DENTAL ANATOMY & HISTOLOGY THE DECIDUOUS DENTITION

THE DECIDUOUS DENTITION :

The deciduous, primary, or, as they are often referred to colloquially, milk teeth have a relatively short life-span before they are exfoliated (shed) to be replaced by the permanent teeth. This usually occurs between the ages of 6 and 13 years. The deciduous incisors and canines have permanent successors but the first and second deciduous molars are replaced by the first and second premolars respectively. The deciduous dentition comprises fewer teeth than the permanent dentition with a total of ten maxillary and ten mandibular teeth. They are as follows, in order of position from the mandible (the corresponding dental shorthand is also given): (a) First incisor (b) Second incisor (c) Canine (d) First molar (e) Second molar The shorthand formula for the deciduous dentition is as follows :

The deciduous teeth have several important differences in morphology, composition, size, colour etc., and these are listed below.

PRINCIPAL DIFFERENCES BETWEEN DECIDUOUS AND PERMANENT TEETH :

1. The deciduous teeth are smaller overall than the permanent teeth. 2. The enamel of the deciduous teeth is whiter and more opaque, which gives the crown a lighter colour than that of the permanent teeth. 3. The enamel of the deciduous teeth is more permeable and more easily worn down. The degree of permeability is lessened after the start of root resorption. 4. The depth of enamel is more consistent and thinner than in the permanent teeth, being from 0.5 mm to 1.00 mm thick. 5. Deciduous teeth have a pronounced cervical margin. The enamel bulges instead of tapering gently, at the cemento-enamel junction, which is straighter than in the permanent teeth. This cervical bulge is accentuated in the mesiobuccal area of deciduous molars 6. In newly-erupted deciduous teeth the cusps tend to be more pointed. 7. The roots of deciduous teeth are shorter, less strong and lighter in colour than those of the permanent teeth. 8. The roots of anterior deciduous teeth are longer in proportion to the crown. The roots of posterior teeth are more divergent to allow for the developing permanent successor. They flare out from each other wider than the crown measurement, and from a minimal common root trunk. 9. The pulp chambers are larger than in the permanent teeth and follow the exterior morphology of the tooth more closely, there tends, therefore to be less depth of dentine. 10. The root canals of deciduous teeth are very fine and narrow mesio-distally.

UPPER FIRST DECIDUOUS INCISOR

CHRONOLOGY:
Initial calcification 3-4 months in utero. Completion of crown 4 months. Eruption 7 months Completion of root 1 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Rounded disto-incisal angle: sharp mesio-incisal angle. 2. Similar to upper first permanent incisor but smaller and chubbier overall. 3. Large lingual cingulum and pronounced bulge on labial surface. 4. Root tilts distally and labially from long axis of crown. 5. One root canal; two cornua, one mesial, one distal cornu slightly larger.

VARIATIONS :
No noticeable variations.

LOWER FIRST DECIDUOUS INCISOR

CHRONOLOGY:
Initial calcification 4 months in utero. Completion of crown 4 months. Eruption 6 months. Completion of root 1 -2 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Single tapered root more rounded than that of lower first permanent incisor, tends to incline distally. 2. Smallest tooth in the deciduous dentition. 3. Sometimes a longitudinal groove on the distal surface of root. 4. Cervical margin most sinuous on mesial side. 5. Large, convex cingulum and pronounced bulge on labial surface. 6. One root canal; two coruua, one mesial, one distal.

VARIATIONS:
The pronounced cervical bulge on the labial surface may be reduced or completely absent.

UPPER SECOND DECIDUOUS INCISOR

CHRONOLOGY:
Initial calcification 4 months in utero Completion of crown 5 months. Eruption 8-9 months. Completion of root 1 -2 years

PRINCIPAL IDENTIFYING FEATURES:

1. Similar shape to upper first deciduous incisor but crown smaller and narrower in proportion. 2. Lingual cingulum less pronounced.

3. Rounded disto-incisal angle; sharp mesio-incisal angle. 4. One root canal; two cornua, one mesial, one distal. Mesial cornu slightly larger.

VARIATIONS:
Rare, in contrast to the highly variable upper second permanent incisor.

