DANYLO HALYTSKY
NATIONAL MEDICAL UNIVERSITY OF LVIV
DEPARTMENT OF THERAPEUTIC DENTISTRY
METHODOLOGICAL GUIDE
for practical classes
„Preclinical course of Therapeutic Dentistry”
(III semester) for the 2-nd year students
Lviv-2011
The methodological guide is worked out by: M. Hysyk, O.
Ripetska
Accountable for an issue  first vice-rector of scientific and
academicl work, professor, Corresponding Member of the Academy of
Medical Sciences of Ukraine, M.R. Gzhegotskiy.
Reviewers: associate professor of department of Surgical
dentistry N. Krupnik,
associate professor of department of Pediatric
dentistry N. Chukhraj
Methodological guide for students in Therapeutic Dentistry (III
semester) was discussed and approved on the sitting of the department of
Therapeutic Dentistry (record of proceedings No15, dated from 11, May,
2010) and approved on the meeting of Methodological committee in
dentistry disciplines on June 22, 2010, protocol No3.
Computer printing: Oksana Zamoiyska
2
CONTENT OF THE COURSE
Page
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Plan of the discipline „Preclinical course of Therapeutic
Dentistry” according to the transfex credit-module
system of the organization of studies (CMSO) ................
Types of independent study work for students………….
Types of individual work for students………..................
The structure of discipline „Preclinical course of
Therapeutic Dentistry” estimation of grades for current
educational activity (converting of traditional marks into
marks, estimation in grates for implementation of
individual tasks)…………………………………………
Introduction ……………………………..........................
Practical lesson 1. Therapeutic dentistry as a basic
dentistry discipline, sections. The contribution of the
Ukrainian scientists into the development of dentistry.
Purpose and tasks of the preclinical course of
Therapeutic Dentistry…………………………………...
Practical lesson 2. Structure of the tooth. Topography
of tissues. Histology of the enamel……………………...
Practical lesson 3. Structure of the tooth. Topography
and histology of the cement and dentine ……………….
Practical lesson 4. Structure of the pulp, periodontal
ligament. Age changes. Concept of the periodontium, its
functions………………………………………………...
Practical lesson 5. Saliva, mouth liquid: composition,
properties, functions ……………………………………
Practical lesson 6. Dental formula. Signs of teeth.
Clinico-anatomical features of incisors of the upper and
lower jaws ………………………………………………
Practical lesson 7. Clinico-anatomical peculiarities of
canines of the upper and lower jaws ……………………
Practical lesson 8. Clinico-anatomical peculiarities of
the structure of premolars of the upper and lower jaws…
Practical lesson 9. Clinico-anatomical peculiarities of
the structure of molars of the upper and lower jaws ……
3
5
7
8
9
11
13
17
22
27
35
40
47
52
57
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Practical lesson 10. Organization and equipment of
dental consulting room. Drills, handpieces, their use.
Labour safety standards. Concept of ergonomics ….......
Practical lesson 11. Dental instruments. Cutting
instruments. Rules of sterilization………………………
Practical lesson 12. Ways of spreading of carious
process in tooth hard tissues and on different surfaces …
Practical lesson 13. Classification of carious cavities
according to Black classification. Principles and modes
of the classical cavity preparation …………...................
Practical lesson 14. The main features of carious
cavities preparation class I according to Black
classification ……………………………………………
Practical lesson 15. Preparation of carious cavities of
class V according to Black classification ………………
Practical lesson 16. Pecularities of the carious cavity
preparation class II according to Black classification ….
Practical lesson 17. Pecularities of the carious cavity
preparation class III according to Black classification …
Practical lesson 18. Peculiarities of the carious cavity
preparation class IV according to Black classification …
Practical lesson 19. Methods of preparation of the
carious cavities according to modern filling materials:
techniques of preparation (M.I.-therapy), ART-method
(non-invasive), tunnel preparing, etc …………………...
Practical lesson 20. Final module control 1....................
4
62
68
74
80
87
90
94
98
100
103
109
THE PLAN OF TOPICS IN „PRECLINICAL COURSE OF
THERAPEUTIC DENTISTRY”
(transfer-credit module system of education (CMSOE) 2-nd year of
studies, III semester
Module 1: Structure of teeth and preparationof carious cavities
( 2,3 credits (69 hours)
№
Theme of practical classes
Pract.
Self
Indiv. work
classes
education
1.
Therapeutic dentistry as a
basic dentistry discipline,
sections. The contribution
of scientists of Ukraine
into its development.
2
Purpose and tasks of the
pre-clinical course of
Therapeutic dentistry
Review of
2.
Structure of the tooth.
scientific
Topography of tissues.
2
1
literature,
Histology of the enamel
preparation
3.
Structure of the tooth.
of abstracts,
Topography and histology
2
1
conducting
of the cement and dentine
of scientific
4.
Structure of the pulp,
researches
periodontal ligament. Age
2
1
changes. Concept of the
periodontium,
its
functions
5.
6.
7.
8.
Saliva, mouth liquid:
composition, properties,
functions
Dental formula. Signs of
teeth. Clinico-anatomical
peculiarities of incisors of
the upper and lower jaws
Clinico-anatomical
peculiarities of the canines
of upper and lower jaws
Clinico-anatomical
peculiarities
of
the
structure of premolars of
5
2
1
2
1
2
1
2
1
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
the upper and lower jaws
Clinico-anatomical
peculiarities
of
the
structure of molars of the
upper and lower jaws
Organization
and
equipment
of
dental
consulting room. Drills,
handpieces, their use.
Labour standarts. Concept
of ergonomics
Dental
instruments.
Cutting instruments. Rules
of the sterilization
Ways of spreading of the
carious process in tooth
hard tissues
and on
different surfaces
Classification of carious
cavities according to
Black
classification.
Principles and modes of
the
classical
cavity
preparation
Peculiarities of carious
cavity preparation class I
according
to
Black
classification
Preparaties of carious
cavities of class V
according
to
Black
classification
Preparaties of carious
cavity preparation class II
according
to
Black
classification
Features of carious cavity
preparation
class
III
according
to
Black
classification
Peculiarities of carious
6
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
2
1
19.
20.
cavity preparation class
IV according to Black
classification
Methods of preparation of
carious cavities according
to
modern
filling
materials: techniques of
preparation
(M.I.therapy),
ART-method
(non-invasive),
tunnel
preparing etc
Final module control 1.
In all
2
1
2
1+1
2
40
2
23
TYPES OF INDEPENDENT STUDY WORK OF STUDENTS
2-nd years of study, III semester (23 hours)
No
Theme of practical class
Number
of hours
1.
Preparation for practical classes 
theoretical training.
Working-out of practical skills:
- Anatomo-physiological peculiarities
of tooth hard tissues. To draw the
scheme of masticatory surfaces of
molars and premolars of the upper
jaw (picture).
- To draw the masticatory surface of
molars and premolars of the lower
jaw (picture).
- To make two models of crowns of the
first premolar of the lower jaw and to
form a carious cavity on one of the
model class I according to Black
classification.
- To make two models of crowns of the
first premolar of the upper jaw and to
form a carious cavity on one of the
13
2.
7
Type of
control
1
1
1
1
Current
control
during the
practical
classes
-
-
-
3.
model class V according to Black
classification.
To make two models of crowns of the
second of crowns of the first molar of
the upper jaw and to form a carious
cavity on one of the model class II
according to Black classification.
To make two models of crowns of
canines of the upper jaw and on one of
them to form the carious cavity class
III according to Black classification.
To make two models of crown of the
upper central incisors and on one of
them to form the carious cavity class
IV according to Black classification
Getting ready for the final module control
1
1
1
3
Final
module
control
TYPES OF INDIVIDUAL WORK FOR STUDENTS
2-nd years of study, III semester (6 marks)
No
Theme
Marks
1.
To work out the technique of preparation of carious
cavities (M.I.-therapy)
To work out the technique of preparation of carious
cavities (ART-method)
To work out the method of the tunnel preparation of
carious cavities
2
2.
3.
8
2
2
THE STRUCTURE OF DISCIPLINE „PRECLINICAL COURSE OF THERAPEUTIC DENTISTRY”,
MARKS FOR CURRENT EDUCATIONAL ACTIVITY
(THE CONVERTATION OF TRADITIONAL ESTIMATIONS IN MARKS, ESTIMATION IN GRADES FOR
IMPLEMENTATION OF INDIVIDUAL TASKS)
module, numder of
Distribution
Convertation of
Grades for
Number of
Number of
educational hours, numder
of practical
traditional marks into
the
grades for
grades for final
of credits, ECTS
classes
grades
implement
current
module control
ation of the
educational
ISRS
activity of
Traditional marks
students
„5” „4” „3” „2”
Module 1. Structure of
Practical
6
4
3
0
6
max
max
teeth and preparation of
classes
6,19=114
80
(in all 19)
min
min
carious cavities  69 hours,
3,19=57
40
2,3 credits
Students which collected 57 marks are admitted to final module control. For individual work 6 marks are added
Module
2.
Filling
Practical
6
4
3
0
6
max
max
materials and endodontics
classes
114
80
(in all 19)
min
min
 66 hours, 2,2 credits
57
40
Students who received 57 grades are admitted to final module control. For individual work 5 marks are added.
9
The convertation of estimations in rating scale into the scale of progress
in studies ECTS
Estimation
of ECTS
Statistical index
Description
Limits of
estimations of
ECTS
A
B
C
D
E
Fx
F
The best 10%
Next followings 25%
Next followings 30%
Next followings 25%
The last 10%
Repeated handing over
Obligatory repeated
course of studies
Excellent
Very good
Good
Satisfactory
Acceptably
Unsatisfactory
Unsatisfactory,
with the
repeated course
of studies
191-200
166-190
136-165
111-135
101-110
10
Introduction
The curricula for students of dental faculties of higher medical
establishments of Ukraine of the III-rd and IV-th levels of accreditation
contains the course of preclinical therapeutic dentistry which is taught
during in the III-rd and IV-th semesters. On the basis of typical curriculum,
educational qualification (EQD) and educational professional programmes
(EPP) of training of specialists, experimental curriculum and in accordance
with principles of ECTS (European credit-transfer systems) and the order
dated from 31.01.2005 No 52 approved by Ministry of Health Care of
Ukraine, current educational programme has been developed by co-workers
of the department of Therapeutic dentistry.
Preclinical course during the 2-nd year of studies provides
thorough and profound preceeding education of students, mastering of
obligatory manual skills, on phantoms, which are extremely important for
the future independent work in the clinic of therapeutic dentistry.
Initial level of knowledge of students on the III-rd and IV-th
semesters foresees knowledge of fundamental medical disciplines.
The educational process is carried out according to the creditmodule system in accordance with the requirements of Bolon’ process.
The specific aim of study of the module 1 „Structure of teeth and
preparation of carious cavities” envisages the thorough study of substantial
modules „Anatomico-histological and clinico-topographical peculiarities of
structure of teeth” and „Preparation of carious cavities”.
Substantial module 1 „Anatomico-histological and clinicotopographical peculiarities of tooth structure” includes:
- the analysis of histological structure and chemical composition
of hard tissues of tooth (the dentine, the cement) and the pulp,
anatomico-histological and physiological structural features of
separate areas of oral mucosa;
- interpretation of age changes, the influence of the function of
salivary glands and the quality of saliva on the condition of
hard tissues of the tooth;
- analysis of clinico-anatomical features of different groups of
teeth;
- explanation of the role of the structure and signs of teeth in the
determination of their belonging to one or another group, side,
upper or lower jaws.
A 2 „Preparation of carious cavities” foresees:
- analysis of dental instruments;
- effective sterilization;
11
-
the classification of carious cavities according to Black
classification;
- the interpretation of the necessity to follow rules of the mode
and stages of the preparation of carious cavities;
- the explanation of peculiarities of preparation of carious
cavities according to Black classification;
- the analysis of indications to the application of different
methods of preparation (classical, M.I.-therapy, ART-therapy,
tunnel preparation) of carious cavities.
The methodological guide contains short description of themes for
each lesson, the list of control questions to evaluate every students’
knowledge of presented material, tests and situational tasks. At the end of
every topic the list of recommended literature is presented, which will be
helpful for preparing the students for their practical classes.
12
Practical lesson No 1
Theme: Therapeutic Dentistry as the most important dental specialty, main
parts of therapeutic dentistry. Contribution of Ukrainian scientists
into the development of dentistry. The aim and tasks of preclinical
course of therapeutic dentistry.
Short description of a theme
Therapeutic dentistry is the discipline that deals with the etiology,
pathogenesis, clinical manifestations and prophylaxis of teeth, periodontal
diseases and diseases of organs and structures of the oral cavity which are
subjected to conservative and combinational treatment.
The main parts of therapeutic dentistry:
 preclinical course;
 odontology;
 endodontics;
 periodontology;
 diseases of the oral mucosa.
Dental diseases influence the human health and create danger for
the spreading of infections inside the body. Some special and somatic
diseases manifest in the oral cavity. Dentistry thus is connected with
therapeutics, endocrinology, haematology, oncology, dermatology,
infectious diseases. In their work dentists use different modern techniques
and technologies. All dentists should be good psychologists and also they
should be familiar with sociology and economics.
Since 1830, dentistry, as the integral part of the medical education
was included at the universities of the Austrian and Hungarian Empire
(universities of Vienna, Prague, Krakiv, Lviv). At the beginning of the 19-th
century the post of the Professor on dental treatment was introduced in the
university. This post was held by Karl Prokip Kaliha – the author of the first
Halytsky textbook “Diseases of teeth and methods of their treatment”,
published in 1838, in Vienna. His successor, the Professor of Dentistry,
Vincent Stransky, who was simultaneously acting as the Director of the
Medical Education at the University (1834-1862).
Starting from 1894, the university readership course on
Odontology and Dentistry was innovated in the curriculum at the medical
department of Lviv University. Andriy Hon’ka and Theodore Bohosevych
were at the head of that course by turns. In 1905, the clinical baseodontological ambulatory of the university with the school of dental
13
technicians was founded to the purpose of that course. The Odontological
Scientific Society began its activity in 1911.
The first department of dentistry in Lviv was founded in 1913 by
A. Cieszynski on the basis of the dental ambulatory that had been
functioning since 1905.
A.Cieszynski received a higher medical education in Munich and
Berlin. In 1913 having been awarded a title by the Austrian Ministry of
Education he became the professor of the Department of Dentistry and the
Head of University Dental Clinic of Lviv Medical Faculty.
Professor A.Cieszynski is well-known as the author of the first
world atlas and textbook in radiology, which ran into several editions, the
author of local novocaine anaesthesia, radical gingiveclomy by Cieszynski –
Vidman – Nejman.
Well-deserved scientific successors were prepared by prof.
Cieszynski. One of his desciples was prof. Lyubomyra Lutsyk, who
became the chief of the newly organized Department of Therapeutic
Dentistry (Dentistry) in the Lviv Medical Institute in 1958.
Since 1970, professor Yu. S. Chuchmay was at the head of the
department. The main direction of scientific research has become the
working-out and approbation of treatment methods of inflammatory
diseases of periodontium by medical means of the prolonged influence.
Prof. G.Chuchmay directed the scientific staff of the department towards
the solution of regional tasks and the problems of preventing and treating
the main dental diseases, providing the dental care of mother and child,
elaborating and approbating the methods of treatment including the
prolonged effect remedies and the investigation of the periodontal
antioxidizing system.
Since 1994 the Department was headed by prof. S.Kukhta. Under
his supervision the investigations of the antioxidizing system condition in
inflammatory periodontal diseases and its pharmacological correction were
continued.
Since 2000 the Department of Therapeutic Dentistry is headed by
D.M.D. V.Zubachyk. Numerous research works of the Department of
Therapeutic Dentistry made a valuable contribution to dentistry.
Specifically, the role of microcirculational alterations in the pathogenesis of
inflammatory periodontal diseases has been revealed, medicational
correction of vitamins A,E,C levels and catalase activity have been
suggested.
Students start the education at the department of therapeutic
dentistry from the III-rd semester.
14
The work which is carried out in the preclinical rooms is similar to
the treatment of patients in the dental consulting rooms. Starting from their
first days in the laboratory the students get used to the place of work, the
position near dental unit, they learn how to use drills, cuttings instruments,
to work upright, in a sitting position, in four hands.
Basic tasks of preclinical dental course:
1. To become familiar with the equipment of denal room.
2. To learn dental instruments (types of instruments, their
functions, the way of work, sterilization, etc.).
3. To learn anatomico-phisiological peculiarities of the structure of
teeth, morphological structure and physiological properties of
dental tissues.
4. To master the technique of preparation of carious cavities.
5. To become familiar with kinds and properties of dental filling
materials.
6. To master techniques of filling the carious cavities of different
localization of all groups of teeth.
7. To learn modern instruments, methods and techniques of the
manipulation in the cavities of all groups of teeth.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
The development of dentistry from ancient times.
When the official status of dental specialist (dental doctor) has been
acknowledged?
What instruments and filling materials were for the first time developed
in dentistry?
Who was engaged in dental practice in the time of Kyivska Rus?
Since when the dental schools started to develop intensively in
Ukraine?
Enumerate the leading modern higher medical educational institutions
of Ukraine responsible for the training of dental specialists?
Prominent scientists of Ukraine, their contribution to the development
of dentistry.
What is known about the history of development of the department of
Therapeutic Dentistry of Danylo Halytskyj Lviv National Medical
University?
What scientists played a leading role in the organization of dental
faculty and specialized departments in Lviv?
15
10. Comment on the tasks of therapeutic dentistry, as a basic dental
discipline.
11. Enumerate the main branches of therapeutic dentistry.
12. What are the main tasks of therapeutic dentistry?
13. What can be said about the relationship of Therapeutic Dentistry with
other medical and biological sciences?
14. How does the therapeutic dentistry interact with other dental
disciplines?
15. In what way do the diseases of teeth and oral mucosa influence upon
the general condition of human health.
16. What is known about preclinical course, basic tasks.
17. Comment on the role of knowledges and skills obtained in the
preclinical course of study for subsequent work in a clinic.
