Ebook Textbook of preclinical conservative dentistry (2/E): Part 1

Textbook of

Preclinical Conservative Dentistry



Textbook of

Preclinical Conservative Dentistry
Second Edition

Editors
Nisha Garg
BDS MDS (Conservative Dentistry and Endodontics)

Professor
Department of Conservative Dentistry and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India

Amit Garg
BDS MDS (Oral and Maxillofacial Surgery)

Associate Professor
Department of Oral and Maxillofacial Surgery
Sri Sukhmani Dental College and Hospital
Dera Bassi, Mohali, Punjab, India

Foreword
AP Tikku

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Textbook of Preclinical Conservative Dentistry
First Edition: 2011
Second Edition: 2017
ISBN: 978-93-86056-83-2
Printed at


Dedicated to
Prisha
and
Vedant



Contributors
Ajay Chhabra MDS
Principal, Professor and Head
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India

Gurkirat Singh Grewal MDS
Senior Lecturer
Department of Conservative Dentistry

and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India

Anamika Thakur MDS
Senior Lecturer
Department of Conservative Dentistry
and Endodontics
Sri Sukhmani Dental College and
Hospital
Mohali, Punjab, India

Harleen Kaur Gill MDS
Senior Lecturer
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India

Ankur Vats MDS
Reader
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India
Ashu Jhamb MDS
Reader
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital

Baddi, Himachal Pradesh, India

Jaidev Singh Dhillon MDS
Principal, Professor and Head
Department of Conservative Dentistry
and Endodontics
Gian Sagar Dental College and Hospital
Patiala, Punjab, India
JS Mann MDS
Associate Professor
Department of Conservative Dentistry
and Endodontics
Government Dental College
and Hospital
Patiala, Punjab, India

Bhumika Ahuja MDS
Reader
Department of Pedodontics
KD Dental College and Hospital
Mathura, Uttar Pradesh, India

Madhu Garg MDS
Professor
Department of Pedodontics and
Preventive Dentistry
JCD Dental College
Sirsa, Haryana, India

Damanpreet MDS

Reader
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India

Mannat Dhillon BDS
Consultant Dental Surgeon
Dental Solutions
Ludhiana, Punjab, India

Daminder Singh MDS
Medical Officer (Dental)
Government Dental College and
Hospital
Patiala, Punjab, India

Manoj Hans MDS
Professor
Department of Conservative Dentistry
and Endodontics
KD Dental College and Hospital
Mathura, Uttar Pradesh, India


viii

Textbook of Preclinical Conservative Dentistry

Navjot Singh Khurana MDS

Lecturer
Department of Conservative Dentistry
and Endodontics
Government Dental College
and Hospital
Patiala, Punjab, India
Nidhi Rani MDS
Senior Resident
Department of Conservative Dentistry
and Endodontics
Postgraduate Institute of Medical
Education and Research
Chandigarh, India
Poonam Bogra MDS
Senior Professor
Department of Conservative Dentistry
and Endodontics
DAV Dental College
Yamuna Nagar, Haryana, India
Priya Verma Gupta MDS FPFA
Professor
Department of Pedodontics and
Preventive Dentistry
Divya Jyoti College of Dental Sciences
and Research
Ghaziabad, Uttar Pradesh, India
RS Kang MDS
Former Associate Professor
Department of Conservative Dentistry
and Endodontics

Government Dental College
and Hospital
Patiala, Punjab, India
Sanjay Miglani MDS
Associate Professor
Faculty of Dentistry
Jamia Millia Islamia
New Delhi, India

Savita Thakur MDS
Senior Lecturer
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India
Shital Kumar MDS
Medical Officer (Dental)
Government Dental College and
Hospital
Patiala, Punjab, India
Simran Pal Singh Bindra MDS
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India
Sunila Sharma MDS
Reader
Department of Pediatric and Preventive
Dentistry
Gian Sagar Dental College and Hospital

Jansla, Punjab, India
Vandana Chhabra MDS
Associate Professor
HS Judge Dental College
Chandigarh, India

Varun Jindal MDS
Reader
Department of Conservative Dentistry
and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India


