Dental Anatomy

Challenge 2010
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Lecture Notes
Lecture Title: Max. Lateral Incisors, Mand. Central Incisors & Mand. Lateral Incisors. Professor Name: Dr. Ashraf AlShawesh Done By: Dental Anatomy Scripts Team

Today we will continue the topic of incisors, last time we finished talking about maxillary central incisor and now we will talk about maxillary lateral incisor, Mandibular Central Incisors and Mandibular Lateral Incisors.

Maxillary lateral incisor

-Labial Aspect
This tooth is narrower mesodistally and shorter incisocervically than the central incisor (this is a type trait, because we use these features to distinguish between maxillary central incisors and maxillary lateral incisors). Usually the lateral and central incisors have the same length. But notice that all the angles of this tooth are more rounded than the angles in the central incisor, so the mesoincisal angle is rounded and distoincisal angle is severely rounded. If you remember, those angles in the maxillary central incisor are less rounded. We said that we have a sharp mesoincisal angle and slightly rounded disoincisal angle in the maxillary central incisor. The HOC (Height of Contour) is further from the incisal edge, they are located away from the incisal edge when compared with the central incisor. The mesial HOC of the maxillary lateral incisor is located at the junction between the incisal third and the middle third. The distal HOC is located exactly at the middle of the crown incisocervically. While in the maxillary central incisor this is located at the junction between the middle third and the incisal third, which means that the HOC of the central incisor is higher (more incisally located) than the HOC of the lateral incisor. The mesial outline is slightly convex and the distal outline is severely convex while in the central incisor the mesial outline is straight and the distal is slightly convex. The root is conical and slightly inclined distally.

- Lingual Aspect
From the lingual aspect its similar to the central incisor, with one important difference which is that all the ridges and the Cingulum is very prominent and marginal edges are very well formed. And as a result of the very prominent features lingually the fossa is very deep (again, this is a type trait because we use this to distinguish between the maxillary central incisor and the maxillary lateral incisor). If we want to order teeth according to which has the most prominent lingual features and which one has the least, it will be: [the most prominent] maxillary lateral incisor, maxillary central incisor, mandibular incisors .

[Note] A mistake that lots of student make while carving : Many students when theyre carving they make a very deep lingual fossa and as a result they get very prominent marginal ridges. Please remember that youre carving a lateral incisor not a central incisor, there are lots of morphological differences between the two. Q: Order the following teeth from those with the deepest fossa to those with the shallowest fossa or from the most prominent cingulum/marginal ridges to the least prominent? A: maxillary lateral incisor, maxillary central incisor, mandibular incisor (the central and lateral are similar). Sometimes because we have a very deep fossa we may see a groove running through (crossing) the cingulum, its called developmental groove. And sometimes at the deepest portion of the fossa we see some pits. This is important because sometimes, these pits are areas of plaque accumulation and when they accumulate plaque they induce caries (class I caries). Thats why its not uncommon to see caries at the lingual surfaces of lateral incisors in particular.

Dens Invaginatus
Sometimes in certain locations the fossa is very deep to the extent that its communicating with the pulp of the tooth. We call this Dens Invaginatus (a condition that we will be covering next year in oral pathology). This present problems because once the tooth erupts in the mouth, the outside of the tooth is communicating with the inside of the tooth, because of that the tooth develops pulpitis and this leads to very serious problems.

- Mesial Aspect
From the mesial aspect of a maxillary lateral incisor, the cingulum is very convex because its prominent; the cementoenamel junction (CEJ) of the cervical line is less curved.

- Distal Aspect similar to the mesial aspect. -incisal aspect:

1. the tooth is ovoid in outline, because the tooth is rounded in all regions. 2. It has smaller mesiodistal dimension (MD) than central. 3. The labial outline is rounded. 4. The mesial Line (ML) and distal line (DL) angles are more rounded.

The pulp is similar to that of the central incisor, we have the pulp that looks like the tooth from the outside and we have two pulp horns. [Note] Many people think that the cusps of the elephant are the canines, but these are the maxillary lateral incisors.