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
16
Practical lesson No 2
Theme: Structure of the tooth. Topography of tissues. Histology of the
enamel.
Short description of a theme
Human dental system belongs to dyfiodontal type, which
means two changes of teeth: deciduons bite which consists of 20 teeth,
permanent bite – 32 teeth. Eruption of deciduons teeth begins on the
sixth-seventh month of the life of a child and is completed in two-three
years. At the age of 5-6 years the permanent teeth started to erupt, the
process is completed by the age of 13 with full replacement of
deciduons teeth by permanent ones. Anatomic formula of teeth of
deciduous dentition – 2.1.2, that means that on each side of the upper
and lower jaws there are two incisors, one canine, two molars.
Anatomic formula of teeth of permanent bite is 2.1.2.3, that means that
on each side of the upper and lower jaws there are two incisors, one
canine, two premolars, two molars. In the teeth of deciduous and
permanent dentition there is a crown (corona dentis), root (radix dentis),
and neck (collum dentis). Inside of each tooth the pulp chamber is located
– cavity (cavum dentis) is divided into a crown part and root canals.
Root canals end in the apical area with a narrow apical openings (foramen
apicis dentis) through which the nerves and vessels enter the tooth cavity.
Teeth are formed by both hard and soft tissues. Hard tissues consist
of the enamel, dentine and cement. The bulk of tooth is made up by a dentine
which is covered by the enamel in the crown area, and by the cement in the
roots of teeth. Soft tissues are formed by the pulp which fills the internal
cavity of a tooth (pulp chamber). Teeth roots are fixed in the alveolar sockets
by the pericementum (or periodontal ligament), which is located in a narrow
slit between the cement of the tooth root and the alveolar wall. In the area of
the neck the teeth are densely embedded the gums.
The crowns of teeth have several surfaces. In the group of front
teeth the four surfaces can be distinguished: vestibular (facies
vestibularis), lingual (facies lingualis), two contact, one of which medial
(facies medialis), and second – lateral (facies lateralis). The line of
convergence of lip and tongue surfaces forms a cutting edge (margo
incisialis). In the group of premolars and molars the vestibular, lingual,
occlusal, and two contact surfaces are distinguished.
17
Enamel  is the most mineralized tissue of the human body. It
consists of 95% of inorganic part, 1,2%  organic part and 3,8%  water.
The mineral components of the enamel are calcium phosphate, calcium
carbonate, fluorine calcium, magnesium phosphate. Mineral structure is
organized in the form of crystals (hydroxy-, carbonate-, chlorine-,
fluorineapatites). The crystals of apatites are organized in the form of
enamel prisms. The enamel prism  is a structural unit of the enamel.
Prisms begin from enamel-dentine junction and diverge in radial direction
to the surface of the enamel, forming S-shaped curve.
The organic component of the enamel consists of 58% of albumins,
42%  (lipids, with the small amount of lactates, sugars and citrates.
Organic substance of the enamel is distributed evenly as a thin
network, but in some places it forms original structures (enamel plates, tufts
and spindles). These are regions of less mineralized enamel.
As the result of cyclic changes during the development of the
enamel prisms (decrease of the mineralization) lines of Retzius are formed.
These lines are seen on longitudinal cuts of the enamel as the yellowish
brown bands .
The surface of the enamel before eruption is covered by a cuticle
(reduced epithelium) which after the eruption is quickly worn away and
replaced by a pelicule, that is a derivation of protein  carbohydrate
complexes of the saliva.
Metabolic processes are carried out due to the presence of hydrate
layer of the connected ions (OH), which appears on the surface of division
between the crystal and liquid in each crystal of the enamel. Apart from
connected, there is free water in the enamel which is located in microspaces
and serves as a carrier of molecules and ions in the structure of the enamel.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
What is meant under the term the enamel? Comment on its chemical
composition.
What is the structure of mineral component of the enamel?
What tissues form the structure of a tooth? Give a description of their
topography.
What is the enamel prism?
How is the organic component of the enamel represented and in what
structures of the enamel there is the greatest amount of organic
substance?
What are Gunter-Shreger’s lines?
18
7.
8.
9.
How are the lines of Rettsius formed?
What are the enamel plates, tufts and spindles?
What types of correlation of cement and enamel in the area of the
dental neck do you know?
10. What covers the surface of the enamel after the tooth eruption?
11. What is the optimal ratio of ions of calcium and phosphorus in the
apatites of the enamel and what happens when the balance is disturbed?
12. In what way the exchange processes in the enamel takes place?
Situation tasks and test control
1. What is the content of mineral elements in the enamel?
A. 90%
B. 95%
C. 87%
D. 83%
2. What is the optimal correlation of calcium and phosphorus in the crystals
of hydroxyapatites?
A. 1,67
B. 2,43
C. 1,17
D. 2,71
3. In what part of the tooth enamel the layer is the thinnest?
A. In the area of fissures
B. In the neck area
C. In an aproximal area
D. On the slopes of cusps
4. Lines which are the optical phenomenon and are visible in the result of
different orientation of prisms in the relation to the plane of the enamel
section:
A. Lines of Rettsius
B. Lines of Owen
C. Lines of Guntera-Shreger
D. Lines of Pikerilya
5. Lines which are the result of cyclic changes during the formation of the
enamel prisms:
19
A. Lines of Rettsius
B. Lines of Guntera-Shregera
C. Lines of Owen
D. Lines of Pikerilya
6. The thin leaf-like structures in the enamel with reduced mineralization,
which pass from the surface of the enamel to enamel-dentine connection:
A. Enamel spindles
B. Enamel tufts
C. Enamel plates
D. Enamel prisms
7. Longitudinal formations in the enamel which diverge from enameldentine connection and penetrate into the enamel up to one third of its
thickness:
A. Enamel prisms
B. Enamel spindles
C. Enamel tufts
D. Enamel plates
8. Thin „blind” canals in the enamel which diverge from enamel-dentine
junction and contain remnants of odontoblastic sprouts :
A. Enamel spindles
B. Enamel tufts
C. Enamel prisms
D. Enamel plates
9. What correlation of the cement and enamel is more frequent in tooth neck
area is found more frequently?
A. Cement covers the enamel
B. The edges of enamel and cement are in close contact with each other
C. The enamel covers the cement
D. The enamel and the cement are at some distance from each other
10. What enamel structure proved to be the most resistant to caries?
A. Carbonic calcium
B. Fluoride of calcium
C. Carbonate apatite
D. Hydroxyfluor apatite
20
11. The thin acquired organic film on the surface of the enamel, invisible
with a naked eye:
A. Dental calculus
B. Pellicle
C. Soft dental plaque
D. Primary cuticle
12. What is the odonoglyphics?
A. Knowledge about the relief of the surface of teeth
B. Knowledge about the structure of the cavity in the tooth
C. Knowledge about tissues which encircle the tooth
D. There is no right answer
13. The chemical analysis of the substance showed that the investigated
tissue consists of 95% inorganic material component matter, 1,2% organic
material and contains 3,8% of water. What type of tissue of a human being
it can be?
A. The cement
B. The dentine
C. The enamel of the tooth
D. Cancellous bone of the alveolar process
E. The bone
14. The roentgenogram made for the patient after the trauma of
maxillofacial area reveals the fracture of the tooth hidden by the alveolar
bone. Name the part of a tooth, located in the alveolar and covered by a
cement?
A. Dental post (columna dentis)
B. Root of a tooth (radix dentis)
C. Zygapophysis (processus articularis dentis)
D. Leg of a tooth (pedunculus pedicle)
E. Alveolar process (processus alveolaris dentis)
Reference literature
1.
2.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
21
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
3. Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.II.–
Poltava: Divosvit, 2007.– 280 p.
4. Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
5. The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
6. Borysenko A.V. Dental caries.– K.: Book plus, 2000.– 342 p.
7. Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
8. Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
9. Tsarynskiy M.M. Therapeutic dentistry.– Rostov: Feniks, 2008.– 508 p.
10. Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine,
2002.– 640 p.
11. Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
Practical lesson No 3
Theme: Structure of the tooth. Topography and histology of the cement and
dentine.
Short description of a theme
A dentine (dentinum)  is a hard tissue, located between the pulp
and tissues which are on the external surface of a tooth. A dentine, as well
as the enamel, has no cells, blood vessels and nervous fibres. Cells which
form a dentine (odontoblasts) are located in the peripheral layer of a pulp.
A dentine is composed of 70-72% of inorganic components, 20%
– of organic components and 10% of water. Basic inorganic bondings are
22
hydroxy- and fluorapatites, carbonic calcium, magnesium and other.
Organic part of a dentine consists of collagen type I and noncollagens
(glycoproteins and glycozaminoglycans).
Basic mineralized substance of a dentine, which consists of bands
of collagen fibres and crystals of inorganic material, is crossed by thin
canals (canaliculi dentales) in radial direction. Part of a dentine, located
very close to a pulp possesses a low content of mineralsand is called
predentin.
In canals of a dentine sprouts of odontoblasts are located the socalled Tomse fibres which are submerged in a dental liquid.
Depending on the direction of collagen two layers can be
distinguished in dentine: external and internal (near the pulp). Radial
direction of fibres (fibres of Korf) prevails in an external layer, while in
parapulpal layer tangential (fibres of Ebner) prevail.
Depending on the degree of the mineralization of dentinal matrix
there can be distinguished highly mineralized basic substance (peritubular
dentine) which forms the wall of dentinal canals; medium mineralized
substance (intertubular dentine) which is between dentinal canals, and low
mineralized substance (around odontoblasts sprouts) which is in dentinal
canals.
Depending on time and mechanism of origin a few types of dentine
can be distinguished. A dentine which appears during dentinogenesis,
before the tooth eruption is called primary. Dentine which appears after the
eruption of teeth is of two types: second regular, which is producted in reply
to functional stimulis on an intact tooth, and second irregular (tertiary)
(appears in reply to pathological processes in tissues of a tooth and has no
regular structure.
Dentinogenesis sometimes takes place directly in the pulp tissues
that leads to the formation of denticles ( dense compact structures of
different form and size.
Cement (cementum)  is a hard tissue of a tooth which fully
covers the external surface of the root of a tooth. It consists of 50-60% of
inorganic components, 23-26%  organic matter and 12% of water. The
basic inorganic components of cement are apatites, calcium, phosphorus
and other substances. Collagen is the basic organic constituent of a cement.
Depending on the presence or absence of cells in calcified cement
cellular and acellular cements are distinguished. Acellular cement covers
the neck equal to one third or half of tooth root, cellular cement is located
near the apex of the root, and in multirooted teeth 
in the area of
bifurcations.
23
The basic substance of the cement is pierced by collagen fibres
which diverge in different directions.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Comment on the dentine and its chemical composition.
What is the structure of a dentine?
What forms the main substance of a dentine?
What is a predentin?
What are the peculiarities of the external layers of the dentine (cloak
dentine)?
What are the peculiarities of the parapulpal dentine?
What are the differences between the cloak and parapulpal dentine?
Give the definition to the term sclerotic and interglobular dentine?
What is meant under the term „primary dentine”?
What are the peculiarities of the secondary dentine?
What are the peculiarities of the tertiary dentine?
Give the definition to the term “denticles”, how are they classified
depending on the localization?
What are the so-called „dead tracks” in dentine?
Comment on the cement, its chemical composition.
What types of cements in human teeth do you know? Where are they
located?
What are the functions of a tooth cement?
Give the definition to the term “hypercementosis”, and what causes this
process?
What are the fibres of Sharpee?
Situation tasks and test control
1. Organic component of a dentine is presented by:
A. Collagen type III
B. Collagen type I
C. Phosphoproteins
D. Chondroitinsulphate
2. Where are odontoblasts situated?
A. In a parapulpal dentine
B. In the peripheral layer of the pulp
24
C. In a cloak dentine
D. In predentin
3. Lines in a dentine which are caused by changes in the process of
mineralization:
A. Lines of Gyuntera-Shreger
B. Lines of Rettsius
C. Lines of Owen
D. Lines of Ebner
4. What type of a dentine is the most mineralized?
A. Peritubular dentine
B. Intertubular dentine
C. The dentine around sprouts of odontoblasts
D. Predentin
5. What are the low mineralized or non mineralized dentinal areas in the
crown of the tooth?
A. Interglobular dentine
B. Secondary dentine
C. Granular Toms layer
D. Sclerotic dentine
6. Name the dentine which appears in the period of dentinogenesis, before
the teeth eruption?
A. Sclerotic dentine
B. Secondary regular dentine
C. Secondary irregular dentine
D. Primary dentine
7. What is the proper term for a dentine which appears after the tooth
eruption, as a result to physiological stimuli?
A. Interglobular dentine
B. Primary dentine
C. Regular secondary dentine
D. Tertiary dentine
8. What dentine appears in response to the influence of pathological
processes in hard tissues of the tooth?
A. Predentin
B. Primary dentine
25
C. Secondary irregular dentine
D. Secondary regular dentine
9. What is the name for denticles located inside the pulp?
A. Interstitial
B. Free denticles
C. Close to the wall of a pulp chamber
D. Concrements
10. Explain the term „dead highways”.
A. An area in a dentine with the disintegration of odontoblasts
B. An area in a dentine with the mineralization of odontoblasts C. Area of
dentine with the absence of dentinal tubules
D. An area of dentine where organic components prevail
11. What is the percentage of inorganic matter in a dentine?
A. 70-80%
B. 50-60%
C. 60-70%
D. 40-50%
12. What hard tissues of a tooth contain cellular elements?
A. The dentine
B. The enamel
C. The cement
D. The dentine and the cement
13. The predentin can be described as:
A. External layer of a dentine which is adjacent to the enamel
B. Highly mineralized dentine which forms the wall of a dentinal tubule
C. External layer of the dentine which is adjacent to the cement
D. Hypomineralized dentine, located near the pulp
14. The patient complains on the absence of the 21st tooth. It was revealed
during the examination that the tooth is destroyed to the level of a gingival
edge. What part of the tooth has been destroyed?
A. The root of the tooth
B. The head of the tooth
C. The crown of the tooth
D. The body of the tooth
E. The apex of the tooth
26
Reference literature
1.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
2. Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
3. Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
is for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.II.–
Poltava: Divosvit, 2007.– 280 p.
4. Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvikh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
5. The methodological manual for practical use of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
6. Borysenko A.V. Dental caries.– K.: Book plus, 2000.– 342 p.
7. Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
8. Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
9. Tsarynskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508
p.
10. Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine,
2002.– 640 p.
11. Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.:
Feniks, 2002.– 640 p.
Practical lesson No 4
Theme: Structure of the pulp and the periodontal ligament. Age changes.
The conception of the periodontium, its functions.
27
Short description of a theme
The pulp of the tooth  is a specialized connecting tissue which
fills the crown and root parts of a tooth cavity. It consists of the basic
substance, cells, fibers, vessels and nerves. 3 layers can be distinguished in
the pulp: peripheral (odontoblastic), subodontoblastic (consists of two parts:
Veyls layer and accumulated cells) and central layer. In the external layer of
the pulp there are two or three lines of odontoblasts  cells providing
trophicity of hard tissues of the tooth and formation of a dentine. Each of
them has a long sprout which as a Toms fiber gets into the dentinal canal
and pierces practically all layers of dentine.
There is a free of cells Veyls area under the layer of odontoblasts.
It consists mainly of intercellular substance in which the reticular fibers and
solitary fibroblasts are located. The nervous subodontoblastic plexus of
Rashkov is also located in this layer.
An intermediate layer of the pulp contains small low differentiated
stellated cells which can be transformed into odontoblasts.
The central layer of the pulp is presented by the loose connective
tissue, with fibroblasts, histiocytes, lymphoid cells, reticular and thin
argyrophilic fibers.
Functions of the pulp are: trophic, plastic, protective.
Age changes of the pulp are characterized by: fibrosis, sclerosis,
atherosclerosis, calcification and others. The pulp chamber is reduced in
volume (obliteration) due to the deposition of secondary and tertiary
dentine.
Periodontal ligament  is the connective tissue, located in a
narrow space 0,2-0,25 mm between dental alveolus and the cement of a
tooth root. It consists of fibers, cellular elements and basic matter.
Fibers are united in thick oblique bundles, which are densely
intertwined with a root cement in one side and bone tissue of alveolus in the
other side.They have radial direction near the apex of the root, horizontal
direction near the neck of the tooth. Besides the collagen fibres there are
also reticular, elastic and oxytalan fibres.
Among cellular elements there are: histiocytes, macrophages,
basophils, a small amount of osteocytes, cementocytes, epithelial cells.
The basic material of the periodontium presented by highmolecular polysaccharides, provides metabolic processes in the periodontal
ligament.
The main functions of the periodontium are: retentional,
amortizable, trophic, plastic, sensory and protective.
28
Three periods of age changes can be distinguished in the
periodontal ligament:
I period (under 20-24 years of age) is characterized by the
development and formation of normal structure of the periodontal ligament;
II period (25-40 years of age) is characterized by the stability of
the structure of periodontal ligament tissues;
III period (more than 40 years old) is characterized by the
destructive changes of separate bundles of collagen fibres, changes of
tissues properties. The destruction of fibre structures is especially evident in
the neck region of the periodontal ligament.
The periodontium  is a complex of anatomical structures around
the tooth (gums, the periodontal ligament, bone tissue of the alveolus and
the cement of a tooth root), which have common innervation and blood
supply, forming the unique unit.
Gums  a mucous membrane which covers the alveolar processes
of the jaws and surround teeth in the neck region. Three anatomical parts of
the gums are: interdental papillas, marginal part and alveolar part.
Interdental papillas  are triangle areas of gums, which fill intervals
between adjacent teeth. The marginal edge of gums is freely adjoining tooth
surfaces and is separated with it by gingival furrow. Alveolar part of gums
is closely connected with the periosteum of alveolar processes of the jaws.
Bone tissues of alveolus consists of the cells (osteoblasts,
osteocytes, osteoclasts) and intercellular substance (bone matrix). Parts of
the upper and lower jaws where teeth are located are called the alveolar
processes. Walls of dental alveolus and supporting alveolar bone with a
compact and spongy substance are distinguished in the alveolar processes.