Foreword
It gives me immense pleasure to introduce you to the second edition of the Textbook of Preclinical
Conservative Dentistry. Since conservative dentistry is backbone of the dentistry, it is mandatory
to train the undergraduate students for restorative procedures before entering the clinics. For
the second time, Dr Nisha Garg and Dr Amit Garg present their well-known book of preclinical
conservative dentistry, best described in simple and easy language with plenty of diagrams,
keeping in mind the syllabus prescribed by many universities of India. Written by the two
prominent authorities on this important aspect of dentistry, Dr Nisha Garg and Dr Amit Garg
have accumulated a incredible amount of knowledge to summarize this important information
into easy-to-read chapters.
From the introduction to preclinical conservative dentistry in chapter one highlighting the importance of preclinical
conservative dentistry, going through dental anatomy, nomenclature, physiology of tooth form, armamentarium,
dental caries, dental materials, adhesive dentistry, basic fundamentals of tooth preparation and step-by-step tooth
preparation for amalgam and composites make this edition a must have preclinical guide for dental students before
entering their clinics. This edition has plenty of line diagrams and photographs for better understanding of the concept.
The authors have also included the too often neglected aspect of conservative dentistry, i.e. importance, anatomy and

tooth preparation of primary teeth, making it understandable how morphology of teeth affect the tooth preparation.
I am pleased to introduce and recommend this book as an excellent guide for students to understand the subject of
conservative dentistry.

AP Tikku
BSc BDS MDS FICD

Dean
Faculty of Dental Sciences
King George’s Medical University
Lucknow, Uttar Pradesh, India



Preface to the Second Edition
In presenting the second edition of Textbook of Preclinical Conservative Dentistry, we would like to express our appreciation
in the kindly manner in which the first edition was accepted by dental students across the country. We once again thank
Almighty God for His blessings in all our endeavors.
The scope of the second edition of this book is as earlier to be simple yet comprehensive which serve as an introductory
for dental students. This book covers basic tooth anatomy, cutting instruments, principles of tooth preparation, dental
materials and their manipulation so as to have fundamental knowledge before handling patients in the clinics.
Emphasis is laid upon the language which is simple, understandable and exclusively designed for beginners in
conservative dentistry.
The line diagrams are in an expressive interpretation of tooth preparation procedures, which are worked upon and
simplified to render them more comprehensive and comparable with real photographs.
In an attempt to improve the book for better clarification of the subject, many eminent personalities were invited
to edit, write and modify the important chapters in form of text and photographs. We are grateful to Dr Manoj Hans,
Dr Daminder Singh, Dr Shital Kumar and Dr Varun Jindal for providing us photographs related to preclinical and clinical
work for better understanding of the subject.
We fall lack of words to thank Dr RS Kang, Dr JS Mann, Dr Navjot Singh Khurana, Dr Ankur Vats, Dr Ashu Jhamb and

Dr Savita Thakur for critically evaluating the chapters and bringing them in the best form.
We offer our humble gratitude and sincere thanks to Mr Vikram Bhojia (Secretary, Bhojia Trust) for providing healthy
and encouraging environment for our work.
We would like to express our thanks to our colleagues for their ‘ready to help’ attitude, constant guidance and positive
criticism which helped in improvement of the book.
We are grateful to Hu-Friedy, GC Fuji, Coltene Whaledent and Dentsply for using their images in our book.
It is hoped that all these modifications will be appreciated and render the book still more valuable basis for preclinical
dentistry.
We thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–
Publishing), Dr Priya Verma Gupta (Editor-in-Chief, Dentistry), Dr Abha Bedi (Development Editor), Seema Dogra (Cover
Designer), Nitesh Jain (Graphics Designer), Deep Kumar Dogra (Operater) of M/s Jaypee Brothers Medical Publishers
(P) Ltd, New Delhi, India for showing personal interest and trying to the level best to bring the book in present form.
We shall be grateful to our readers if they critically analyze the text and send us useful suggestions to improve quality
of the book for next edition.