LOWER SECOND DECIDUOUS INCISOR

CHRONOLOGY:
Initial calcification 4 months in utero. Completion of crown 4 months. Eruption 7 months. Completion of root 1 -2 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Single tapered root with round cross-section, tends to incline distally. 2. Rounded disto-incisal angle; sharp mesio-incisal angle. 3. Incisive edge slopes downwards from mesial to slightly lower distal surface. 4. Crown may, in some cases, show twisting on root for incisive edge to follow mandibular arch. 5. Larger than lower first deciduous incisor. 6. Lingual surface may be more concave than that of the lower first deciduous incisor. 7. Single root; two cornua, one mesial, one distal.

VARIATIONS:
No noticeable variations. A feature of the deciduous dentition is its consistency in its morphology

UPPER DECIDUOUS CANINE

CHRONOLOGY:
Initial calcification 5 months in utero. Completion of crown 9 months. Eruption 16-20 months. Completion of root approximately 3 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Mesial slope of cusp longer than distal slope. 2. Conical crown with pronounced cervical bulge and pointed cusp. 3. Labial and lingual longitudinal ridges extending from cusp tip. 4. Crown more bulbous than that of upper permanent canine. 5. Diamond-shaped outline with rounded comers from incisal aspect. 6. Cervical margin rises further incisally on the mesial than on the distal surface. 7. Single root often more than twice the length of the crown. Slender taper with similar crosssection to that of the upper permanent canine; distally inclined. 8. Single root canal; pulp chamber elongated and directed towards cusp.

VARIATIONS:
Asymmetrical and symmetrical crown forms are equally common. Other wise no noticeable variations.

LOWER DECIDUOUS CANINE

CHRONOLOGY:
Initial calcification 5 months in utero. Completion of crown 9 months. Eruption 16-20 months. Completion of root 2 - 3 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Smaller and slimmer overall than the upper deciduous canine. 2. Less well-defined labial and lingual longitudinally ridges; lingual ridge often completely absent. 3. Concave lingual surface. 4. Distal slope longer than mesial. 5. Cervical margin more sinuous on mesial side 6. Single tapering root inclines distally and slightly labially. 7. Single root canal; pulp chamber elongated and directed towards cusp

VARIATIONS:
No noticeable variations. Lingual longitudinal ridge occasionally present on lingual surface.

UPPER FIRST DECIDUOUS MOLAR

CHRONOLOGY:
Initial calcification 5 months in utero. Completion of crown 6 months. Eruption 12-16 months. Completion of root 2-2 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Pronounced bulge on mesial side of buccal surface: molar tubercle of Zuckerkandl. 2. Trapezoid coronal outline with narrow occlusal surface running mesiodistally. 3. Lingual surface shorter, mesiodistally, than the buccal. 4. Mesiolingual cusp largest and most pointed. 5. Widest labiolingual crown measurement at mesial end. 6. Three root canals; four cornua, mesiobuccal, distolingual, distobuccal and mesiolingual

VARIATIONS:
Palatal and distobuccal root sometimes fuse. Mesiobuccal cusp sometimes has an accessory cusp mesial to it. Distolingual cusp sometimes absent. Zuckerkandls tubercle is occasionally scarcely discernible

LOWER FIRST DECIDUOUS MOLAR

CHRONOLOGY:
Initial calcification 5 months in utero. Completion of crown 6 months. Eiuption 12-16 months. Completion of root 2-2 years

PRINCIPAL IDENTIFYING FEATURES:

1. Molar tubercle of Zuckerkandl; an exaggerated cervical bulge on the buccal surface of the crown over the mesial root, with a considerable cervical constriction. 2. Four cusps : buccal cusps compressed labiolingually with no clear separation between them in contrast to the two lingual cusps which are clearly defined and roughly conical in shape. 3. Mesiolingual cusp largest. 4. Tooth longer mesiodistally than labiolingually. 5. Mesial marginal ridge more pronounced than distal. 6. Two roots flattened mesiodistally. Mesial is the longer and from the mesial aspect appears rectangular. 7. Two root canals : three cornua: mesiobuccal, lingual, distobuccal.

