2:16 pm, Jun 02, 2015

A Didactic Concept
of Dental Morphology
Intrinsic and Extrinsic Anatomical Study of a
Maxillary Central Incisor
Tininha Gomes, CDS

Abstract
Dental morphology is unique to each person; like a fin-
gerprint, it is not repeated in nature. Thus, innumerable
tooth shapes can be found, following the physiological
principles of form and function.1 Despite the wide variety
of formats, we can group the dental structures into three
geometric shapes, considering their contours and exter-
nal angles: square, ovoid or round, and triangular teeth.
The color is another very important factor that influences
the way we see the shape of a tooth. Human teeth are
polychromatic and feature colorful transitions from cervi-
cal to incisal, mesial to distal, and buccal to lingual faces.
These transitions arise from differences in the thickness
of enamel and dentin and optically influence the shape
of the tooth.2 A front tooth can appear wider if its color is
lighter and its opacity is greater. It is possible to improve
the didactics and knowledge of dental anatomy by draw-
ing and coloring the shape and hue of the dentin as well
as by determining their morphological and chromatic
relationship with the overlying enamel. This also forms
the basis for understanding and memorizing the various
types of teeth and their vast range of colors.

Key Words: morphology, incisor, crown, dentin, enamel

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 Gomes

A basic understanding
of tooth morphology
is a key factor in
obtaining the ideal
esthetic result in
anterior teeth.

Journal of Cosmetic Dentistry 97

Introduction …only through repeated practice
Unlike photographs, drawings can reproduce details
even when the object is seen via different media or of creating crown sculptures do we
viewing angles.1To skillfully and efficiently elabo- develop the ability and critical thinking
rate the correct morphology of the anterior teeth, it is necessary for proper planning.
necessary to reproduce the morphology of the details
inherent in human teeth through drawings and then
carve them with an easy-to-handle material. The most Before we start planning, we must study, design, and develop the form
appropriate materials for the practical study of dental of a unitary tooth properly, beginning with its basic features and moving
shape are dental waxes. to the most complex ones. These include size and shape of the root; size
This article presents a didactic concept, initially by and shape of the crown; crown-to-root ratio; the five surfaces (mesial,
drawing and painting a maxillary central incisor on distal, lingual, vestibular, and incisal/occlusal); dentin format; enamel
paper in order to improve the knowledge about the shape; relation between dentin and enamel; incisal triangles; macro and
intrinsic and extrinsic features of this tooth. After that, micro texture; dimensions; proportions; color, etc.1,5-9
the same shape and color characteristics will be re- In many cases, the overall esthetic result depends upon more than the
produced in wax. In this way, we will show the basic full-color reproduction by layering techniques; it also depends upon the
principles in every detail of this tooth’s morphology modeling of the morphology.7
and establish an important criterion in the anterior This knowledge or demonstration of the characteristics of morpho-
esthetic rehabilitation. logical details and their interdependencies can be obtained by reading
books and attending classes. However, only through repeated practice of
Discussion creating crown sculptures do we develop the ability and critical thinking
It must be emphasized that teeth do not exist as sepa- necessary for proper planning.8
rate entities; rather, they are part of the dental arch. Natural teeth, seen daily in clinical work, differ in many ways. This
Therefore, proper alignment and positioning in the means there are many types of teeth that we should be able to build. A
arcade should be ensured. This understanding leads classification originally used for the selection of anterior teeth for den-
us to improve the planning and execution of the case, tures considers three basic morphological types: square, triangular, and
the three-dimensional morphological correction, and oval. Any clinical case must present accordance with any of these catego-
the final details.1,3,4. ries.1,3,7,10
A patient’s dental contours should not be exces- The shape of the individual dental contour (i.e., according to each pa-
sively systematized and should be based upon the tient), should avoid any excess in systematization and should be based
principles of function and harmonious relationship upon the principles of function and harmonious relationship between
between face shape, arch, and teeth.1,3 face shape, arch, and teeth.1
Square teeth have straight contour with linear, The dental anatomy focuses its studies on the specific and detailed
sharp, and parallel transition lobes and angles. Ovoid characteristics of human teeth.7
teeth have a rounded contour with smooth linear A tooth has an organic shape. It is best perceived when observed in the
transition angles (without lobes) presenting incisive context of the masticatory apparatus. However, learning about the mor-
and cervical convergence. Teeth classified as triangu- phology of a natural tooth requires that it be recreated as a single element
lar feature a straight contour with linear transition to obtain a better understanding of its anatomy.1,8
angles and sharp lobes, and present a cervical conver- The most classical method for the study of teeth is the reproduction
gence.1,3-5 of the anatomy through drawing. By drawing, the individual character-
istics are determined with strokes angles, edges, contour shape, equato-
Execution rial line, slopes, anatomical profile, etc. Each face of the tooth should be
The execution of a triangular-shaped maxillary central analyzed.1,6,8
incisor will be discussed step by step from design to After a detailed study of each tooth component, it is important to de-
the complete sculpture in wax. velop the stratification pattern of the dentin and the enamel superim-
Esthetics has become a major theme in modern posed onto it, taking into consideration the range of colors displayed by
dentistry. Several principles and theories about how natural teeth. This helps to understand the close relationship of tooth
natural teeth should look like have been discussed. shape with color, which are closely intertwined.2,11-13
A basic understanding of tooth morphology is a key The way in which the color of natural teeth is perceived is the result
factor in obtaining the ideal esthetic result in anterior of the interaction of light with the chromatic properties and internal and
teeth. external morphology of dentin and enamel. This shows how important
it is to study the relation of form with color. Developing a technique that
combines design and practical implementation can be a great tool in the
pursuit of perfection in dental work.2,8,14,15

