
both wax and amalgam restorations, are the carver #5 Tanner and carver 2 mm cleoid
discoid UWD5 (Figure A-6).

Figure A-6 Carver #5 Tanner and carver 2 mm cleoid discoid UWD5


As you use these instruments, you will develop preferences as to which instrument
you find works best for you in different situations. If you were to ask various people who
are outstanding at waxing teeth, their instrument choice in different situations, you would
find there are many individual preferences upon instrument uses.

216

Drip Wax Block Exercise


This course has three major goals in helping you become a dentist. One is for you
to learn how to make a wax pattern, which may be used to fabricate a cast gold
restoration. You will be fabricating cast gold restorations in subsequent courses and
perhaps in dental practice.
A second goal is for you to develop the manual dexterity necessary to successfully
control dental instruments.

These skills will be used every day in dental practice

spanning basic intraoral examination to complex technical surgeries.


The third, and perhaps primary goal of waxing, is to learn to recognize and form
proper anatomical contours of the individual teeth. The ability to recognize and correct
formed embrasures and interproximal contacts are skills that may be first practiced in
wax and then directly applied to any current or future restorative materials. Developing
these skills in wax allows the student to practice and easily and inexpensively correct
mistakes.
There are basically two methods of forming or making a wax pattern. One method
involves adding excess wax and carving it down to the desired form. The second is
incrementally adding wax to form the desired shape. Generally, both methods are used
when waxing a crown.
For the first wax exercise, Drip Wax Block Exercise, you will learn how to add
wax without obtaining bubbles and to develop a shiny surface on the wax.
Place warm wax in one of the wells of your block (Figure A-7). Add wax to it by
simultaneously melting the outer layer of the previous wax as you add new wax so they
adhere together without trapping air bubbles.

217

Figure A-7 Drip wax block


After you fill the well, go around the outer edge with a warm instrument to remove
any bubbles you may have in the wax adjacent to the stone. Develop a flat surface that is
even with the top of the stone cast.
Most individuals like to polish the wax in the following manner: Melt a very fine
superficial layer of the wax by rapidly passing the flame of a Hanau alcohol torch across
the surface. This will usually provide a smooth, unpolished surface. Allow it to cool
before proceeding.
Many individuals next use a soft bristled toothbrush to smooth some of the fine
bumps left by flaming the wax. In future projects you will wax teeth and want to
maintain deep grooves you placed in the wax. Lightly flaming the wax generally does
not melted the wax in these grooves and there are often small chips of wax partially
adhered in the grooves. The toothbrush also helps to clean and smooth these grooves.
Some individuals would next use a paper towel to help smooth any remaining fine
bumps. You should then use part of a nylon stocking to polish the wax surface by
rubbing it over the wax. You may then use liquid soap on a cotton roll to further polish
the wax. The soap should be washed off the wax surface and dried with an air syringe.
Continue to practice this on the other wells in your stone block.

218

Disinfect Extracted Teeth


We requested that you bring extracted teeth for different projects that you will
perform during all four years of dental school. You must assume some of the extracted
teeth you brought were taken from individuals who had a contagious disease and some of
the teeth have the potential of causing you and your classmates harm. Whenever you
work with these potentially hazardous teeth, be careful not to spread fluid that contacted
the teeth around your laboratory, and wear the gloves that are available at the dispensary.
These teeth can be disinfected (made harmless) by either fixing them in 10%
formalin or autoclaving them in the school's sterilization department. Teeth that have
fillings (tooth-colored or silver) should be fixed with 10% formalin and not sterilized in
an autoclave. Most of you have the teeth stored in a diluted liquid bleach solution, which
needs to be removed. A good technique to remove the solution is to loosen the lid of
your storage jar so the liquid can flow out, but the teeth will not. Pour the liquid into
your sink drain, but make sure you do not allow any teeth to fall into the drain. Any
contaminated fluid that touches the base of your sink or counters should be cleaned off
with soap and water.
Teeth with or without fillings can be fixed by adding enough 10% formalin so they
are totally submerged in the solution and letting them soak in the solution for two weeks.
The 10% formalin solution is stored under the fume hood (located in each laboratory).
When working with this solution, it should be under the fume hood with the fan turned
on, and you should wear gloves, safety glasses, and a chemical-resistant apron. During
the soaking period, the jar must be labeled with a 10% Formalin label that is available
at the dispensary. After the teeth have soaked in this solution for two weeks, pour the
solution into the 10% formalin chemical waste container that is also stored under fume
hood. Use tap water to rinse the excess formalin off the teeth, and store the teeth in a

219

clean jar with enough tap water to totally submerge the teeth. Label the jar appropriately,
e.g., Fixed teeth in tap water.
An alternative method for disinfecting teeth that do not have fillings is to sterilize
them in an autoclave. Get autoclave bags from sterilization, write your name and bench
number on the bag in pencil, place the teeth in the autoclave bags, take the bags to
sterilization, and pick them up two days later. Store the teeth in a clean jar with tap
water, and label the jar appropriately, e.g., Autoclaved teeth in tap water.
When grinding or cutting the disinfected teeth, wear a mask and eye protection. If
you decide you no longer want certain teeth, dispose of them by placing them in the
container marked for disinfected teeth with amalgam (even for the teeth without amalgam
restorations), which is under your fume hood .
Do not store teeth in your cubicle that have not been disinfected.

If you

temporarily have them in the laboratory or clinical areas, make sure the container is
appropriately labeled, and disinfect them as soon as possible.
If you have questions on this subject, ask Dr. Wright. You can also read the article:
Dominici JT, Eleazer PD, Clark SJ, Staat RH, Scheetz JP. Disinfection/sterilization of
extracted teeth for dental student use. J Dent Educ 2001;65(11):1278-80. The two-week
10% formalin soak is based upon the January 4, 2008 UTHSCSA Clinical Quality
Assurance Committee meeting agreement.

220

Self Test 1
1. The maxillary and ___________ arch may be divided at the ___________ ______ into
a right and left _____________ each containing ______ teeth.
2. The _____________ teeth move across the _____________ teeth.
3. There are a total of _____ permanent teeth.
4. There are _____ classes of permanent teeth.
5. There are _____ incisors per arch.
6. There is (are) _____ canine(s) per quadrant.
7. There are _____ mandibular incisors.
8. There are ______ maxillary canines.
9. There are a total of _____ premolars.
10. There are ______ molars if the wisdom teeth are not counted.
11. There is (are) _____ first molar(s) in the maxillary left quadrant.
12. There are _____ incising teeth.

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Self Test 2

Figure A-8 Self-Test II


Name the surfaces indicated by the arrows in Figure A-8
A = _____________________ surface
B = _____________________ surface
C = _____________________ surface
D = _____________________ surface
E = _____________________ or ____________________ surface
F = _____________________ or ____________________ surface
G = _____________________ or ____________________ surface
H = _____________________ surface
The collective term for E and F is _______________.
Surfaces indicated by the letters _______ and _______ are proximal surfaces.
The mesial or distal surface indicated by letter _______ is not a proximal surface.

