Content_Chapter 16_Hard_Tissue_Examination.pdf

Chapter 16 Hard Tissue Examination of the Dentition  Learning Objectives 1. Identify three divisions of human dentition 2. Explain developmental and noncarious dental lesions 3. Describe types of dental injuries and tooth fractures 4. List classifications of dental carious...

Chapter 16 Hard Tissue Examination of the Dentition  Learning Objectives 1. Identify three divisions of human dentition 2. Explain developmental and noncarious dental lesions 3. Describe types of dental injuries and tooth fractures 4. List classifications of dental carious lesions 5. Explain the development of early childhood caries 6. List factors to observe during dental charting 7. Explain basic principles of occlusion 8. Classify occlusion according to Angle’s classification 9. Describe functional and parafunctional contacts 10. Give examples of parafunctional habits 11. Discuss types of occlusal trauma  THE DENTITIONS Primary (Deciduous) Dentition Formation begins in utero  THE DENTITIONS Mixed or Transitional Dentition Between age of 6-12yrs Know the ORDER of eruption Copyright © 2017 Wolters Kluwer All Rights Reserved 4  THE DENTITIONS Permanent Dentition 32 Teeth Mineralization starts at birth Roots are completely formed about 3 years after eruption 5 Copyright © 2017 Wolters Kluwer All Rights Reserved  THE TEETH Clinical Crown Anatomical Crown Clinical Root Anatomical Root Copyright © 2017 Wolters Kluwer All Rights Reserved 6  HARD TISSUE EXAMINATION PROCEDURE  Dental Charting of Existing Restorations  Assessment of Carious and Non-Carious Lesions Developmental enamel and dentin lesions Non-Carious Cervical Lesions Caries (Using Surfaces) Pathology noted during clinical or radiographic exam  Occlusion  Study Models  ASSESSMENT OF CARIOUS AND NON- CARIOUS LESIONS Visual Examination: looking for differences in COLOR and TRANSLUCENCY DRY THE TEETH WITH AIR Use the dental light Clinical Examination: DO NOT use a sharp explorer tip Radiographic Examination: caries, anomalies, impactions, fractures, resorptions, periapical radiolucencies Copyright © 2017 Wolters Kluwer All Rights Reserved 8  Dental Charting Existing (BLUE) Restorations Record Missing, Supernumerary, and Unerrupted Record Sealants Record Fillings (amalgam or composite) Record Crowns Record Root Canals Record Bridges Record Removable Partial Dentures, Complete Dentures Record Space Maintainers Radiographs will be beneficial to complete this recording Copyright © 2017 Wolters Kluwer All Rights Reserved 9 Copyright © 2017 Wolters Kluwer All Rights Reserved 10 Dental Charting Treatment Planned (RED) Restorative NEEDS Record Extractions Record Sealants Record Fillings (amalgam or composite) Record Crowns Record Root Canals Record Bridges Record Removable Partial Dentures, Complete Dentures Record Space Maintainers Copyright © 2017 Wolters Kluwer All Rights Reserved 11 Copyright © 2017 Wolters Kluwer All Rights Reserved 12  OCCLUSION Normal Malocclusion Malrelationships (groups) Malpositions (individual) Functional Occlusion Traumatic Occlusion Copyright © 2017 Wolters Kluwer All Rights Reserved 13  STUDY MODELS Provides visual record of occlusal relationships Becomes an effective visual aid to patient education Records Hard and Soft Tissue Copyright © 2017 Wolters Kluwer All Rights Reserved 14 Now……What Am I Looking For???? Copyright © 2017 Wolters Kluwer All Rights Reserved 15 DEVELOPMENTAL ENAMEL LESIONS Enamel Hypoplasia Hypomineralization Hypomaturation DEVELOPMENTAL DEFECT OF DENTIN Dentogenesis Imperfecta Copyright © 2017 Wolters Kluwer All Rights Reserved 16  Developmental Enamel Lesions Enamel Hypoplasia- DEFECT that occurs as a result of a disturbance during formation of the enamel matrix Amelogenesis Systemic Condition Local Insult or Injury Congenital Syphilis Imperfecta During Tooth GENETIC Development Developmental Enamel Lesions Hypomineralization- occurs during the mineralization stage of the enamel Copyright © 2017 Wolters Kluwer All Rights Reserved 18  Developmental Enamel Lesions Hypomaturation- occurs during the last stages of mineralization and results in the enamel fracturing easily. It may appear as opaque or discolored