VARIATIONS:
Mesiolingual cusp sometimes very insignificant. Buccolingual crest occasionally absent

UPPER SECOND DECIDUOUS MOLAR

CHRONOLOGY:
Initial calcification 6 months in utero. Completion of crown 10-12 months. Eruption 1 - 2 years. Completion of roots 3 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Morphology of upper first permanent molar duplicated on a smaller scale. 2. More prominent bulge on cervical part of buccal surface. 3. Roots have wider divergence than those of upper first permanent molar. 4. Cusp of Carabelli present in most cases. 5. Three root canals; three cornua; mesiolingual, distobuccal and distolingual.

VARIATIONS:
Cusp of Carabelli may be absent. Very rarely the distolingual cusp may be so reduced as to be scarcely discernible. The palatal and distobuccal roots may sometimes be fused.

LOWER SECOND DECIDUOUS MOLAR

CHRONOLOGY:
Initial calcification 6 months in utero Completion of crown 10-12 months Eruption 1- 2 years. Completion of roots 3 years

PRINCIPAL IDENTIFYING FEATURES:

1. Same number of cusps and roots; similar arrangement to the lower first permanent molar. 2. Smaller than lower first permanent molar but larger than the lower first deciduous molar.

3. Prominent cervical bulge on buccal surface of crown. Buccal surface inclined lingually 4. Occlusal outline rectangular. 5. Buccal cusps approximately equal in size. 6. Two widely divergent roots; mesial root longer and flattened mesiodistally. 7. Two or occasionally three root canals; four or five cornua, one to each cusp.

VARIATIONS:
No noticeable variations. Mesial root sometimes shows a tendency to divide partially or completely into two root canals, one buccal and one lingual.

PERMANENT DENTITION
The full complement of teeth in the permanent dentition is thirty-two, sixteen teeth in either jaw. Starting from the midline and progressing posteriorly, they are as follows (the corresponding dental shorthand is also given): 1 : Central incisor 2 : Lateral incisor 3 : Canine 4 : First premolar 5 : Second premolar 6 : First molar 7 : Second molar 8 : Third molar The shorthand dental formula for the permanent dentition is as follows :

THE PERMANENT INCISORS:

There are four incisors in the maxilla and four in the mandible, and they are situated centrally with two incisors on either side of the midline, so that they function together in cutting and shearing food into small pieces suitable for mastication. The maxillary incisors are larger than the mandibular incisors with a conical, tapering root and a crown that is relatively wider mesiodistally. The root of the lower incisors is flattened mesiodistally with a blunter apex. The incisors of both the upper and lower jaws are named according to their position from the midline. Those centered on either side of the midline are called the first or central incisors, and the second from the midline are known either as lateral or as second incisors. Also common to the upper and lower incisors is the typical incisor form which is essentially chiselshaped with a wedge-shaped crown outline when viewed from the mesial or distal aspects. Unworn, newly-erupted specimens of incisor teeth have three small mamelons or bumps on the incisive edge which are soon pm to a flat edge after masticatory use. The cervical margin of all the incisors is very sinuous and rises towards the incisive edge on the mesial and distal surfaces. The mesial rise is much higher than that on the distal surface. Well-developed marginal ridges give the upper incisors a shovel-shaped appearance and this variation of the lingual surface occurs most commonly in certains communities, namely among the Mongoloid and American Indian peoples.

The Permanent Canines :

The function of the canines is to grip and tear food. They are the last of the anterior group of teeth and are situated third from the midline. Because of their self-cleansing morphology they usually last longer than any other tooth in the mouth, and it is not uncommon to see very old patients with only four teeth left in their mouths - the upper and lower canines. For this reason the canines are very useful teeth because of their long, stout roots which provide good anchorage for dentures. They are the longest teeth, overall, in the mouth and have a much stronger appearance than any of the anterior teeth. The thick root gives the canine eminence of the alveolar bone which is important in maintaining normal facial shape.

The Premolars :
There are two premolars on either side of the dental arch, named first and second from the midline, making a total of eight premolars in the full permanent dentition. They replace the deciduous molars, and are also known as bicuspids because they usually have two cusps, one buccal, one lingual. Their function is intermediate between that of the canines and the molars through their position in the jaw. The first premolars are adjacent to the canines and have an elongated buccal cusp so that from the buccal aspect they resemble the canine. This would indicate that they share its function in tearing food. Farther posteriorly, the second premolars are situated adjacent to the molars and have a crown form adapted more for the function of crushing. The buccal cusp, although larger, is rounded and less pronounced, whereas the occlusal surface is more obvious. The crown is much smaller than that of the molars, however, with a completely different morphology. The premolars have a single root except for the maxillary first premolar which has a buccal and a lingual root. The mandibular first premolar is smaller than the second, the opposite arrangement exists between the maxillary premolars. The crowns of mandibular premolars have a marked lingual inclination whereas those of the upper premolars are placed centrally on the root.