The external and internal surfaces of alveolar processes are covered by
cortical layer which is made up from the compact substance of plate bone.
All of spaces between the walls of a dental alveolus and cortical plates of
alveolar processes are filled by a spongy substance.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
Describe the structure of the pulp chamber.
What layers does the pulp consist of?
What cellular elements contain the pulp and what is their role in the
functioning of the pulp?
How is innervation of the pulp provided?
What nervous plexus does the pulp contain?
How is blood supply of the pulp carried out?
29
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Comment on the functions of the pulp.
What age changes are typical for the pulp?
What are the main constituents of the periodontal ligament?
What functions does the periodontal ligament carry out?
How is blood supply and innervation of the periodontal ligament
provided?
What cellular elements does the periodontal ligament contain, what is
their role?
What age changes take place in the periodontal ligament?
What structures are called “ islets of Malyasse”?
Give the definition to the term “the periodontium”.
What are the functions of the periodontium?
Describe the histological structure of the gums.
What anatomical areas the gums consist of?
What is the composition of bone tissue of alveole?
Situation tasks and test control
1. What part of a dental germ forms the pulp?
A. Dental sack
B. Enamel organ
C. Dental papilla
D. The pulp of enamel organ
2. How many layers are there in the pulp of the tooth?
A. One
B. Two
C. Four
D. Three
3. What cells are under the peripheral layer of the pulp?
A. Pulpocytes (star-shaped cells), preodontoblasts
B. Histiocytes, odontoblasts
C. Histiocytes
D. Odontoblasts
4. In what layer of the pulp the odontoblasts are situated?
A. Central layer
B. Intermidium layer
C. Peripheral layer
30
D. In all of layers
5. What cells of the pulp ensure its plastic function?
A. Dendrite cells
B. Odontoblasts
C. Mast cells
D. Histiocytes
6. What is the composition of fibred elements of the pulp?
A. Elastic and collagen
B. Elastic and reticular
C. Elastic, collagen and reticular
D. Collagen, argyrophil and reticular
7. What fibres are not present in the pulp?
A. Collagen
B. Elastic
C. Argyrophil
D. Reticular
8. What is the amount of nervous plexus in the pulp?
A. One
B. Two
C. Three
D. Plexus are absent
9. In what part of the pulp the nervous plexus of Rashkov is located?
A. In a central layer
B. In a peripheral layer
C. In the area of Veyl
D. In the layer of cells accumulation
10. What type of vascularization is typical for the pulp?
A. The end type
B. Collateral type
C. Mixed type
D. The proper answer is absent
11. The histological structure of periodontal ligament allows to classify it as
the connective tissue. What type of connective tissue the periodontal
ligament belongs to?
31
A. Dense coarse-fibered
B. Loose and organized
C. Loose and not organized
D. the periosteum of the alveolus
12. What is the thickness of the periodontal slit?
A. 0,1-0,15 mm
B. 0,2-0,25 mm
C. 0,05-0,1 mm
D. 0,35-0,40 mm
13. What cellular elements of the periodontal ligament can be the source for
the development of the radicular cysts?
A. Fibroblasts
B. Cells of Malyasse
C. Plasmatic cells
D. Osteoblasts
14. What blood vessels do not participate in the blood supply of the
periodontal tissues?
A. A. dentalis
B. A. interradicularis
C. A. interdentalis
D. A. lingualis
15. The pulp and the periodontal ligament are closely connected
morphologically. A lot of their functions are equal. What functions are
typical for the periodontal ligament exclusively and not for the pulp?
A. Plastic
V. Trophic
C. Distribution of the pressure
D. Protective
E. Sensory
16. What groups of fibres form the dental ligament?
A. Transseptal and oblique
V. Cemento-periostal and horizontal
C. Apical and interradicular
D. All mentioned before
32
17. What amount of gingival liquid is produced within 24 hours?
A. 0,05-0,1 mm
B. 0,1-0,5 mm
C. 0,5-2 mm
D. 2-5 mm
18. The epithelium of a gingival sulcus possesses the following
peculiarities:
A. Is nonkeratinized
B. Lamina propria does not form papillae
C. It is thinner, than the epithelium of gums
D. All mentioned before
19. What is a normal depth of gingival sulcus?
A. 0,1-0,5 mm
B. 0,5-2 mm
C. 2-3 mm
D. 3-4 mm
20. What cells of the bone take part in its resorption?
A. Osteogenic cells
V. Osteoblasts
C. Osteocytes
D. Osteoclasts
21.What is the histological structure of the marginal gums ?
A. Squamous keratinized epithelium, submucosal layer
B. Squamous non-keratinized epithelium, lamina propria, submucosal layer
is not clearly marked
C. Multi-layered squamous keratinized epithelium, lamina propria
D. Multi-layered cylindrical epithelium, basal membrane, submucosal layer
22. The epithelium of a gingival sulcus is attached to:
A. Tooth pelicle
B. Tooth cementum
C. Is not attached, but forms a dense superficial ring
D. The cuticles of the tooth enamel
23. During the period of a changed bite the marginal gums:
A. Are unchangeable
B. Are fully smoothed out
33
C. Have an expressed scalloped surface
D. Are convex and oedematic
24. Taking into account that dentinogenesis is the function of the pulp,
name the lifetime when it takes place?
A. During embryonic development
B. During the first 6 months of life
C. Till the age of 7-14 years old
D. Till the period of the physiological change of the bite
E. Throughout the whole life
25. The successful treatment of pulp inflammation to great extend depends
on the knowledge of its anatomico-histological structures. Several layers
can be distinguished on the transversal cut of the pulp. Name the layer,
which is not typical for the pulp of the tooth.
A. Endothelial
B. Peripheral
C. Subodontoblastic
D. Layer of star-shaped cells
E. Central layer
Reference literature
1.
2.
3.
4.
5.
6.
7.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
Tsarinskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508 p.
Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine,
2002.– 640 p.
34
8.
Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
Practical lesson No 5
Theme: Saliva, mouth liquid: composition, properties, functions.
Short description of a theme
Saliva (saliva)  is a mixture of secretions of three conjugated
large, and a great number of small salivary glands. The secretion from the
excretory ducts of the salivary glands is mixed with the desquamative
epithelial cells, food particles, salivary bodies, mucosa, gingival fluid as
well as the microorganisms and their waste products. A biological liquid
which is termed as a mouth liquid appears in the result.
1500-2000 ml of saliva is produced daily in an adult organism. The
rate of saliva secretion is variable and depends on:
- age (after 55-60 salivation is slown down);
- nervous excitement;
- food irritants;
- the time of a day (during sleep the salivation diminishes in 8-10
times).
The salivation rate influences on the susceptibility of teeth to
dental caries.
Rekters, excretes, secretes and incretes appear in the result of
processes of vital activities, metabolism and synthesis of secretory cells.
Rekters – inorganic matters (water, microelements, ions), which
take part in the metabolism, but are resistant to chemical transformation and
remain just the same as they were while entering the cells..
Ekskrets as waste products of disintegration (carbon dioxide,
urinary and lactic acids), that as far as they accumulate in the body, they are
gradually excreted from the cells.
Secrets are specific products composed of complexes of
macromolecules and synthesized in cells in the result of anabolic processes.
Inkrets are substances of hormone-like nature, together with the
hormones of endocrine glands take part in the humoral regulation of activity
35
of organs and systems. Salivary glands produce hormone-like substances
which take part in the regulation of the phosphoric-calcium exchange of
bones and teeth and the regeneration of the epithelium of mucous
membrane of the oral cavity.
As to the percentage saliva consists of water 99-99,4% and of 0,61 % ( dissolved in it organic and mineral substances). As for the inorganic
components there are calcium salts, phosphates, potassium and sodium
connections,
chlorides,
hydrocarbonates,
fluorines,
rodanides,
microelements present in saliva. Ionic activity of calcium and phosphorus in
a mouth liquid serves as the index of solubility of hydroxy- and
fluorapatites. Saliva in the physiological conditions (рН=6,8-7,0) is
supersaturated in relation to hydroxy- and fluorapatites and has
remineralizing features.
With the diminishing of рН of mouth liquid the solubility of
enamel prisms increases. The critical value of index of рН is from 4,0 to
5,5.
The organic components of mouth liquid are partially synthesized
by the salivary glands (glycoproteins, amylase, mucin, Ig A), partially have
a hematogenic origin (amino acid, urea).
The enzymes of saliva are represented by five groups:
carboanhydrazes, esters, proteases, enzymes of transfer and mixed group.
There are over 60 enzymes in a mouth liquid. Amylase (partly hydrolyse
carbohydrates; phosphatase (acid and alkaline) take part in to the
phosphorus-calcium exchange, providing mineralization of the enamel and
dentine. Lizotsim has a bactericidal action, takes part in the protective
reactions of the organism and processes of regeneration of epithelium of
mucous membrane of the oral cavity. Nukleases provide the antiviral
defence of mucous membrane of the oral cavity.
Buffer capacity of the saliva  is the ability to neutralize the acids
and alkalines by hydrocarbonate, phosphatic and albumen buffer systems.
The buffer capacity of the saliva increases, if the diet contains proteins and
vegetables, while the amount of carbohydrates in food is reduced. A high
buffer capacity promotes resistance of teeth to dental caries.
The concentration of hydrogen ions (рН) in a mouth liquid varies
in different people and in different time of a day. The average index of рН
of mouth liquid fluctuates within the limits of 6,5-7,5.
Functions of the saliva:
1. digestive ( consists of primary enzymatic processing of food and
formation of food bolus before swallowing;
2. protective ( realized in various ways:
- due to mucin the mucous membrane of the oral cavity is covered
36
with the thin layer of mucus which protects it from drying up and
influence of mechanical factors;
- cleaning the surface of teeth and mucous membrane of the oral
cavity from microorganisms and their waste products and food
debris;
- a bactericidal action is carried out by enzymes (lyzocyme,
lactoferrin, RNA-aza, DNAaza, leucines);
3. the mineralizing action resists to demineralization of the enamel
and helps its mineralization;
4. the anticarious action is expressed in the mouth liquid, it
dissolves and ensures excretion of the sugars of food products,
neutralization of acids in dental plaque.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
What is the saliva mouth liquid?
What is the composition of the saliva?
What enzymes serve as integral parts of the saliva. Comment on their
action?
What is meant under the term „buffer capacity of the saliva”?
What are the protective properties of the saliva?
Is it possible to influence on the quantitative composition of mouth
liquid?
Is it possible to influence on qualitative composition of mouth liquid?
Name the large salivary glands of the oral cavity, and also the location
of output of their ducts.
Into what secretory sections the salivary glands are divided depending
on the character of their secret?
What is the composition of the secret of saliva of parotid salivary
glands?
What is the composition of the secret of saliva of submandibular
salivary glands?
What is the composition of the secret of saliva of sublingual salivary
glands?
What are the functions of saliva?
What is meant under the term ”salivary bodies”?
What hormones and hormone-like substances are produced by large
salivary glands and what are their function?
37
Situation tasks and test control
1. At what рН of the saliva the optimal conditions are created for
reminerralization of hard tissues of the tooth?
A. 7-8
B. 6-7
C. 5-6
D. 8-9
2. Parotin, which is secreted by salivary glands, belongs to such matters as:
A. Rekteriv
B. Ekskretiv
C. Secrets
D. Inkretiv
3. What is the composition of the secret which is produced by the parotid
salivary glands?
A. Serous
V. Mucous
C. Mixed
4. What is the composition of the secret which is produced by the
submandibular salivary glands?
A. Mucous
B. Serous
C. Mixed (serous-mucous)
5. What types of final sections are in the sublingual salivary gland?
A. Albuminous
B. Albuminous and mixed
C. Mucous
D. Mixed
6. In what pathological conditions the secretion of saliva increases?
A. In case of duodenal ulcer
B. In case of regular taking of depressants
C. In diabetes mellitus
D. In anaemias
7. In what pathological conditions the secretion of saliva is reduced?
A. In all below -mentioned
38
B. In case of the depression
C. In case of fever
D. In case of uremia
8. What salivary glands in the state of rest secrete the largest amount of
saliva?
A. Small salivary glands
B. Parotid glands
C. Sublingual glands
D. Submandibular glands
9. Stenon’s duct is the excretory duct of:
A. Small salivary glands
B. Parotid glands
C. Submandibular salivary glands
D. Small salivary glands of the lips
10. Varton’s duct is the it is excretory duct of:
A. Small salivary glands of the lips
B Sumandibular salivary glands
C. Sublingual salivary glands
D. Parotid salivary glands
11. Bartolin’s duct is the excretory duct of:
A. Small salivary glands of the lips
B. Parotid salivary glands
C. Sublingual salivary glands
D. Submandibular salivary glands
12. What is the amount of calcium in the saliva?
A. 1,2 mmol/l
B. 0,5 mmol/l
C. 1,0 mmol/l
D. 2,0 mmol/l
13. What must be the level of рН in the saliva in order to provoke
demineralization of the enamel?
A. 6,1
B. 5,9
C. 5,5
D. 6,3
39
14. What type of immunoglobulins is not produced by the salivary glands?
A. Ig E
B. Ig A
C. Ig N
D. Ig G
Reference literature
1.
2.
3.
4.
5.
6.
7.
8.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Pre-clinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.(Lviv, 2002.)
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.( Lviv,
2003.) 98 p.
Dmitrieva AA. Therapeutic dentistry.(M.: Medpress-inform, 2003.) 896
p.
Pediatric dentistry (Editor prof. L.O. Khomenko).( K.: Book plus,
1999.)524 p.
Tsarinskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508 p.
Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine,
2002.– 640 p.
Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
Practical lesson No 6
Theme: Dental formula. Signs of teeth. Clinico-anatomical features of
incisors of the upper and lower jaws.
Short description of a theme
The teeth of a human being can be divided into several groups
according to the shape, function, location and the number of roots.
40
A permanent bite consists of 32 teeth. Dental system can be
divided into 4 quadrants. An examination starts from the right upper
quadrant, moving clockwise.
In a chart corresponding to Zsigmondy the permanent teeth are
marked by the Arabic figures, the central incisor corresponds to number 1,
wisdom tooth (to the number 8, temporal teeth are marked the Roman
ciphers. For denotation of separate teeth, draw the proper part of segment
and inscribe the number of tooth.
Permanent bite
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
R 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 L
V
IV
III
II
V
IV
III
II
Deciduous bite
I
I
II
III
IV
V
III
IV
V
R
L
I
I
II
The international chart of FDI has been introduced in 1970. This is
a simple two-digit number chart, where quadrants are numbered by turns
follows: the upper right quadrant (number 1, upper-left 2, lower left 3 and
lower right 4 (in permanent bite). Quadrants of deciduous teeth are marked
from 5 to 8. Teeth are numbered by turns from a middle line. The first
number marks a quadrant, second the appropiate tooth.
R
18
38
17
37
R
16
36
55
85
15
35
54
84
14
34
53
83
13
33
12
32
52
82
11
31
21
41
51
81
61
71
22
42
62
72
23
43
24
44
63
73
25
45
64
74
26
46
65
75
27
47
28
48
L
The teeth of the same name of the right and left parts of dental arc
differ in structure. There are four signs due to which it is possible to define
the belonging of a tooth either to the right or left side: the angle of the
crown, curvature of the crown, deviation of the root, approximal surface.
The sign of the angle of the crown: an angle, formed by a cutting
edge and middle surface, is more sharp, than an angle, formed by a cutting edge
and distal surface of the tooth. The same rule is observed for the teeth of
masticatory group.
41
L
The sign of the curvature of the crown is characterized by greater
curvature of the medial part of vestibular surface of the crown and less
convexity of distal part of vestibular surface. This sign is more expressed
determined at the review of tooth from the side of masticatory surface or cutting
edge.
Sign of the root: deviation of longitudinal axis of the root from the
middle line of the crown laterally for incisors and canines, premolars and
molars  in distal direction; in other words, the apexes of the roots of
frontal group of teeth are deviated from a middle line laterally, in
masticatory group of teeth roots have the distal deviation.
Sign of approximal surface  approximal medial surface of
the crown is always wider as compared with approximal distal surface.
Incisors (dentes incisivi). Incisors are eight teeth located in the
middle of dental rows. They get into the first contact with meal, executing
the first phase of mastication  cutting offs. The crowns of teeth are located
almost in the frontal plane and in accordance with a function have a form of
shoulder-blades which end with a cutting edge. Incisors have one root with
one canal (lower lateral incisors in a 40% of choices have two canals).
Roots are compressed in mesio-distal direction. In each jaw 2 central and 2
lateral incisors can be distinguished.
The upper medial incisor  is the biggest from the group, with a
shovel-shoped crown. 3 denticles are distinguished on the cutting edge
which pass to the vestibular surfaces rollers is barely shown in 3
(mamelones). Palatal surface has a triangular in shape and is concave. Two
longitudinal rollers are situated from both sides, they thicken gradually
towards a neck, meeting at the middle line of a tooth to form the so-called
dental tubercle (tuberculum dentale). A pit appears in the place of rollers
fusion. The lateral surfaces have a form of wedge which narrows towards a
cutting edge. Root is cone-shaped. There are longitudinal furrows on the
medial and lateral surfaces of the root. The cavity of tooth corresponds to
the the external form. On a transversal cut it has a form of a triangular
crack. The cavity gradually grow narrow in the direction towards the root
and continues in relatively wide and straight root canal.
The sign of the curvature of the crown and the sign of the angle of the
crown are well expressed in the central upper incisors.
The upper lateral incisors are smaller in size than central upper
incisors. Their vestibular surface is convex. Palatal surface possesses a
triangular forn and is concave. Lateral rollers are well expressed. Near the
neck of the tooth they form a tubercle, with a blind pit in front of them
(foramen caecum). Lateral angle is more round than central one. A root is
compressed in mesio-distal direction and on a transversal cut has an oval
42
form, furrows are marked on each side. Lateral upper incisors have well
expressed signs of the angle and the curvature of the crown.