:: The Permanent Mandibular Incisors ::

-Arch traits (How to distinguish the maxillary incisors as a group from mandibular incisors as another group)
Crown: 1) Narrower mesiodistally (MD). 2) Greater height/width proportion. 3) Smaller mesiodistal (MD)/labiolingual proportion (LL). Root: 1) Smaller mesiodistal (MD)/labiolnguial (LL) proportion. 2) Generally oblong in x-section.

-Type traits (How to distinguish mandibular central incisor from mandibular lateral incisor)
Its not difficult to distinguish between maxillary lateral incisor and maxillary central incisor, but its difficult to distinguish between the mandibular central incisor and the mandibular lateral incisor, because these two teeth are nearly equal in size and dimensions and have prominent different features.

Permanent Mandibular Central Incisors:

We call the similarities between these two teeth (central and lateral), type traits. Also because you see these two teeth within the same arch then its also an arch trait. When you see an arch with two similar incisors then its a mandibular arch, but when they are different then its a maxillary arch.

-Labial Aspect:
Its very narrow mesiodistaly; in fact its the narrowest teeth mesiodistaly of ALL TEETH!

Its bilaterally symmetrical which means the mesial half is exactly the same as the distal half. It has 3 mamelons. Mesial and distal mamelons are of equal prominence (in the maxillary central incisors we said that the mesial mamelon is higher than the distal one). The mesioincisal and distoincisal angles are both 90 and located at the same level incesiocervicaly. The heights of contour (HOC) are also at the same location (level) and very close to the incisial edge. Both mesial and distal outlines are almost straight lines. The cementoenamel junction (cervical line) is convex cervically, and the root is narrow and conical.

-Lingual Aspect:
The fossa here is very shallow. The cingulum and marginal edges are less prominent because when teeth contact, the edge of the central incisor has to make contact with the fossa of the upper incisor thats why the fossa of the upper teeth must be deep but here, what makes contact with the fossa of the lower teeth? Nothing really so thats why its not that deep. Lastly, the cementoenamel junction summit is exactly at the center.

- Mesial Aspect:
The labial HOC is within the cervical third, and From HOC toward incisial edge, the labial outline is straight. The root is broad (wide) from mesial or distal aspect and narrow from lingual or labial aspect, so the cross section is rectangle with round angels that we call oblong .

2 Root Canals??
This greater dimension -labiolingualy than mesiodistaly- makes a 30% possibility of having 2 root canals in this tooth. So if you want to do root canal treatment for this tooth always look for a second root canal. But In the maxillary central and lateral incisors the possibility for having 2 root canals is 0% because the root is conical. Q: What happens if a dentist removed the pulp tissue from one canal and left the other canal with pulp tissue without removing it? A: after a period of time the patient will come back complaining of the pain, because there is still another canal that you didnt treat. Thats why you have to be aware of

the 30% possibility of having two root canals in this tooth. Also there is a 30% possibility of having 2 root canals in the mandibular central incisor.

-Distal Aspect
the cementoenamel junction (CEJ) is less curved than in the mesial aspect. The root is broad and flat, sometimes we see a shallow depression in the center of the root and its avoiding cross section.

-Incisal Aspect:
the incisal aspect of this tooth is triangular .And the labial surface is flat compared to the labial surface of the central incisor. The labial surface of the maxillary lateral or central incisor should be convex mesodistally but here it is flat, the dimension of the tooth is greater labiolingualy than mesiodistaly but its not true for the maxillary incisors and we seldom see labial lobules. We dont see lobules in the labial surface of this tooth but we see lobules on the maxillary central incisors. In newly erupted central incisor we see on the labial surface two shallow grooves marking the junction of the different lobes of the tooth and we said the margins of these lobes are the mamelons but we said these actually get worn away easily leaving us the incisal edge (converting the incisal ridge to an incisal edge). Long axis of the incisal edge is perpendicular to the labiolingual line. This is very important because this is the only feature that makes you distinguish between mandibular incisors. We said mandibular central incisors look like mandibular lateral incisal but cant we distinguish between them?? Actually we can, the best feature to distinguish is the long axis of the incisal edge. This should be perpendicular to the labiolingual line. So if we see the labiolingual line -labial to lingual- perpendicular to the incisor edge then the teeth is mandibular central incisor. If its not perpendicular then its a mandibular lateral incisor.