The Permanent Molars :

The permanent molars are the most posteriorly situated teeth in the mouth and are named first, second and third according to their position from the midline. There are twelve molars in all, in the full permanent dentition and they have the important masticatory function of crushing and grinding food. They do not replace any deciduous teeth. The crown form also suggests that these teeth are grinders because of the wide occlusal surface accommodating anything from three to six cusps. A large crown surmounts the widely spread roots : the mandibular molars have two roots, one mesial and one buccal; the maxillary molars have three roots, mesiobuccal, distobuccal and palatal, of which the palatal is the largest. Between the cusps are complex groove, ridge and fissure patterns characteristic for each tooth and these are detailed in the individual descriptions of the various teeth. Generally speaking, the outlines and contours of the maxillary molars are similar. There are usually four cusps, the distolingual being the smallest, and they are more pronounced than those of the permanent mandibular molars. The first maxillary molar is larger than the second, which is in turn larger than the third, and this is mainly due to a gradual reduction in size of the distolingual cusp, which may even be absent in third molars. The occlusal outline of maxillary molars is rhomboidal, compared with the more oblong outline of mandibular molars. The buccal and lingual sides of the rhomboid are parallel with the curve of the dental arch. The proximal surfaces are in line with imaginary lines radiating outwards from a point in the midline of the posterior edge of the hard palate. The crowns of the maxillary molars are seated centrally on the roots whereas those of the mandibular molars incline lingually, a characteristic of all posterior mandibular teeth. The mandibular molars have a rectangular or square occlusal outline. They have their widest measurement mesiodistally in comparison with the upper molars which have a wider buccolingual measurement. The first

mandibular molar is the largest molar in the lower j aw. The third molar varies in size, however, and may be larger or smaller in comparison with the lower second molar. The roots of lower molars tend to curve distally.

UPPER FIRST PERMANENT INCISOR

CHRONOLOGY:
Initial calcification 3-4 months after birth. Completion of crown 4-5 years. Eruption 7-8 years. Completion of roots 10 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Mesial surface straight and at right-angles to incisive edge. 2. Disto-incisal angle more rounded. 3. Crown large in proportion to root - widest anterior tooth. 4. Well-marked marginal ridges on concave palatal surface. 5. Large convex cingulum. 6. Crown inclined palatally. 7. Smooth, convex labial surface. 8. Single tapering root with rounded triangular cross-section. 9. Single root canal; two cornua, one mesial and one distal.

VARIATIONS:
Cingulum may be considerably elongated towards incisive edge. Malformed macrodont forms occasionally occur. Exaggerated marginal ridges produce a shovel-shaped incisor form. There are frequent defects in mineralization near the incisive edge.

LOWER FIRST PERMANENT INCISOR

CHRONOLOGY:
Initial calcification 3-4 months after birth. Completion of crown 4-5 years. Eruption 6-7 years. Completion of roots 9 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Single root, flattened mesiodistally, tends to curve distally. 2. Incisive edge at right-angles to a line bisecting crown labiolingually 3. Root 12 millimetres long. 4. Distal longitudinal groove on root more marked than mesial. 5. Smallest tooth in permanent dentition. 6. One root canal; two cornua, one mesial, one distal.

VARIATIONS:
Sometimes two root canals present, one buccal, one lingual. Rarely, root may be slightly bifurcated at apex. Size of root or crown may vary.

UPPER SECOND PERMANENT INCISOR

CHRONOLOGY:
Initial calcification 10-12 months after birth. Completion of crown 4-5 years. Eruption 8-9 years. Completion of roots 11 years.

PRINCIPAL IDENTIFYING FEATURES:

1 Mesio-incisal angle acute; disto-incisal angle more rounded. 2. Incisive edge has marked downward slope to the shorter distal surface. 3. Crown more rounded and narrower mesiodistally than upper central incisor. 4. Cingulum on palatal surface often encloses a pit. 5. Palatal surface more concave than upper central incisor. 6. Single root with elegant taper to pointed, distally-curving apex. 7. Single root canal; two cornua, one mesial and one distal.