Nisha Garg
Amit Garg



Preface to the First Edition
Operative dentistry is one of the oldest branches of dental sciences forming the central part of dentistry as practiced in
primary care. It occupies the use of majority of dentist’s working life and is a key component of restorative dentistry. The
subject and clinical practice of conservative dentistry continues to evolve rapidly as a result of improved understanding
of etiology, prevention and management of common dental diseases. The advances and developments within the last
two decades have drastically changed the scope of this subject. But before taking professional training, gathering basic
knowledge along with operating skill is mandatory.
The main objective of this book is to provide students with the knowledge required while they are developing
necessary clinical skills and attitude in their undergraduate training in conservative dentistry and endodontics. We have
tried to cover wide topics like morphology of teeth, cariology, different techniques, instruments and materials available

for restorations of teeth along with the basics of endodontics.
So we can say that after going through this book, the student should be able to:
• Sit properly while operating and be able to organize their operating environment efficiently
• Understand the morphology of teeth and differentiate one tooth from another
• Chart teeth
• Understand basics of cariology, its prevention and conservative management
• Tell indications and contraindications of different dental materials
• Apply modern pulp protective regimens
• Select suitable restorative materials for restoration of teeth
• Understand the basics of endodontic treatment like what are the indications of endodontic treatment, basic
instruments, access preparation, biomechanical preparation and obturation of root canal system.

Nisha Garg
Amit Garg



Contents
1. Introduction to Preclinical Conservative
Dentistry�������������������������������������������������������������������1
Nisha Garg

Causes of Loss of Tooth Substance 1
Objectives of Operative Dentistry 3
Objectives of Preclinical Conservative Dentistry 3
Armamentarium  3
Preclinical Tooth Preparations  4

2. Morphology of Permanent Teeth������������������������6
Amit Garg, Mannat Dhillon

Definitions  6
Maxillary Teeth  7
Mandibular Teeth  15

3. Morphology of Primary Teeth����������������������������26
Priya Verma Gupta, Sunila Sharma

Importance  26
Difference Between Primary and
  Permanent Dentition  27
Maxillary Teeth  28
Mandibular Teeth  32

4. Structure, Nomenclature and Tooth
Physiology��������������������������������������������������������������39
Amit Garg, Ajay Chhabra

Tooth Nomenclature  41
Tooth Notation Systems  42
Nomenclature of Tooth Surfaces  46
Physiology of Tooth Form  46

5. Chair Position and Dental Operatory����������������51
Amit Garg, Gurkirat Singh Grewal

Common Positions for Dental Procedures  51
Antisepsis in Clinics  53
General Precautions  53

6. Dental Caries���������������������������������������������������������56
Nisha Garg

Theories  56
Etiology  58

Classification  60
Histopathology  65

7.Armamentarium���������������������������������������������������70
Nisha Garg, Amit Garg

Nomenclature  70
Parts  71
Instrument Formula  72
Different Instrument Designs  73
Exploring Instruments  74
Hand Cutting Instruments  76
Restorative Instruments  79
Instrument Grasps  81
Finger Rests  82
Rotary Cutting Instruments  84
Matrix Retainers and Bands  89
Wedges  94

8. Principles of Tooth Preparation���������������������� 101
Nisha Garg

Purpose of Tooth Preparation  101
Classification  101

Definitions  104
Number of Line and Point Angles  105
Steps  108
Initial Stage  108
Final Stage  112

9. Tooth Preparation for Amalgam and
Composite Restorations����������������������������������� 122
Nisha Garg, Poonam Bogra

Preparation for Amalgam Restoration  122
Tooth Preparation for Composite Restoration  129

10. Tooth Preparation for Primary Teeth������������� 135
Madhu Garg, Priya Verma Gupta, Bhumika Ahuja

Rationale for Tooth Preparation  135
Principles of Tooth Preparation  135
Classification of Dental Caries  137
Tooth Preparation  137
Matrix Bands and Retainers  141
Steps for Amalgam Restoration for
  Primary Teeth  143


xvi

Textbook of Preclinical Conservative Dentistry

11. Dental Materials������������������������������������������������� 145

Amit Garg, Vandana Chhabra

Dental Cements  145
Zinc Oxide Eugenol Cement  146
Zinc Phosphate Cement  149
Zinc Silicophosphate Cements  151
Calcium Hydroxide  152
Zinc Polyacrylate Cement/Zinc Polycarboxylate
 Cement 152
Glass Ionomer Cement  154
Pulp Protection Materials  159
Dental Amalgam  160
Dental Casting Alloys  166