How can we know where the distal is and where the mesial is?
-The inclination should always follow the arch of the mandible, so because of that the part of incisal edge located more lingually is the distal part and the part of the incisal edge located more labially is the mesial part. Q: Is it true or false? The incisal edge in the mandibular lateral incisor is perpendicular to labiolingual line? A: false. Pay attention please that the mesial outline equals the distal outline , and that the pulp is wide labiolingualy and narrow mesiodistally. Remember that we have 30%

possibility to have 2 root canals in this tooth.

Mandibular Lateral Incisors

The mandibular lateral incisor may look similar to the mandibular central incisor, but they are not. They have some unique features that make them different.

-Labial Aspect:
The mandibular lateral incisor is slightly wider mesiodistally than the central incisor and it lacks bilateral symmetry. Generally the mamelons of that tooth doesnt have equal shoulders. The mesial incisal angel is sharp but the distal incisal angel is slightly rounded. Because of the inclination of the incisal edge, wecan see more of the incisal edge when we look at the tooth from the distal aspect. The cementoenamel junction (CEJ) is less pronounced distally.

- Lingual & Mesial Aspects:

Almost similar to that of the central.

- Distal Aspect:
more of the incisal edge is visible, CEJ is less pronounced.

-Incisal Aspect:
The Most Important feature that make us distinguish between the mandibular lateral and central incisor is that the incisal edge is not perpendicular to the labiolingual line (LL). The distoincisal (DI) angel is more towards the lingual surface and the Mesioincisal (MI) angel is more towards the labial surface. The pulp is similar to that in the central incisor.

Incisal relationship
Now as we learned about the anatomy of the incisors we should also know the relationship between them when theyre functioning and in contact with each other in different ways. We call the different ways of the teeth to contact Classes.

Classes, what are they?

When the incisal edge of the lower incisal is located exactly at the lingual fossa of the upper incisor then we call this Class 1. While when the Lower incisal of the lower incisor is located posterior to the lingual fossa of the upper incisor then this is we is known as

Class 2. When incisal edge of the lower incisor is located anterior to the upper incisor then this is Class 3. [Note] Normal people (many of us) have Class 1 case but also a good percent of people got Class 2 case and in fact, there is a minor percent of those who have the Class 3 case.

Overlap Story
Because Human teeth dont bite edge to edge -except in certain occasions and problems - we always have overlap (Horizontal overlap and vertical overlap). One of the overlap called the " Over-Bite " which is when the incisal edge of the maxillary incisor is located lower than the incisal edge of the mandibular incisors, so the vertical distance between the two incisal edges is known as Over-Bite .There is another term known as " Over-Jet " which represent the horizontal distance between the incisal edge of upper incisal and incisal edge of lower incisal. Normal situation of Over-Bite and Over-Jet is from two to three millimeters (2-3 mms). [Note] Monkeys bite teeth over teeth (edge to edge) but humans dont. Q: The vertical overlap between the mandibular incisors and maxillary incisors is called?? A: Over-bite.

Reverse Overjet (-1) Reverse overjet occurs when the lower jaw is 'oversized', or the upper jaw is undersized or a combination of both.

What Happens in Class II?

Because the incisal edge is not in contact , then the over-bite and over-jet can bei increased and in this situation we say that in this case there is " Zero" over-bite and over-jet .

Types of Class II
* Class II (division I), Class II (division II) We agreed that in Class II , the incisal edge of the lower incisor is located lingual "more posterior " to

the fossa of the upper incisor . But what if the maxillary incisor is to the outside then it's class II (division I). When the maxillary incisor goes lingually then we call it retroclined and its class II.

[NOTE]

For the maxillary central incisor when it's Proclined (incisal edge goes labially) its

Class II division I but when the incisal edge goes Lingually then it's Class II division II.

When Maxillary incisor goes Lingual then Retroclined it's Class II (division II). The Over-jet m Vertical overlap increase

When the maxillary Central incisor is Proclined labially then we call it Class II (division I). The over-bite increase

::SUMMARY::
Maxillary Lateral Incisors
labial lingual mesial distal Incisal pulp

-Narrower MD & shorter IC . -Root is of same length. -More rounded in general. -HOCs are farther from incisal edge. -Root is conical and slightly inclined distally.