enamel. Copyright © 2017 Wolters Kluwer All Rights Reserved 19  Developmental Defects of Dentin Dentinogenesis Imperfect: GENETIC dysplasia of the dentin; results in rapid wear and attrition of teeth. Radiographically seen as no pulp Teeth appear opalescent brown/grayish discoloration  NONCARIOUS DENTAL Lesions ATTRITION Wearing away of a tooth as a result of tooth-to-tooth contact; teeth in use Occurrence- seen in men more than in women of comparable age Etiology- Bruxism Environmental Tobacco, cultural habits Appearance- Initial lesion called a wear facet Advanced into the dentin, reduced occlusal plane  FIGURE 16.05: Attrition. Copyright © 2017 Wolters Kluwer All Rights Reserved  Noncarious CERVICAL Lesions Erosion- the loss of tooth substance by a chemical process that does not involve known bacterial action Abrasion- mechanical wearing away of tooth substance by forces other than mastication Abfraction- break away and results from microfractures in the hydroxyapatite crystals of enamel and dentin due to the tooth flexing Copyright © 2017 Wolters Kluwer All Rights Reserved  Development of Dental Caries Requirements for the development of a carious lesion are: Microorganisms S mutans and Lactobacillus Fermentable carbohydrate Susceptible tooth surface  G.V. Black’s Classification of Carious Lesions I = single pit II = posterior proximal III = anterior proximal IV = anterior includes incisal V = cervical VI = cusp or edge Copyright © 2017 Wolters Kluwer All Rights Reserved 26  Enamel Caries Stages in the Formation of a Carious Lesion INITIAL: Subsurface demineralization  First clinical evidence  Remineralization  Also called incipient caries MODERATE: Progression of carious lesion, spread of carious lesion, extends through the enamel and into the dentin ADVANCED: Cavitation exposing dentin  Radiographically decay can extend into the inner half of dentin or into the pulp  Caries Terminology Nomenclature by Surfaces Simple- Single surface, O Compound- Two surfaces, MO, OB Complex- more than 2 surfaces MOD, MODB, MODBL Types of Dental Caries Pit and Fissure- fault in enamel Smooth Surface- proximal surfaces common Primary- virgin tooth Recurrent- next to or under existing restoration Arrested- not progressing Rampant- sudden and rapid progression of several areas Copyright © 2017 Wolters Kluwer All Rights Reserved 28  Early Childhood Caries ECC Otherwise known as Baby Bottle Decay Demineralization along the cervical 1/3 of maxillary anterior primary teeth Then spreads to maxillary and mandibular molars Copyright © 2017 Wolters Kluwer All Rights Reserved 29  Root Caries Soft, progressive lesion of the cementum and dentin; usually shallow and wide spreading laterally Stages in the Formation of a Root Surface Lesion Initial lesion- non cavitated, discolored Moderate/extensive lesion- cavitated, discolored Risk Factors for Root Caries Age, Root exposure, History of root caries, Number of teeth present, Poor OH/ biofilm removal  OCCLUSION Normal Occlusion: ideal mechanical relationship between the teeth of maxillary and mandibular arches with equal forces Malocclusion: Any deviation from normal occlusion Copyright © 2017 Wolters Kluwer All Rights Reserved 31  Occlusion Static occlusal relationships are seen when the jaws are closed in centric occlusion, that is, the maximum intercuspation or contact of the teeth of the opposing arches. Dr. Edward Hartley Angle is credited with first describing an occlusal classification system in 1900. Dr. Angle based his classification on the relationship of the first molars. Normal Occlusion Angle’s Class I Facial Profile Molar Relation Canine Relation  Malocclusion Because the mandible is movable and the maxilla is stationary, the classes describe the relationship of the mandible to the maxilla Class II- retrognathic (Division I and Division II) Class III- prognathic Copyright © 2017 Wolters Kluwer All Rights Reserved  Types of Facial Profiles Angle’s Class II Angle’s Class I Angle’s Class III Malrelations of Groups of Teeth Crossbites- posterior and anterior Edge-to-Edge Bite- incisal/anterior End-to-End Bite- posterior  Posterior Crossbite A: Mandibular teeth lingual to normal position. B: Mandibular