TOOTH, HISTOLOGY, FORM AND

OCCLUSION
ý Structure of teeth:

Enamel:

• Enamel provides a hard durable shape for teeth function and a

protective cover to vital tissues of dentin and pulp.

• Enamel is a mineralized epidermal tissue.

Chemical composition of enamel:

• Enamel is highly mineralized crystalline structure containing from 95 to
98% inorganic substances by weight (Hydroxyapatite).
• The organic content forms about 1 to 2% and water content forms about
4% by weight [6% by volume].

Physical Structure of enamel:

• Human enamel has a physical unit structure called enamel rod or
prisms. The rods are perpendicular to DEJ and tooth surface except
at cervical region where they are directed more apically.
• They are separated by inter-prismatic area known as prism sheath
• When fluorides incorporated in enamel, hydroxyapatite will be
converted into fluoroapatite which is more resistant to acids.

Direction of Enamel Rods

 Tooth form & Occlusion

Permeability of Enamel:
• The micropores form a dynamic connection between the oral cavity
and the dentinal tubule fluids.
• Various fluids, ions and low molecular weigh substances can diffuse
through the semipermeable enamel.
• This ion exchange may be related to acid demineralization,
remineralization and fluoride uptake of enamel from saliva or
toothpaste.
Color of Enamel:
• The natural color of the enamel in the incisal edge and cusp tips is
gray or whitish blue where there is no underlying dentine.
• As the enamel becomes thinner the color of the dentine shows
through and the enamel appears to be darker.

Importance of understanding of physical structure of enamel in

restorative dentistry
1- The enamel rod boundaries form natural cleavage planes through
which fracture might occurs.
2- The enamel prisms weaken if the underlying dentin support is
removed à called undermined enamel.
3- The enamel rod boundary and central core differentially soluble
during acid etching during bonding to resin composite.
4- The direction of enamel rods affects the direction of enamel wall
during cavity preparation
5- Bonding to the end of enamel rod is better than side of enamel rod

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 Tooth form & Occlusion

Dentin:
- Dentin provides support for enamel.

- It is not hard as enamel àit is more elastic than enamel à supporting

the brittle non-resilient enamel.

Chemical composition

- Dentin is formed of 75% inorganic material, 20% organic material and

about 5% water by weight [20 volume % water].
- It is less mineralized than enamel but more mineralized than cementum
or bone.
Physical structure:
- Dentinal tubules contain the cytoplasmic process of an odontoblast +
dentinal fluid.
- The tubules are lined with peri-tubular dentin, which is more
mineralized than the surrounding inter-tubular dentin.
- The number of tubules per unit area
à At the pulpal side is 45,000/mm,
à Toward DEJ to reach 19,000/mm.

Types of dentin

1- Primary dentin:

Dentin formed before and shortly after eruption usually completed 3 years
after tooth eruption for permanent teeth.

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 Tooth form & Occlusion

2- Secondary dentin:

It is a continuation of primary dentin formed at slower rate as the tooth

ages even without external stimuli. It is laid down particularly on the roof
and floor of the pulp chamber à ò its size and shape.

3- Reparative dentin (tertiary dentin):

It is formed in response to irritation as abrasion, erosion, attrition and

caries.

Reparative dentin is confined to the localized irritated area & becomes

apparent microscopically about 1 month after the stimulus.

Dentin sensitivity:

The most accepted theory for pain transmission is the hydrodynamic

theory which states that pain is transmitted through movements of fluid
within dentinal tubules.

Dentin permeability:
Two types of dentinal permeability may be considered:
1- Intra-tubular permeability:
- Dentinal tubules are filled with dentinal fluid providing wetness to
dentin surface.
- The movement of fluid within dentinal tubules causes dentin
sensitivity or pain.

2- Inter-tubular permeability:
- With resin composite restoration, it requires pre-etching of tooth
substrate to provide micro-spaces inside tooth that allow diffusion
of bonding to the tooth. (formation of hybrid layer)

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 Tooth form & Occlusion

Factors affecting dentin permeability :

1. The remaining dentin thickness
2. Diameter of the tubules.
3. Number of tubules
4. Exposure of dentin to irritants: Hypermineralization of dentin occurs
making dentin impermeable.