VARIATIONS:
Subject to an enormous degree of variation, one common type being the peg-shaped lateral incisor which has a thin root surmounted by a small cornical crown. Sometimes the crown is underdeveloped with a sharp bend mesially.

LOWER SECOND PERMANENT INCISOR

CHRONOLOGY:
Initial calcification 3-4 months after birth. Completion of crown 4-5 years. Eruption 7-8 years. Completion of roots 10 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Slightly larger than lower first incisor; fan-shaped crown, incisive edge wider mesiodistally 2. Incisal aspect: incisive edge not at right-angles to bisecting line of root, but twisted to follow line of dental arch. 3. Root 14 millimetres long. 4. Mesial surface of crown slightly longer than distal so that incisive edge slopes slightly. 5. Faint mesial and distal marginal ridges but more pronounced than in lower first incisor. 6. One root canal; two cornua, one mesial, one distal.

VARIATIONS:
No noticeable variations except for occasional differences in crown and/or root sizes

UPPER PERMANENT CANINE

CHRONOLOGY:
Initial calcification 4-5 months after birth Completion of crown 6-7 years. Eruption 11-12 years. Completion of roots 13-15 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Single, pointed cusp approximately in line with long axis of root. 2. Distal slope of cusp longer than mesial with convex junction at proximal surface. 3. Long stout proportions overall. 4. Bulky cingulum - sometimes pointed. 5. Marked convex labial outline. 6. Cervical line less sinuous on distal surface. 7. Very long single root with rounded triangular cross-section. 8. Disto and mesiopalatal surfaces of root often grooved longitudinally. 9. Single root canal; no cornua.

VARIATIONS:
Labiolingual measurement may be exaggerated. Very occasionally, a supplementary cusp of variable size may be present on distal slope of crown. Cingulum may be pointed. Tip of root sometimes bent sharply mesially or distally.

LOWER PERMANENT CANINE

CHRONOLOGY:
Initial calcification 4-5 months after birth. Completion of crown 6-7 years. Eruption 9-10 years. Completion of roots 12-14 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Distal surface more rounded than mesial. 2. Crown narrower mesiodistally than upper canine so that crown appears larger in proportion. 3. Only the mandibular canine is capable of bifurcated root, a not uncommon variation. 4. Poorly defined cingulum. 5. Mesial slope of cusp shorter than distal. , 6. Crown appears to lean distally in relation to root. 7. Mesial surface of crown in approximately straight line with root. 8. Labial surface of crown in continuous longitudinal arc with root. 9. One or two root canals; no cornua.

VARIATIONS:
Single longitudinally-grooved root with two root canals. Bifurcation of root to a labial and a lingual root. Size of root and/or crown may vary.

UPPER FIRST PREMOLAR

CHRONOLOGY:
Initial calcification 18-21 months after birth. Completion of crown 5-6 years. Eruption 10-11 years. Completion of roots 12-13 years.

PRINCTPAL IDENTIFYING FEATURES:

1. Two roots, buccal and lingual - tend to curve distally. 2. Two sharply-defined cusps: buccal larger than palatal. 3. Concave canine fossa on mesial surface of crown extending to pronounced longitudinal groove on mesial surface of root. 4. Central developmental groove interrupts mesial marginal ridge. 5. Mesial slope of buccal cusp longer than distal. 6. Palatal cusp mesially placed in relation to buccal cusp. 7. Occlusal outline more angular than the upper second premolar. 8. Two root canals; two cornua, one directed to either cusp.

VARIATIONS:
Crown may flare out or taper in from the cervix. Variations are present mainly in the root, the buccal root may be divided into a mesio and distobuccal root giving a total of three roots (and three root canals) or there may be just a single longitudinally-grooved root.

LOWER FIRST PREMOLAR

CHRONOLOGY:
Initial calcification 1-2 years Completion of crown 5-6 years. Eruption 10-12 years. Completion of roots 12-13 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Two occlusal fossae, distal larger than mesial. 2. Two cusps joined by central enamel ridge: large pointed buccal cusp with centrally placed apex; diminutive lingual cusp. 3. Crown inclined lingually on root. 4. Buccal surface of crown convex; lingual surface almost straight. 5. Circular occlusal outline flattened and grooved on mesiolingual surface. 6. Single rounded root, tends to curve distally. Mesial longitudinal groove more marked than distal. 7. Single root canal; one cornu corresponding with buccal cusp.