The lower medial incisor  is the smallest one in the group of
incisors. A crown is as a narrow incisor. A root is strongly compressed in
mesio-distal direction and has a sharp apex. On both surfaces of the root
longitudinal furrows are evident. On a distal surface a furrow is expressed
better, what allows to determine the belonging of the.tooth to a certain side,
as ordinary signs of teeth are not expressed. The cavity of tooth has the
appearance of triangular crack which is gradually continued to the canal.
The lower lateral incisor is not a great difference from the lower
medial incisor. It has to some extent better expressed signs of teeth. In 60%
cases the root canals have a shape of the root, I-st type (one root canal
through all the length of the root), in 35% cases  II-nd type (two-root
canals which are opened in one point at the apex) and 5%  III-rd type (2
root canals are opened by two separate apex openings).
Control questions to practical lesson
What is meant under the term „the sign of an angle of the crown”?
What is the sign of the root?
What is the sign of the curvature of the crown?
Give the definition of the term „the approximal surface sign”?
What is the role of incisors in the process of mastication?
Describe the structure of the upper medial incisor.
Describe the anatomical features of the upper lateral incisor.
Describe the structure of the lower central incisor.
Describe the anatomical features of the lower lateral incisor.
What is the structure of the root canals of the lower incisors?
What is the structure of the root canals of the upper incisors?
How are the teeth of the permanent bite maked in the Zsigmondy
scheme?
13. How are the teeth of the temporal bite marked in a chart for
Zsigmondy?
14. How are teeth of the permanent dentition marked according to the
international chart of FDI?
15. How are teeth of the deciduous dentition marked according to the
international chart of FDI?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
43
Situation tasks and test control
1. Incisor of shovel-shaped form, there are 3 tubercles on his cutting edge.
A vestibular surface is protuberant, the tongue surface is concave, triangular
in shape. The signs of corner and curvature of crown are clearly marked.
One root and one root canal. What type of tooth is it?
A. The upper medial incisor
B. The upper lateral incisor
C. The lower medial incisor
D. The lower lateral incisor
2. Incisor is of small size. A root is compressed into medio-distal direction,
on the lateral surfaces ( longitudinal furrows. The signs of corner, curvature
of the crown and root are insignificantly expressed. Define, what type of
tooth is it.
A. The lower lateral incisor
B. The upper medial incisor
C. The upper lateral incisor
D. The lower medial incisor
3. Incisor is medium-sized, the vestibular surface is convex A lateral corner
is well rounded. The tongue surface is concave with lateral rollers which
form a hump near the neck. At the front from it there is a blind pit. All of
signs of belonging of teeth are expressed. Define, what type of tooth is it.
A. The lower lateral incisor
B. The upper medial incisor
C. The upper lateral incisor
D. The lower medial incisor
4. Incisor is of a small size, with the chisel-shaped crown. A lip surface is
insignificantly convex. The tongue surface is concave in vertical direction.
A root is compressed on both sides. The signs of teeth are not expressed,
belonging to that or other sides is determined after a furrow on the lateral
surface of the root. Define, what type of tooth is it.
A. The lower lateral incisor
B. The upper medial incisor
C. The upper lateral incisor
D. The lower medial incisor
5. Indicate the location of the equator of the central incisor of the upper jaw.
A. Between the middle and the neck third
44
B. Exactly on the middle of the tooth crown
C. On the verge of the middle and cutting third of the crown
D. It is not determined in this tooth
6. What form of incisors are most variable after a form, and on the degree of
reduction occupy the second place in to the dento-alveolar to the system of
man, yielding only third permanent molar?
A. The lower lateral incisor
B. The upper medial incisor
C. The upper lateral incisor
D. The lower medial incisor
7. What are mamelones?
A. The lateral crests on the palatal surface of incisors
B. Longitudinal rollers, located on the vestibular surface of incisors
C. Cervical belt in the neck area of incisors on the palatal surface
D. The interchange of deepenings and cavities on the surface of enamel,
which appear at crossing of lines of Rettsius with the surface of enamel
8. Name the incisor in which idenfication signs of the tooth are hardly
distinguishable, and belonging to the certain side is possible only due to a
furrow on the distal surface of the root?
A. The lower lateral incisor
B. The upper medial incisor
C. The upper lateral incisor
D. The lower medial incisor
9. Name the sign of the root typical for incisors:
A. The deviation of the longitudinal ax of the root from a medial line, lateral
B. The deviation of the longitudinal ax of the root from a medial line, distal
C. The deviation of the longitudinal ax of root from a medial line, medial
D. The apexes of the roots of frontal group of teeth do not have certain
inclination in any direction
10. What structure of the root canals of the lower incisors according to the
statistical data is found more often
A. One-root canal located centrally
B. Two root canals which are opened in one apex opening
C. Two root canals, located in the oral and vestibular directions, that end
with the separate apex openings
D. One root canal which divides and ends with two separate apex openings
45
11. In what sequence the examination of the dentition is conducted?
A. From the right upper quadrant to move counter-cloakwise
B. From the left upper quadrant to move clockwise
C. From the lower right quadrant to move counter-cloakwise
D. From the right upper quadrant to move clockwise
12. How is the permanent second premolar of the upper jaw marked on the
left side in Zsigmondy’ scheme?
А. V
В. 5
C. 5
D. 4
13. How is the temporal first molar of the lower jaw marked on the righ side
in a chart of Zsigmondy?
А. 6
В. IV
C. IV
D. 4
14. How is the permanent second molar of the lower jaw marked on the left
according to the international scheme of FDI?
A. 7
B. 47
C. 37
D. 75
15. How many root canals are there in 43-rd tooth?
A. 2
B. 3
C. There is no precise answer
D. Two, that begin with general
E. Equal to the number of roots
16. In order to succeed in the treatment of dental caries, the profound
knowledge of the topographical anatomy are necessary. Specify the number
of surfaces of the crown of the 12th tooth
A. 2
B. 3
C. 4
46
D. 5
E. 6
Reference literature
1.
2.
3.
4.
5.
6.
7.
8.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
Tsarynskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508
p.
Therapeutic dentistry (Editor Yu.M. Maksimovskyj).– M.: Medicine,
2002.– 640 p.
Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
Practical lesson No 7
Theme: Clinico-anatomical features of canines of the upper and lower jaws.
Short description of a theme
Canines (dentes canini). Canines are characterized by a wedgeshaped crown and a large single root. Their function is to tear into pieces
the dense, hard parts of food during the first phase of masticatory process.
47
Canines of the upper and lower jaws have a cone-shaped form and
are the most developed among the one-root teeth. A cutting edge is formed
by two segments, which meet under an angle forming a cutting cusp the
medial line of which is shorter than lateral one. Vestibular surface is convex
and divided into 2 facets: (smaller (medial) and greater (lateral) by slightly
pronounced roller. On a palatal surface between three rollers, starting from
a dental cusp, two recesses can be distinguished. Contact surfaces have a
triangle form. The root is well developed, cone-shaped, slightly compressed
on both sides. Signs of an angle and a curvature of the crown are clearly
marked.
Canines of the lower jaw are smaller than the upper ones.
Vestibular surface is convex with slightly expressed roller, that is why
medial and lateral segments are unclear. The surface directed orally is
concave with an expressed tubercle. There are noticeable furrows on the
lateral surfaces of the root.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
What is the role of canines in the process of mastication?
Describe the anatomical structure of canines of the upper jaw.
Describe the structure of canines of the lower jaw.
What anatomical peculiarities are typical for the system of root canals
of the upper canines?
What anatomical peculiarities are typical for the system of root canals
of the lower canines?
Sign of a curvature of the crown.
Sign of the corner of the crown.
Sign of the deviation of the root.
Name the sign that confirms that due to the similar features the exact
tooth belongs to canines.
Describe the structure of the surface of the crown of the tooth of the
upper canine.
At what period the laying and eruption of the upper canines occurs?
At what period the laying and eruption of the lower canines happens?
What nervous fibres and blood vessels are responsible for the
innervation and blood supply of the upper canines?
What nervous fibres and blood vessels are responsible for the
innervation and blood supply of the lower canines?
48
Situation tasks and test control
1. This tooth is the most developed among the teeth with one root due to its
cone-shaped crown. There are 2 faces on the vestibular surface (medial and
distal. On the oral surface there are two recesses. A root is well developed
of cone-shaped form, compressed in mesiodistal direction. Define, what
tooth is mentioned.
A. The upper canine
B. The lower canine
C. The central incisor of the upper jaw
D. The first premolar of the upper jaw
2. At what age does the eruption of the upper canines occur?
A. 11-13 years
B. 13-14 years
C. 9-10 years
D. 7-8 years
3. What nerve is responsible for the innervation of the upper canines?
A. n. alveolaris superior medius
B. nn. alveolaris superiores anteriores
C. nn. alveolaris superiores posteriores
D. all of the above-mentioned nerves are involved
4. Through what arteries is the blood supply of the upper canines carried
out?
A. nn. alveolaris inferiores anteriores
B. nn. alveolaris superiores posteriores
C. nn. alveolaris inferiores posteriores
D. nnd. alveolaris superiores anteriores
5. What anatomical elements fail to be determined on the surface of the
upper canine?
A. Palatal tubercle
B. Cutting tubercle
C. Medial and distal tubercles
D. Additional distal tubercle
6. What symbol is used to mark the upper right canine after the international
chart of FDI?
A. 23
49
B. 13
C. 44
D. 33
E. 26
7. At what age does the eruption of the lower canines take place?
A. 8-9 years
B. 9-10 years
C. 10-12 years
D. 11-13 years
E. 13-14 years
8. Name the root of thet tooth which is the longest among all the roots of the
dentition, grown to 16-18 mm in length?
A. The first upper premolar
B. The upper central incisor
C. The upper canine
D. The lower canine
E. The first premolar
9. What form does the root of the upper canine possess on the transversal
section?
A. Round
B. Oval
C. Figue-of-eight
D. Crack-shaped
E. Conical
10. Name the sign that confirms that due to similar features, the exact tooth
belongs to canines?
A. Sign of curvature of a crown
B. Sign of the corner of a crown
C. Sign of the root
D. All of signs are well expressed
E. All signs are badly expressed
11. How is the lower right canine marked according to the international
scheme of FDI?
A. 43
B. 33
C. 3
50
D. 13
E. 23
12. What is еру number of the root canals in the lower canines?
A There is only one canal in all cases
B. In 94% cases (1 root canal, while in 6% two canals)
C. There are 2 root canals in all of cases
D. In 55% cases (1 root canal, while in 45% – two canals)
Reference literature
1. Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook for
the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Dyvosvit, 2005.– 392 p.
2. Atlas of microanatomy of organs of oral cavity of /LA. Lutsik, V.F.
Makeev, A.M. Yashchenko, O.E. Zavadka, Yu.V. Makeeva, Yu.Ya.
Kryvko.– Lviv: Nautilius, 1999.– 208 p.
3. Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
4. The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
5. Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
6. Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
7. Tsarynskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508 p.
8. Therapeutic dentistry (Editor Yu.M. Maksymovskyj).– M.: Medicine,
2002.– 640 p.
9. Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
51
Practical lesson No 8
Theme: Clinico-anatomical features of structure of premolars of the upper
and lower jaws.
Short description of a theme
Premolars (dentes premolares)  teeth the basic function of which
is grinding and squashing of meal. All of the lateral teeth possess
masticatory surfaces, on which tubercles are located – buccal and lingual.
The first upper premolar is characterized by the crown of
prismatic form, a buccal surface is always wider from a lingual, the
diameter of the crown is larger toward buccal-lingual direction. A cheek
surface is protuberant (the signs of curvature of the crown are clearly
marked), passes to the lateral surface, forming well-rounded corners.
In the first upper premolar all the signs are well expressed and
helpful in determining the belonging of teeth to the right or left half of the
jaw.
The second upper premolar is similar to the first, but its crown is
somewhat smaller. Both cusps of masticatory surface are equally
developed. The tooth has one cone-shaped root, with the lateral surfaces
compressed on both sides. Sometimes there is a partial split near an apex.
The first lower premolar has a rounded form of the crown,
narrowed to some extent in buccal direction. There are two cusps on a
masticatory surface: large, somewhat inclined in the cavity of the mouth
(buccal), and small  (lingual). Cusps near the front and back surfaces
are united by the enamel rollers. The same roller sometimes lies from
the middle of the cheek cusp to the tongue and then two pits appear from
its sides.
The second lower premolar. The crown of the tooth is rounded.
Due to the greater development of the tongue cusp it is larger than the
crown of the first premolar. A masticatory surface has two identically
developed cusps, on each side between them there are enamel rollers and a
deep furrow. A buccal surface does not differ from the anatomic surface
of the first premolar, contact ones are of greater size, protuberant and
gradually pass to the lingual surface.
52
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
What is the role of premolars in the process of mastication?
Describe the structure of the crown of the tooth of the first premolar of
the upper jaw.
What anatomical features are typical for the system of root canals of
the first premolars of the upper jaw?
Describe the structure of the crown of the tooth of the second premolar
of the upper jaw.
What anatomical features are typical for the system of root canals of
the second premolars of the upper jaw?
Describe the structure of the crown of the tooth of the first premolars of
the lower jaw.
What anatomical features are typical for the system of root canals of
the first premolars of the lower jaw?
Describe the structure of the crown of the tooth of the second premolar
of the lower jaw.
What anatomic features are typical for the system of root canals of the
second premolars of the lower jaw?
Reverse sign of curvature of the crown and its role in the process of
mastication.
What anatomical elements does the occlusal surface of premolars
consist of.
At what age a laying and eruption of the upper premolars takes place?
At what age a laying and eruption of the lower premolars occurs?
Situation tasks and test control
1. How are the matural depressions on the masticatory surfaces of the
molars called?
A. First premolar of the upper jaw
B. Second premolar of the upper jaw
C. First premolar of the lower jaw
D. Second premolar of the lower jaw
2. For which of these teeth a split of the root is typical?
A. First premolar of the lower jaw
B. First premolar of the upper jaw
C. Upper canine
D. Second premolar of the lower jaw
53
3. A tooth has the oral-shaped crown. A vestibular surface is protuberant,
slighty marked longitudinal roller, a contact surface is protuberant. There
are cusps of identical size on a masticatory surface. One root, cone-shaped,
oblate in mediastinal direction. What type of tooth is it?
A. First premolar of the upper jaw
B. Second premolar of the lower jaw
C. First premolar of the lower jaw
D. Second premolar of the upper jaw
4. Premolar is the smallest in the group. A crown is rounded, there are two
cusps on a masticatory surface: the buccal more than the lingual, they are
divided by a small furrow, on front and back surfaces the cusps are
connected by rollers. A root is direct, some compressed in mediastinal
direction. What is it a tooth?
A. First lower premolar
B. First upper premolar
C. Second lower premolar
D. Second upper premolar
5. Which of these teeth possess 2 root canals more frequently?
A. Second premolar of the upper jaw
B. First premolar of the lower jaw
C. First premolar of the upper jaw
D. Second premolar of the lower jaw
6. At what age the eruption of the lower first molars occurs?
A. 10-11 years
B. 12-13 years
C. 9-10 years
D. 8-9 years
7. Specify, what nerve provides innervation of the upper premolars.
A. alveolaris superiores anteriores
B. alveolaris superior medius
C. alveolaris superiores posteriores
D. all of the above-stated nerves are involved
8. At what age the eruption of the second upper premolars occurs?
A. 10-11 years
B. 9-10 years
54
C. 11-12 years
D. 12-14 years
9. At what age the eruption of the first upper premolars occurs?
A. 10-11 years
B. 8-9 years
C. 9-10 years
D. 11-12 years
10. Topographo-anatomical differences of the pulp chambers in the 15th and
16th teeth:
A. In the curvature of the palatal wall
B. Appearance on a vestibular wall
C. In the form of medial wall
D. In the form of distal wall
E. In the number of the pulp horns on the root of the pulp chamber
11. A doctor anaesthetized rami alveolares of the 2-nd branch of
n.trigeminus and extracted the tooth which has two roots. Name the type of
the tooth?
A. First incisor
B. Second incisor
C. Camne
D. First premolar
E. First molar
12. What signs of tooth belonding is typical for the second upper
premolars?
A. Reverse sign of the curvature of crown
B. Direct sign of curvature of the crown
C. Sign of a root
D. Direct sign of the curvature of the crown, sign of the root and corner of
the crown
13. At what age the eruption of the lower second premolars occurs?
A. 8-9 years
B. 9-10 years
C. 11-12 years
D. 12-13 years
E. 13-14 years
55
14. How is the second lower premolar on the left marked, according to the
international scheme of FDI?
A. V
B. 35
C. 25
D. 45
E. IV
Reference literature
1.
2.
3.
4.
5.
6.
7.
8.
9.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Dyvosvit, 2005.– 392 p.
Atlas of microanatomy of organs of oral cavity of /L.A. Lutsyk, V.F.
Makeev, A.M. Yashchenko, O.E. Zavadka, Yu.V. Makeeva, Yu.Ya.
Kryvko.– Lviv: Nautilius, 1999.– 208 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
Tsarynskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508
p.
Therapeutic dentistry (Editor Yu.M. Maksymovskyj).– M.: Medicine,
2002.– 640 p.
Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
56
Practical lesson No 9
Theme: Clinico-anatomical features of the structure of molars of the upper
and lower jaws.
Short description of a theme
Molars (dentes molares  from лат. millstones). Large buccal teeth
are used to grind hard food. Crown is of large size, with the precise outlines
of the masticatory surface. In the upper molars there are three roots, in the
lower ones – two roots.. The size of these teeth gradually diminishes from
the first to the third.
The first upper molar has a crown of a diamond-shaped form,
elongated in the anterior-posterior direction, a masticatory surface is
diamond-shaped. Four cusps (two buccal and two palatal) of masticatory
surface are separated by H-like furrow. A cheek surface is protuberant,
has the well expressed sign of the curvature of the crown, the back is more
convex, but as to the sizes the front is greater than the back one.
