Dental Anatomy

Challenge 2010
Propound

Lecture Notes
Lecture Title: Morphology of molars Professor Name: Dr. Ashraf AlShawesh Done By: Dental Anatomy Scripts Team

Permanent molars are identified and distinguished from the rest of

the teeth because of a number of class traits ,they should have 3 or more cusps . # How to distinguish between premolars and molars?
( because some premolars have 3 cusps as mandibular 2nd premolar )

Very simple, Molars should at least have 2 buccal cusps , where premolars have only one buccal cusp always , but we can see 2 lingual cups for premolars .

- Arch Traits (Upper and Lower Molars Differences ( First Roots maxillary molars have 3 roots , and they are located below the cups 2 of them buccaly and one lingual 1. MesioBuccal root Below the Mesiobuccal cusp 2. DistoBuccal Root Below Distolbuccal cusp 3. Lingual Root mandibular molars have 2 roots not necessarily located below the cusps, They locate below the marginal ridges : 1. Mesial Root Second Crowns Maxillary molars : buccolingually width is (11 mm), greater than mesiodistally width (10 mm) Mandibular molars : mesiodistal width is (11 mm) greater than buccolingual width (10 mm) . 2. Distal Root

Third Cusps * Maxillary molars , we see 4 cups : -Three of them as major and main cusps, Triangular in shape "TRIGON " 1. mesiobuccal 2. distobuccal 3. Mesiolingual - And one is lesser extra cups at the corner * Distolingual * Mandibular molars ,we see 4 cups of equal sizes . Fourth Oblique Ridge This is present only in maxillary molars ( Not mandibular ), its is a ridge that runs obliquely from one corner to another , from the tip of mesiolingual cusp to the tip of distobuccal cusp. Fifth Cusps Sizes The two Buccal cusps in maxillary molars are different in their sizes , Plus that the mesiolingual cusp is larger than distolingual cups in maxillary molars , whereas these two buccal cusps and two lingual are in equal sizes on mandibular molars. # Roots Roots become more distally inclined and also fused as we go posteriorly. As you see here (slide 5) in the upper molar the roots are separated and vertical, as we go posteriorly roots become closed to each other and also distally inclined, as we go toward the third molar, the roots become fused and distally inclined.

This feature is important in distinguishing these teeth without having these teeth put together [when you hold the teeth separately].

Maxillary permanent first molar

First Buccal aspect 1. The mesiobuccal (MB) and distobuccal (DB) cusps are of equal height, but they are not of equal size. The bigger is the mesiobuccal but the distobuccal is smaller. In this feature we talk about the upper molar, because in the lower molar the two cusps should be equal in size. 2. The mesiobuccal (MB) is wider. 3. The two cusps mesiobuccal and distobuccal are separated by buccal groove..B groove, it extents until the halfway then disappears terminate halfway. 4. The slopes of distobuccal (DB) are steeper, which means the tip of this cusp is more acute (angled) because slopes are steep not flat, they tend to be flatter in the case of mesiobuccal cusp. 5. The tip of the mesiolingual cusp can be seen between buccal cusps; this means there is a huge cusp located lingually which is the mesiolingual cusp. The tip of this cusp is not located exactly behind the tip of the mesiobuccal, it tends to be hider. 6. The mesial profile is highly convex in the occlusal area, but tends to be flat in the cervical area (2/3s). 7. The mesial height of contour is located at the junction between the quarter 3 and the quarter 4. 8. The cervical line or the cervical third (1/3) is usually flat or sometimes concave. 9. The distal profile is entirely convex.

10. The distal height of contour is located at three fifth (3/5) of the distance from the cervical line to the tip of the cusp (MR cusp). * The D HOC is lower than the M HOC. *This is a general feature of all teeth except the mandible first premolar. 11. The cervical line is slightly two curved segments separated by an apical peak.
(This is not really important, if you want, we can consider it as straight line).