12. Adhesive Dentistry�������������������������������������������� 171
Nisha Garg, Jaidev Singh Dhillon, Damanpreet

Enamel Bonding  172
Dentin Bonding  172
Dentin Bonding Agents  173
Evolution of Dentin Bonding Agents  173
Dental Composites  177

13. Basics of Endodontics��������������������������������������� 185
Nisha Garg, Sanjay Miglani

Etiology of Pulpal Diseases  186
Progression of Pulpal Pathologies  186

Endodontic Instruments  186

Access Cavity Preparation  188
Access Cavity of Anterior Teeth  189
Access Cavity Preparation for Premolars  190
Access Cavity Preparation for Maxillary Molars  190
Access Cavity Preparation for Mandibular
 Molars 190
Working Length Determination  191
Significance of Working Length  191
Irrigation of Root Canal System  192
Cleaning and Shaping  192
Basic Principles of Canal Instrumentation  193
Techniques of Root Canal Preparation  193
Obturation of Root Canal System  194
Coronal Restoration  195
Common Errors During Endodontic Treatment  195

14. Examination Spotters��������������������������������������� 198
Nidhi Rani, Harleen Kaur Gill

Instruments  198
Materials  202

Glossary����������������������������������������������������������������������� 209
Anamika Thakur, Simran Pal Singh Bindra

Index��������������������������������������������������������������������������������������������������������215


1

cHAPTER

Introduction to Preclinical
Conservative Dentistry
Nisha Garg

Chapter Outline





Introduction
Causes of Loss of Tooth Substance
Objectives of Operative Dentistry
Objectives of Preclinical Conservative Dentistry

Introduction
“Operative dentistry is science and art of dentistry which
deals with diagnosis, treatment and prognosis of defects of
the teeth which do not require full coverage restorations for
correction. Such treatment should result in the restoration
of proper form, function and esthetics while maintaining
the physiologic integrity of the teeth in harmonious
relationship with the adjacent hard and soft tissues, all
of which should enhance the general health and welfare
of the patient”. It plays an important role in enhancing
dental health and now branched into dental specialties.
But before practicing operative dentistry, one should
understand the concept of tooth preparation because

operative dentistry deals with diagnosis, prevention,
interception and restoration of the defects of natural teeth.
Preclinical operative dentistry is a branch of operative
dentistry where practical training is given for tooth
preparation and restoration of teeth with various materials
on dummy models in simulated oral environment.

Need for Preclinical Conservative Dentistry
As we know oral cavity is a small area which consist of
lips, cheeks, palate and a mobile tongue. To do tooth
preparation in this area, a great skill is required. So in

 Armamentarium
 Preclinical Tooth Preparations
 Viva Questions

order to have proper understanding of anatomical and
dimensional considerations, it is always recommended
to do tooth preparations on artificial acrylic teeth called
typhodont teeth. Typhodont teeth are screwed on to the
phantom head. By doing tooth preparation in dummy
models, a person is able to juxtapose his acquired skill
in clinical patient easily. Repeated tooth preparations in
extracted natural teeth increase the skill and efficiency
of the person. Moreover this training increases the
confidence and psychomotor skills for handling tissues.
Basic purpose of preclinical conservative dentistry
is to make the students to gain expertise for restorative
procedures before handling the patient. This develops
confidence in the student before they manage the patient.

CAUSES OF LOSS OF TOOTH SUBSTANCE
•
•



•
•
•
•

Dental caries (Fig. 1.1)
Noncarious loss of tooth structure
–Attrition (Fig. 1.2)
–Abrasion (Fig. 1.3)
–Erosion (Fig. 1.4)
Traumatized or fractured teeth (Fig. 1.5)
Esthetic improvement (Fig. 1.6)
Replacement or repair of restoration (Fig. 1.7)
Developmental defects (Fig. 1.8)


2

Textbook of Preclinical Conservative Dentistry

Figure 1.1:  Clinical picture showing pit and fissure caries in premolar

Figure 1.4:  Clinical picture showing generalized erosion of

maxillary anterior teeth

Figure 1.2:  Clinical picture showing generalized attrition of
mandibular anterior teeth

Figure 1.5:  Clinical picture showing fractured central incisor
which can be corrected by esthetic treatment

Figure 1.3:  Clinical picture showing generalized abrasion of teeth

Figure 1.6:  Clinical picture showing spacing between teeth which
can be corrected by restorative procedures


Introduction to Preclinical Conservative Dentistry

Figure 1.7:  Clinical picture showing fractured amalgam restoration
requiring replacement

objectives of operative dentistry
Following are the objectives of operative dentistry:

Diagnosis
Diagnosis is determination of nature of disease, injury or
other defect by examination, test and investigation.