The first upper molar has three well – developed roots: two
buccal (medial and distal) and one palatal. The shortest root is
buccal-distal. Well-developed buccal roots are flattened out from
the front to the back. A palatal root has a cylindrical form. All
four signs of a tooth are well expressed.
The second upper molar. A form of the crown, as well as the
form of masticatory surface, may be of four types.
The third upper molar possesses a different form and size. As a
rule, the crown has three cusps, but may have more. The number of
roots also varies from one to four or five.
The first lower molar – is the largest among the molars of the lower
jaw. A masticatory surface is similar to the cone, with two well-expressed
furrows on it. The buccal surface of a tooth is convex and the wellmarked sign of curvature of the crown, while the lingual is small and
lower.
A tooth has two roots (medial and distal, which are bent backward.
All the signs of differences of the teeth are well expressed).
The pulp chamber is located on the cervical part of the crown and
on the area of the neck. It passes through furcation of the roots and
extends in root canals, the one of which is well accessible, located in the
distal and two (medial-buccal and mesio-lingual) in the medial root.
57
The second lower molar is smaller than the first, but the same form. A
masticatory surface has 4 cusps, separated by a cruciform furrow. Very rarely
there are 5 cusps. A tooth has 2 roots - distal and medial, rarely they are fused.
The signs of the root are well expressed.
The third lower molar belongs to the group of reduced teeth and has
different variations. A tooth is subjected to the rule of diminishing of size. A
crown keeps the type of crowns of the lower teeth of this group. Sometimes
there are few underdeveloped roots. The pulp chamber of the lower wisdom
tooth varies in shape, which depends on the form of the crown; canals more
frequent 3: one distal and two medial.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
What is the role of molars in the process of mastication?
Describe the features of anatomical structure of the first upper molars.
What features of structure of root canals are characteristic for the first
upper molars?
Describe the features of anatomical structure of the second upper
molars.
What features of structure of root canals are characteristic for the
second upper molars?
Describe the features of anatomic structure of the third upper molars.
What features of structure of root canals are characteristic for the third
upper molars?
Describe the features of anatomical structure of the first lower molars.
What features of structure of root canals are characteristic for the first
lower molars?
Describe the features of anatomical structure of the second lower
molars.
What features of structure of root canals are characteristic for the
second lower molars?
Describe the features of anatomical structure of the third lower molars.
What features of structure of root canals are typical for the third lower
molars?
What is meant under the term “tubercle of Carabelli?
Situation tasks and test control
1. What is the name the natural depressions on the masticatory surfaces of
58
the molars?
A. Blind pits (fossa caecum)
B. Blind foramen (foramen caecum)
C. Cracks (rhagades)
D. Fissures
E. Folds (fissura)
2. During the review of the first lower molar from the side of a cheek, the
carious cavity with the softened walls and bottom is revealed. What is name
of the affected surface of tooth?
A. Facies of contactus
B. Facies of aproximalis
C. Facies of vestibularis
D. Facies of occlusialis
Å. Facies of oralis
3. The inflammatory process appeared as a result of destruction of the
dental trifurcation root. Specify the most reliable causal tooth.
A. First lower molar
B. Second lower molar
C. First upper molar
D. Second upper premolar
E. First lower premolar
4. While examining the patients, the dentist revealed the damage of the
bifurcation of root of the permanent tooth. In what exact tooth the
complication occurred?
A. First lower molar
B. Second lower premolar
C. First upper molar
D. Second upper molar
E. First upper premolar
5. The main tasks of the dentist who is going to restore completely the
damaged tooth is to secure the restoration of the anatomical structure and
functions of the tooth. What tooth with its mastificatory surface is the most
suitable for the modelling of 4 cups (tubercles)?
A. 26
B. 35
C. 43
D. 45
59
E. 47
6. Number the meskes (opening) of the root canals will be found out after
opening of the pulpal chamber in the 26th tooth?
A. 1 palatal, 2 buccal
B. 2 medial, 1 distal
C. 2 palatal, 2 buccal
D. 4 medial, 2 distal
E. 1 palatal, 1 buccal
7. After opening the cavity in the 24th tooth at a review and probing found
out the openings of two root canals (palatal and buccal. The location of
what canal should be defined?
A. The examination and probing of 24th tooth
B. The opened cavity in the 24th tooth
C. Showed the presence of opennings in two root canals
D.
E. There are 2 root canals in the 24th tooth
8. The endodontic treatment of what tooth may be helpful in revealing 3
openings of the root canals on the bottom of a pulp chamber?
A. 44
B. 25
C. 35
D. 13
E. None in the above-mentioned examples
9. The furrow of the first order resemblingth the X -shaped form is typical
for:
A. First molar of the upper jaw
B. Second molar of the upper jaw
C. First molar of the lower jaw
D. Second molar of the lower jaw
10. Triangular pit, the anatomical formation which is located on:
A. The occlusive surface of the molars
B. The vestibular surface of the molars
C. The oral surface of the molars
D. The contact surface of the molars
60
11. For what tooth is the presence of Carabelli tubercle typical?
A. Third upper molar
B. First upper molar
C. First lower molar
D. Second lower molar
12. Name the molar, on the masticatory surfaces of which there may be 6
cups.
A. First lower molar
B. First upper molar
C. Third lower molar
D. Second upper molar
13. 5 cups – 2 oral and 3 buccal are revealed on the occlusive surface.
Specife the tooth.
A. First lower molar
B. Second upper molar
C. Second lower molar
D. First upper molar
14. In which of these teeth (60% of cases) the second mesiobuccal canal
occurs most likely?
A. First upper molar
B. Second upper molar
C. First lower molar
D. Second lower molar
Reference literature
1.
2.
3.
4.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Atlas of microanatomy of organs of oral cavity of /L.A. Lutsyk, V.F.
Makeev, A.M. Yashchenko, O.E. Zavadka, Yu.V. Makeeva, Yu.Ya.
Kryvko.– Lviv: Nautilius, 1999.– 208 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
61
5.
6.
7.
8.
9.
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
Tsarynskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508
p.
Therapeutic dentistry (Editor Yu.M. Maksymovskyj).– M.: Medicine,
2002.– 640 p.
Preclinical course of therapeutic dentistry /E.A. Skorikova, V.A.
Volkov, N.P. Bazhenova, N.V. Lapina, I.V. Erechev.– Rostov.: Feniks,
2002.– 640 p.
Practical lesson No 10
Theme: Organization and equipment of dental office. Dental drills,
handpieces, regulations of exploitation. Accident prevention.
Concept of ergonomics.
Short description of a theme
Equipment of dental office. While organizing the dental surgery –
one working place must be a spacious apartment with good natural
illumination, by an area not less than 14 m2. For every additional dentist’s
chair an area is added not less than 10 m2. Thus, the number of additional
dentists chairs must not exceed two, so the dimensions of the dental office
for 3 dentist’s chairs must have an area not less than 34m2.
The height of dental surgery must be not less, than three meters, in
order to provide, at least, 12 m3 amount of air for one person.
The walls must be smooth, without cracks and slits, painted with the
oil paints of soft colours. The floor must be covered by floor linoleum on a
height of 5-10 cm in order to prevent the penetration of remains of mercury
while working with amalgam.
The dental office must be equipped with the system of ventilation. In
order to normalize the microclimate the domestic air-conditioners should
be applied.
62
The work of a dentist is associated with considerable tension on the
eyesight during the working hours. The favourable conditions for
implementation of visual work are provided by rational natural light of the
office in combination with artificial light from dental apparatuses.
The dental office must not be cluttered up.
The work of a doctor who conducts the differentiated reception of
patients only from therapeutic dentistry, has to be equipped with:
1. The dental chair.
2. A doctor’s chair.
3. Dental illumination, spittoon, suction, a vacuum cleaner,
diathermocoagulator, an electro-diagnostic device, etc..
4. Chair-side table of a doctor.
5. Office table for current documentation.
6. A washstand for washing hands.
7. A washstand for washing of dental instruments.
8. A hood with a sterilizer.
9. Sterile table.
10. A built-in closet for storage of medicines, tools, bandaging and
stoppings materials.
11. Table for diagnostic and medical apparatus.
Expediently, that the left half of dental office is at disposal of a
doctor, at some distance from tables with medicines and sterile instruments,
as well as from the place where the patients are seen. Right half of the office
is for an auxiliary personnel.
Ergonomics is a science which is engaged in the study of rational
organization of the work. A term is formed according to the two Greek
words: ergo  work, nomos  law.
In dentistry it deals with four basic problems:
1. dentists, co-workers and patients;
2. an apparatus, tools and materials;
3. organization of the work in dental office;
4. working conditions.
The most optimal is the work of a dentist in sitting position with a
patient in recumbency. The stress is laid on the following variants:
1. The technique which can be named „Centric” – a doctor
works without an assistant, and that is why occupies a central
place, to have a good access, to both the patient and to all of
necessary devices and instruments.
2. The technique of work with „four hands”, which requires:
 qualified assistant;
 proper additional equipment.
63
The rational work of a dentist must take into account all of
methods depending on a necessity, in fact none of them is universal.
Principles of rationalization in dentistry require the proper to this procedure
position of doctor, assistant and patient. It improves not only the hygiene of
work of dentist team, but also considerably promotes the productivity and
efficiency of the work and.make a patient feel comfortable.
Basic medical interference in the clinic of therapeutic dentistry is
preparing of hard tissues of teeth by the circulating coniferous forests.
Evolutional development of unit can be represented in that way:
hand, foot (stand-up foot undemountable, demountable, difficult; combined
foot and with a motor), electric (stand-up with an electromotor (stationary),
hangings wall from electromotor, portable), ultrasound, turbine
(pneumatic), laser drills.
Dental handpieces serve for fixing of all of rotating instruments in
various interferences. The handpieces of several types are produced: direct
with an automatic clamp, angle-shaped with a turning head, turbine.
The strictly specialized handpieces are divided into endodontic
(NZ-3-2) , preventive, for sound and ultrasonic treatment of root canals, for
the compression of amalgam, for the curretage in periodontal
manipulations, etc.
Operating conditions:
- low-speed with reduction of revolutions up to 300-800
revolutios per min. (green ring). Dental Werk: 1:1,8 (LT
Incolight Excalibur) and 4:1 (LT Incolight Endo Cursor),
Endo-Lift M4 (Kerr) 4:1, MM 324 (Tulsa Deuxal, France),
MM10E (France) 6:1.
- Reversed-forward (after and against a clockwise pointer) on
90° (yellow ring): MM 324 (Tulsa Deuxal, France), W8H
(Austria) 4:1.
- Reversed-forward motions on 90° and upward-downward
motions with amplitude 0,3-1,0 mm. (Canal Leader T-1
(Siemens), Canal-Leader 2000 (SET, Germany).
There are also handpieces for sound (with frequency of vibrations
1500-6500 Hertzs) and ultrasonic (20000-30000 Hertzs) treatment of root
canals. The transmission of fluctuating motions in a canal is carried out in
all directions, predetermining the effect of cavitation. The permanent supply
of irrigator (NaOCl) and cooling is needed.
Prophylactic handpieces provide a circular, reversed-forward
motions within the limits of 360°.
64
Handpieces for the compression of amalgam create fluctuating
motions of the special instruments for the compression of amalgam (ON-1,
Kavo Amalgam Kondensator 66LD).
Handpieces for mechanical curretage at periodontal manipulations
of the system „Profin” with attachments of Eva Dentatus (saws) and „Perio-Tor” provide motion of instruments only for axes.
Straight and contra-angle handpieces have frequency of rotation of
drills up to 10 thousand rotations per min. (NP-10-À, NP-10, NUM-10,
WELL-10-02, Well-10) and up to 30 thousand rotations per min. (NP-30À,
WELL-30, Well-30/45). The handpieces for microengines have frequency
of rotation up to 10-40 thousand rotations per min. (NPB-10-1, NUB-10-1).
Turbine handpieces have frequency of rotation 150 thousand rotations per
min. (NT-100) and 300 thousand rotations per min. (NTS-3000-2);
dentotechnical handpiece (NTZ-16) – up to 160 thousand rotations per min.
Control questions to practical lesson
1.
What must be the area of premises for the organization of a dentistry
office for two working places?
2. What are the demands to illumination of a dentistry office?
3. Describe the equipment of a dentistry office.
4. What is ergonomics?
5. Name the main ergonomic provisions of both the doctor and patient
at implementation of dentistry manipulations.
6. Name the types of drills, their setting and principle of work.
7. What modern drills do you know?
8. What speed of revolutions of the instrument do modern drills are able
to get?
9. What types of handpieces do you know?
10. Name the strictly specialized handpieces.
11. Name the modes of operations of endodontic handpieces.
12. What is the frequency of rotation of the drill to the turbine
handpieces and micromotor handpieces possess?
Situation tasks and test control
1. Modern dental settings are usually equipped by micromotors. What is the
range of frequency of rotation of the working instrument which is provided
by micromotor?
65
A.
B.
C.
D.
E.
1000-30 000 revolutions per minute
0-3000 revolutions per minute
10 000-100 000 revolutions per minute
100 000-500 000 revolutions per minute
0-10 000 revolutions per minute
2. Most stages of the operative treatment of dental caries and possible
complications are performed with a help of handpiece. What actions from
the above-mentioned are impossible to handpiece execute by a turbine tip?
A. Opening of the carious cavity
B. Forming the walls of the carious cavity
C. Treatment of the root canals by rotatory instruments
D. Opening of the pulp chamber
E. Extraction of the coronal pulp
3. The demands of accident prevention during the work in a dentistry office
set minimal permissible distance between a doctor who works with the
dental setting, and earth-grounded object (batteries of the central heating,
water-pipes). What must this distance (in meters) be?
A. 0,5 m.
B. 2 m.
C. 2,5 m.
D. Not important
E. 1 m.
4. Characterizing the possibilities of the dental setting, the producers often
utillize a concept „turbine three” („troika”). What elements are necessarily
included in this concept?
A. Turbine handspiece, air , pistol for water
B. Air, salivary ejector, turbine handpiece
C. Three turbine handpieces of different power
D. Turbine, mechanical, angular and direct
E. Air, mechanical and turbine handpieces
5. For drilling the carious cavity on the masticatory surface of the 47th tooth
a turbine handpiece and cylinder diamond were selected. What device is the
most suitable for the fixation of drill in the turbine handpieces?
A. Tsangoviy a spring or spiral clamp
B. A lateral bolt and eventual is on end of the drill
C. Screw-thread connection
D. Rusk connection
66
E. Bayonett became drenched
6. Specify the range of frequencies of rotations of the working instrument in
turbine handpieces during the opening of the carious cavity?
A. 3000- 10 000 revolutions per minute
B. 300 000-500 000 revolutions per minute
C. 30 000-50 000 revolutions per minute
D. 10 000-30 000 revolutions per minute
E. 300-400 revolutions per minute
7. One of the demands to premises for the dental surgery is the area. What
must the minimal dimensions be for three dental chairs?
A. 28 м2
B. 18 м2
C. 14 м2
D. 38 м2
E. 24 м2
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
67
Practical lesson No 11
Theme: Dental instruments, their settings. Cutting instruments. The rules of
sterilization.
Short description of a theme
While treating the patient a dentist applies various instruments
which are necessary for conducting of this or that manipulation. As to
their expediency they may be divided into seven groups: 1) instruments
for the inspection of the mouth, 2) instruments for drilling of the carious
cavity, 3) instruments for filling the carious cavity, 4) instruments for
polishing and polishing of fillings, 5) instruments for medicamental
treatment and treatment of root canals, 6) instruments for the extraction of
dental deposits, 7) instruments for the preparation of amalgam.
Instruments used for the inspection of the mouth: 1) dental
mirror, 2) dental pincers, 3) probe.
The cutting instruments for preparing of the carious cavities
include the hand (enamel knife, power-shovel) and machine (drills)
instruments.
Depending on the material drills are divided: steel, carbid,
diamond. Drills produced for ordinary (direct and angular) and turbine
handpieces.
The drill consists of bar, neck and head.
As to their form they are divided into: spherical, fissure, coneshaped, wheel-shaped, (with a shallow notch), polirs (without notches).
The size of the drills is fixed in figures is. Diameter ¹1=0,85 mm
¹3=1,1 mm ¹5=1,6 mm ¹7=2 mm ¹13=3,1 mm. Length of a drill for direct
handpiece 44 mm, angular – 17, 22, 27 mm. Dental drills 17 mm in length
are used in practice of child's dentistry and in the treatment of wisdom teeth
.
The form of the working surface of the drills predetermines their
function. The round drill serves to open the carious cavity, to remove the
softened dentine, to open the pulp chamber,to enlarge the openings of root
canals. Cone drills are used to form the shape of cavity. The wheel-shaped
drills are used for making retentional points.
68
Sterilization (from Fr. Sterilisation, from лат. Sterilis - sterile) 
is a complete destruction or elimination of all living microorganisms,
accomplished by physical methods.
Disinfection (from France. Desinfectio)  freeing from infectious
agents.
Asepsis  is the system of prophylactic measures, directed on
preventing of penetrating of microorganisms in a wound, organs and
tissues of a patient, in the process of any medical measures. Asepsis
includes: sterilization of instruments, materials, devices; special treatment
of hands of a doctor; following the set of rules during the process of
treatment; realization of the special hygienic and organizational
measures in medical establishment.
Antisepsis  is the system of measures, directed to eliminate
microorganisms in a wound. It must adhere to principles of antisepsis,
because, working in the oral cavity the dentist always deals with the
infected wound. The prophylaxis of contact infection consists in
sterilization of all devices and instruments, a patient is in touch with. To
follow strictly the rules of treatment of hands of a doctor is very important.
Sterilization is carried out by the use of physical factors and
chemical matters. As to the physical factors they are as follows: high
temperature, ultraviolet rays, ultrasound. The chemical methods
include the use of alcohol, iodine, chloraminum, etc. The important
condition of application of chemical facilities is bactericidal action,
absence of the destructive action on material or instrument.