222

Progressive Wax Block Exercise


This project will help you develop fundamental knowledge and skills in
manipulating wax and using the PKT (P. K. Thomas) instruments (Figure A-9). The
small wire-like PKT instruments are used in this exercise by warming their tips and using
them to melt and carry small increments of wax to form the occlusal surfaces of the teeth
in a step-by-step procedure.

Figure A-9 PKT #1 and 2


Your exercise block (Figure A-10) has three sections: 1) four rows of four teeth, 2)
two rows of four teeth, and 3) two large molars. Start with the section with four rows of
four teeth, on the row that is cut flat. Using your PKT instruments, attempt to add wax to
the first row to make it look like the second row. Once this is accomplished, add wax to
the second row to make it look like the third row. Finally, add wax to the third row to
make it look like the fourth row.
Using the same steps, go to the two-row section and attempt to add wax so that you
make the cut teeth look like the other row of teeth. Finally, add wax to the large
individual molar so it looks like the adjacent tooth.

223

When beginning to form the occlusal surfaces of teeth by the wax-additive method,
learn to control the temperature of the wax in order to draw or flow ridges of fine
dimensions; the wax must only be slightly warmer than its chill temperature or hardening
point. When the amount of wax and temperature are correct, fine detail can be smoothly
traced with the waxing instruments.

Figure A-10 Progressive Wax Block


This exercise is designed to enable you to develop a feel for correct temperatures
when adding wax with fine instruments. The ability to form smooth, fine ridges and
cusps by adding wax are necessary waxing skills for forming teeth with appropriate
anatomy. With practice, you should be able to develop manual dexterity and begin to
orient the hands and eyes to the fine detail that dentistry demands.

224

Self Test 3
Label the structures in Figure A-11 using the numbers of the following terms:
1.

Anatomical crown

2.

Clinical crown

3.

Root

4.

Bifurcation

5.

Cementoenamel junction or CEJ or cervical line

6.

Cementodentinal junction or CDJ

7.

Dentinoenamel junction or DEJ

8.

Pulp chamber

9.

Pulp horn

10. Pulp canal


11. Periodontal ligament
12. Alveolar bone
13. Enamel
14. Cementum
15. Dentin

225

Figure A-11 Tooth and supporting structure cross-section

226

Cast Landmark Exercise


This exercise is to be completed on the maxillary and mandibular KI casts.
Information needed to complete the exercise is available in your Dental Anatomy
Manual, and, if you are unsure about a landmark, ask your laboratory instructor. Use
your pencil to mark the following landmarks:

A. Maxillary
1. On the maxillary right central incisor, mark a line on the facial surface from incisal
to cervical.
2. On the maxillary left 1st premolar, mark a line on its lingual surface extending from
the mesiolingual line angle to the distolingual line angle.
3. On tooth #2, place a dot on the mesiobucco-occlusal point angle.
4. On tooth #5, mark a line on the facio-occlusal line angle from the mesiofacioocclusal point angle distally, to the distofacio-occlusal point angle.
5. On tooth #9, divide the labial surface of the clinical crown into the gingival 1/3,
middle 1/3, and incisal 1/3 with lines.
6. On tooth #7, divide the labial surface of the clinical crown into the mesial 1/3,
middle 1/3, and distal 1/3 with lines.
7. In the maxillary left posterior quadrant, mark the central developmental grooves.
8. On tooth #3, on the mesiobuccal cusp, mark the distal cusp ridge. On the tooths
distobuccal cusp, mark the mesial cusp ridge.
9. Place a dot in the central pit of tooth #2.
10. Place a dot in the mesial pit of tooth #4.
11. On tooth #14, place a line along the crest of the distal marginal ridge.
12. On tooth #13, place a line along the crest of both marginal ridges.
227

13. On tooth #5, mark the crest of the buccal triangular ridge.
14. On teeth #10 and #11, place an X on the cingulum.
15. Mark the lingual fossa of tooth #8.

B. Mandibular Cast
1. On tooth #29, place a line along the crest of both marginal ridges.
2. On tooth #20, mark the crest of the triangular ridge of the buccal cusp.
3. Mark the crest of the transverse ridge of #28.
4. On tooth #19, on the mesiolingual cusp, mark the distal cusp ridge.
distolingual cusp, mark the mesial cusp ridge.

On the

5. Place a dot in the central pit of tooth #18.


6. Mark the primary grooves of #30.
7. Mark only the secondary grooves of #18.
8. On tooth #18, mark the linguo-occlusal line angle.
9. Mark the mesio-occlusal line angle of tooth #30.
10. Outline the facial surface of the mandibular left second premolar.
11. On the mandibular left first molar, place a vertical line on the mesiobuccal line
angle.
12. On tooth #31, mark the crest of the distal marginal ridge.
13. On tooth #18, place a dot on the mesiobucco-occlusal point angle.
14. Mark the distobuccal line angle of tooth #30.
15. Mark the lingual fossa of tooth #24.
16. Place a dot in the buccal pit of #31.

228

#10 Mesial Half Exercise

229

230

#8 Full Crown Exercise


1. Outline Form
a. looks like a tooth
b. contour
c. line angles
d. embrasures
incisal
gingival

labial
lingual

e. incisal edge length and position


2. Anatomy
a. ridges
marginal ridges
b. lingual fossa
c. cingulum
d. labial depressions
3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size
4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin

Grading Criteria
Very Good
Outline
Form

5. Waxing Skills
a. surface finish rough or rippled

Anatomy
Interprox
Contact

b. voids
internal
external

Margins
Waxing
Skills

c. surface polish

231

Needs Minor
Improvement

Needs Major
Improvement

#8 Class 4 and 5 Composite Exercises


This exercise is primarily to help you better understand the clinical relevance of
developing the skill of waxing anterior teeth. You will place resin composite restorations
in Class 4 and Class 5 tooth preparations in tooth #8. For both restorations, first apply
Scotchbond Multipurpose Bonding Agent, followed by the Z100 resin composite
restorative material. Using finishing burs and Sof-Lex disks and strips, develop the
proper contours of your restorations. You can add more composite as you desire. Once
your laboratory instructor approves your contours, polish the restoration with Sof-Lex
disks and strips and abrasive-impregnated rubber polishing points.
For the materials used in this exercise, apply them in the following manner:
Scotchbond Multipurpose Bonding Agent (due to cost we will not use primer)
1. Apply phosphoric acid etchant to the cavity preparation for 15 sec.
2. Rinse under running tap water for 15 sec.
3. Dry with your air syringe until thoroughly dry.
4. Apply adhesive to primed cavity preparation surfaces; thin adhesive by blotting
applicator/brush on absorbent paper, then returning it to the cavity preparation to
absorb excess adhesive.
5. Light cure for 20 sec.
Z100 Resin Composite Restorative Material
1. Place the composite in increments that are no thicker than 2 mm. The Wetting Resin
will decrease the degree the material sticks to your instrument.
2. Light cure each increment separately for 20 sec.