# Buccal surface 1. From the buccal aspect, part of the distal surface is visible. Why? Because the angle between the buccal surface and the distal surface is obtuse this why we can see some portion of distal surface. * Notice that we cannot see any part of the mesial surface. Why? Because the angle between the buccal surface and the mesial surface is acute. 2. The cervical third 1/3 is convex, the cervical part of the crown starts flat and then it has subconvixity. 3. The occlusal two thirds 2/3 are flat. # Roots 1. Three roots are visible: mesiobuccal , distobuccal and lingual (palatal). 2. The bifurcation is the area which root trunks start to divide. *The buccal bifurcation is the area of division for making the mesiobuccal and distobuccal root is located at the junction between the cervical third and the middle third 1/3. * So if you measure the root from the apex to the cervical line, divided into three equal thirds, you will find the bifurcation located at the junction between the middle third and the cervical third.

3. The shallow vertical groove in the midline of the buccal root trunk. * The area of the root before division is called the root trunk, usually this area is about one third 1/3 of the length of the root and tends to be very small in deciduous teeth. 4. The mesiobuccal and distobuccal roots are narrow and incline toward each other in the apical third. * This is a type trait. Why? Because as we go distally toward the second molar and then to the third molar, the two roots become closure to each other and distally inclined. 5. The mesiobuccal root apex is in line with the mesiobuccal cusp tip. As we go toward the second molar the roots become closer, thats why we feel that the distance between the two roots is smaller.
As a general role : if you see a molar and its roots are away from each other and they are outside the limit of the crown this is an upper first molar . But if you see that the roots are close to each other and the distance between them is smaller than the dimension of the crown this is second molar. And if the roots were very close to each other and sometimes fused this is a third molar.

6) The longest of these three roots is the lingual roots, which is visible between the two other roots.

SecondThe lingual aspect: 1) Two cusps with unequal size. 2)The mesiobuccal is much bigger than the distobuccal, also the mesiobuccal has a small tubercle on its lingual surface which is called Tubercle of Carabelli . 3)The mesiolingaul cusp makes 3/5 of the mesiodistal width, and it has a prominent but blunt apex.

4)The distolingual cusp is rounded shorter and narrower than the mesiolingual cusp. An important type trait: In the first molar this cusp is larger than the same cusp in the second molar and also its much larger than that in the third molar - if it is present - because in many of the cases this cusp is absent in the third molar. 5) A lingual groove runs between the cusps lingualy, terminates in the midway on the lingual surface. 6) The mesial profile is convex except in the flat cervical third. 7) The distal profile is entirely convex. 8) The lingual surface: - Its evenly convex OC. This whole surface is like a part of a sphere means that the convexity is equal. But in the buccal surface we have a buccal cervical ridge, and the HOC is not exactly in the middle thats why its not uniformly convex. The lingual groove divides the lingual surface into mesial and distal segments, and the cusp of Carabelli (if present) is located all the time on the mesial part or in the mesiolingual cusp .This actually is racially variant means that it differs from one population/race to another.

{The Dr. said that he has done a study on the cusp of carabelli, he will put it on e-learning and we have to learn the results. According to that study Jordanians (Arabs) are very similar to Europeans because both are Caucasians so the percentage of this trait (cusp of carabelli) is similar (its a little bit higher in Europeans). In Asians and black people the percentage is very low. And in Eskimos its very rare to see this trait.}

- The term cusp of carabelli shouldnt always be used because its only classified as a cusp when its very huge , and less than 5% of the people has a very huge one to call is a cusp , thats why its called sometimes tubercle of carabelli. And when its not present, we will have a groove instead, which we call in this case the negative expression of carabelli trait . 9)Roots: - The three roots are visible. - -The Proximal outline of the buccal roots is visible as well. - -The lingual root: * Is very huge - wide cervicaly and it tends to go up between the two roots. *Its tapered (means starts wide and gets narrower as we go up) with a blunt apex. *Shallow vertical depression from the cervical line to 2/3s of the length can be visible here. *The L root apex is in line with crown midline. This is a type trait because in the maxillary second molar the apex tends to go distally.

# The mesial aspect:

1) The maximum mesio-distal dimension (width) is at the cervix of the crown. 2) The mesio-lingual is higher than the mesio-buccal cusp. 3) The buccal- cervical 1/3 is strongly convex, the HOC buccaly is very close to the cervical line, but lingually its located halfway. 4) The lingual outline is uniformly convex. 5) The cervical line is slightly convex occlusally .

