Ternopil State Medical University named by I.

Gorbachevskyj

Topic.

Historical stages of Therapeutic Dentistry, its chapters. The value of scientific research of Ukrainian scientists. Dental instruments. Histological and clinical anatomy of the teeth. Dental charting. Signs of teeth.
Department of Therapeutic Dentistry Lecturer: Levkiv Mariana

 Dentistry has a long and fascinating history. From the earliest times, human beings have been plagued by dental disease. Many of the remarkable techniques used in modern dentistry can be traced to the very earliest of times in every culture.

Therapeutic Dentistry- is a part of dentistry that studies the reasons and mechanisms of teeth diseases, periodontium tissues diseases and oral mucosa diseases, theirs diagnosis, treatment methods and prevention. Therapeutic Dentistry includes such chapters: - Propaedeutic course; - Preventive dentistry and Endodontology; - Periodontology; - Oral Pathology- (deals with oral mucosa diseases). Propaedeutic course - deals with the history of dentistry, study the anatomical and physiological features of the oral cavity, dental instruments and dental office equipment, ergonomics issues, ethics and deontology, structure of Ukraine dental service.
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Preventive dentistry & Endodontics A branch of dentistry that deals with the prevention, diagnosis and treatment of the diseases affecting dental pulp, root and periapical tissues. Restoring a tooth portion affected by dental caries, root canal treatment of the tooth whose dental pulp is infected etc. are some of the commonly performed treatment procedures in Endodontics.

Periodontics

Periodontology or Periodontics is the specialty of dentistry that studies supporting structures of teeth, diseases, and conditions that affect them..

Oral Pathology
Oral pathology is the specialty of

dentistry and pathology which deals

with the nature, identification, and

management of diseases affecting the

oral and maxillofacial regions.
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BASIC INSTRUMENTS
There are a few basic instruments that are universal to almost every procedure in dentistry.

Hand instruments
Working end(s) of instruments Are the functional parts of the instrument Can have a variety of functions including: cutting, packing, carving, placing and condensing Are adapted to the function of the particular instrument May be bevelled (i.e. the working end is cut at an angle) An instrument can be single-ended (one working end) or double-ended (two working ends) Shank of an instrument The part between the working end and the handle Can be straight or angled The function of the instrument determines the angle and exibility of the shank Handle of an instrument Is the part of the instrument that the operator grasps Design is related to the function of the instrument
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Set of examination instruments Mouth mirror

Functions To provide indirect vision To reect light For retraction and protection of oral tissues For magnication (the number of the mirror represents size of mirror head)

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Sickle/contra-angled probe
Functions Detection of: defective pits and ssures; calculus; decient margins of restorations, crowns and bridges; caries; Examination (pointed tip allows good tactile sensitivity) Varieties Can be single-ended or double-ended Many different styles available Working ends may vary (straight, curved)

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Periodontal probe
Function and features Measure the depth of periodontal pockets Tip is calibrated in millimetres Blunt end reduces the possibility of tissue trauma Varieties Single-ended or double-ended Can be straight, curved or at right angles Plastic types available

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College tweezers
Functions Placing small objects in the mouth and retrieving small objects from the mouth Locking type lock to prevent dropping materials Varieties Locking and non-locking types Working ends can be straight, curved, serrated or smooth

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INSTRUMENTS USED IN BASIC RESTORATIVE PROCEDURES

Spoon excavators
Functions and feature A spoon-shaped working end for spooning out dentinal caries from the cavity preparation Edges of working end are sharp Any remaining caries will be removed with the conventional handpiece and a round bur

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Mixing spatulas
Function and feature Used to mix dental materials Anodised aluminium spatula will not stick to any composite materials or discolour materials

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Flat plastic instrument.

Also called: plastic instrument Functions To deliver materials to the cavity preparation To remove excess materials Varieties Various sizes and shapes available Can be single-ended or double-ended

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Round-ended plastic
Functions and feature Used to create anatomical shapes in composite material during restorations The ball-ended plastic instrument can also be used to pack and condense composite materials

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Rotary instruments
HANDPIECES AND BURS Dental handpieces and rotary attachments help to make dental treatment more comfortable for the patient and reduce the amount of time needed to complete procedures.

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Air turbine handpiece

Also called: fast handpiece, high speed handpiece, air rotor handpiece Type Contra-angled Functions, precaution and features Removal of tooth tissue during restorations and preparation of teeth for xed prosthetic appliances Polishing of restorations High speeds create heat and friction handpiece must be run with water to cool the tooth to prevent pulpal damage High speed saves treatment time and reduces vibration

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Driven by Turbine may need to be lubricated check manufacturers instructions Compressed air rotates the turbine, which then rotates the bur Speed Check manufacturers specications (can run up to 500000rpm) Grip Accepts friction grip attachments Attachment Dental unit Varieties Different types of chucks available (e.g. those which need bur changing tool) With or without light Smaller heads for difcult access