teeth facial to normal position. C: Unilateral crossbite: right side, normal; left side, mandibular teeth facial to normal position. Anterior Crossbite Edge-to-Edge Bite Anterior Teeth End-to-End Bite Posterior Teeth  Open Bite Open Bite- Lack of occlusal or incisal contact between certain maxillary and mandibular teeth because either or both have failed to reach the line of occlusion  Overjet Overjet- The horizontal distance between the labioincisal surfaces of the mandibular incisors and the linguoincisal surfaces of the maxillary incisors. Measured with PROBE  Underjet Underjet- Maxillary teeth are lingual to mandibular teeth. Measurable horizontal distance between the labioincisal surfaces of the maxillary incisors and the linguoincisal surfaces of the mandibular incisors. Measured with PROBE Overbite Vertical overlap measured by % Normal overbite < 33% Moderate overbite 33-66% Deep (severe) overbite >66% Very Deep overbite- mandibular teeth into palatal tissue Terminology for Malposition of Individual Teeth Labioversion: A tooth that has assumed a position labial to normal. Linguoversion: Tooth position is lingual to normal. Buccoversion: Tooth position is buccal to normal. Supraversion: Elongated above the line of occlusion. Infraversion: Tooth is depressed below the line of occlusion, for example, primary tooth that is submerged or ankylosed. Torsiversion: Tooth is turned or rotated. Copyright © 2017 Wolters Kluwer All Rights Reserved 46 Primary Teeth with Primate Spaces Without primate spaces: closed arches put the child at risk for crowding of the permanent dentition A: Mandibular primate space between the canine and the first molar. B: Maxillary primate space between the lateral incisor and the canine. Eruption Patterns of the First Permanent Molars A: Terminal step. The distal surface of the mandibular second primary molar is mesial to the distal surface of the maxillary primary molar. B: Terminal plane. The distal surfaces of the mandibular and maxillary second primary molars are on the same vertical plane; permanent molars prone to erupt in end- to-end occlusion.  Dynamic or Functional Occlusion In contrast to static occlusion, which pertains to the relationship of the teeth when the jaws are closed, dynamic or functional occlusion consists of all contacts during chewing, swallowing, or other normal action. The posterior guidance system of the mandible is the temporomandibular joint. The anterior guidance is provided by the canines during lateral excursion of the mandible. Occlusal Contacts Functional Contacts- normal Parafunctional Contacts- abnormal Proximal Contacts- interproximal interface is the common boundary of two adjacent teeth. It is dynamic and varies with age, crowding, masticatory (chewing) force, and tooth alignment. FUNCTIONS: Dissipates masticatory forces around the dental arch. Prevents mesial migration or drifting of teeth. Protects the arch integrity. Prevents food impaction. The loss of normal proximal contacts can ultimately impact bone health and result  Trauma from Occlusion Types of Occlusal Trauma PRIMARY OCCLUSAL TRAUMA results from excessive occlusal force on a tooth with normal bone support. SECONDARY OCCLUSAL TRAUMA results when normal or abnormal occlusal forces are placed on a tooth with bone loss and inadequate alveolar bone support. Effects of Trauma from Occlusion may be a factor in the rate of progression of existing periodontal disease Recognition of Signs of Occlusal Trauma Progressive change in tooth mobility. Fremitus is movement of the teeth subjected to dynamic or functional occlusion. It can be assessed by gently palpating the buccal aspect of the teeth as the patient taps up and down. Discomfort or sensitivity of teeth to pressure, chewing, and/or percussion. Tooth drifting or pathologic migration Thickening of the lamina dura Widening of PDL space, particularly angular thickening (triangulation). Root resorption. Copyright © 2017 Wolters Kluwer All Rights Reserved 51  Documentation Existing and missing teeth Existing restorations White spot and cavitated carious lesions Non-carious lesions Non-carious cervical lesions Occlusion Occlusal habits Previous orthodontic treatment