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DENTAL ANATOMY FOR THE ENT RESIDENT Hedyeh Javidnia, PGY2 November 7, 2008.

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Presentation on theme: "DENTAL ANATOMY FOR THE ENT RESIDENT Hedyeh Javidnia, PGY2 November 7, 2008."— Presentation transcript:

1 DENTAL ANATOMY FOR THE ENT RESIDENT Hedyeh Javidnia, PGY2 November 7, 2008

2 Dental Anatomy Dental Anatomy Odontogenesis Odontogenesis Types of Dentition Types of Dentition Tooth Surfaces Tooth Surfaces Mandibular & Maxillary Anatomy Mandibular & Maxillary Anatomy ObjectivesObjectives..

3 Anatomy of a tooth. a. Anatomical crown- portion of tooth covered with enamel a. Anatomical crown- portion of tooth covered with enamel Dental Anatomy Anatomic crown

4 b.Clinical crown- visible part of b.Clinical crown- visible part of tooth above the gum line. Anatomical crown Clinical crown Dental Anatomy

5 c. Root (1) Part of tooth embedded in the alveolar process and covered by cementum. (1) Part of tooth embedded in the alveolar process and covered by cementum. Dental Anatomy

6 d. Apex- tapered end of root tip. d. Apex- tapered end of root tip. e. Apical foramen- opening at the root tip. e. Apical foramen- opening at the root tip. Dental Anatomy

7 Tissues of the tooth. a. Enamel (1) Makes up anatomic crown. (2) Hardest material in the human body (3) Incapable of remodeling and repair. Dental Anatomy

8 Enamel

9 b.Dentin (1) Makes up bulk of tooth. (2)Covered by enamel on crown and cementum on the root. (2)Covered by enamel on crown and cementum on the root. (3)Not as hard as enamel. (4) Exposed dentin is often sensitive to cold, hot, air, and touch (via dentinal tubules). Dental Anatomy

10 Dentin Enamel Dentinal Tubules

11 c. Cementum (1) Covers root of tooth. (1) Covers root of tooth. (2) Overlies the dentin and joins the enamel at the cemento-enamel junction (CEJ). (2) Overlies the dentin and joins the enamel at the cemento-enamel junction (CEJ). (3)Primary function is to anchor the tooth to the bony socket with attachment fibers. (3)Primary function is to anchor the tooth to the bony socket with attachment fibers. Dental Anatomy

12 Dentin Enamel Dentinal Tubules Cementum

13 d. Pulp (1) Made up of blood vessels and nerves entering through the apical foramen. (1) Made up of blood vessels and nerves entering through the apical foramen. (2) Contains connective tissue, which aids interchange between pulp and dentin. (2) Contains connective tissue, which aids interchange between pulp and dentin. Dental Anatomy

14 Dentin Enamel Dentinal Tubules Cementum Pulp

15 4. Periodontium a. Alveolar process. a. Alveolar process. (1) Bone extensions of the maxillae and mandible that supports the teeth. (1) Bone extensions of the maxillae and mandible that supports the teeth. (2) Cortical plate is the dense outer layer of bone covering the spongy (cancellous) bone (2) Cortical plate is the dense outer layer of bone covering the spongy (cancellous) bone Dental Anatomy

16 Dentin Enamel Dentinal Tubules Cementum Pulp Alveolar Process Cortical Plate Spongy Bone

17 b. Periodontal ligaments. (1) Dense connective fibrous tissues that connect teeth to the alveolar bone. (2) One end is embedded in cementum and other end in bone. (3) Supports and protects the tooth from normal shock. Dental Anatomy

18 Dentin Enamel Dentinal Tubules Cementum Pulp Alveolar Process Cortical Plate Spongy Bone Periodontal Ligaments

19 c. Gingiva - surrounds the teeth and covers the alveolar process. Dental Anatomy

20 Dentin Enamel Dentinal Tubules Cementum Pulp Alveolar Process Cortical Plate Spongy Bone Periodontal Ligaments Gingiva

21 Odontogenesis A.Bud Stage B.Cap Stage C.Bell Stage D and E. Dentinogenesis and amelogenesis F.Crown formation G.Root Formation H.Eruption

22 A. Bud Stage Bud stage is characterized by rounded, localized growth of epithelium surrounded by proliferating mesenchymal cells, which are packed closely beneath and around the epithelial buds Meckels cartilage Intramembranous ossification

23 B. Cap Stage Vestibular lamina When the appropriate depth is reached, the basal layer at the tip of the dental lamina thickens, forming a concavity.