# Mesial surface : the mesialmarginal ridge is marked by several tubercles, its very often to see the marginal ridges made of by diffusion of number

of tubercles and this is a one of type traits; because usually we dont see that in second or third molars this fissure (several tubercles) only found in the mesial marginal ridges of upper molars and sometime we find sublimental grooves between this tubercles. - the contact area is located between the middle and occlusial third, and this contact area tends to be wide because this tooth tend to make contact with the maxillary second premolar at this area. - cervical third is flat or concave. - The occlusial 2/3 are convex.

#Root - we can see only 2 roots the mesiobuccal and the lingual lingual like a banana shape because its curved; its curved lingually first and then its curved buccally. both the mesiobuccal and lingual roots are projected toward crown profile both of them are projected outside the profile of the crown .

And its a type traits because we dont see this fissures on second or third molars also we see the cusp or tubercle of carabilly on the mesiolingual cusp, at this stage we can call it tubercle and when it become very huge as big as any of this cusps we call it the cusp of carabilly
Note : we must be careful about using cusp of carabilly, in your book you can find cusp of carabilly but in fact its not classified as cusp its only in very low percentage of people where the size of this elevation is huge to extend that it can classified as cusp but in many of the situations is small elevation its call the tubercle of carabilly and it may absent in 50% of population and we dont have any difference between the male and the female or right and left side of 9 your mouth so when we call cusp of carabilly thats mean the tubercle of carabilly depending on the size of that elevation.

# Distal aspect
1) The distobuccal is more prominence than the distolingual 2) only a small portion of the mesial cusp are visible because The distal marginal ridge is loop thats why we can see part of the occlusial surface but if we look at the tooth mesialy we will not see any part of the distal cusp because the mesial marginal ridge is high 3) The distal marginal ridge is short and less prominence than the mesial marginal ridge 4) The distal marginal ridge does not have tubercle, its not tuberculated 5) The buccal and lingual profiles are similar to those seen on the mesial aspect 6) the cervical line is nearly straight its not curved # Distal surface - it is uniformly convex similar to the lingual surface # Root - we see 3 roots from this site, why we only see 2 roots here?because mesiobuccal root is wide buccolingualy and its distobuccal hidden behind it the when we look at the from the distal aspect we can see three cusps because the distobuccal cusp is narrower than the mesiobuccal cusp thats why we can see three cusps.

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# Occlusal surface
1) we have 2 angle that are acute, and 2 angle that are obtuse, because of that this tooth not square in shape its rhomboid( (in shape, as we go posteriorly -toward the second molar- the acuteness and obtuseness increase 2) the acute angles are the mesiobuccal and the distolingual 3) the obtuse angles are the mesolingual and the distobuccal, as we know each cusp has four ridges from the tip(mesial, distal, lingual and buccal ), each ridge that participate at the occlusial surface of the tooth is called triangular ridge, now take this cusp which is the distobuccal cusp and take the mesiolingual cusp, the mesiolingual cusp its a huge cusp because of that it participate or connections with the mesiobuccal and distobuccal at the same time , so the triangular ridge of the mesiolingual cusp is continuous with the triangular ridge of the mesiobuccal cusp making one continuous ridge called transverse ridge, the mesial ridge goes towards the marginal ridge and this cusp not have distal ridge that goes distally but this ridge goes distobuccaly to make the oblique ridge, thats why the oblique ridge formed by two parts: the triangular ridge of the distobuccal cusp the distal cusp ridge of the mesiolingual cusp. Please always remember that the oblique ridge consist of 2 parts : 1) The triangular ridge of disto-buccal cusp . 2) Distal-buccal ridge of mesio-buccal cusp .

Normally the distal ridge has to go distaly but in this case it goes disto-buccaly , so thats why its a distal cusp ridge .thats why we have this marginal ridge .