Prevention
It includes the procedures done for prevention before the
manifestation of any sign and symptom of the disease.

Interception
It includes the procedures undertaken to prevent the
disease from developing into a more serious or full extent.

Preservation
Preservation of the vitality and periodontal support of
remaining tooth structure is obtained by preventive and
interceptive procedures.

Restoration
It includes restoring form, function, phonetics and
esthetics.

Maintenance
After restoration is done, it must be maintained for
providing service for longer duration.

3

Figure 1.8:  Clinical picture showing intrinsic discoloration of teeth
which can be corrected by esthetic restorations

objectives of preclinical
conservative dentistry
• To have knowledge about anatomy of teeth
• To gain expertise for restorative procedures before
handling the patient in simulated clinical conditions
• To gain expertise for restorative procedures before
handling the patient by performing restorative
procedures in simulated clinical conditions

• To gain expertise for manipulation of different dental
materials
• To have knowledge of different instruments used in
restorative dentistry
• To understand the fundamentals of tooth preparation.

Armamentarium
Armamentarium (instruments) used in preclinical
conservative dentistry should be arranged as following
(Fig. 1.9):
• Exploring instruments: Mouth mirror, straight probe,
explorer and tweezers
• Excavating instrument: Spoon excavator
• Cutting instruments: Chisel, hatchet, gingival marginal
trimmer and hoes
• Mixing instruments: Cement mixing spatula, mortar
and pestle
• Filling instrument: Plastic filling instrument, amalgam
carrier, teflon-coated instruments
• Condensers: round and parallelogram condenser


4

Textbook of Preclinical Conservative Dentistry

Figures 1.9:  Photograph showing armamentarium required for restorative procedures

• Carvers: Diamond shaped (Frahm’s), Hollenback’s
carver

• Ball burnishers
• Others: Glass slab, Ivory no. 1 and 8 retainers and
bands, Toffelmire retainer and bands, wedges, dappen
dish
• Contrangle micromotor hand piece, round, straight,
tapered, inverted cone diamond points.

preclinical Tooth preparations

on typhodonts and extracted teeth. Typhodonts are
artificial acrylic teeth mounted on maxillary and
mandibular arches which can be fixed to human-shaped
rubber faces to simulate the oral cavities. Typhodonts can
also be mounted separately on plaster moulds or blocks
(Fig. 1.10D). Typhodonts are advantageous because of
their easy accessibility, availability in anatomical forms.
But these have disadvantages like:
• There is no separation between enamel and dentin
• Because of their softness they get cut very fast.

Tooth Preparations on Plaster Models

Tooth Preparations on Extracted Teeth

Before going for tooth preparation on typhodonts or
extracted teeth, it is advisable to practice on plaster models.
These plaster models are prepared by pouring plaster
of paris in readymade tooth moulds. Students practice
class I to V tooth preparations on these models. Working
on plaster models have many advantages. Students can

understand concept of tooth preparation better on bigger
models. Outline form, line and point angles, convergence
of walls, and carving can be understood in a better way on
plaster models (Figs 1.10A to C). By these, student can
easily replicate tooth preparations on typhodonts and
extracted teeth.

After performing tooth preparations on plaster models and
typhodonts, students are advised to practice on extracted
natural teeth. These teeth should be mounted in plaster
blocks or phantom jaws. These teeth have advantages
over typhodonts because being natural, these show
differentiation of enamel and dentin. But these teeth carry
risk of contamination and they are not easily available.

Tooth Preparations on Typhodonts
Before going for tooth preparation in patient’s mouth, it is
always advisable to practice all types of tooth preparations

Shortcomings of Preclinical Practice
• Knowledge of saliva control and isolation can not be
experienced in preclinical work
• One can not be familiar with tongue interference which
is common while working on mandibular arch
• Retraction of soft tissues is completely different in
patients
• Patient anxiety and apprehension can not be
experienced with mannequins.