The physical methods of sterilizations are the following: steam,
methods of infra-red irradiation, radiation and ultrasonic methods, hot air.
Chemical methods include gas and sterilization of preparations by chemical
solutions. The choice of method of sterilization is determined by features
and properties of subjected material.
According to the standard, treatment of tools is carried out in
three stages: disinfection, previous sterilization cleaning and sterilization.
Control questions to practical lesson
1.
2.
3.
4.
5.
What value does the effective sterilization of dental instruments have?
What diseases may be prevented if the dentist uses high-quality and sterile tools?
How is the treatment of dental instruments carried out?
What instruments are sterilized by the method of cold sterilization and
why?
What methods are used to sterilize handpieces?
69
6.
7.
8.
9.
10.
11.
12.
13.
What is „sterilization”?
Explain the meaning of the term of „disinfection”.
What is asepsis?
What is antisepsis?
What types of sterilization are employed in dentistry?
Name the solutions which are utillized for cold sterilization.
What is sterilized by the steam under pressure?
Enumerate the physical methods of sterilization.
Situation tasks and test control
1. One of instruments used more frequent by in the process of treatment of
the teeth is smoother. Name the stage of filling the carious cavities in which
this instrument is not used?
A. Bringing the material into a cavity
B. Design of a filling
C. Mixing up the stopping material
D. Bringing of material is for an insulating base
E. It’s quite possible to execute all the above-mentioned
2. Choose the drill for forming the enamel edge during cavitation on the
masticatory surface of a 36th tooth:
A. Cylindrical diamond
B. Spherical hand-alloy
C. Spherical diamond
D. Cone-shaped hand-alloy
E. Inverted cone-shaped diamond
3. You are to perform the cavitation of carious cavity of medium sizes on
the masticatory surface of molar. Choose the drill for forming its bottom.
A. Spherical steel
B. Inverted cone-shaped
C. Cylindrical diamond
D. Spherical steel
E. Inverted cone-shaped hand-alloy
4. You are to prepare the instruments for cavity preparation of the 3rd class.
Among the offered tools there are several drills with the marking rings of
different colors. Choose the diamond drill with coarse:
A. Black
70
B.
C.
D.
E.
Red
White
Dark blue
Green
5. You are performing the cavity preparation on the masticatory surface of
the 47th with a moderate caries. Choose the drill for forming its bottom:
A. Spherical steel
B. Inverted cone-shaped, hand-alloy
C. Inverted cone-shaped steel
D. Cylindrical diamond
E. Spherical steel
6. You have performed the cavity preparation concerning a moderate caries.
In accordance with recommendations of the sanitary and antiepidemic
organization the drills which have been used are to under go three stages of
treatment (cleansing). What must be the first stage?
A. Rinse with the distilled water
B. Wetting in washing solution
C. Disinfection
D. Washing in running water
E. Sterilization by a thermal method
7. You conduct drilling of the carious cavity on the proximal surface of the
36th tooth according to general principles. Choose the cone-shaped drill to
form the bottom of the carious cavity:
A. Spherical diamond
B. Inverted cone carbid
C. Spherical carbid
D. Cylindrical carbid
E. Inverted cone-shaped steel
8. The carbid cone-shaped drill it compared with the steel possess greater
wearproofness, cutting ability, heat-resistance. What material is the most
suitable for their making?
A. Carbido-tungsten
B. Instrumental steel with coating of nitride of titanium
C. Alloy ed steel
D. Chromonickel steel
E. Titanic alloys
71
9. During the first practical lesson on drilling the carious cavities a student
fails to fix the drill in the mechanical handpiecce for cone-shaped
handpiece. Specify the difference in drills for various handpieces?
A. By material of a working part
B. By the form of a working part
C. By material of end
D. By the diameter of a working part
E. By the diameter of end
10. While examining the patient it is necessary to define the consistency of
dentine on the botton of the carious cavity which is diagnosed in the 36th
tooth. Specify the instrument, that allows to define the degree of softening
influence of dentine.
A. Dental mirror
B. Angual dental probe
C. Excavator
D. Dental pliers
E. Dental probe
11. You are to assist the doctor, who proceeds to prepare the carious cavity
on the masticatory surface of the 46th tooth. Choose the instrument for
conducting the first stage of preparing the cavity:
A. Conical drills
B. Excavator
C. Diamond cylindrical drill
D. Inverted-conical, hand-alloy dental drill
E. Spherical hand-alloy dental drill
12. During the practical training you help a doctor who prepares a carious
cavity in fissure of the masticatory surface of the 16th tooth. Choose the
instrument for conducting the second stage of preparing.
A. Excavator
B. Inverted-conical, hand-alloy dental drill
C. Cylindrical diamond dental drill
D. Hand-alloy cylindrical dental drill
E. Ail to choose
13. You are to perform the dental caries preparation on the medial surface
of the 12th tooth at close contact between the teeth. Choose the most rational
instrument for the first stage of preparing.
A. Cylindrical diamond dental drill
72
B.
C.
D.
E.
Spherical steel dental drill
Inverted-conical steel dental drill
Spherical hand-alloy dental drill
Enamel knife
14. While preparing the carious cavity which is located on to medio-distal
surface of the 22nd tooth, we preceed to the formation of its shape. What
instruments are the most suitable for it?
A. Enamel knife
B. Cylindrical conical dental drill
C. Inverted-conical dental drill
D. Spherical dental drill
E. Wheel-shaped dental drill
15. Compliting the previous stages of preparing the carious cavity on a
proximal surface, we preceed to the formation of its shape. Choose the
instrument for forming the gingival wall.
A. Spherical dental drill
B. Excavator
C. Enamel knife
D. Inverted-conical dental drill
E. Conical dental drill
16. You instruct the nurse of the dentistry office as to the methods of
sterilization of dental instruments. Specify the time for sterilization of the
dental drill by dry-air method:
A. 120оС  40 min.
B. 180оС  40 min.
C. 140оС  30 min.
D. 100оС  30 min.
E. 200оС  40 min.
17. What method of disinfection of the dental handpieces will you choose, if
in the directions as to its use there is no special instruction?
A. A cold method of sterilization by means of certificated sterilizers
B. Ultraviolet boxing
C. Cleaning in the ultrasonic bath
D. Boiling in a sterilizer at 100оС  45 min.
E. Dry-air method
73
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson №12
Theme: Ways of spreading the cariosity in hard tissues of a tooth and on
various surfaces.
Short description of a theme
Ways of spreading the cariosity in hard tissues of a tooth and on its
various surfaces possess its own peculiarities.
Thus the teeth of the upper jaw are affected by the caries more
often than the lower ones. Obviously, it is quite possible that due to the
active motions of the lower jaw the teeth are supplied with blood in full
measure, and are cleaned more effectively from the food debris.
The first molars are affected more frequently. This accounts for
that the first molars are the first to erupt, and take the greatest load within
the period of formation of permanent occlusion. As to the frequency of
origin of pathological processes, the second molars gain the second place,
74
while the premolars and upper incisors – the third place, on fourth place are
canines. The frontal teeth of the lower jaw are affected by dental caries
rarely.
The certain conformity is in the localization of carious cavities.
Thus, in the molars the pathological process begins more frequently on the
proximal, on the occlusive areas of fissures or proximal surfaces. In
premolars and incisors – on proximal surfaces, in canines – on the
vestibular surfaces of necks. The tongue areas of teeth are affected by caries
very rarely.
In non-vital teeth a pathological process arises extremely rarely,
but, if it happens, it is the vestibular surface in the area of necks.
The caries of tooth is characterized by the damage of one or some
types of tissues of tooth. But, if one hard tissue is affected, than it should be
remembered that the whole tooth will be involved by the pathological
process, because all its structures are in permanent anatomical-functional
connection.
Due to the curvature of surface of a crown of the tooth, uneven
thickness of the enamel and other factors, the spread of dental caries is
determined by the site of its appearance. A caries in the enamel of
masticatory surface develops deeply in the form of a triangle with an apex
in the point of origin. As a result the tooth decay on a surface remains
unnoticeable for a long time, while the damage of the deep tissues is deep
enough.
In a dentine due to a greater content of organic substances as
compared with enamel, a caries spreads more rapidly not only in a depth but
also in the sides, especially in the area of enamel-dentine junction. This
leads to the undermined edges of the enamel, which is not supported by the
dentine. The spread of caries in a dentine in a depth takes place also in the
form of a triangle, but with an apex directed to the side of the pulp of a
tooth.
On proximal surfaces (more frequently in the area of a contact
point) a decay spreads as two cones with a basis on the enamel-dentine
junction. But the character of direction of the enamel prisms determines
more wider the entrance opening. The undermined edges of the enamel are
mostly observed in the direction of the masticatory surface and cutting edge.
The massive and cariesresistant lateral verges of the crown of the tooth
prevent the dental caries from spreading to the sides of the crown.
Caries on the contact surfaces has a tendency to spread in the
cervical area of the crown. The precervical small carious cavities of the IInd class sometimes are difficult to diagnose due to their hidden localization.
75
In the necks of the teeth a caries arises mainly on a vestibular
surface and has a tendency to the circular involvement of all the gingival
areas.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Is there any difference in the ways of spreading of cariosity in hard
tissues of a tooth?
Is there any difference in the ways of spreading of cariosity on various
surfaces of a tooth?
Why are the teeth of the upper jaw affected by a caries more often?
What is the difference in the blood supply of the upper and lower jaws?
Why does the caries in the first molar develop more frequently than in
other teeth?
Name topographical-anatomical classification of carious cavities after
Black.
Is there any conformity in the location of the carious cavities?
What surface of the molars are more frequently affected by caries?
What surface of the premolars are more frequently affected by caries?
What surface of the canines are more frequently affected by caries?
What is the frequency of development of caries in non-vital teeth?
What is the curvature of a crown of the tooth?
What is the role of curvature of a crown in case of occurring of dental
caries?
What value does curvature of a crown of the tooth have in case of
occurring of carious damage?
What is thickness of the enamel in different areas of the tooth?
What is the role of thickness of the enamel in case of occurring of
dental caries?
How does a dental caries develop in the enamel of the masticatory
surface?
What is the chemical composition of the enamel and dentine?
Does the chemical composition of the enamel and dentine influence on
the activity of cariosity?
How does a cariosity spread in the dentine?
Why do the edges of the enamel appear if they are deprived of the
support of the dentine?
How does the affection on the contact surfaces of a tooth spread?
What prevents a dental caries from spreading into the sides if the
contact surfaces are affected?
76
24. What does exist tendency to distribution of caries on contact surfaces?
25. Why is it difficult to diagnose the small carious cavities of the class II?
26. What are the peculiarities of spreading of caries on the precervical
areas?
Situation tasks and test control
1. The teeth of what jaw are more frequently affected by caries?
A. Lower
B. Upper
C. Identically
D. There is no right answer
2. Active movements of the lower jaw provide:
A. Progress of cariosity
B. Slow blood supply
C. Blood supply, good cleaning, from food debris
D. The unsatisfactory cleaning from food debris
E. Pathological artrition teeth
3. What teeth are more frequently affected by caries?
A. Second incisors
B. First premolar
C. First molar
D. Dog-tooth
E. Second premolar
4. How to distribute the groups of teeth after frequency of appearance of
caries in an increasing order?
A. Frontal teeth of the lower jaw, canine, premolar and the upper incisors,
second molar, the first molar
B. Frontal teeth of the upper jaw, canine, premolar and the upper incisors,
the first molar, the second molar
C. Frontal teeth of the lower jaw, the second molar, the first molar, dogteeth, premolar and the upper incisors
D. Dog-teeth, premolar and the upper incisors, second molar, the first
molar, frontal teeth of the lower jaw
E. Dog-teeth, premolar and the upper incisors, frontal teeth of the lower
jaw, the second molar, first molar
77
5. What surfaces on the molars are more frequently affected by dental
caries?
A. Masticatory
B. Masticatory and proximal
C. Aproximal
D. Precervical
E. Vestibular or buccal
6. What surfaces of the premolars and incisors are more frequently affected
by caries?
A. Masticatory and proximal
B. Precervical
C. Vestibular or buccal
D. Masticatory
E. Aproximal
7. A caries in the enamel of fissures on masticatory surface penetrates
deeper in the form of:
A. cone with a basis on the enamel-dentine junction
B. triangle with a basis in the deep layers of the pathological process
C. triangle with a basis in the point of origin
D. triangle with a top in the point of origin
E. two cones on the enamel-dentine junction
8. A caries in a dentine penetrates deeper in the form of:
A. triangle with the apex, directed to the side of a pulp of a tooth
B. triangle with a basis in the point of origin
C. two cones on enamel-dentine junction
D. triangle with a basis in the deep layers of the pathological process
E. cone with a basis on enamel-dentine junction
9. Due to what factor the activity of cariosity in the enamel and dentine is
different?
A. Histological structure
B. Chemical composition
C. A+B
D. Belonging to a certain group of teeth
E. It is not a matter of principle
10. Due to what changes the edges of the enamel, which are not supported
by the dentine, are undermined:
78
A. to pathological changes in the enamel that takes place more rapidly
B. to pathological changes in the dentine that takes place slower
C. to pathological changes in the dentine that takes place more rapidly
D. there is no faithful answer
11. In the area of a contact point of the proximal surfaces the affection
spreads in the form of:
A. triangle with the apex, directed to the side of the pulp of a tooth
B. one cone on the enamel-dentine junction
C. two cones are with a basis on the enamel-dentine junction
D. triangle with the apex in the point of origin
E. in different forms
12. The wider entrance opening of the cavities on the contact surfaces is
predefined:
A. By a character of direction of the enamel prisms
B. Belonging to a certain group of teeth
C. By the activity of cariosity
D. By the remoteness of cariosity
E. There is no right answer
13. A caries on contact surfaces has a tendency to overwhelming spreading:
A. On the masticatory surface of a tooth
B. Precervical area of the crown
C. Vestibular surface of the tooth
D. A+B
E. There is no proper answer
Reference Literature
1.
2.
3.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Atlas of microanatomy of organs of oral cavity of /L.A. Lutsyk, V.F.
Makeev, A.M. Yashchenko, O.E. Zavadka, Yu.V. Makeeva, Yu.Ya.
Kryvko.– Lviv: Nautilius, 1999.– 208 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
79
4.
5.
6.
7.
8.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Dmitrieva AA. Therapeutic dentistry.– M.: Medpress-inform, 2003.–
896 p.
Pediatric dentistry (Editor prof. L.O. Khomenko).– K.: Book plus,
1999.– 524 p.
Tsarynskiy M.M. Therapeutic dentistry.– Rostov.: Feniks, 2008.– 508
p.
Therapeutic dentistry (Editor Yu.M. Maksymovskyj).– M.: Medicine,
2002.– 640 p.
Practical lesson No 13
Theme: Classification of the carious cavities after Black. Principles and
mode of the classic cavity preparation.
Short description of a theme
A decay of teeth is a local pathological process, which shows up
after their eruption whith the following demineralization, softening of hard
tissues of a tooth with next formation of a cavity. Carious cavities can
appear practically on every surface of a tooth, however more frequently – in
fissures of the premolars and molars, on the contact surfaces and in
precervical areas.
Their grouping that we name classes, was offered at the beginning
of the XXth century by G.V.Black. Black’s classification divides the
carious cavities in accordance with their location and anatomical group of
teeth.
Class I – the carious cavities, located in fissures of the premolars
and molars, and also in natural pits of the incisors and molars.
Class II – the carious cavities, located on the contact surfaces of the
premolars and molars.
Class III – the carious cavities, located on the contact surfaces of
incisors and canines without the damage of a cutting edge and the corner of
the crown of a tooth.
80
Class IV – the carious cavities, located on the contact surfaces of
incisors and canines with the damage of a cutting edge and the corner of the
crown of a tooth.
Class V – the carious cavities, located in thr precervical areas in all
groups of teeth.
In some American editions it is possible to come across the
additional VI class for cavities, located on cusps and cutting edges of all
groups of teeth, in the so-called caries-resistant areas.
The preparation of the carious cavity – instrumental intervention on
hard tissues of teeth, that consists of certain consistent manipulations. It is
directed on the carving of pathologically changed hard tissues with the
purpose of arresting the subsequent progression of carious process, and also
creation the necessary conditions for the fixation of a filling and restoration
of the anatomic form and function of a tooth.
The preparation of the cavity is the important stage of treatment of
tooth decay, because its correct performing eliminates the further
destruction of hard tissues and provides the reliable fixation of the filling.
There are few principles of preparation of the carious cavities.
Principle of “expansion for the sake of prevention” (Black) is preventive
expansion of limits of the carious cavity, by carving of caries-resistant areas
(fissures, pits) to the so-called immune areas, which are rarely affected by
caries (cusps, smooth and smooth protuberant surfaces).
Principle of „biological expedience” (I.G. Lukomskiy) – the
tissues of a tooth are carved carefully and preparation is completed within
the limits of apparently healthy areas. Consequently, the basic principle
which is to be followed while preparing the carious cavity is the complete
carving of pathologically changed tissues and cautious attitude toward the
non-affected by caries the enamel and dentine.
To attain the purpose, it is necessary while preparing the carious
cavity:
- to define the elements of the carious cavity and provide it
reliable healthy control;
- to perform consistently all the stages of preparation;
- to choose correctly the instruments for the formation of
carious cavity;
- to follow the certain principles of preparing the carious cavity:
biological expedience, taking into account the limits of
expansion and topography of a cavity, technical rationality.
While preparing the hard tissues of a tooth the classification of
Black is usually used. However, regardless of localization of the carious
81
cavity, there are the general stages of preparing the hard tissues of a tooth,
which are as follows:
- anaesthetization;
- opening (opening and expansion) of the carious cavity;
- necrectomy;
- the cavity formation;
- smoothing of the edges of the enamel, finishing.
The opening of the carious cavity is carried out by spherical or the
fissure dental drills. They are selected so that the size of working part was
not larger, than the entrance opening of the present carious cavity.
The expansion of a cavity is performed within the limits of the
practically healthy, hard tissues of a tooth which are not affected by caries.