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 Gomes

Step by step procedural approach for making a central incisor tooth

in wax: a study of the relationship between shape and color.

Figure 1: Color scheme for the planning of the tooth

shape with optical effects. a) Cervical with a more
saturated dentin. b) Middle third with lighter dentin
(greater brightness). c) Incisal third, mammelons with
high translucent saturation dentin. d) Hypoplasia with
very white enamel. e) Region between mammelons
and proximal angles in translucent blue. f) Halo in
the incisal edge with more opaque white enamel. g)
Crack in the enamel: cervical,in brown; middle third
and incisal in beige. h) Completion of tooth shape with
translucent enamel. i) More saturated dentin in the
palatal concavity.

Figure 2: After preparation of the tooth root in wax on a metal

pin, the morphology planning takes place with the construction
of three vertical edges that will comprise the developmental
lobes. Note the roundness of the distal edge and the inclination
of the central edge, respecting the long axis of the crown
(distally tilted on the cervical).

D M

M D M D

Figure 3: Mesial and distal views. Note the three Figure 4: Palatal view. Reproduction of mesial and distal palatal
inclined planes with greater inclination to the palatal edges, converging to the root with a whiter, but translucent
face of the incisal third, where greater volume of wax.
translucent wax (enamel) will be added.

Journal of Cosmetic Dentistry 99

 Figure 5: Mesial and distal views, showing the
appearance of these faces. Note the axial tilt of the
vestibular edges and the sinuous palatal edges.
The mesial and distal faces were not yet filled.

1/3 Cervical 1/3 Cervical

edge palatal distal
1/3 Medial 1/3 Medial

1/3 Incisal 1/3 Incisal

M edge palatal mesial D D

Mammelons Central

Mammelons Distal Mammelons Mesial

Figure 6: Addition of translucent orange wax (counter- Figure 7: Addition of translucent blue wax (reflection
opalescence) in the incisal portion of the vertical of blue-opalescence) in the region of the proximal
edges, drawing the shape and sinuosity of the three angles; and the incisal contour, filling the sinuosity of
mammelons. A characterization with opaque white wax mamelons.
was made in the central mamelon.

Figure 8: Filling of the mesial and distal surfaces with a Figure 9: Filling of the cervical protuberance in the cervical
translucent wax. third with a more saturated wax.