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Straight handpiece
Functions Used in surgical procedures to remove bone (cannot use air turbine as the water is not sterile) Used extra-orally at chairside or in the dental laboratory (e.g. for denture adjustments) Speed can run up to 40 000rpm Grip Accepts long shank attachments Attachment Electric motor that ts into the base of the handpiece

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Slow Speed Handpieces

Type Contra-angled Functions Removal of caries Polishing Procedures that require torque Rene cavity preparations and adjust occlusion Driven by Gears Speed The speed of the handpiece ranges from 0 to 40 000 rpm Attachment Electric motor that ts into the base of the handpiece

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Burs
Head This is the working end Function depends on the size and shape of the head Many different sizes and shapes, each used for a different function (cutting, polishing and nishing) Neck The part that connects the head to the shank usually narrows towards the head Shank The part that ts into the handpiece Shapes and lengths vary, depending on function Can sometimes be marked to identify bur type (stripes or coloured bands)
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Some points to remember about rotary attachments and burs

Most often called burs, but also available are wheels, discs, rubber points, rubber cups and stones Each has a particular function (cutting, polishing, nishing or caries removal) Are made from various materials (tungsten carbide, diamond and steel) Can have utes (the cutting edges) The end of the shank determines which handpiece the attachment will t into: Long straight shank straight handpiece Latch grip conventional type/slow speed handpiece Friction grip shank air turbine handpiece/high speed handpiece Other various attachments such as snap or screw-type attachments
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Shape and function

Shape determines function; the examples that follow relate to tungsten carbide burs: Rose head/round cutting and removing caries Pear to shape the cavity preparation Fissure to shape and prepare the cavity preparation

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Grip and corresponding handpiece

Refers to the way the burs shank is gripped into the handpiece Composition Refers to the head of the bur and what it is made from Generally: Most latch grip burs are made of steel Most ction grip burs are made of tungsten carbide or diamond Most long shank burs are made from steel if they are meant for surgical procedures and stainless steel if they are meant for laboratory purposes

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Anatomical and histological features of teeth

1. 2. In adult humans there are 32 permanent teeth. These are preceded during childhood by 20 deciduous teeth.

3.

The tooth lies in a bony socket, the alveolus, that is covered an oral mucosa called the gingiva (gums)

Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED.

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Tooth structure

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Enamel
Physical characteristics of enamel Enamel is highly mineralised and is the hardest tissue in the body. Enamel covers the anatomical crown of the tooth and varies in thickness; it is semi-translucent and its colour can vary from bluish white to hues of yellow. Chemical composition of enamel Enamel consists of 9697% inorganic material (by weight), the main inorganic component being hydroxyapatite, 1% organic material (by weight), the main organic component being protein and 23% water (by weight).

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 Structure of enamel Enamel is made up of millions of enamel prisms or rods, which run from the amelo-dentinal junction to the enamel surface. Each prism is made up of a large number of enamel crystallites.

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Dentine
Physical characteristics of dentine Dentine is mineralised tissue forming the bulk of the tooth. It underlies the enamel in the crown area and is covered by the cementum in the root area. Dentine is pale yellow in colour and is harder than bone and cementum but not as hard as enamel. Chemical composition of dentine Dentine consists of 70% inorganic material (by weight) of which the main inorganic component is hydroxyapatite (Ca10(PO4)6(OH)2). Organic material constitutes 20% (by weight). The main organic component is collagen bres embedded in amorphous ground substance. The remaining 10% (by weight) is water.

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Structure of dentine Dentine consists of many dentinal tubules that run parallel to each other, following a double curved course, and extend from the pulp to the amelodentinal junction. Each dentinal tubule contains an odontoblast process surrounded by intercellular ground substance composed of ne collagenous brils. The odontoblast cells are a layer of closely arranged cells on the pulpal surface of the dentine with their nuclei situated at the basal (pulpal) end of each cell.

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Cementum
Physical characteristics of cementum Cementum is a pale yellow, calcied tissue covering the root dentine. It is softer than dentine and can easily be worn away, resulting in exposure of the dentine. Its thickness varies according to location; it is thickest towards the apical third of the root and thinnest cervically. Chemical composition of cementum Cementum is 65% by weight inorganic (mainly hydroxy-apatite), 23% organic (mainly collagen) and 12% water.

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Dental pulp
Pulp is a soft vascular connective tissue occupying the centre of the tooth. The shape of the pulp approximately follows the shape of the outer surface of the tooth. The pulp is made up of a pulp chamber in the crown and root canals extending the length of the root. The shape and number of root canals can vary considerably. At the apex of each root is a foramen or foramina through which blood vessels, nerves and lymphatics pass. Small projections of the pulp are found under each cusp; these are known as pulp horns or cornua.

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Dental pulp
The dental pulp is surrounded by dentine and is contained in a rigid compartment.