During the expansion, carving of decayed fissure is foreseen, alignment of
the enamel edge, round acute angles to prevent the origin of the second
caries.
Necrectomy  is an excision of the necrotic (carious) hard tissues.
There are two types of necrectomy – complete and partial necrectomy.
Complete necrectomy is the complete excision of the necrotic dentine from
the walls and bottom of the carious cavity; partial necrectomy is the
complete excision of necrotic dentine from the walls and partly – from the
bottom of the carious cavity. Partial necrectomy is assumed in the case of
deep caries, when the bottom of the carious cavity is very thin and there is
the real danger of opening of the pulp. In such cases it is assumed to leave a
dense pigmented dentine on the bottom, and in case of acute deep caries –
even small layer of the softened dentine with further remineralization.
Nekrectomy is carried out by spherical drill and excavator.
Formation of the carious cavity is carried out with the help of
fissures, inverted cones and cone-shaped drills.
Treatment of the edges of the carious cavity is the final stage of
formation, which is carried out by polirs. The enamel edge must be formed
according to direction of enamel prisms.
Elements of the carious cavity: bottom, walls, corners, edges.
There are such concepts, as basic and additional cavities: the first is made in
place of pathological focus, the second – within the limits of healthy hard
tissues for the best fixation of a filling.
The peculiarities of the formation of a cavity, mainly, depends
from the localization of the pathological process and group belonging of a
tooth. However there are general rules for preparing of all the cavities,
namely:
1) passing of a bottom of a cavity (surface, reverse to the pulp) to
the lateral wall must be at right angles;
82
2) passing of one wall to another must be under a corner (except
for the cavities of the V class);
3) edges of the enamel must be even and smooth;
4) a bottom of the carious cavity must be flat or to some extend
repeat the form of the masticatory surface of a tooth.
Each cavity out of five classes possesses its own peculiarities.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
What is caries of a tooth?
Name the basic principles of the cavity preparation.
What is the cavity preparation directed on?
What is meant under “conception of Black”?
Where are the caries-resistant areas located?
What is meant under the term “immune areas”?
What is meant under the term “biological expedience”?
Name the stages of preparing of the carious cavities.
Name instruments which are used for opening of the carious cavity.
Name instruments which are used for expansion the carious cavity.
What is necrectomy?
What types of necrectomy do you know?
What instruments are used in performing necrectomy?
What instruments are used for forming of the carious cavity?
What instruments are used for smoothing of edges of the cavity?
Name the basic elements of the carious cavity.
Name the general rules for the preparation of all carious cavities.
Situation tasks and test control
1. What signs are assumed as a basis in the classifications of the carious
cavities after Black?
A. Histological
B. Clinical
C. Topographical
D. Anatomical-topographical
E. Clinical-topographical
2. According to Black to the III-rd class belong the carious cavities located
on a surface:
83
A.
B.
C.
D.
E.
To the contact incisors
Contact premolars
Precervical incisors
Masticatory molars
Masticatory premolars
3. The carious cavity, located on the distal contact surface of the 36th tooth,
according to the classification of Black belongs to the class:
A. I
B. III
C. II
D. IV
E. V
4. In accordance with the classification of Black to the II-nd class belongs
the carious cavities, located on:
A. To the contact surface of canines
B. To the contact surface of molars
C. To the vestibular surface of molars
D. To the oral surface of incisors
E. To the lateral surface of incisors
5. On what surfaces are the medio-occlusal-distal cavities formed?
A. On the front and back contact
B. On the occlusive and vestibular
C. On the back contact with an additional site
D. On the front contact with an additional site
E. Contact with a general additional site
6. The aim of purpose of odontopreparation:
A. A, B, C, D
B. To carve the demineralized hard tissues of a tooth
C. To create necessary conditions for the reliable fixation of a filling
D. To restore the thread of an anatomic form and function of a tooth
E. B, D
7. What is the first stage of preparing of the carious cavity?
A. Antiseptic treatment
B. Finishing of the enamel edges
C. Opening of the carious cavity
D. Forming
84
E. Necroctomy
8. The purpose of necrectomy in the prevertion of carious recurrence is:
A. Warning of relapse of caries
B. Creation of a contact point
C. Restoration of the shape of a tooth
D. Restoration of the function of a tooth
E. Defence of the pulp of a tooth
9. What dental instruments are used to determine the quality of preparing of
carious cavity?
A. Pluger, probe
B. Probe, smoother
C. Pincers, mirror
D. Probe, mirror
E. Probe, pincers
10. What is the proportion between the basic and additional cavities in
preparing the II-nd class after Black?
A. 1:2
B. 2:1
C. 2:3
D. 3:1
E. 1:3
11. Opening of the carious cavity is conducted by the dental drill:
A. Cylindrical
B. Spherical
C. Inverted-conical (cone-shaped)
D. Whell-shaped
E. Load-shaped
12. Necrotomy is conducted by:
A. Fissura-shaped drill
B. Whell-shaped drill and excavator
C. Dental drill and excavator
D. Carborundum
E. Excavator
13. The cavity preparation on the masticatory surface of the 36th tooth you
procced to its forming. Choose the dental drill for forming the enamel edge:
85
A.
B.
C.
D.
E.
Spherical hard alloy
Spherical diamond
Cone-shaped hard alloy
Inverted cone-shaped diamond
Cylindrical diamond
14. You are to prepare the carious cavity of the 1st class in a middle caries.
Choose the dental drill for forming of its bottom.
A. Spherical steel
B. Inverted cone-shaped steel
C. Cylindrical diamond
D. Spherical steel
E. Inverted cone-shaped hard alloy
15. Which of the stages of preparing the carious cavity is conducted after
necrectomy?
A. Forming the carious cavity
B. Drug therapy
C. Opening of the carious cavity
D. Expansion of the carious cavity
E. Imposition of insulating gasket
16. While reviewing the patient you reveals the carious cavity on the palatal
surface of the 12th tooth. What class does it belong to after Black?
A. 2nd class
B. 3rd class
C. 4th class
D. 1st class
E. 5th class
Reference literature
1.
2.
3.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
86
4.
5.
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson No 14
Theme: The peculiarities of the cavity preparation of the class I (Black
classification).
Short description of a theme
The form of cavity of the class I is more often determined by the
features of those natural sulci in which the carious has developed. It can be
of cylindrical, diamond-shaped, five-pointed, cruciform. When there are
two cavities, separated from each other by a small number of healthy
tissues, they are united and prepared, as one cavity, but when there is a
sufficient layer of intact tissues between them, than they are prepared
separately.
While preparing the carious cavities in natural pits of the incisors, it
should be kept in mind about the location of the pulp. The newly formed
cavity is of cylindrical shape.
Complications in preparing the carious cavities class I. Heavy
complication is a perforation of the bottom of the carious cavity. More
frequently it occures when the entrance into the carious cavity was not
widened. Sometimes the reason of perforation are not precise manipulations
by the drill or excavator. The second complication is a fracture of the wall
of the carious cavity as a result of load-shaped motions by a excavator. The
perforation of the wall of the carious cavity more frequently happens near
the neck of a tooth; the main reason of such complication  is bad
illumination of the operating field and lack of the experience of a doctor.
87
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
What is caries, and its classification?
What carious cavities belong to the cavities of the I class?
Name the elements of the carious cavity.
How should the cavity of the class I be formed if there are two carious
cavities closely placed on the masticatory surface of a tooth?
How should the cavity of the class I be formed if there are two
cavities on the same tooth localized on a masticatory surface and
in the fissure of a buccal surface?
Whether it is always needed to put a carious cavity into a masticatory surface,
if it is located on a buccal surface?
What dental drills are used for the formation of the carious cavity of the class
I?
Situation tasks and test control
1. While reviewing the patient you reveal a carious cavity on the palatal
surface of the 12th tooth. What class does it belong to after Black?
A. 1st class
B. 2nd class
C. 3rd class
D. 4th class
E. 5th class
2. You are to prepare the carious cavity of 1st class in the middle caries.
Choose the dental drill for forming the bottom of the carious cavity:
A. Spherical steel
B. Spherical steel
C. Inverted cone-shaped steel
D. Cylindrical diamond
E. Inverted cone hard alloy
3. At the time of your practical training you help a doctor who is preparing
the carious cavity of 1st class in the 16th tooth. Choose a cutting instrument
for conducting the stage of necrectomy.
A. Hard alloy cyrindrical conical drill
B. Conical hard alloy dental drill
C. Cylindrical diamond dental drill
D. Exacavator
88
E. Whell-shaped hard alloy dental drill
4. On the masticatory surface of the 46th tooth in the area of fissures there
are two carious cavities which are closely located. How in this case should
the preparation be conducted?
A. To unite carious cavities into one
B. To form two separate cavities
C. To be of no importance
D. Depends on stopping material which will be used in restoration
E. Depends on the age of a patient
5. On the masticatory surface of the 17th tooth, two carious cavities are
localized in the area of fissures there is a carious pigmentation of fissures.
How should the cavity preparation be conducted?
A. Preparation of the carious cavities with carving of fissures, carve the
adjoining areas of cusps and form a large oval cavity
B. Both carious cavities are unite into one, fissures are left non-prepared
C. Preparation of both carious cavities with carving of fissures, while the
adjoining healthy areas of the enamel are left non-prepared, the crossshaped oval cavity is formed
D. The carious cavities are prepared separately, the remineralizing therapy
is conducted in fissures
E. The carious cavities and fissures are prepared separately
6. While reviewing the oral cavity of a patient, the carious cavity on the
cheek surface of the 46th tooth was revealed. What class does this cavity
belong to after Black?
A. I
B. II
C. III
D. IV
E. V
7. On the masticatory surface of the molar there are two carious cavities,
separated by thick rollers of healthy enamel. How should the carious
cavities be prepared?
A. To unite carious cavities into one
B. To form two separate cavities
C. Is of no importance
D. Depends on stopping material that will be used for restoration
E. Depends on the age of a patient
89
8. During the cavity preparation on the masticatory surface of the 36th tooth
you procced to its formation. Choose the dental drill for the formation of the
enamel edge:
A. Spherical carbid hard alloy
B. Cylindrical diamond
C. Spherical diamond
D. Cone-shaped hard alloy
E. Inverted cone-shaped diamond
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson No 15
Theme: Preparing of the carious cavities of the V class (Black
classification).
90
Short description of a theme
As the carious cavities of the V class are localized in the cervical
areas within the limits of one surface of a tooth, the preparation of the
cavities ia practically the same, as in case of class I.
The opening and necrectomy of the carious cavities does not have
substantial peculiarities. During the opening it is necessary to remove all the
pathologically changed enamel, preserving the healthy hard tissues. If on
the surface there are two carious cavities, separated by the narrow area of
the healthy enamel, they are united in one general. After the cavity
preparation has been completed, the cavity assumes the oval shaped form.
The gingival wall should be throughly treated.
During preparing of cavities of the V class after Blekom it should
be kept in mind as to the possibility of damaging the pulp. As a rule, the
depth of a cavity does not exceed 1,5 mm. If the cavities are deeper than 1,5
mm bottom is formed protuberant.
In order to ensure the best fixation of the filling, the precise right
angles are made between the walls and the bottom of the cavity,
insignificant inclination of walls is sometimes assumed toward the surface
of the cavity.
A high pain sensitivity during the cavity preparation of the V class
foresees the application of different types of anaesthesia.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
Classification of the carious cavities according to Black.
What carious cavities belong to the V class?
What are the stages of preparation?
What instruments are necessary for the conducting of preparation?
What are the elements of the carious cavity?
What are the peculiarities of preparing of the carious cavities of the V
class after Black.
7. The removal of the hypertrophied papilla.
8. Comment on the peculiarities of forming the gingival wall.
9. Enumerate the peculiarities of forming the bottom of the carious cavity.
10. Describe the technique of creation the additional retentional points.
11. What are the peculiarities of forming the cavities of the V class after
Black.
91
Situation tasks and test control
1. A patient appealed to the doctor with plural carious affections, located on
the necks of the upper incisors and canines, the lower canines and
premolars. Classify the revealed cavities after Black:
A. 4th class
B. 2nd class
C. 1st class
D. 3rd class
E. 5th class
2. While reviewing the 27-year old patient, the painful carious affections
were found in the area of necks of 45, 44, 34 teeth. What class of the
carious cavities these affections belong to?
A. 5th class
B. 2nd class
C. 3rd class
D. 4th class
E. 1st class
3. While demonstrating the method of the cavity preparation of 5th class on
a phantom a teacher executed necrectomy. You are to continue the
treatment. Specify the next stage.
A. Opening of the carious cavity
B. Drug therapy
C. Forming of the carious cavity
D. Expansion of the carious cavity
E. Creation of the retention points
4. You work through the technique of the cavity preparation. In the carious
cavities of what class is it possible to except the stage of „opening the
carious cavity”?
A. 4th class
B. 2nd class
C. 3rd class
D. 5th class
E. 1st class
5. In what cases can the bottom of the carious cavity of the V class after
Black be formed protuberant?
92
A. Due to the close location of a pulp and the danger of opening the cavity
of a tooth
B. For better adhesion of a stopping
C. From the cosmetic reasons
D. Due to the inconvenience of the access to the cavity
E. For preventing the spread of the cariosity
6. While forming the cavities of the V class after Black the cutting off the
thin edges of the enamels is conducted:
A. For the best regional adhesion of the stopping
B. For prevention of a crack of dead parts of the enamel without the
underlying dentine
C. With a cosmetic purpose
D. In order to the increase the mechanical retention of a filling
E. B, D
7. In the location of the carious cavity of the V class after Black is below
the level of a gingival edge in order to create the optimal access during the
preparing of the carious cavity is carried out:
A. Amputation of gums
B. Retraction of gums
C. Trepanation of gums
D. Separation of gums
E. None of the above-mentioned manipulations is conducted
Reference literature
1.
2.
3.
4.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
93
5.
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson No 16
Theme: The peculiarities of the cavity preparations of II class according to
Black.
Short description of theme
Sometimes it is difficult to find out the carious cavities of II class
after Black, and also to prepare through the presence of adjacent teeth.
Foremost it is necessary to create an access to them, taking off the layer of
intact enamel and dentine from the side of masticatory, palatal or tongue
surfaces. If the neighbouring tooth is missed the access is considerably
simplified and the preparation does not almost differ from conducting the
manipulations in the cavities of I class.
Then the teeth are densely placed, it is necessary to disconnect
them; this manipulation will help to provide the best access to the carious
cavity. It is provided by the use of the special device – separator or cutting
of contact surfaces of teeth by a separational disk (the last is applied rarely).
If a carious cavity is placed on a contact surface higher from the
line of equator, after preparing it has a typical rectangular form. From class
I it differs only by absence of one of the walls, that requires a creation of
supporting elements. If its localization is below the line of equator, to be
fully formed it must contain two elements: basic cavity and additional
ground.
The moulding of a basic cavity is carried out according to general
rules. Special care should be given to preparation of a gingival wall which
must be at right angles to the bottom of a cavity.
When the sizes of carious cavity are sizable it is necessary to form
the additional cavity. Its width must be equal to the width of a basic cavity,
and its length is to reach the middle of the masticatory surface. In the case
the sizes of a basic cavity are larger an additional ground is formed thus,
that its length must be greater than half of the masticatory surface, and a
94
size on a side, opposite to a basic cavity must be wider, than the entrance
size of a basic cavity. The depth of additional cavity must be 0,5-1 mm
lower than the enamel-dentine junction.
If the medial and distal contact surfaces of premolars and molars
are effected by caries simultaneously an additional ground on a masticatory
surface is formed as a common for both.
If the carious cavities of II class are close to each other, it is
recommended to prepare them during one visit.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Classification of the carious cavities according to Black.
What carious cavities belong to the II class?
What are the stages of preparation?
What instruments are the necessary for conducting the preparation?
What are the elements of the carious cavity?
What are the peculiarities of the cavity preparation of II class after
Black?
Separation of teeth. Methods.
Structure of a separator. Principle of work.
Cavity preparation depends on the level of their localization.
Name the types of access to the affected contact surface of teeth.
Basic cavity, determination. Features of formation.
An additional cavity, determination, meaning, indications to its
creation.
Correlation of basic and additional cavities as to a width and depth.
What complications can arise in preparing of the carious cavities of II
class after Black?
Situation tasks and test control
1. The operative treatment of the carious cavity of III class is conducted a
patient. What is the difference of the carious cavities of I and III classes
depth of affection?
A. In depth defeat
B. By the sizes of a cavity
C. By the functional group of a tooth
D. By correlation with a pulp chamber
E. By the affected layers of a dentine
95
2. You conduct the cavity preparation of II class in the 36th tooth according
to general principles. Choose the dental drill for forming the bottom of a
carious cavity.
A. Cylindrical carbid
B. Spherical diamond
C. Inverted cone-shaped hard alloy
D. Spherical hard alloy
E. Inverted cone-shaped steel
3. After performing the preparatory stages, a doctor proceeds to the
preparing of a carious cavity which is located on the distal surface of the
35th tooth. Specify the way of an access to it.
A. Through the oral surface
B. Through the vestibular surface
C. Separation of a tooth by a diamond disk
D. Through a gingival surface
E. Through a masticatory surface
4. What is the proportion between a basic and additional cavities in
preparing the II class after Black?
A. 1:2
B. 2:1
C. 2:3
D. 3:1
E. 1:3
5. The carious cavity on a distal contact surface of the 27th tooth belongs to:
A. To the III class according to Black
B. To the I class according to Black
C. To the II class according to Black
D. To the IV class according to Black
E. To the V class according to Black
6. According to Black the carious cavities belong to the II class if they are
located on:
A. Contact surfaces of canines
B. Buccal surface of molars
C. Contact surfaces of incisors
D. Contact surfaces of premolars and molars
E. A, C
96
7. On what surfaces the medial-occlusal-distal cavities are formed?
A. Contact surfaces with a general additional site
B. Front and back contact
C. Occlusal and vestibular
D. The back contact with an additional site
E. The frontal contact with an additional site
8. On the proximal surfaces of the 35th tooth carious cavity of middle sizes,
a masticatory surface is preserved, the 36th tooth is absent. How in this case
to form a cavity?