232

Class 5 Composite Restoration


1. Outline Form
a. Contour
2. Margins:
a. Over extended
b. Under extended
c. Bulky
3. Finish
a. Surface finish
b. Damage to surrounding tooth
c. Surface polish

Class 4 Composite Restoration


1. Outline Form
a. Contour
b. Line angles
c. Embrasures
d. Incisal edge length and position
2. Interproximal Form
a. Contact (yes or no)
b. Contact position and size
c. Gingival embrasure form and contour
3. Margins:
a. Over extended
b. Under extended
c. Bulky
4. Finish
a. Surface finish
b. Damage to surrounding tooth
c. Surface polish

233

#8 Full Crown Practical Exam

Bench # _____

1. Outline Form
a. looks like a tooth
b. contour
c. line angles
d. embrasures
incisal
gingival

labial
lingual

e. incisal edge length and position


2. Anatomy
a. ridges
marginal ridges
b. lingual fossa
c. cingulum
d. labial depressions
3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size
4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin

Grading Criteria
Very Good
Outline
Form

5. Waxing Skills
a. surface finish rough or rippled

Anatomy
Interprox
Contact

b. voids
internal
external

Margins
Waxing
Skills

c. surface polish

234

Needs Minor
Improvement

Needs Major
Improvement

Comparing Occlusal Contacts Exercise


The purpose of this exercise is to gain an understanding of ideal occlusal contact
locations. The contacts found in most individuals widely vary from this ideal pattern, but
when we fabricate restorations, we attempt to place these occlusal contacts in their ideal
locations.

In this introductory exercise, you will map your lab partners maximum

intercuspation contacts.
On Figure A-17, draw the ideal cusp-to-marginal ridge and cusp-to-fossa occlusion
on the teeth on the right side of the mouth. On your partners left side, mark his or her
maximum intercuspation (MI) contacts and draw these occlusal contacts on the
appropriate side of Figure A-17.
Maximum intercuspation contacts should be marked in the mouth by having
articulating paper or ribbon between the teeth while your partner taps them together in
MI. Your partner should be seated in an upright position with normal head posture (head
position can influence occlusal contacts) when the contacts are marked. A piece of
articulating ribbon, sufficiently large to cover one quadrant, is placed over the dried
occlusal surface of the lower arch.
Instruct your partner to tap the back teeth together. If this does not adequately
mark the teeth, then ask your partner to squeeze the teeth together. There should be
marks on both the maxillary and mandibular teeth indicating the areas of the MI contacts.
Draw the identified contact areas on the occlusal surfaces of the teeth in Figure A-17 and
compare the two sides of Figure A-17.

235

Figure A-17 Drawing to record maximum intercuspation contacts


236

#8 Maximum Intercuspation Exercise


Evaluate Anatomy
1. Consider outline form, interproximal form, margins, facial and lingual anatomy, and
finish.
Evaluate MI Contacts
2. Required MI contacts:
Mesial marginal ridge
Distal marginal ridge
3. Ensure the heaviest initial stone contact, each composite contact, and incisal pin
require the same force to pull shim stock from between them.
4. Mark the contacts with Accufilm and evaluate their locations.

237

#6 Maximum Intercuspation Exercise


Evaluate Anatomy
1. Consider outline form, interproximal form, margins, facial and lingual anatomy, and
finish.
Evaluate MI Contacts
2. Required MI contact:
Mesial marginal ridge
3. Ensure the heaviest initial stone contact, composite contact, and incisal pin require the
same force to pull shim stock from between them.
4. Mark the contacts with Accufilm and evaluate its location.

238

#4 Full Crown Exercise


1. Outline Form (Occlusal, Facial, Lingual, and Proximal)
a. looks like a tooth
b. contour
c. lobe form
d. line angles
e. embrasures
occlusal
gingival

buccal
lingual
B

L
Mesial Aspect

2. Occlusal Anatomy
a. ridges
marginal ridges
triangular ridge form
b. grooves
primary direction and depth
secondary direction and depth
c. cusp placement and size

M
Buccal Aspect

239

3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size

4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin

5. Waxing Skills
a. surface finish rough or rippled

Buccal Aspect

Lingual Aspect

b. voids
internal
external
c. surface polish

Grading Criteria
Very Good
Outline
Form
Occlusal
Anatomy
Interprox
Contact
Margins
Waxing
Skills

240

Needs Minor
Improvement

Needs Major
Improvement

#4 Maximum Intercuspation Exercise


Evaluate Anatomy
1. Consider outline form, interproximal form, margins, occlusal anatomy, and finish.
Evaluate MI Contacts
2. Required MI contacts:
Mesial marginal ridge
Lingual cusp tip
Distal marginal ridge
3. Ensure the heaviest initial stone contact, each composite contact, and incisal pin
require the same force to pull shim stock from between them.
4.

Mark the contacts with Accufilm and evaluate their locations.

241

Identify Extracted Teeth


This exercise should help you identify your extracted teeth and study for your
Tooth Identification Quiz. Because of the difficulty in differentiating the mandibular
central and lateral incisors and of the variability in shape among third molars, your quiz
will not include these teeth. Try to put together a complete set of teeth.
Below are generalizations for the average tooth. It is recommended you first
determine the tooth type, then whether it is maxillary or mandibular, and finally which
side it is from. It may be helpful to remember root-tips tend to curve toward the distal.
Tooth

Maxillary Teeth

Mandibular Teeth

Central
Incisors

Large crown to root compared


to the maxillary lateral incisor

Incisal edge is straight from M to D

Lateral
Incisors

Rounded D incisal edge


Larger than mandibular lateral

Incisal edge curves toward D


Rounded D incisal edge

Canine

Larger cingulum than on mandibular


Incisal portion rounded on D
M arm shorter than D arm

Long and narrow


F wear facets
M crown and root surfaces form
straight line

First
B cusp 1 mm greater height
Premolar 2 roots (60%)
L cusp toward M

ML groove
B cusp has much greater height
Prominent transverse ridge

Second
Cusps equal height
Premolar One root

3 cusps (only premolar)


ML cusp larger than DL cusp

First
Molar

Cusp of Carabelli (5th cusp)

Distal cusp (5th cusp)

Second
Molar

No cusp of Carabelli

No distal cusp
Occlusal grooves form a +
242

#29 Maximum Intercuspation Exercise


Evaluate Anatomy
1. Consider outline form, interproximal form, margins, occlusal anatomy, and finish.
Evaluate MI Contacts
2. Required MI contacts:
Buccal cusp tip
Distal fossa
3. Ensure the heaviest initial stone contact, each composite contact, and incisal pin
require the same force to pull shim stock from between them.
4. Mark the contacts with Accufilm and evaluate their locations.