Introduction to Preclinical Conservative Dentistry

A

B

C

5

D

Figures 1.10A to D:  (A to C) Photograph showing Class I and II tooth preparations on plaster model; (D) Tooth preparation in typhodont

Scope of operative dentistry
of the teeth which do not require full coverage
• To have knowledge of dental anatomy and histology
restorations for correction.” Such corrections and
• To understand the effect of the operative procedures on
restorations result in the restoration of proper tooth
the treatment of other disciplines
form, function and aesthetics while maintaining the
• To know condition of the affected tooth and other teeth
physiological integrity of the teeth in harmonious
• To examine not only the affected tooth but also oral and
relationship with the adjacent hard and soft tissues.
systemic health of the patient
Q.3. Why is subject preclinical operative dentistry
• Provide optimal treatment plan to restore the tooth to
important?

return to health and function and increase the overall Ans. Since oral cavity is a small area which consist
well being of the patient
of lips, cheeks, palate, and a mobile tongue. To
• Thorough knowledge of dental materials which can be
do tooth preparation in this area, a great skill is
used to restore the affected areas
required. Repeated tooth preparation in extracted
• To understand the biological basis and function of
natural teeth increases the skill and efficiency of the
various tooth tissues
person.
• To maintain the pulp vitality and prevent occurrence of Q.4. Why should one practice on dummy models
pulpal pathology.
before doing patients?
Ans. By doing tooth preparation in dummy models,
a person is able to juxtapose his acquired skill
Viva Questions
in clinical patient easily. Moreover this training
Q.1. What is preclinical operative dentistry?
increases the confidence and psychomotor skills for
Ans.Preclinical operative dentistry is a branch of
handling tissues.
operative dentistry where practical training is given
Q.5. What are different causes of loss of tooth
for tooth preparation and restoration of teeth with
structure?
various materials on dummy models in simulated
Ans. • Caries
oral environment.

• Noncarious loss of the tooth structure
Q.2. Define Operative dentistry?

• Malformed, traumatized, or fractured teeth
Ans.According to Sturdvent, “Operative dentistry is
• Esthetic improvement
defined as science and art of dentistry which deals
• Replacement or repair of restoration
with diagnosis, treatment and prognosis of defects
• Developmental defects.


CHAPTER

2

Morphology of Permanent Teeth
Amit Garg, Mannat Dhillon

CHAPTER OUTLINE
Introduction
Definitions
Maxillary Teeth
t
Central Incisor
t
Lateral Incisor
t
Canine
t
First Premolar
t
Second Premolar
t
First Molar
t
Second Molar

INTRODUCTION
As we know there are 32 teeth in permanent dentition
and 20 teeth in deciduous dentition. A tooth has crown
and a root portion. Crown part of the tooth is covered
with enamel and root portion of tooth is covered by
cementum. The crown and root join at cementoenamel
junction (CEJ).

DEFINITIONS
Cervical line: Each tooth has a crown and root portion.
The crown is covered with enamel and the root portion is
covered with cementum. The crown and root join at the
CEJ. This junction is also called the cervical line.
Cingulum: It is enlargement or the bulge on the cervical
third of lingual surface of the crown in anterior teeth
(incisors and canines).
Ridge: It is linear elevation on the surface of a tooth. Its
named according to its location.
Marginal ridges: These are rounded borders of enamel
that form the mesial and distal margins of occlusal surfaces
of posterior teeth (premolars and molars) and mesial and

Mandibular Teeth
t
Central Incisor
t
Lateral Incisor
t
Canine
t
First Premolar
t
Second Premolar
t
First Molar

t
Second Molar
Viva Questions

distal margins of the lingual surfaces of anterior teeth
(incisors and canines).
Triangular ridges: These descend from the tips of the
cusps of molars and premolars toward the central part of
occlusal surfaces.
Transverse ridge: When both buccal and lingual triangular
ridges join, they combine to form a transverse ridge.
Oblique ridge: It is a ridge obliquely crossing the occlusal
surfaces of maxillary molars. It is usually formed by the
union of triangular ridge of distobuccal cusp and distal
cusp ridge of the mesiolingual cusp.
Fossa: It is an irregular depression or concavity on lingual
surface of anterior and occlusal surface of posterior teeth.
Its named according to its shape or location.
Lingual fossae: Occur on lingual surface of incisors.
Central fossae: Occur on occlusal surface of molars.
Sulcus: It is a long depression on the surface of tooth
ridges and cusps.
Developmental groove: It is shallow groove between the
primary parts of the crown or root.