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# Fosses and Grooves The area between the mesial marginal ridge and the transverse ridge is FOSSA mesial triangular fossa . any fossa just located inside a marginal ridge is called triangular fossa ( its a rule ) . The fossa located between the transverse ridge and the oblique ridge this fossa " central fossa " . We didn't talk about disto-lingual , this is the tip of the cusp . Of course we dont see permanent lingual ridge for the lingual cusp . WHY ??? because the surface uniformly convex so thats why we see mesial and distal cusp ridges and this one here is triangular . The area between the triangular cusp ridge of the disto-lingual cusp and the mesial ridge DISTAL TRIANGULAR FOSSA . we have one fossa that is lift , this fossa is located just distal to the triangular ridge and it's located mesial to the triangular ridge of the disto-lingual cusp . Again just distal to the oblique ridge and between the oblique ridge and the triangular ridge of the disto-lingual cusp , this area , this fossa is called " distal fossa "
o

So thats why this tooth has 4 fossa : 1) 2 triangular fossa . 2) one central fossa . 3) one distal fossa .

**What about the grooves ????? We have the buccal groove , disto-lingual groove and we have the central groove . The central groove starts from the mesial pit to the central pit .

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What about the groove that causes the margin of the oblique ridge ? its the transverse ridge groove . # Occlusal table : The area enclosed between the mesial and distal and also you have to include the marginal ridges , so the area enclosed inside the mesial and distal ridge of all cusp and also marginal ridge is called occlusal table . Occlusal table contains the fossa that we discussed .

# The Pulp
FINALLY THE PULP SYSTEM IN THIS TOOTH , generaly each root has one canal except the mesio-buccal has 2 canals , this is in 60% of the people . Q: IN 60% OF PEOPLE HOW MANY CANAL WE HAVE ??? A: 4 canals . Q: HOW CAN WE HAVE 4 CANALS AND 3 ROOTS ???? A: one root contain 2 canal ( mesio-buccal )

Its very very very rare to see more than one root canal in the lingual or disto-buccal root , but its often to see 2 roots in mesio-buccal canal .

So remember That : THAT IS POSSIBLE IN 60% OF PEOPLE TO SEE 4 CANALS IN THIS TOOTH , EXTRA CANAL SHOULD ONLY EXIST WITHIN OR INSIDE THE MESIOBUCCAL ROOY .

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Summary

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Class Traits

3 or more cusps At least 2 buccal cusps One or more lingual cusps In general 2 or 3 roots

Arch Traits

3 roots: 2 B & 1 L Crown: BL > MD dimension 3 major cusps: ML,MB,DB (Lesser-sized DL ,sometimes missing) Oblique ridge: ML to DB cusp B cusps are unequal in size ML cusp > DL cusp

Type Traits

DL cusp reduces in size when going posteriorly & may be missing in 3rd molar 1st molar is the largest & shows the least morphological variation Cusp of Carabelli Roots become more D inclined & much closer when going posteriorly

Test Yourself

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1) Its possible for the permanent molars to have all the following except: a. 2 3 roots. b. 3 or more cusp, maximum 2 of them are buccal cusps. c. One or more lingual cusps. d. 3 or more cusps, minimum 2 of them are buccal cusps. 2) The following is a type trait of the maxillary permanent molar: a. It has an oblique ridge that runs from the ML to the DB cusp. b. It has a cusp that is called the cusp of cerabelli. c. the buccal cusps are unequal in size. d. Nothings correct. 3) The pulp of the maxillary 1st molar: a. has horns that are unequal in size in a MD section. b. has 3 horns that are equal in size in BL section. c. Its chamber is narrower in BL section. d. has 2 horns that are equal in height in a MD section. 4) We can see this on the occlusal surface/table of the maxillary 1st molar: a. Obtuse MB, DL angles. b. A major triangular fossa on the distal side. c. A minor central fossa. d. A central fossa that has a central pit and groove. 5) In the Lingual view of the maxillary 1st molar: a. Only 2 roots are visible. b. All 3 roots are visible. c. The lingual root is tapered with a blunt apex. d. b + c .
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Noha Ghazal Hadeel Jaradat Hebah Ramadnah Sundos Abu Zaid Salam Bataineh Hadeel sumrain Asmaa Almawas

Rawda Najjar Baraah Alslamat A9eel Ghawanmeh Ahmed Al Shamary Eman Idkaidek Hibah Jarrah Abeer M. derawi

Eman nazzal

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