-Marginal ridges & cingulum are more pronounced -Lingual fossa is deeper. -Developmental groove and pit

-Cingulum more convex -CEJ less curved

-similar to the mesial aspect

-Ovoid outline -Smaller MD than central -Labial outline is rounded -ML & DL line angles are more rounded

- Similar to central

Mandibular Central Incisor

labial -The narrowest MD of all incisors. -Bilaterally symmetrical . -3 mamelons. -90 MI & DI angles and are at same level IC (type traits). -Both HOCs are within the incisal third. -M & D outlines are almost straight lines. -CEJ convex cervically. -Root is narrow & conical. lingual -Shallow fossa & less prominent cingulum & marginal ridges. -CEJ summit in the center. Mesial - Labial HOC within cervical third From HOC toward incisal edge labial outline is straight -Root broad & flat -A shallow depression in the midpoint. -Ovoid in x-section. distal -CEJ is less curved. Incisal -Triangular. -Labial surface is flat compared to max. incisors. -Seldom labial lobe groove . -Long axis of incisal edge is perpendicular to LL line. -Mesial outline = distal outline in length. pulp Broad LL and narro w MD

Mandibular Lateral Incisor

labial Lingual & mesial -Nearly identical to that of central Distal Incisal pulp

-Slightly wider than central -Lack of bilateral symmetry -MI angle is sharp while -DI angle is rounded & more -cervically situated

-More of the incisal edge is visible. -CEJ is less pronounced.

-Incisal edge is not perpendicular to LL line -DI angle is more toward lingual

- Similar to that of central

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Some important notes about Incisal relations :

class 1 Incisal edge of the lower incisors lies exactly at the lingual fossa of upper incisor class 2 Incisal edge of the lower incisors lies posterior at the lingual fossa of upper incisor class 3 Incisal edge of the lower incisors lies anterior at the lingual fossa of upper incisor Overbite ( vertical overlap ) Overjet ( horizontal overlap ) [Note]: normal distance of overbite and overjet is from 2 to 3 mm Reverse Overjet ( negative ve horizontal overlap ) (Ex: -2 or -3 mm)

Test Yourself:
1) In the mandibular lateral incisor , all of the following is correct EXEPT : a) labial surface is slightly wider than central b) labial surface is narower than central c) ECJ is less pronounced d) b & e e) The pulp is larger of central pulp 2) Incisal surface of maxillary lateral incisor is ovoid outline : a) true b) false 3) Which of the following is correct about mandibular central incisor : a) in pulp : Broad MD and narrow LL b) Root is narrow and flat c) Both HOCs are within the incisal third

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d) CEJ is concave cervically e) c & d 4) Which of the following situations is considered as class 3 of incisal relations : a) Incisal edge of the lower incisors lies exactly at the lingual fossa of upper incisor b) Incisal edge of the lower incisors lies anterior at the lingual fossa of upper incisor c) Incisal edge of the lower incisors lies posterior at the lingual fossa of upper incisor 5) If the distance of overjet = - 2.5 mm , it is called : a) Overjet b) Overbite c) reverse overjet d) reverse overbite

Quiz-questions from this lecture:

The tusks of the elephant are its maxillary lateral incisors. What is the narrowest tooth mesiodistaly? Mandibular central incisor. Whats the possibility of having two canals in the mandibular central or lateral incisor? 30%. The long axis of the incisal edge of a mandibular central incisor is perpendicular to the labiolingual line. What does the vertical overlap between the mandibular incisors and maxillary incisors called? Over-bite.

Answers 1 2 3 4 5 d a e b c

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Quote of the Day: A dream doesn't become reality through magic; it

takes sweat, determination and hard work.
Abeer M. Dirawi Hebah Ramadnah Rmz Rabbadi A9eel Ghawanmeh Russia Al Shboul Salam Bataineh Ahmed Al Shamary Sundos Abu Zaid Eman Idkaidek Eman Nazzal Hibah Jarrah Sawsan Z. Jwaied Hadeel Sumrien Rawda Najjar GaYda'a Kana'an Noha Ghazal ** : " . "

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