Morphology of Permanent Teeth

7

Pits: These are small pinpoint depressions located at the

junction of developmental grooves or at ending of those
grooves.

r
#FMPX
DJOHVMVN
UIFSF
JT
B
TIBMMPX
DPODBWJUZ
XIJDI
JT

bordered by mesial and distal marginal ridge, incisal
ridge and cingulum (Fig. 2.2B).

Lobe: It is one of the primary sections of formation in the
development of the crown.

Mesial Aspect

Tubercle: Smaller elevation on some portion of crown
produced by an extra formation of enamel. Its commonly
found on palatal surface of maxillary first molar. It differs
from cusp as it is formed by enamel only while cusp is formed
of pulp horn covered by dentin and enamel (Fig. 2.1).

r
8FEHF
USJBOHVMBSTIBQFE
DSPXO
XJUI
CBTF
UPXBSET

cervix and apex towards incisal ridge
r
*ODJTBM
FEHF
PG
DSPXO
JT
JO
MJOF
XJUI
DFOUFS
PG
UIF
SPPU
r
-BCJBM
PVUMJOF
JT
DPOWFY
GSPN
DFSWJY
UJMM
JODJTBM
FEHF
r
-JOHVBM
PVUMJOF
JT
DPOWFY
BU
UIF
QPJOU
XIFSF
JU
KPJOT
DSFTU

of curvature at cingulum. After this it becomes concave
and then slightly convex again when it approaches
linguoincisal ridge
r
$FSWJDBM
MJOF
DVSWFT
JODJTJBMMZ
ǔJT
DVSWF
JT
NPSF
PO
UIF

mesial surface than on distal surface (Fig. 2.2C).

MAXILLARY TEETH

Distal Aspect

Mamelons: These are three rounded protuberances found
on the incisal edges of newly erupted incisor teeth.
Cusp: Elevation on the crown portion of a tooth making up
a divisional part of the occlusal surface.

%JTUBM
BTQFDU
JT
BMNPTU
TJNJMBS
UP
UIBU
PG
NFTJBM
BTQFDU

except in following:
Labial Aspect
r
$SPXO
BQQFBST
UIJDLFS
BU
NFTJBM
r
8JEFTU
NFTJPEJTUBMMZ
m
NN

PG
BOZ
BOUFSJPS
UFFUI

r
$VSWBUVSF
PG
DFSWJDBM
MJOF
JT
MFTT
UIBO
PO
UIF
NFTJBM

with almost square or rectangle shape
surface (Fig. 2.2D).
r
.FEJBM
PVUMJOF
JT
TUSBJHIU
PS
TMJHIUMZ
DPOWFY
XIFSFBT

Incisal Aspect
the distal outline is more convex
r
%JTUPJOJDJTBM
BOHMF
JT
OPU
BT
TIBSQ
BT
NFTJPJODJTBM
BOHMF
r
*ODJTBM
FEHF
JT
DFOUFSFE
PWFS
UIF
SPPU
(Fig. 2.2E)
r
*ODJTBM
PVUMJOF
JT
BMNPTU
TUSBJHIU

CVU
OFXMZ
FSVQUFE

r
-BCJBM
TVSGBDF
BQQFBST
CSPBE
BOE
ëBU

XIFSFBT
UIF

teeth may show mamelons
lingual portion tapers lingually towards the cingulum.
r
$FSWJDBM
PVUMJOF
GPMMPXT
B
TFNJDJSDVMBS
TIBQF
XJUI

convexity towards root surface (Fig. 2.2A).

Lateral Incisor

Central Incisor

Box 2.1: Special features of maxillary lateral incisor

Lingual Aspect
r
.FTJBM
BOE
EJTUBM
PVUMJOFT
DPOWFSHF
QBMBUBMMZ
r
#FMPX
DFSWJDBM
MJOF

B
TNPPUI
DPOWFYJUZ
JT
QSFTFOU
DBMMFE

cingulum

t
Most commonly found missing tooth
t
Peg-shaped lateral—Common finding
t
Palatogingival groove.