100 Summer 2015 • Volume 31 • Number 2

 Gomes

Figure 10: Mesial and distal views, showing the

volume and configuration of the cervical third with the
presence of cervical protuberance.

Figure 11: Filling of the vestibular middle-third using a

translucent white wax with high brightness.

Figure 12: Filling of the vestibular incisal third with translucent wax Figure 13: Covering of the whole vestibular face with highly
(enamel), covering the orange mamelons and the translucent blue. translucent wax, creating the morphological aspect of the crown
of a maxillary central incisor. Note the sinuosity created in the
incisal edge.

Journal of Cosmetic Dentistry 101

 A classification originally used for the selection of anterior teeth
for dentures considers three basic morphological types: square,
triangular, and oval.

Figure 14: Palatal face concavity filled with a translucent wax. Note that Figure 15: Delimitation of the mesial and distal transverse edges
the marginal ridges were not built yet. (or bright lines) in blue and the line of the long axis in red. Note
that the mesial edge is straighter as the mesial surface is flatter
and has a more acute angle. The distal transverse edge is more
rounded because the distal surface is slightly convex. The line of
the long axis is distally inclined in the cervical third following the
slope of the root.

Figure 16: Construction of the mesial and distal marginal ridges on the Figure 17: Mesial and distal views of the maxillary central incisor
palatal surface with opaque white wax and the palatine central lobe and finalized waxing.
cingulate (forming a discrete enamel bridge) with a translucent white
wax.

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 Gomes

Central lobe
Mesial lobe Distal lobe

Labial incisal edge

Palatal incisal edge

Mesial marginal ridge Distal marginal ridge

Figure 18: Palatal view of the finished waxing. Note

the brightness on the marginal ridges, the enamel M D
bridge formed by the union of the palatal central lobe
and the cingulate, the side lobes present in the palatal
concavity, and the incisal edge formed by the two
incisal edges at an angle of 45 degrees in relation to
one another. Figure 19: Incisal view of the finished waxing. Note the three lobes of
vestibular development, the vestibular micro texture, the incisal edge formed
by the two vestibular and palatal edges, and the lines converging from the
marginal ridges to the root.

Figure 21: Slant view of the vestibular face of the

finished tooth.

Figure 20: Finished vestibular face with all the

chromatic characteristics, cracks, more translucent
incisal third, and sinuosity of the incisal edge.

Figure 22: Slant view of the palatal face of the finished

tooth.

Journal of Cosmetic Dentistry 103

Summary 9. Manauta J, Salat A. Layers Camadas: Atlas sobre a estratificação da resina composta [Lay-
This article has documented the study of a maxillary ers: an atlas of composite resin stratification]. São Paulo: Editora Quintessence. 2013. p.
central incisor, originally hand-drawn and colored 259-62. Portuguese.
with crayons, simulating the internal and external
stratification of a tooth in order to promote the un- 10. Gnan C. Morphologie der zähne [Morphology of the teeth]. Berlin: Quintessenz biblio-
derstanding and definition of morphological and col- thek; 2006. p. 15-20. German.
or characteristics. This drawing was then reproduced,
at least in part, in wax. This kind of study is valuable 11. Montagna F, Barbesi M. De la cera a la cerâmica. Bogotá: Actualidades Médico Odon-
because the main features of a tooth will always be tológicas Latinoamérica, C.A.; 2008. p. 13-22. Spanish.
presented. The path for memorization may be easier
if the tooth illustrations are developed and correlated 12. Adolfi D. A estética natural [Natural esthetics]. São Paulo: Editora Santos; 2002. p. 16-34.
with its color. The method presented can facilitate Portuguese.
study even though each professional has his or her
own interpretation of the studied tooth. 13. Kataoka S, Nishimura Y. Natürliche morphologie: form und gestalt keramischer restau-
rationen [Nature’s morphology: an atlas of tooth shape and form]. Berlin: Quintessenz
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Disclosure: The author did not report any disclosures.

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