VARIATIONS:
Lingual cusp may be larger than normal or, on he other extreme, it may be absent altogether. Accessory cusps may be present on the slopes of the buccal and lingual cusps. The root is bifurcated in rare cases.

UPPER SECOND PREMOLAR

CHRONOLOGY:
Initial calcification 2 2 years Completion of crown 6-7 years. Eruption 10-12 years. Completion of roots 12-14 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Two cusps, one palatal, one buccal: shallower and more equal in size than in upper first premolar. 2. No canine fossa-mesial surface convex. 3. Oval occlusal outline. 4. Single root flattened mesiodistally-longer than roots of upper first premolar. 5. Mesial slope of buccal cusp shorter than distal slope-exactly opposite to the situation in the upper first premolar but similar to the upper canine. 6. Occlusal mesiodistal fissure does not interrupt mesial marginal ridge. Tendency for additional fissures and grooves. 7. One or two root canals; two cornua, one directed to either cusp.

VARIATIONS:
Crown may flare out or taper in from the cervix. As in the upper canine, there may occasionally be an accessory cusp on the distal slope of the buccal cusp. Additional shallow grooves radiating from the central fissure may be present. Very rarely the root shows a tendency to bifurcate and follow the root form of the upper first premolar.

LOWER SECOND PREMOLAR

CHRONOLOGY:
Initial calcification 2 - 2 years Completion of crown 6-7 years. Eruption 11-12 years. Completion of roots 13-14 years.

PRINCIPAL IDENTIFYING FEATURES:

1. 2. 3. 4. Larger crown than lower first premolar. Cusps more equal in size and less pointed. Occlusal outline almost circular with no mesiolingual flattening. Central fissure curves around buccal cusp to join mesial and distal fossae; distal fossa larger. 5. Well-marked mesial and distal marginal ridges-mesial higher than distal. 6. Single root, flattened mesiodistally, curves distally to blunt apex. 7. Single root canal; two or three cornua, one to each cusp.

VARIATIONS:
Crown is subject to more variation than the lower first premolar. It may flare out to a wide occlusal surface from a narrow cervix, and may show two or three-cusped forms. Very rarely, the root may be slightly bifurcated.

UPPER FIRST PERMANENT MOLAR

CHRONOLOGY:
Initial calcification Birth or slightly before. Completion of crown 2 -3 years. Eruption 6-7 years. Completion of roots 9-10 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Cusp of Carabelli on lingual surface of mesiolingual cusp in 5 0-75 percent of cases. 2. Roots well developed and separated : palatal root longest and most divergent; buccal roots flattened mesiodistally. 3. Rhomboidal occlusal outline. 4. Largest maxillary tooth. 5. Four cusps : mesiolingual largest; distobuccal smallest; characteristic oblique ridge joins these two cusps. 6. Buccal cusps more pointed than lingual cusps. 7. Crown wider buccolingually than mesiodistally. 8. Lingual surface most convex. 9. Neonatal line. 10. Three root canals; four cornua, one to each cusp.

VARIATIONS:
Cusp of Carabelli often absent

LOWER FIRST PERMANENT MOLAR

CHRONOLOGY:
Initial calcification Birth or slightly before. Completion of crown 2 -3 years Eruption 6-7 years. Completion of roots 9-10 years.

PRINCIPAL IDENTIFYING FEATURES:

1. 2. 3. 4. 5. 6. 7. Five cusps: three buccal, two lingual. Mesiobuccal cusp largest. Bulbous, lingually inclined buccal surface with two grooves. Largest mandibular tooth. Buccal aspect: all five cusps visible. Lingual aspect: three cusps visible. Crown longer mesiodistally than buccolingually; buccal surface longer than lingual. Occlusal outline approximately oblong. Primitive Dryopithecus pattern present in nearly all cases, i.e. five-cusped tooth with bases of mesiolingual and centrobuccal cusps meeting at the central fossa. 8. Neonatal line, classically on the mesiobuccal cusp. 9. Five roots : mesial root longer, flattened mesiodistally, grooved longimdinally and curved distally, distal root more rounded and less distally curved. 10. Two or three root canals; four or five cornua, one to each cusp.