243

#4 Full Crown Practical Exam

Bench # _____

1. Outline Form (Occlusal, Facial, Lingual, and Proximal)


a. looks like a tooth
b. contour
c. lobe form
d. line angles
e. embrasures
occlusal
gingival

buccal
lingual
B

L
Mesial Aspect

2. Occlusal Anatomy
a. ridges
marginal ridges
triangular ridge form
b. grooves
primary direction and depth
secondary direction and depth
c. cusp placement and size

M
Buccal Aspect

244

3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size

4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin

5. Waxing Skills
a. surface finish rough or rippled

Buccal Aspect

Lingual Aspect

b. voids
internal
external
c. surface polish

Grading Criteria
Very Good
Outline
Form
Occlusal
Anatomy
Interprox
Contact
Margins
Waxing
Skills

245

Needs Minor
Improvement

Needs Major
Improvement

#3 Full Crown Exercise


1. Outline Form (Occlusal, Facial, Lingual, and Proximal)
a. looks like a tooth
b. contour
c. lobe form
d. line angles
e. embrasures
occlusal
gingival

buccal
lingual

L
Mesial Aspect

2. Occlusal Anatomy
a. ridges
marginal ridges
triangular ridge form
b. grooves
primary direction and depth
secondary direction and depth
c. cusp placement and size

M
Buccal Aspect

246

3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size

4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin

5. Waxing Skills
a. surface finish rough or rippled
b. voids
internal
external

Lingual Aspect

c. surface polish

Grading Criteria
Very Good
Outline
Form
Occlusal
Anatomy
Interprox
Form
Margins
Waxing
Skills

247

Needs Minor
Improvement

Needs Major
Improvement

#3 Maximum Intercuspation Exercise


Evaluate Anatomy
1. Consider outline form, interproximal form, margins, occlusal anatomy, and finish.
Evaluate MI Contacts
2. Required MI contacts:
Mesial marginal ridge
ML cusp tip
DL cusp tip
Central fossa or oblique ridge
Distal marginal ridge (optional)
3. Ensure the heaviest initial stone contact, each composite contact, and incisal pin
require the same force to pull shim stock from between them.
4. Mark the contacts with Accufilm and evaluate their locations

248

#3 Full Crown Practical Exam

Bench # _____

1. Outline Form (Occlusal, Facial, Lingual, and Proximal)


a. looks like a tooth
b. contour
c. lobe form
d. line angles
e. embrasures
occlusal
gingival

buccal
lingual

L
Mesial Aspect

2. Occlusal Anatomy
a. ridges
marginal ridges
triangular ridge form
b. grooves
primary direction and depth
secondary direction and depth
c. cusp placement and size

M
Buccal Aspect

249

3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size

4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin

5. Waxing Skills
a. surface finish rough or rippled
b. voids
internal
external

Lingual Aspect

c. surface polish

Grading Criteria
Very Good
Outline
Form
Occlusal
Anatomy
Interprox
Form
Margins
Waxing
Skills

250

Needs Minor
Improvement

Needs Major
Improvement

#30 Full Crown Exercise


1. Outline Form (Occlusal, Facial, Lingual, and Proximal)
a. looks like a tooth
b. contour
c. lobe form
d. line angles
e. embrasures
occlusal
gingival

buccal
lingual

2. Occlusal Anatomy
a. ridges
marginal ridges
triangular ridge form
b. grooves
primary direction and depth
secondary direction and depth
c. cusp placement and size

Buccal Aspect

251

3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size

4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin
Buccal Aspect

Lingual Aspect

5. Waxing Skills
a. surface finish rough or rippled
b. voids
internal
external
c. surface polish

Grading Criteria
Very Good
Outline
Form
Occlusal
Anatomy
Interprox
Contact
Margins
Waxing
Skills

252

Needs Minor
Improvement

Needs Major
Improvement

#30 Full Crown Practical Exam


1. Outline Form (Occlusal, Facial, Lingual, and Proximal)
a. looks like a tooth
b. contour
c. lobe form
d. line angles
e. embrasures
occlusal
gingival

buccal
lingual

2. Occlusal Anatomy
a. ridges
marginal ridges
triangular ridge form
b. grooves
primary direction and depth
secondary direction and depth
c. cusp placement and size

Buccal Aspect

253

Bench # _____

3. Interproximal Contact
a. contact (yes or no)
b. contact position
c. contact size

4. Margins:
a. over extended (flash)
b. under extended (short / open)
c. bulky
d. thin
Buccal Aspect

Lingual Aspect

5. Waxing Skills
a. surface finish rough or rippled
b. voids
internal
external
c. surface polish

Grading Criteria
Very Good
Outline
Form
Occlusal
Anatomy
Interprox
Contact
Margins
Waxing
Skills

254

Needs Minor
Improvement

Needs Major
Improvement

#30 Canine Guidance Exercise


Evaluate Anatomy
1. Evaluate anatomy before powdered wax is applied.
-.25 for each minor problem
-.50 for each major problem, maximum -1.0
Evaluate MI Contacts
2. Ensure the heaviest initial stone contact, each contact on waxed tooth, and incisal pin
require the same force to pull shim stock from between them.
-.50 if stone does not hold shim stock
-.50 if incisal pin needs to be adjusted
3.
4.
5.
6.
7.
8.

Lightly apply powdered wax with a brush.


Slightly wet opposing teeth with cotton roll or finger.
Gently close articulator until pin contacts the incisal guide table.
Open articulator and check for contacts and smashed wax.
If not all required MI contacts are marked, close articulator and gently tap.
Open articulator and reevaluate for contacts (repeat tapping and use typewriter ribbon
or Accufilm if believe contacts will appear).
9. Evaluate required MI contacts, must have:
Mesiobuccal cusp tip
Distobuccal cusp tip
Distal cusp tip (optional)
Central fossa
Distal marginal ridge

-.25 for each misplaced contact


-.25 for each missing contact
-.25 for each heavy contact
-.25 for each extra contact
-.50 for each heavy/misplaced contact
-2.0 for contact so heavy as to fracture wax
255

Evaluate Excursive Contacts


10.Check condylar guidance settings to ensure articulator is properly adjusted. For this
exercise horizontal is 35 and lateral is 15.
-.25 for any discrepancy
11.Close the articulator and move the mandibular cast to the right, ensuring the incisal
pin remains in contact with the raised incisal guide wing. The wing should allow for
light contact between #6 and 27.
-.25 for incorrect wing setting
12.Open articulator and evaluate to make sure there are no laterotrusive contacts on #30.
-.25 for each laterotrusive contact
-.50 for laterotrusive contact that fractures the wax
Faculty may draw laterotrusive, mediotrusive or protrusive contacts on drawing

13.Close the articulator and move the mandibular cast to the left, ensuring the incisal pin
remains in contact with the raised incisal guide wing. The wing should only allow for
light contact between #11 and 22.
-.25 for incorrect wing setting
14.Open articulator and evaluate to make sure there are no mediotrusive contacts on #30.
-.25 for each mediotrusive contact
-.50 for mediotrusive contact that fractures the wax
15.Close the articulator and move the mandibular cast forward (protrusive) ensuring the
incisal pin remains in contact with the tilted incisal guide table. Table should allow
light contact between incisors.
-.25 for incorrect table
16.Open articulator and evaluate to make sure there are no protrusive or lateral protrusive
contacts on #30.
-.25 for each contact
-.50 for each contact which fractures off wax
Instructor Initials _____
Grade: _____
256

Analysis of Mandibular Movements Exercise


In this introductory exercise, you will observe your lab partners excursive
movement occlusion, Posselt diagrams in the horizontal and sagittal planes, and chewing
pattern.
Warning: If you have TMD symptoms, it is recommended you do not have your
Posselt diagram constructed.