Importance of studying dentin structure

1- During cavity preparation:

- The cutting efficiency differs between enamel and dentin where
cutting of dentin is less difficult than enamel cutting.
- Heat generation should be minimized as much as possible to avoid
thermal irritation to the pulp.
2- During restorative placement in deep cavity preparation, dentin should
be sealed to avoid any irritational influence of restoration on the pulp

3- During bonding to tooth structure,

- The inter-tubular permeability is important to from
Hybrid Layer
- Bonding to dentin is more difficult than that to
enamel
4- Any stimulus that causes movement of dentinal fluid à dentin
sensitivity and pain.

Movement of dentinal fluid causing

hypersensitivity

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 Tooth form & Occlusion

How to distinguish enamel from dentin during tooth

preparation?
During cavity preparation dentin is usually distinguished from enamel by:

• Color: Dentin is normally yellowish white and darker than enamel.

• Reflectance: dentin surfaces are more opaque and dull & less reflective
to light than enamel which appear shiny.

• Sound:

Dentin à dull sound with explorer.

Enamel à sharp higher pitch with explorer.

• Tactile sensation: a feeling of greater yield to pressure than enamel.

PULP:
• The dental pulp is a specialized connective tissue that occupies the pulp
cavity in the tooth.

• The pulp serves four functions:

- Formative: is the production of primary and secondary dentin.

- Nutritive: the pulp supplies nutrients and moisture to the dentin

- Sensory: it mediates the sensation of pain. The pulp does not

differentiate between heat, touch, pressure or chemicals.

- Defensive: the pulp response to mechanical thermal, chemical, or

bacterial stimuli by reparative dentin.

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 Tooth form & Occlusion

TOOTH FORM
Definition:
The normal tooth form is the proper alignment and relations of the
tooth with the adjacent, opposing and other related structures in oral cavity
in order to serve four functions:
1) Mastication.
2) Esthetics.
3) Speech.
4) Protection of supporting tissue.
The form of the teeth refers to:
1) Tooth contour.
2) Tooth contact & embrasures
3) Tooth occlusal anatomy & occlusion

Aim of maintenance of normal tooth form:

1. Maintain healthy and comfortable masticatory apparatus.
2. Ensure efficiency in function (incising and grinding of food).
3. Assist in speech.
4. Important in Esthetics and good appearance.
5. Protection of supporting structures.

Abnormal tooth form: leads to

1) Food accumulation
2) Gingival inflammation & recession
3) Abnormal jaw movements.
4) T.M.J. disturbances.
5) Affection of supporting structures.

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 Tooth form & Occlusion

I. Tooth Contour

The facial and lingual surfaces of teeth have some degree of convexity
that provides protection and stimulation to the gingival and underlying
structures during mastication.

Normal tooth contour:

Definition:
The convexity of axial surfaces of teeth.
Function:
1) Protection of supporting tissues.

2) Stimulation of gingiva as it guides the deflected food during mastication

in a direction parallel to it buccally and lingually. In this way it:
a. Massages the gum.
b. Stimulate circulation.
c. Clean the tooth surfaces.

Location:

1) Anterior teeth (incisors and canines): Cervical 1/3 of the crown on

facial and lingual surface.

2) Posterior teeth: Buccally à Gingival 1/3

Lingually à middle 1/3 of lingual surface.

3) Proximal height of contour provides:

i. Contact.
ii. Embrasure.

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 Tooth form & Occlusion

Abnormal tooth contour:

A. Over-contoured à Deprive the gingival tissue from the natural

massaging action of food and the tooth from a natural cleaning
mechanism à gingival and periodontal affection.

B. Under-contoured (flat) à The food will be impinged directly onto the

gum margins à gingival and periodontal affection.

C. Properly contoured à The deflected food will be directed parallel to the

gum buccally and lingually that provides natural massaging for
gingiva.

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 Tooth form & Occlusion

II. Tooth proximal contact

Definition:

The area of height of contour of the proximal surface of a tooth that

touches its adjacent tooth in the same arch.

Initially it starts as contact point à contact area by time

Functions:

1. It provides healthy inter-dental papillae.

2. It prevents food accumulation à Good oral hygiene.
3. Maintain the inter-digitation of teeth.
4. It helps in growth of jaws
5. Proper esthetic appearance.

Location of proximal contact

1) Upper and lower incisors: Incisal 1/3 slightly to labial surface.

2) Premolars and molars: junction of occlusal and middle 1/3 of the
proximal surface.