VARIATIONS:
There may be four cusps instead of five giving a more square occlusal outline, similar to the lower second molar. Mesiolingual cusp may sometimes be larger than the mesiobuccal. Mesial root may be bifurcated giving the tooth a total of three roots.

UPPER SECOND PERMANENT MOLAR

CHRONOLOGY:
Initial calcification 2 -3 years. Completion of crown 7-8 years. Eruption 12-13 years. Completion of roots 14-16 years.

PRINCIPAL IDENTIFYING FEATURES:

1. No cusp of Carabelli. 2. Rhomboidal occlusal outline more obvious, and narrower mesiodistally, than upper first molar. 3. Roots less divergent; both buccal roots approximately the same length, closer together, parallel, slight distal inclination. 4. Coalescence of roots more common than in upper first molar. 5. Oblique ridge joins mesiolingual and distobuccal cusps; both distal cusps greatly reduced in size. 6. Crown slightly smaller overall than upper first molar, although very close resemblance. 7. Three root canals; three or four cornua, one to each cusp.

VARIATIONS:
There are three main variations from the classic four-cusped form: (a) three cusps with the distolingual cusp absent; (b) three-cusped form compressed mesiodistally with the mesiobuccal, middle (coalescence of distobuccal and mesiolingual cusps), and the distolingual in a straight row; (c) similar to upper first molar crown morphology but with a reduced distolingual cusp. Fusion of the roots sometimes occurs, especially between the two buccal roots or between the palatal and mesiobuccal roots.

LOWER SECOND PERMANENT MOLAR

CHRONOLOGY:
Initial calcification 2-3 years. Completion of crown 7-8 years. Eruption 11-13 years. Completion of roots 14-15 years

PRINCIPAL IDENTIFYING FEATURES:

1. Square occlusal outline -rounded corners. 2. Four cusps : two. lingual, two buccal, separated by a pronounced central cruciform fissure pattern on occlusal surface. 3. Not as wide mesiodistally as lower first molar. 4. Buccal surface bulbous and lingually inclined with one groove. 5. Lingual cusps higher than buccal cusps. 6. Two roots similar to lower first molar but less broad, closer together and occasionally fused. Axes of both roots approximately parallel and curved distally. 7. Two or three root canals; four cornua, one to each cusp.

VARIATIONS:
May present a crown form similar to the lower first molar with three buccal and two lingual cusps. Roots may sometimes be fused.

UPPER THIRD PERMANENT MOLAR

CHRONOLOGY:
Initial calcification 7-9 years. Completion of crown 12-16 years. Eruption 17-21 years.

Completion of roots 18-25 years. PRINCIPAL IDENTIFYING FEATURES: 1. Triangular occlusal outline because diminutive distolingual cusp often absent. 2. Roots short, underdeveloped, convergent, often fused- curve distally. 3. Smallest maxillary molar; crown smaller overall than upper second molar. 4. Largest cusp : mesiolingual. 5. Mesial contact area only. 6. Usually three roots; three root canals; three or four cornua, one to each cusp.

VARIATIONS:
Subject to more variation than any other tooth in the human dentition. Variants are usually smaller than other maxillary molars and sometimes so malformed as to be considered anomalous teeth. Crown may have similar form to upper second molar, or may be underdeveloped and conical with a small tapering root. Accessory cusps and roots may be present

LOWER THIRD PERMANENT MOLAR

CHRONOLOGY:
Initial calcification 8-10 years. Completion of crown 12-16 years. Eruption 17-21 years. Completion of roots 18-25 years.

PRINCIPAL IDENTIFYING FEATURES:

1. Crown form similar to lower second molar. 2. Two roots; short, underdeveloped, ofen fused, marked distal inclination. 3. Square/oblong occlusal outline-corners well rounded. 4. Either four or five cusps. 5. Buccolingual measurement least at distal end. 6. Markedly convex distal surface inclined lingually. 7. Two or more root canals; four or five cornua.

VARIATIONS:
A very variable tooth but less so than the upper wisdom tooth. Crown may show three, four, five or multi-cusped variations so that it is larger, in many cases, than in the lower second molar.