If you develop any discomfort with any of these

movements, it is recommended the exercise be discontinued.

Excursive Movement Occlusion


Ask your partner to close into MI. From that position, ask your partner to slide his
or her mandible approximately 2-3 mm to the right and hold that mandibular position
with the mandibular teeth lightly touching the maxillary teeth. Are the teeth on the right
side in laterotrusion or mediotrusion? ________________. Are the teeth on the left side
in laterotrusion or mediotrusion? ________________. Are the teeth on the right side in
canine guidance occlusion (Figure A-18), group function occlusion, or neither?
________________________________. In an ideal occlusion, should the posterior teeth
on the left side touch? ______ (yes or no). Does your partner feel any posterior teeth on
the left side touching? ______ (yes or no).

257

From McNeil C. Science and Practice of Occlusion. 1997


Figure A-18 Canine guidance occlusion
Ask your partner to close back into MI. From that position, ask your partner to
slide his or her mandible approximately 2-3 mm to the left and hold that mandibular
position with the mandibular teeth lightly touching the maxillary teeth. Are the teeth on
the left side in canine guidance occlusion, group function occlusion, or neither?
________________________________. Does your partner feel any of the posterior teeth
on the right side touching? ______ (yes or no).
Ask your partner to close back into MI. From that position, ask your partner to
slide his or her mandible approximately 2-3 mm anteriorly and hold that mandibular
position with the mandibular teeth lightly touching the maxillary teeth. In an ideal
occlusion, should any posterior teeth touch? ______ (yes or no). Does your partner feel
any posterior teeth touching? ______ (yes or no).

258

Constructing Posselt Diagrams


The Posselt diagrams are representations of the envelope of movement or border
movements of the mandible. They are made by tracking the mesiofacio-incisal point
angle of a mandibular central incisor tooth during all mandibular border movements.
As you perform this exercise, keep in mind the objective is not that you obtain
numbers for each blank space, but to understand each position in the Posselt diagrams,
the movements between these positions, why adding or subtracting measurements to
obtain another measurement makes sense, and that these are the mandibular border
movements.
Sagittal Plane
1. While your partner is closed in MI, make a horizontal pencil mark on one of the
mandibular central incisors denoting the incisal vertical overlap of the maxillary incisor.
Ask your partner to open and measure the distance from the pencil mark to the incisal
edge of this mandibular incisor (Figure A-19). This measurement is _____ mm. This is
the amount of vertical overlap your partner has between the maxillary and mandibular
central incisors in MI.
If your partners central incisors do not overlap, but have a vertical gap between them
(sometimes called an open bite), measure this gap and your partners overlap is a
negative number of the measured distance.
Place this number on the appropriate line near the end of this exercise, in your
Sagittal Plane Summary.

259

Figure A-19 Measuring vertical overlap


2.

Ask your partner to open maximally and measure between the maxillary and

mandibular central incisal edges (Figure A-20). This measurement is _____ mm. Your
partner's maximum opening is the incisal edge-to-incisal edge measurement (you just
measured this) plus the vertical overlap, for a total of _____ mm. This is designated in
Figure A-23 as MI-to-Max (maximum opening capability). Place the MI-to-Max number
on the appropriate line in your Sagittal Plane Summary.

Figure A-20 Measuring maximum opening


260

3. With your partners jaw muscles relaxed and your partner looking straight ahead (rest
position, designated as R in Figure A-23), ask him or her to maintain this position while
you measure the central incisor vertical overlap (if there is a gap between the incisal
edges instead of an overlap, measure this and it is a negative number); this measurement
is _____ mm. Subtract from this number the vertical overlap measurement to obtain the
distance your partners rest position was from MI. Place this number on the appropriate
line (MI-to-R) in your Sagittal Plane Summary.
4. While your partner is closed in MI, measure from the facial surface of the mandibular
incisor to the facio-incisal line angle of the maxillary incisor (Figure A-21).
measurement is _____ mm.

This

This is the horizontal overlap of the maxillary and

mandibular incisors in MI; it is also called overjet.


If your partners mandibular central incisor is anterior to the maxillary incisor,
measure this distance and your partners horizontal overlap is a negative number of the
measured distance. Place this number on the appropriate line in your Sagittal Plane
Summary.

Figure A-21 Measuring of horizontal overlap


261

5. To obtain the measurement MI-to-P (maximum protrusion) for Figure A-23, have
your partner protrude the mandible as far as possible. Measure from the facial surface of
the maxillary incisor to the facio-incisal edge of the mandibular incisor in this protruded
position (Figure A-22). This measurement is _____ mm. Add this number with the
horizontal overlap to obtain MI-to-P (maximum protrusion) and place this number on the
appropriate lines in your Sagittal Plane Summary and Horizontal Plane Summary.

Figure A-22 Measuring maximum protrusion


6. This step will involve measuring the distance between centric relation contact (CRC)
and maximum intercuspation (MI) (Figure A-23). Freshen the pencil line that you earlier
placed on the mandibular central incisor that marked the vertical overlap. Also mark a
vertical line on the mandibular central incisor that is in line with the embrasure of the
maxillary central incisors. If the maxillary and mandibular central incisor embrasures are
aligned (this is relatively rare), you do not have to place this pencil mark.
With your partner in rest position, grasp the chin with light pressure and move the
mandible up and down until a relaxed rotary motion is achieved along an arc of about 410 mm. Note that there are alternate methods of placing an individual into CR; these will
be taught later. When the relaxed rotary motion is perceived by the operator with no
262

help from your partner, the teeth are then brought into light contact (CRC). Closely
observe your partner's anterior teeth and ask him or her to squeeze the teeth together.
The mandible will slide from CRC to MI. Measure or estimate the distance and direction
between CRC and MI, or the "slide from centric," using the horizontal and vertical pencil
lines previously drawn.
Even though the slide is due to a vertical discrepancy between CRC and MI, it also
has an anterior and in some cases an additional lateral (right or left) component. Record
the observed vertical, anterior, and lateral components on the appropriate lines in your
Sagittal Plane Summary and Horizontal Plane Summary.
7. The movement from CRC to H (Figure A-23) is a pure hinge or rotary movement,
which you must again perceive. At point H, the mandible cannot open wider without the
condyles translating. This measurement can be estimated by the "feel" of your finger
touching your partner's chin or condyles, observing the movement arcs of the incisal
point, or by your partner's feel. Once the position H has been estimated, measure from
the maxillary central incisor's facio-incisal edge to the horizontal pencil line on the
mandibular central incisor. CRC and MI are generally very close, so this measurement
can generally be used for CRC-to-H; it is generally around 20 mm. Estimate the distance
from H to Max by subtracting your MI-to-Max distance from your CR-to-H distance.
Place these distances on the appropriate lines in your Sagittal Plane Summary.