Functions of pulp The dental pulp has the following functions:

At late bell stage the cells at the periphery of the pulp differentiate into odontoblasts forming dentine. It provides nutrients to the odontoblasts. (trophic function ) It acts as a sensory organ especially when dentine is exposed. The pulp rapidly responds to stimuli such as caries and attrition by laying down reparative or reactionary dentine. (reparative function) It mobilises defence cells when bacteria enter it. (protective function) Cells proliferating in the pulpal tissue create pressure; this is thought to play a part in tooth eruption.
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Periodontal ligament
The periodontal ligament is a specialised brous connective tissue that surrounds the root area of the tooth. It consists mainly of collagenous bres. It has the following functions: It provides a support mechanism for the tooth; it cushions teeth against excessive occlusal forces, preventing damage to the blood vessels and nerves at the root apex. It maintains the functional position of a tooth by keeping the teeth in contact and prevents the tooth from drifting or tilting. The periodontal bres undergo continuous change. Its cells form, maintain and repair the alveolar bone and cementum. Sensors in the periodontal ligament provide proprioceptive input, detecting pressures on the tooth. The periodontal ligament has a rich supply of blood, which provides nutrients to the cementoblasts.

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The periodontal ligament is made up of two groups of bres: the gingival bre groups and the principal bre groups. The gingival bre groups of the periodontal ligament include: Dentino-gingival bres (free gingival bres) are attached to the cementum and fan out into the gingival tissue. Trans-septal bres run horizontally from the cervical area of one tooth to the adjacent tooth. Alveolo-gingival bres arise from the alveolar crest and run coronally into the attached and free gingiva. Circumferential bres (circular) encircle the neck of the tooth.

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The principal bre groups of the periodontal ligament are: Oblique bres which run obliquely from alveolar bone to tooth. Apical bres which radiate from the apex of the tooth to the adjacent alveolar bone. Horizontal bres which run horizontally from the cementum to the adjacent alveolar bone. Inter-radicular bres which are found between the roots of multi-rooted teeth and run from the root to the adjacent alveolar bone.

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TEETH STRUCTURE
Primary teeth

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TEETH STRUCTURE
Permanent teeth

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TOOTH FUNCTION
Types 1. Incisor Function Incisor is a tooth that has one root; function: to cut and cut off food. Canines are the teeth that have one root and has the function to rip the food. teeth that had two/one roots; used to grind and chew food. Molar tooth is a tooth that has two/three roots; have a function for crushing and chewing food.

2. Canine

3. Premolar

4. Molar

Morphological differences between primary and permanent teeth

There are numerous differences between the primary and permanent dentition, many of which give rise to considerations in relation to operative treatment. Essentially, primary teeth have: A shorter crown. A lighter colour. Narrower occlusal surfaces. Thinner enamel and dentine. Relatively larger pulps. Curved roots (to accommodate the developing permanent successor).

Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. ALL RIGHTS RESERVED.

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Numbering Systems
Universal/National System
Developed in 1968 Most commonly used in the United States

Fdration Dentaire Internationale System

Canada and European countries use this Easily adapted by computer and is widely used in most countries

Palmer System
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Universal numbering system

A system is used in the United States, called the universal system. This is a two-digit system but the teeth are numbered from 1 through to 32 in a clockwise direction starting with the upper right third molar: Right 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Upper Lower 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 Left
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ISO/FDI numbering system

The mouth is divided into four quadrants and each quadrant is given a number, starting with the upper right quadrant and working in a clockwise direction. For example, the upper left quadrant is 2. The teeth are then allocated a number starting from the midline, so all central incisors are 1 and all third molars are 8. Therefore the lower right second premolar is 45. Right 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 Upper Lower 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Left

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Palmer Notation System

In this system, the dentition is divided into quadrants and the teeth in each quadrant are numbered 1 to 8 starting at the midline. Each quadrant is separated by a vertical line for right and left and by a horizontal line for upper and lower. Thus |6 is the upper left rst molar in the permanent dentition. Right 8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8 Upper Lower 8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8 Left
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Universal/National Numbering and Lettering System

8 9 Maxillary right Maxillary left
Maxillary right 1
Third molars

F Maxillary left J

16 17

A T
Second molars

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Mandibular right Mandibular right 25 24 Mandibular left

Mandibular left

Primary teeth

Permanent teeth
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Fdration Dentaire Internationale System for Numbering

Maxillary right quadrant 1

Maxillary left quadrant 2

1
Maxillary right quadrant 5

1
Maxillary left quadrant 6

8
Third molars

5 5
Second molars

5 5

Mandibular right quadrant 8 Mandibular right quadrant 4 Mandibular left quadrant 3

Mandibular left quadrant 7

Primary teeth

Permanent teeth
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Palmer System for Numbering

1
Maxillary right quadrant

1
Maxillary left quadrant Maxillary right quadrant

A A

Maxillary left quadrant

8 8

8 8

E E

E
Mandibular right quadrant

Mandibular right quadrant

Mandibular left quadrant

A A

Mandibular left quadrant

Primary teeth

Permanent teeth
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