Labial Aspect

A

B

Figures 2.1A and B: Schematic representation showing
cusp and tubercle

r
8IFO
DPNQBSFE
UP
DFOUSBM
JODJTPS

JU
IBT
NPSF

curvature, rounded incisal edge and rounded incisal
angles, mesially and distally (Box 2.1)
r
.FTJPJODJTBM
BOHMF
DBO
CF
BT
TIBSQ
BT
UIBU
PG
DFOUSBM

incisor
r
%JTUBM
PVUMJOF
JT
NPSF
SPVOEFE
UIBO
DFOUSBM
JODJTPS
r
$SFTU
PG
DPOUPVS
NFTJBMMZ
JT
BU
QPJOU
PG
KVODUJPO
PG

middle and incisal third and on distal side, it lies more
towards cervical aspect
r
-BUFSBM
JODJTPS
JT
OBSSPXFS
NFTJPEJTUBMMZ
BOE
TIPSUFS

cervicoincisally than central incisor (Fig. 2.3A).


8

Textbook of Preclinical Conservative Dentistry

A

B

D

C

E

Figures 2.2A to E: Schematic representation showing (A) Labial aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Incisal aspect of maxillary central incises

Lingual/Palatal Aspect

Incisal Aspect

r
1BMBUBM
BTQFDU
JT
OBSSPXFS
UIBO
MBCJBM
r
$JOHVMVN
JT
QSPNJOFOU
XJUI
BŁOJUZ
UPXBSET
EFFQ

developmental grooves within lingual fossa
r
.BSHJOBM
SJEHFT
BSF
NPSF
QSPNJOFOU
UIBO
UIBU
PG
DFOUSBM

incisor
r
8IFO
DPNQBSFE
UP
DFOUSBM
JODJTPS

MJOHVBM
GPTTB
JT
NPSF

concave and circumscribed (Fig. 2.3B).

r
.BZ
SFTFNCMF
DFOUSBM
JODJTPS
PS
DBOJOF
r
-BCJBM
TVSGBDF
JT
NPSF
DPOWFY
XJUI
QSPNJOFOU
DJOHVMVN
r
-BCJPMJOHVBM
EJNFOTJPOT
NBZ
CF
HSFBUFS
UIBO

mesiodistal dimensions (Fig. 2.3E).

Canine
Labial Aspect

r
.FTJPEJTUBM
EJNFOTJPOT
BSF
TIPSUFS
UIBO
DFOUSBM
JODJTPS
r
-BCJBM
TVSGBDF
JT
TNPPUI
XJUI
TMJHIU
TIBMMPX
EFQSFTTJPOT
r
"MNPTU
TJNJMBS
UP
UIBU
PG
DFOUSBM
JODJTPS
r
%VF
UP
NPSF
EFWFMPQNFOU
PG
NJEEMF
MPCF

MBCJBM
SJEHF
JT

r
$VSWBUVSF
PG
DFSWJDBM
MJOF
NPSF
PO
NFTJBM
TVSGBDF
UIBO

seen
on distal surface (Fig. 2.3C).
r
.FTJBM
PVUMJOF
JT
DPOWFY
GSPN
DFSWJY
UP
NFTJBM
DPOUBDU

area
Distal Aspect
r
%JTUBM
PVUMJOF
JT
VTVBMMZ
DPODBWF
GSPN
DFSWJDBM
MJOF
UP

r
8JEUI
PG
DSPXO
BQQFBST
NPSF
UIBO
PO
NFTJBM
TVSGBDF

distal contact area
because of placement of crown on the root
r
*ODJTBM
FEHF
DPNFT
UP
B
EJTUJODU
QPJOU
JO
GPSN
PG
DVTQ

r
$VSWBUVSF
PG
DFSWJDBM
MJOF
JT
VTVBMMZ
MFTT
UIBO
UIBU
PG

*U
IBT
NFTJBM
BOE
EJTUBM
TMPQFT
.FTJBM
TMPQF
JT
TIPSUFS

mesial surface (Fig. 2.3D).
than distal slope

Mesial Aspect