263

Sagittal Plane Summary


Vertical Overlap = _____ mm
MI-to-Max = _____ mm
MI-to-R = _____ mm
Horizontal Overlap = _____ mm
MI-to-P = _____ mm
CRC-to-MI: Vertical component = _____ mm; Anterior component = _____ mm
CRC-to-H = _____ mm
H-to-Max = _____ mm

CRC

MI

R
H

Max
Figure A-23 Posselt diagram in sagittal plane

264

Horizontal Plane
1. CRC-to-P (Figure A-23 and A-25) can be calculated by adding MI-to-P plus the
anterior component of CRC-to-MI that you placed in the Sagittal Plane Summary. Place
this on the appropriate line in your Horizontal Plane Summary.
2. CRC-to-R and CRC-to-L (Figure A-25) are horizontal border movements. Because
MI is usually close to CRC and it is easy to measure from MI, most people use MI-to-R
and MI-to-L for this measurement. With you partner closed into MI, mark a vertical line
on the mandibular central incisor that is in line with the embrasure of the maxillary
central incisors. If the maxillary and mandibular central incisor embrasures are aligned
(this is relatively rare), you do not have to place this pencil mark.
Ask your partner to move his or her mandible as far as possible to the right and
measure from the embrasure of the maxillary central incisors to your pencil line. Do the
same after your partner has moved his or her mandible as far as possible to the left
(Figure A-24). Record your numbers on the appropriate line in your Horizontal Plane
Summary.

Figure A-24. Measuring left lateral movement; in this example the maxillary and
mandibular central incisor embrasures were aligned in MI.

265

Horizontal Plane Summary


MI-to-P = _____ mm
CRC-to-MI: Anterior component = _____ mm; Lateral component = _____ mm
CRC-to-P = _____ mm
CRC-to-L = _____ mm
CRC-to-R = _____ mm

Place the obtained distances on the sagittal plane Posselt diagram (Figure A-23) and on
the horizontal plane Posselt diagram (Figure A-25). Take a few minutes to review how
you obtained these distances and their significance.

Figure A-25 Posselt diagram in horizontal plane

266

Mapping Chewing Patterns


The point of reference for this exercise will again be the incisal point previously
chosen on the mandibular central incisor. Chewing gum is an ideal substance to use for
this exercise, but boxing wax, raisins, soft candy, etc. may be used.
Figure A-26 shows the typical chewing stroke as viewed from the front (frontal
plane), referenced with MI. The typical chewing stroke starts by opening in a relatively
vertical direction, slowly curving to the lateral, and then closing lateral to the opening
stroke. Closure is directly toward MI and ends in that region.
This movement occurs on the side for which the food is being chewed. In Figure
A-26, the mandible is moving to the right and the food being chewed is on the right side.
Ask your partner to chew on one side, then ask your partner to chew on the other side.
You should observe the movement diagramed in Figure A-26 on the one side and then
shift to the other side, as your partner moves the substance being chewed.

Figure A-26 Typical right-sided chewing stroke

267

Have your lab partner chew normally for several strokes, and observe and record in
Figure A-27 the direction and dimension of the average stroke.
Vertical opening during chewing _____ mm.
Lateral movement during chewing _____ mm.

Figure A-27 Diagram for recording chewing stroke

(S/U) _____
Instructor's Initials _____

268

Articulator Exercise
Use the mounted casts on your articulator to help you answer the following questions:
1.

Are these casts mounted to simulate:


a. MI
b. CR
c. Some other position

2.

As you move the mandibular cast to the right, are the casts in:
a. Group function
b. Canine guidance
c. Some other relationship
d. Both a and b

3.

When you move the mandibular cast to the right:


a. The right condylar element translates
b. The right condylar element rotates
c. The left condylar element translates
d. The left condylar element rotates
e. a and d
f. b and c
g. None of the above

4.

When you move the mandibular cast to the right:


a. The right side is the laterotrusive side
b. The right side is the mediotrusive side
c. The right side is the working side
d. The right side is the balancing side
e. a and c
f. b and d
g. None of the above

5.

When you move the mandibular cast to the right, do any of the opposing teeth on the
left touch?
a. Yes
b. No
269

6.

When you move the mandibular cast to the right, should the opposing teeth on the
left touch?
a. Yes
b. No

7.

When you move the mandibular cast to the right, if opposing teeth on the left side are
touching, these contacts are called:
a. Laterotrusive contacts
b. Mediotrusive contacts
c. Working contacts
d. Balancing contacts
e. a and c
f. b and d
g. None of the above

8.

Move the mandibular cast to the right, move the right condylar guide from 40o to 0o.
What occurs with the relationship between the mounted casts?
a. No change
b. The posterior teeth move closer together
c. The posterior teeth move further apart

9.

Move the mandibular cast to the right, move the right condylar guide to 60o. What
occurs with the relationship between the mounted casts?
a. No change
b. The posterior teeth move closer together
c. The posterior teeth move further apart

10. What is the cause for the observations in questions 8 and 9?


_______________________________________________________________________
_______________________________________________________________________
11. Move the mandibular cast to the right, move the left condylar guide from 40o to 0o.
What occurs with the relationship between the mounted casts?
a. No change
b. The posterior teeth move closer together
c. The posterior teeth move further apart

270

12. Move the mandibular cast to the right, move the left condylar guide to 60o. What
occurs with the relationship between the mounted casts?
a. No change
b. The posterior teeth move closer together
c. The posterior teeth move further apart
13. What is the cause for the observations in questions 11 and 12?
_______________________________________________________________________
_______________________________________________________________________
14. If you moved the mandibular cast to the left, changing which condylar guide would
cause the distance between the posterior teeth to change?
a. Right condylar guide
b. Left condylar guide
15. Move the mandibular cast so the incisors are end-to-end (protrusive). Describe the
changes that occur when the left condylar guide is moved from 40o to 0o.
_______________________________________________________________________
_______________________________________________________________________
16. With the mandibular cast positioned so the incisors are end-to-end (protrusive).
Describe the changes that occur when the left condylar guide is moved from 0o to
60o.
_______________________________________________________________________
_______________________________________________________________________
17. What effect would decreasing the condylar guidance have on a posterior tooth waxup during protrusive and balancing excursions?
_______________________________________________________________________
_______________________________________________________________________
18. What effect would increasing the condylar guidance have on a posterior tooth waxup during protrusive and balancing excursions?
_______________________________________________________________________
_______________________________________________________________________

271

#30 Canine Guidance Practical Exam

Bench # ______
Heaviest stone contact marked, articulator zeroed and wax removed ______
Evaluate Anatomy
1. Evaluate anatomy before powdered wax is applied.
-.25 for each minor problem
-.50 for each major problem, maximum -1.0
Evaluate MI Contacts
2. Ensure the heaviest stone contact, each contact on waxed tooth, and incisal pin require
the same force to pull shim stock from between the contacts.
-.50 if stone does not hold shim stock
-.50 if incisal pin needs to be adjusted
3.
4.
5.
6.
7.
8.

Lightly apply powdered wax with a brush.