Abnormal Proximal Contact will lead to:

- Food accumulation

- Proximal Caries.
- Gingival and periodontal inflammation
- Bad esthetics (especially in anterior region)
- Drifting of teeth with faulty occlusion

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 Tooth form & Occlusion

Faulty restoration of the level of contact area:

At a higher level At a lower level
• No occlusal embrasure • No gingival embrasure
• Food accumulation • Gingivitis and
gingivally periodontitis
• Concentration of stresses • Food stagnation
• Fracture of restoration occlusally
especially at the marginal
ridge

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 Tooth form & Occlusion
Embrasures
Definition:
A perfect v shaped inter-proximal space between each two adjacent teeth and
named according to direction toward which they radiate:
1. Facial.

2. Lingual.

3. Incisal - occlusal.

4. Gingival.

Sequelae of abnormal Embrasure

1. Narrow embrasure or absent à wide contact à stresses on the teeth and

the supporting structure à the food will be deflected away from the gingival
tissues à gingival and periodontal affection

2. Large embrasure à ò protection to the supporting structures as the food

will be forced by the opposing cusp inter-proximally à gingival and
periodontal affection

N.B. the lingual embrasure is wider than the buccal one in posterior teeth, to
allow the food to be displaced lingually, so the tongue can return the food to the
occlusal surface.

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 Tooth form & Occlusion
III- Occlusal anatomy

occlusal surfaces serve many functions:

1) Mastication of food.

2) Stabilization of the jaws in different positions.

3) Maintenance of the inter-arch relationship.

4) Maintenance of the vertical dimension of occlusion (VDO)

Anatomic markings:

1) Cusps.
2) Ridges
3) Fosse
4) Grooves

1) Cusps:
• Cusps that contact the opposing teeth in the central fossa in centric
occlusion à supporting cusps [centric, holding]
• Cusps that overlap the opposing teeth during centric occlusion ànon
supporting [non centric, non holding]
• Each cusp has four cusp inclines two outer and two inner mesial and
distal inclines.

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 Tooth form & Occlusion
2) Ridges:
• Marginal ridges are elevated ridges located mesially and distally of the
occlusal surface.
• Oblique ridges are characteristics of maxillary molars.
• Transverse ridge is characteristics for lower first premolar.

3) Fossae:

• Depressions between the cusps are termed fossae.

• Non-coalesce enamel in a fossa is termed a pit.

4) Grooves:

Two types of fissures exist.

- Normal fissure shape, in cross section they have wide opening, followed
by a narrow cleft.
- Atypical fissure pattern [10%] with a narrow opening and a bulbous
widening at the base àconsidered as caries risk area.

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 Tooth form & Occlusion
Occlusion
Occlusion literally means "closing"; while in dentistry, occlusion means the
contact of teeth in opposing dental arches when the jaws are closed (static
occlusal relationships) and during various jaw movements (dynamic occlusal
relationships).

Posterior occlusal stability

is defined as simultaneous, even contact between sufficient posterior teeth
to direct occlusal forces axially, stabilizing the positions of both the teeth
and the jaws.
Importance: spread occlusal forces over a wide area, preventing damage to
individual components of the masticatory system, usually the teeth.
It requires stable inter-cuspal contact in addition to presence of sufficient
number of teeth.

Factors affecting occlusal stability

1-Number of posterior teeth
2-Proximal tooth contact as preventing teeth drifting in edentulous spaces
3-Shape of occlusal surface of restoration

Requirements:
1- Posterior stability is best maintained by preventive dentistry, thus
avoiding unnecessary loss, or the need for extensive restoration of teeth.
2- Most edentulous spaces should be restored to prevent unwanted tooth
movement
3- Restorations of all types should be shaped correctly to reproduce
occlusal anatomy

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 Tooth form & Occlusion

• Improper restoration of these anatomic features lead to affection of

the functional performance à physiologic adaptation to new
circumstances à wears facets within physiologic adaptation.

• If abnormalities are beyond adaptive power of tissue, pathologic

changes occur as:
a) Development of abnormal chewing habits and abnormal jaw
movements.
b) Looseness or teeth.
c) Tooth wear
d) Affection of supporting structures and development of periodontal
diseases.
e) T.M.J, disturbances.

• Ideal restoration of damaged teeth:

1) The incisors should be provided with incisal edges to cut food.

2) The cuspids have pointed cusps with mesial and distal slope à tearing
of food.

3) Premolars and molars à cusps and ridges acting as morters and

pestles à grinding of food.

4) The mandibular and maxillary teeth are arranged in to facilitate jaw

movements.

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