24 C. Bell Stage Continued growth leads to bell stage, where the enamel organ resembles a bell with deepening of the epithelium over the dental papilla Continuation of histodifferentiation (Inner dental epithelium - ameloblasts and Dental papilla - odontoblasts) Dental lamina Outer dental epithelium Inner dental epithelium Dental papilla Dental follicle Cervical loop

25 At the same time or soon after the first layer of dentin (mantle dentin) is formed, the inner dental epithelial cells differentiate into ameloblasts and secrete enamel proteins. The ameloblasts will then start laying down organic matrix of enamel against the newly formed dentinal surface. The enamel matrix will mineralize immediately and form the first layer of enamel. The formation of enamel is called amelogenesis. Ameloblasts First layer of enamel Dentin Odontoblasts D. Amelogenesis

26 E. Dentinogenesis Dentin is formed by odontoblasts that differentiate from ectomesenchymal cells of dental papilla with influence from the inner dental epithelium Differentiation of odontoblasts is mediated by expression of signaling molecules and growth factors in the inner dental epithelial cells

27 Incremental pattern of dentin and enamel formation from initiation to completion F. Crown Formation Growth areas of developing crown. Growth at cusp tip, intercuspal region, and cervical region

28 G. Root Formation Development of root begins after the enamel and dentin formation has reached the future cementoenamel junction Epithelial cells of the inner and outer dental epithelium proliferate from the cervical loop of the enamel organ to form the Hertwigs epithelial root sheath. The root sheath determines if a tooth has single or multiple roots, is short or long, or is curved ir straight Hertwigs epithelial root sheath

29 Hertwigs epithelial root sheath Inner dental epithelium Outer dental epithelium Stratum intermedium Eventually the root sheath will fragment to form several discrete clusters of epithelial cells known as epithelial cell rests of malassez. These will persist in adults within the periodontal ligament The epithelial rests appear as small clusters of epithelial cells which are located in the periodontal ligament adjacent to the surface of cementum. They are cellular residues of the embryonic structure known as Hertwig's epithelial root sheath. Epithelial Cell Rests of Malassez

30 Soon after root formation begins, tooth begins to erupt until it reaches its final position While roots are forming, the supporting structures of tooth also develop – periodontal ligament and cementum As the root sheath fragments, the dental follicle cells will penetrate between the epithelial cells and lie close to the newly formed root dentin These cells will differentiate into cementoblasts, which will make cementum H. Tooth Eruption and Development of supporting structures

31 REVIEW: Odontogenesis A.Bud Stage B.Cap Stage C.Bell Stage D and E. Dentinogenesis and amelogenesis F.Crown formation G.Root Formation H.Eruption

32 Types of Dentition 1. Deciduous (baby) teeth a. Twenty ( 20) primary teeth. a. Twenty ( 20) primary teeth. b. Arches - maxillary and mandibular. b. Arches - maxillary and mandibular. c. Quadrants - each arch divided in half. c. Quadrants - each arch divided in half. (1) Maxillary right and left. (1) Maxillary right and left. (2) Mandibular right and left. (2) Mandibular right and left. Enamel is thinner, pulp is thicker

33 d. Teeth in each quadrant. (1) Central incisor ( 2) Lateral incisor ( 3) Cuspid (4) 1st molar (5) 2nd molar Deciduous Teeth

34 f. Numbering system. (1) Alphabetical. (1) Alphabetical. (2) Maxillary - patients right to left, A through J. (2) Maxillary - patients right to left, A through J. (3) Mandibular - patients left to right, K thru T. (3) Mandibular - patients left to right, K thru T. Deciduous Teeth K L M N O P Q R S T A B C D F H I J E G R L MAXILLARY MANDIBULA R

35 Types of Dentition 2. Permanent teeth. a. Thirty-two (32) permanent teeth. a. Thirty-two (32) permanent teeth. b. Arches - maxillary & mandibular. b. Arches - maxillary & mandibular. R L

36 c. Quadrants. (1) Maxillary right and left. (1) Maxillary right and left. (2) Mandibular right and left. (2) Mandibular right and left. R L Permanent Teeth

37 d. Teeth in each quadrant. (1) Central incisor. (1) Central incisor. (2) Lateral incisor. (2) Lateral incisor. (3) Cuspid (canine). (3) Cuspid (canine). Permanent Teeth

38 (4) 1st bicuspid (5) 2nd bicuspid (6) 1st molar (7) 2nd molar (8) 3rd molar (wisdom tooth) (wisdom tooth) Permanent Teeth

39 1. Facial - next to cheeks & lips. a. Labial- anterior facial. a. Labial- anterior facial. b. Buccal - posterior facial. b. Buccal - posterior facial. 2. Lingual- next to tongue. 3. Mesial - towards midline, an imaginary line between central incisors. 4. Distal- away from midline. 5. Incisal- cutting edge of anterior teeth. 6. Occlusal- chewing surface of the posterior teeth. Tooth Surfaces

40 7. Proximal surfaces - mesial or distal surface of a tooth lying next to another tooth. 8. Interproximal space (embrasure) - spaces between teeth, filled with hard and soft tissue (interdental papilla). (embrasure) - spaces between teeth, filled with hard and soft tissue (interdental papilla). Tooth Surfaces

41 9. Cusps- pronounced elevations on the occlusal surfaces of a tooth terminating in a conical or rounded surface. Tooth Surfaces

42 Anatomy of the Mandible

43 Anatomy of the Maxilla

44 The End!!


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