Slightly wet opposing teeth with cotton roll or finger.
Gently close articulator until pin contacts the incisal guide table.
Open articulator and check for contacts and smashed wax.
If not all required MI contacts are marked, close articulator and gently tap.
Open articulator and reevaluate for contacts (repeat tapping and use typewriter ribbon
or Accufilm if believe contacts will appear).
9. Evaluate required MI contacts, must have:
Mesiobuccal cusp tip
Distobuccal cusp tip
Distal cusp tip (optional)
Central fossa
Distal marginal ridge

-.25 for each misplaced contact


-.25 for each missing contact
-.25 for each heavy contact
-.25 for each extra contact
-.50 for each heavy/misplaced contact
-2.0 for contact so heavy as to fracture wax
272

Bench # ______
Evaluate Excursive Contacts
10. Check condylar guidance settings to ensure articulator is properly adjusted. Condylar
guide setting is ___ and lateral is 15.
-.25 for any discrepancy
11. Close the articulator and move the mandibular cast to the right, ensuring the incisal
pin remains in contact with the raised incisal guide wing. The wing should allow for
light contact between #6 and 27.
-.25 for incorrect wing setting
12. Open articulator and evaluate to make sure there are no laterotrusive contacts on #30.
-.25 for each laterotrusive contact
-.50 for laterotrusive contact that fractures the wax
Faculty may draw laterotrusive, mediotrusive or protrusive contacts on drawing

13. Close the articulator and move the mandibular cast to the left, ensuring the incisal pin
remains in contact with the raised incisal guide wing. The wing should only allow for
light contact between #11 and 22.
-.25 for incorrect wing setting
14. Open articulator and evaluate to make sure there are no mediotrusive contacts on #30.
-.25 for each mediotrusive contact
-.50 for mediotrusive contact that fractures the wax
15. Close the articulator and move the mandibular cast forward (protrusive) ensuring the
incisal pin remains in contact with the tilted incisal guide table. Table should allow
light contact between incisors.
-.25 for incorrect table
16. Open articulator and evaluate to make sure there are no protrusive or lateral
protrusive contacts on #30.
-.25 for each contact
-.50 for each contact which fractures off wax
Grade: _____

273

#6-11 Anterior Guidance Exercise


Evaluate Anatomy
1. Evaluate anatomy before powdered wax is applied.
-.25 for minor problem
-.50 for multiple minor problems
-.75 for major problem on single tooth
-1.0 for major problem on multiple teeth
Evaluate MI Contacts
2. Ensure the heaviest stone contact, each contact on waxed teeth, and incisal pin require
the same force to pull shim stock from between the contacts.
-.50 if stone does not hold shim stock
-.50 if incisal pin needs to be adjusted; faculty will set pin to correct length.
3.
4.
5.
6.
7.
8.

Lightly apply powdered wax with a brush.


Slightly wet opposing teeth with cotton roll or finger.
Gently close articulator until pin contacts the incisal guide table.
Open articulator and check for contacts and smashed wax.
If not all required MI contacts are marked, close articulator and gently tap.
Open articulator and reevaluate for contacts (use typewriter ribbon or Accufilm if
believe contacts will appear).
9. Evaluate required MI contacts, must have:
Mesial #6
Mesial and distal #7
Mesial and distal #8
Mesial and distal #9
Mesial and distal #10
Mesial #11
Note: no contact on distal #6 or 11.

274

-.25 for each misplaced contact


-.25 for each missing contact
-.25 for each heavy contact
-.25 for each extra contact
-.50 for each heavy/misplaced contact
-2.0 for contact so heavy as to fracture wax
Evaluate Excursive Contacts
10. Check condylar guidance settings to ensure articulator is properly adjusted for this
case (Horizontal 40 and Lateral 17). Faculty will adjust to correct setting if
incorrect.
-.5 for any discrepancy
11. Close the articulator and move the mandibular cast to the right, ensuring the incisal
pin remains in contact with the custom incisal guide table.
12. Open the articulator and evaluate laterotrusive contact only on mesial cusp arm #6.

-.25 for each heavy or incomplete laterotrusive contact


-.50 for laterotrusive contact that fractures the wax or incorrect location
-.75 for missing laterotrusive contact
13. Close the articulator and move the mandibular cast to the left, ensuring the incisal pin
remains in contact with the custom incisal guide table.
14. Open the articulator and evaluate laterotrusive contact only on mesial cusp arm #11.

275

-.25 for each heavy or incomplete laterotrusive contact


-.50 for laterotrusive contact that fractures the wax or incorrect location
-.75 for missing laterotrusive contact
15. Close the articulator and move the mandibular cast forward (protrusive) ensuring the
incisal pin remains in contact with the custom incisal guide table.
16. Open articulator and evaluate for protrusive contacts, must have mesial marginal
ridge #8 and 9. Optional contacts distal marginal ridge #7 and 10.

-.25 for each contact


-.50 for each contact which fractures off wax
Instructor Initials _____
Grade: _____

276

#11-14 Group Function Exercise

Bench # ______

Evaluate Anatomy
1. Evaluate anatomy before powdered wax is applied.
-.25 for minor problem
-.50 for multiple minor problems
-.75 for major problem on single tooth
-1.0 for major problem on multiple teeth
Evaluate MI Contacts
2. Ensure the heaviest stone contact, each contact on waxed teeth, and incisal pin require
the same force to pull shim stock from between the contacts.
-.50 if stone does not hold shim stock
-.50 if incisal pin needs to be adjusted
3.
4.
5.
6.
7.
8.

Lightly apply powdered wax with a brush.


Slightly wet opposing teeth with cotton roll or finger.
Gently close articulator until pin contacts the incisal guide table.
Open articulator and check for contacts and smashed wax.
If not all required MI contacts are marked, close articulator and gently tap.
Open articulator and reevaluate for contacts (repeat tapping and use typewriter ribbon
or Accufilm if believe contacts will appear).
9. Evaluate required MI contacts, must have:
Mesial #11
Mesial marginal ridge or fossa #12
Lingual cusp tip #12
Mesial marginal ridge or fossa #13
Lingual cusp tip #13
Mesial marginal ridge or fossa #14
Central fossa or oblique ridge #14
ML cusp tip #14
DL cusp tip #14

277

Bench # ______
-.25 for each misplaced contact
-.25 for each missing contact
-.25 for each heavy contact
-.25 for each extra contact
-.50 for each heavy/misplaced contact
-2.0 for contact so heavy as to fracture wax
Evaluate Excursive Contacts
10. Check condylar guidance settings to ensure articulator is properly adjusted for this
case (Horizontal 40 and Lateral 15).
-.25 for any discrepancy
11. Close the articulator and move the mandibular cast to the left, ensuring the incisal pin
remains in contact with the raised incisal guide wing. The wing should allow for
light contact between #11 and 22.
-.25 for incorrect wing setting
12. Open the articulator and evaluate for laterotrusive contacts, must have:
Mesial cusp arm #11
Mesial cusp arm #12
Mesial cusp arm #13
Mesial cusp arm #14

-.25 for each heavy or incomplete laterotrusive contact


-.25 for each extra laterotrusive contact
-.50 for laterotrusive contact that fractures the wax or incorrect location
-.75 for missing laterotrusive contacts listed above
13. Close the articulator and move the mandibular cast to the right, ensuring the incisal
pin remains in contact with the raised incisal guide wing. The wing should only
allow for light contact between #6 and 27.
-.25 for incorrect wing setting

278

Bench # ______
14. Open articulator and evaluate for mediotrusive contacts.
-.25 for each mediotrusive contact
-.50 for mediotrusive contact that fractures the wax
Faculty may draw mediotrusive or protrusive contacts on this drawing:

15. Close the articulator and move the mandibular cast forward (protrusive) ensuring the
incisal pin remains in contact with the tilted incisal guide table. Table should allow
light contact between incisors.
-.25 for incorrect table
16. Open articulator and evaluate for protrusive and lateral protrusive contacts.
-.25 for each contact
-.50 for each contact which fractures off wax
Instructor Initials _____
Grade: _____

279

Evaluating the Masticatory System

Palpation Tenderness:
Circle + if tender and - if not tender to palpation
Right

Left

Anterior region of temporalis muscle

Middle region of temporalis muscle

Posterior region of temporalis muscle

TMJ

Masseter muscle

Anterior digastric muscle

Posterior digastric muscle

Sternocleidomastoid muscle

Splenius capitis muscle

Trapezius muscle

Lateral pterygoid area

Medial pterygoid muscle

Student ________________
Partner ________________
Instructor Initials ________
280

Masticatory and Cervical Palpations


Anterior Region of
the Temporalis
Muscle

Bilaterally palpate approximately one and a half inches


behind the eye canthus and one-half inch above the
zygomatic arch.

Middle Region of the Bilaterally palpate the central portion of the middle
Temporalis Muscle temporalis, approximately two inches above the TMJs.
Posterior Region of
the Temporalis
Muscle

Bilaterally palpate the central portion of the posterior


temporalis, above and behind the ears.

TMJ

Three areas of the TMJ are palpated bilaterally, and any


one of these can be tender without tenderness of the
others. A common mistake is not having your partner
open sufficiently to palpate the TMJ adequately. 1) Ask
your partner to open approximately 20 mm and palpate
the condyle's lateral pole. 2) Ask your partner to open as
wide as possible and palpate the depth of the depression
behind the condyle with the fingertip. 3) With the finger
in the depression, pull forward to load the posterior
aspect of the condyle.

Masseter Muscle

Bilaterally palpate the center of the masseter muscle. If


you are unsure of the muscle's extent, ask your partner to
clench, and its extent can easily be felt.

Anterior Digastric
Muscle

The anterior digastric muscle runs from the lingual


surface of the chin, near the midline to the hyoid bone. I
cannot delineate this muscle from the surrounding tissue,
but palpate superiorly the area this muscle transverses. If
tenderness is observed, rule out an oral disorder causing
this tenderness.

Posterior Digastric
Muscle

The posterior digastric muscle runs from the hyoid sling


medial to the sternocleidomastoid muscle and attaches
medial to the mastoid process. Place a fingertip posterior
to the angle of the mandible and medial to the
sternocleidomastoid muscle and apply the palpation force
posteriorly.

281

Sternocleidomastoid
Muscle

Bilaterally palpate the full length of both


sternocleidomastoid muscles by squeezing them between
your thumb and index finger.

Splenius Capitis
Muscle

This muscle is located in the depression just posterior to


the sternocleidomastoid muscle along the base of the
skull. Palpate approximately one inch below the skull,
compressing the muscle up against the skull base. The
head is stabilized during palpation by placing the palm of
the other hand above the forehead.

Trapezius Muscle

Palpate approximately one inch below the skull,


compressing the muscle against the skull base. The head
is stabilized by placing the palm of the other hand above
the forehead.

Lateral Pterygoid
Area

Slide the fifth digit along the lateral side of the maxillary
alveolar ridge to the most posterior region of the vestibule
(the location for the posterior superior alveolar injection).
Palpate by pressing in a superior, medial and posterior
direction.

Medial Pterygoid
Muscle

Place the index finger a little posterior to the traditional


insertion site for an inferior alveolar injection and press
laterally. If your partner gags, your finger is too posterior.

282

#11-14 Group Function Practical Exam

Bench # _____
Wax removed ______

Evaluate Anatomy
1. Evaluate anatomy before powdered wax is applied.
-.25 for minor problem
-.50 for multiple minor problems
-.75 for major problem on single tooth
-1.0 for major problem on multiple teeth
Evaluate MI Contacts
2. Ensure the heaviest stone contact, each contact on waxed teeth, and incisal pin require
the same force to pull shim stock from between the contacts.
-.50 if stone does not hold shim stock
-.50 if incisal pin needs to be adjusted
3.
4.
5.
6.
7.
8.

Lightly apply powdered wax with a brush.


Slightly wet opposing teeth with cotton roll or finger.
Gently close articulator until pin contacts the incisal guide table.
Open articulator and check for contacts and smashed wax.
If not all required MI contacts are marked, close articulator and gently tap.
Open articulator and reevaluate for contacts (repeat tapping and use typewriter ribbon
or Accufilm if believe contacts will appear).
9. Evaluate required MI contacts, must have:
Mesial #11
Mesial marginal ridge or fossa #12
Lingual cusp tip #12
Mesial marginal ridge or fossa #13
Lingual cusp tip #13
Mesial marginal ridge or fossa #14
Central fossa or oblique ridge #14
ML cusp tip #14
DL cusp tip #14

283

-.25 for each misplaced contact


-.25 for each missing contact
-.25 for each heavy contact
-.25 for each extra contact
-.50 for each heavy/misplaced contact
-2.0 for contact so heavy as to fracture wax
Evaluate Excursive Contacts
10. Check condylar guidance settings to ensure articulator is properly adjusted for this
case (Horizontal 40 and Lateral 15).
-.25 for any discrepancy
11. Close the articulator and move the mandibular cast to the left, ensuring the incisal pin
remains in contact with the raised incisal guide wing. The wing should allow for
light contact between #11 and 22.
-.25 for incorrect wing setting
12. Open the articulator and evaluate for laterotrusive contacts, must have:
Mesial cusp arm #11
Mesial cusp arm #12
Mesial cusp arm #13
Mesial cusp arm #14

-.25 for each heavy or incomplete laterotrusive contact


-.25 for each extra laterotrusive contact
-.50 for laterotrusive contact that fractures the wax or incorrect location
-.75 for missing laterotrusive contacts listed above
13. Close the articulator and move the mandibular cast to the right, ensuring the incisal
pin remains in contact with the raised incisal guide wing. The wing should only
allow for light contact between #6 and 27.
-.25 for incorrect wing setting
14. Open articulator and evaluate for mediotrusive contacts.
-.25 for each mediotrusive contact
-.50 for mediotrusive contact that fractures the wax

284

Faculty may draw mediotrusive or protrusive contacts on this drawing:

15. Close the articulator and move the mandibular cast forward (protrusive) ensuring the
incisal pin remains in contact with the tilted incisal guide table. Table should allow
light contact between incisors.
-.25 for incorrect table
16. Open articulator and evaluate for protrusive and lateral protrusive contacts.
-.25 for each contact
-.50 for each contact which fractures off wax
Grade: _____

285