A. While preparing of the carious cavity it is expedient to show out it on a
masticatory surface
B. To perform preparation from the side of the absent tooth without
forming the additional cavity
C. While preparing of the carious cavity it is necessary to show out it on a
tongue surface
D. While preparing of the carious cavity it necessary to show out it on a
buccal surface
E. While preparing of the carious cavity it is expedient to show out it in a
cervical area
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
97
Practical lesson No 17
Theme: The peculiarities of cavity preparations of III class according to
Black.
Short description of a theme
It should be taken into account the possibility of access to the
carious cavity, sizes and degree of destruction of walls.
The absence of neighbouring teeth allows to prepare a cavity
within the limits of contact surface, that as a central cavity. As a rule, it has
a triangular form with basis, reverse to the neck, and by a top – to the
cutting edge of a tooth.
If a cavity on a contact surface is deep and considerably extended
on an area, except for a basic cavity it is expedient to create also an
additional site.
During the cavity preparation of III class the vestibular surface of a
crown of the tooth is preserved for the aesthetic purpose, even in case of
absence of the underlying dentine. When the vestibular surface of a crown
of the tooth is a effected by caries, all stages of cavity preparation are
carried out from the side of the vestibule of the mouth, all the stages of
preparing are carried out from the side of vestibule of the mouth.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Classification of the carious cavities according to Black.
What carious cavities belong to the III class?
What are the stages of preparation?
What instruments are necessary for conducting the cavity preparation?
What are the elements of the carious cavity?
Form and sizes of the cavities of the III class.
The peculiarities of forming the cervical wall.
The peculiarities of forming the bottom of the carious cavity.
Expedience of creation of additional site, indications.
The peculiarities of preparing the vestibular surface.
98
Situation tasks and test control
1. The operative treatment of the patient’s carious cavity of IIIth class is
conducted in a patient. What is the difference between the carious cavities
of IInd and IIIrd classes?
A. By the functional group of a tooth
B. By the sizes of a cavity
C. In depth defeat by a depth of affection
D. By correlation with a pulp chamber
E. By the affected layers of a dentine
2. Indication for the creation of additional site in the cavity preparation of
III class is:
A. Affection of the oral surface
B. Affection of the vestibular surface
C. Difficult access to the cavity
D. Affection of the vestibular and oral surfaces
E. Affection of the cutting edge
3. A patient complains of the aesthetical defect of the frontal group of teeth
on the upper jaw. Objectively: on the contact surfaces of the 11th and 21st
teeth there are the carious cavities without the affection of a cutting edge
and corner of a crown within the limits of cloak dentine. What class
according to classification of Black do they belong to?
A. To the II class
B. And to the I class
C. To the IV class
D. To the III class
E. To the V class
4. In the 12th tooth there is a carious cavity of III class according to Black,
the access is difficult. What does the tactical scheme of preparation consist
in?
A. Trepanation of a cavity is performed through a vestibular wall and its
subsequent preparation
B. Access is created through the oral surface with the subsequent preparing
of a cavity and forming the additional place on this surface
C. Trepanation of a cavity is performed through the oral wall and its
subsequent preparing
D. All answers are correct
E. There is no proper answer
99
5. A carious cavity is located on the contact distal surface of the 23rd tooth,
the 24th tooth is absent. Name the ways of the approach for creation the
cavity of rational form.
A. A cavity is prepared from the side of the absent tooth and is formed of
three-cornered form
B. Access is created by trepanation of the oral surface
C. Access is created by trepanation of a vestibular surface
D. All answers are correct
E. There is no proper answer
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson No 18
Theme: The peculiarities of preparing of the carious cavities of IV class
after Black.
100
Short description of a theme
Preparing is conducted almost just like the cavities of III class, but
basic and additional cavities are always created practically. It is predefined
that during the stopping it is necessary to restore the corner of a cutting edge
which puts the promoted requirements as to fixing in them the restoration
material.
The additional cavity of different form (trapezoidal, as a tail of a
swallow) is created on the palatal or tongue surfaces of a tooth. Its sizes
must be not less one third of a palatal (tongue) surface of a tooth. The width
of ground must equal to the width of a basic cavity, while the bottom is to
be disposed some what below from enamel-dentine junction.
For the best fixator of a filling material in the cavities of the IV
class are widely applied the parapulpal, anchor posts, other additional
strong points which create in the specially prepared openings, and also in
the areas of walls of a cavity.
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
Classification of the carious cavities according to Black.
What carious cavities do belong to the IV class?
What are the stages of preparation?
What instruments are necessary for conducting of preparing?
What are the elements of the carious cavity?
Name the surfaces of incisors and canines.
What carious cavities belong to the IV class after Black?
What are the variants of localization of the carious cavities of the IV
class after Black.
9. Describe the preparing of basic and additional cavities, form, sizes.
10. Comment on the methods of improvement of fixing of the stopping.
Situation tasks and test control
1. The knowledge on topographical anatomy of a tooth is necessary for the
successful treatment of caries. Name the number of surfaces of a crown of
the 12th tooth:
A. 6
B. 3
C. 2
101
D. 5
E. 4
2. According to Black, the carious cavities belong to the IV class:
A. Located on the aproximal surfaces of incisors and canines without
violation of safety of a cutting edge and corner of a crown of a tooth
B. Located on the aproximal surfaces of premolars
C. Located on the aproximal surfaces of incisors and canines with violation
of safety of cutting edge and corner of a crown of a tooth
D. Located in the cervical areas of incisors and canines
E. Located in the cervical areas of premolars
3. What from the methods of preparing of carious cavity will provide the
most reliable fixing of stopping in 22nd tooth?
A. Application of parapulpal point and creation of additional cavity is on
the oral surface of a tooth
B. Creation of additional cavity is on the oral and vestibular surfaces of a
tooth
C. Creation of additional cavity is on the vestibular surface of a tooth
D. Creation of additional cavity is on the oral surface of a tooth
E. Creation of additional cavity on the oral surface of tooth and along a
cutting edge
4. On to aproximal-medial surface of 42nd tooth the deep carious cavity with
the affectoin of the corner of a crown of the tooth. What class does this
carious cavity belong to according to the classification of Black?
A. To the II class
B. To the IV class
C. And to the I class
D. To the III class
E. To the V class
Reference literature
1.
2.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
102
3.
4.
5.
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson No 19
Theme: The techniques of the cavity preparation are under modern filling
materials: techniques of preparing (M.I.-therapy), ART-technique
(non-invasive), tunnel preparing and others.
Short description of a theme
In connection with the introduction of the highly by effective
programme of the prophylaxis of caries, appearance of glassionomer
cements and other materials which form the chemical connection with
dental tissues of a tooth and own the anticarious action, possibility to
decrease the volume of carving of the dental tissues has appeared.
Worthy of note is the approach which is called M.I.-therapy (from.
Eng. Minimal Intervertion Treatment  minimum invasion treatment, or
Minimal Invasive Dentistry  minimum invasion dentistry).
The conception of the minimal invasive treatment (MIL) consists
in focusing on the maintenance of dental health of a patient and reduction of
requirement in invasive methods (preparing and stopping). In the basis of
conceptions three inter connected principles (FDI Commision project are
distinguished, 1 (1997):
1. Early detection and estimation of risk factors of the appearance
of caries.
2. Individual prophylaxis of caries.
3. Minimal invasive stopping of the carious affection by bioactive
103
materials.
The primary purpose of the MIL is to include the patient in the
group with the diminished risk by the active revealing of possible reasons of
development of caries, normalization of mineral balance and priority of
prophylactic measures.
The introduction of the conception of the MIL into practice,
predetermines a requirement in preparing and stopping of a very small
carious cavities. This direction is termed as micropreparation. The series of
special instruments are worked out, the size of a working part of which, as a
rule, does not exceed 1 mm.
The design of the formed carious cavity is closed individually. The
complete carving should be done obligatory of nonviable tissues and create
the conditions for the high-quality stopping of a defect.
By putting the conception of the MIL into practice, it should be
kept in mind that it is oriented on the active bilateral collaboration of a
doctor and a patient.
Wide introduction of M.I.-therapy (МІТ) in Ukraine is restrained
by a number of factors:
1. this method is for patients who live in highly developed
countries, wherever the middle index of KPV exceeds 4.
2. apart from the special instruments, an additional equipment is
needed: ultrasonic device with the special attachments,
stomatological microscope (increase 3,5×25) or binocular
lenses (increase 3,5×5,5).
3. МІТ (highly-skilled, author treatment, technology of which
requires additional time, financial and physical expenses.
4. A method is intended for patients who possess a stable, strong
motivation on saving the dental health and active collaboration
with the dentist.
Second direction of development of the MIT is the ART-technique
(atraumatic restorative treatment). The technique of treatment is maximally
simple. A carious cavity is cleaned up by excavator, without preparing,
filled with glass ionomer cement. It is used during conducting of sanation in
the regions with difficult access. The ART-technique is recommended by
WHO in order to render dental aid for the socially – unprotected groups of
population.
The ART-technique is a method of the minimal preparing (MMP).
For the treatment, both the hand instruments and drills are used. After
opening the cavity only a demineralized enamel is carved, while it remains
of the edges of cavity, even, if there is no support of dentine under it. A
necrotic dentine is removed. As a result the cavity of pear-shaped form
104
appears with a small entrance opening. Expedience of MMP consists in that
a dental enamel remains steady and lasting in the aggressive environment of
the oral cavity.
The tunnel preparing (access) is an occlusal access at which the
extensive carving of tissues of a tooth is conducted from a masticatory
surface. The occlusive access leads to a considerable loss of tissues in
occlusive surface and in the first place of the crest. The opening of the
cavity in the tunnel preparing is conducted from the masticatory surface, in
the area of three-cornered pit, retreating 2-2,5 mm of the edge of a tooth.
The drills create a tunnel, directed to the contact carious, which is called the
occlusive-aproximal. Thus, a cavity is opened, without damaging a marginal
crest. The tunnel preparing is conducted with small carious damages which
are localized mainly in the area of equator or a bit below (between a contact
point and neck of a tooth). The drawback  is impossibility of visual control
of a little quality of necrotomy, high risk of opening the cavity of a tooth
(especially for young people).
Control questions to practical lesson
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
What factors allow to apply the technique of diminishing the volume of
carving the hard tissues?
What does the conception of MIL consist in?
What inter connected principles underlie in basis of the conception of
MIL?
How is the individualized prophylaxis of caries work out?
What is meant under minimal invasive filling of the carious affections
by bioactive materials and its significance for efficiency of the MIL?
What is the main purpose of the M.I.-Therapy?
What is meant by the term micropreparation?
What are the peculiarities of the instruments for micropreparation?
How is a carious cavity formed during the micropreparation?
What is obligatory for successful performance of the principle of
micropreparation?
What objective and subjective factors restrain a wide introduction of
method of M.I.-Therapy?
What is the ART-method?
What is the technique of treatment in ART-method?
What dental instruments are necessary for conducting ART-method?
What is the MMP-method?
How is the method of the tunnel preparing condected?
105
17. What are the drawbacks of the method of the tunnel preparing?
Situation tasks and test control
1. What is the basic conception of minimal invasive treatment of the carious
cavities?
A. Prophylaxis
B. The new approach to the peculiarities of preparing
C. Dependence on stopping material
D. Theoretical working-up
2. How many interconnected principles (FDI Commision project, 1 (1997)
underlie in the conception of MIL?
A. 1
B. 3
C. 2
D. 4
E. 5
3. What is the size of working part of the special instruments for minimal
invasive treatment and stopping of the carious cavities?
A. Less than 1 mm
B. More than 1 mm
C. 1 mm
D. Can be used as a classical one
E. No matters are of importance
4. If a carious cavity is within the limits of the enamel, what form should be
created more often (after the method of MIL)?
A. Rectangular
B. Piriform
C. Cone-shaped
D. Triangular
E. Any
5. If a carious cavity is within the limits of the dentine, what form should be
created more often (after the method of MIL)?
A. Rectangular
B. Piriform
C. Cone-shaped
106
D. Triangular
E. Any
6. What does the technique of preparing consist in after the ART-method?
A. A carious cavity is cleaned up by the excavator
B. A carious cavity is cleaned up by the excavator and drill
C. A carious cavity is cleaned up only by drill
D. By another means
E. Is left untreated by instruments
7. What group of patients was recommened by WHO (1994) as the choice
for the ART-technique?
A. For all patients in case of certain indications
B. Socially uprotected people
C. According to the choice of a doctor
D. According to the choice of a patient
E. To be of no importance
8. What does the method of conducting the minimal cavitation, that has
been developed due to the method of the ART differ from it?
A. Only a dental drill is used
B. Both the dental drill and cutting instruments are used
C. Only hand cutting instruments are used
D. In general a carious cavity is not prepared
E. Lack of proper answer
9. How is a carious cavity prepared according to the method of the minimal
cavitation?
A. Only a demineralized enamel is carved, the entrance opening of a small
size is left
B. An enamel is carved on the edges of a cavity
C. A demineralized enamel is carved and on the edges of a cavity
D. An enamel is not carved
E. To be of no particular importance
10. The variety of what access is the tunnel preparation?
A. Direct
B. Gingival
C. Vestibular or tongue
D. Occlusial
107
11. What is the purpose of performing the tunnel access?
A. To simplify the performing of technique of preparation
B. To save the visual control of quality of preparing
C. To save of marginal comb
D. To economize of time of a doctor and a patient
E. To decrease the risk of perforation of the tooth cavity
12. What are the indications for the benefit of choosing the access by a
tunnel method?
A. Carious cavities are of large size
B. Small carious cavities with localization mainly in the area of equator or a
little bit below
C. All of carious cavities of III class according to Black
D. All of carious cavities of IV class according to Black
E. All of carious cavities of V class according to Black
13. What are the drawbacks of the method of the tunnel preparation?
A. Complication is in the subsequent preparing of the carious cavity
B. Complication of implementation
C. Impossibility of visual control of a quality of necrectomy
D. Considerable expense of time
E. Necessity in the special cutting instruments
Reference literature
1.
2.
3.
4.
5.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dental faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.I.–
Poltava: Divosvit, 2005.– 392 p.
Borovskiy E.V. Therapeutic dentistry: a textbook is for the students of
dental faculties of higher medical educational establishments.– M.:
Med. Inform. agency, 2006.– 840 p.
Nikolyshyn A.K. Therapeutic dentistry /A.K. Nikolyshyn: a textbook is
for the students of dentistry faculties of higher medical educational
establishments of IV level of accreditation in two volumes, T.IІ.–
Poltava: Divosvit, 2007.– 280 p.
Preclinical course of therapeutic dentistry: course of lectures /L.O.
Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv, 2002.–
159 p.
The methodological manual for practical of therapeutic dentistry
108
/L.O.Tsvykh, O.A. Petryshyn, V.V. Kononenko, M.V. Hysyk.– Lviv,
2003.– 98 p.
Practical lesson No 20
Theme: Final module control.
A list of theoretical questions for preparation of students to final module
control.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Dentistry as a science. History of its development.
Basic tasks of therapeutic dentistry.
Intercommunication of therapeutic dentistry is with other special and
medical disciplines.
The role of the scientists of Ukraine in the development of therapeutic
dentistry.
Purpose and task of phantom course.
Scientific organization of working conditions of a dentist.
Structure of a tooth. Topography of tissues. Histology of the enamel.
Structure of a tooth. Topography and histology of the cement and
dentine.
Structure of the pulp and periodontium. Age changes.
Concept of the periodontium, its function.
Saliva, mouth liquid: composition, properties, functions.
Dental formula. Signs of teeth.
Clinical anatomical features of the structure of incisors of the upper
and lower jaws.
Clinical anatomical features of the structure of canines of the upper
and lower jaws.
Clinical anatomical feature of the structure of premolars of the upper
and lower jaws.
Clinical anatomical features of the structure of molars of the upper and
lower jaws.
Organization and equipment of dentistry clinic. Drills, handpieces,
governed exploitation. Accident prevention. Concept of ergonomics.
Dental instruments, their settings. Cutting instruments. Governed
sterilization.
109
19. Ways of distribution of cariosity in hard tissues of a tooth.
20. Ways of distribution of cariosity in hard tissues of a tooth on its
different surfaces.
21. Classification of carious cavities is on Blekom.
22. Principles and mode of the classical preparing.
23. Features of preparing of the carious cavities of the I class according to
Black.
24. Preparing of carious cavities of the II class according to Black
25. Features of preparing of the carious cavities of the III class according
to Black.
26. Features of preparing of carious cavities of the IV class according to
Black.
27. Features of preparing of carious cavities of the V class according to
Black.
28. A method of preparing of the carious cavities by modern stoppings
materials (M.I.-terapiya).
29. A method of preparing of the carious cavities by means of modern
stoppings materials of ART-tecnique (non-invasive).
30. Method of the tunnel preparing and others.
A list of mastering manual skills for final module control
1.
2.
3.
4.
5.
6.
7.
8.
9.
To capture skills of interpretation of qualitative and quantitative
composition of saliva.
Be ready to write a dental formula for temporal and permanent bites.
To represent the anatomical features of the structure of incisors of the
upper and lower jaws (drawing).
To represent the anatomical features of the structure of canines of the
upper and lower jaws (drawing).
To represent the anatomical features of the structure of premolars of
the upper and lower jaws (drawing).
To represent the anatomical features of structure of molars of the
upper and lower jaws (drawing).
To learn the groups of dental instruments. To represent the form of
working part of cutting instruments (drawing).
To learn the methods of sterilization of dental instruments.
To make two models of a crown of the first premolar of the lower jaw
and on one of them to form a carious cavity of the I class according to
Black.
110
10. To make preparation on a phantom carious cavity of I class according
to Black.
11. To make two models of a crown of the first premolar of the upper jaw
and on one of them to form the carious cavity of the V class according
to Black.
12. To make preparation on a phantom carious cavity of the Vclass
according to Black.
13. To make two models of a crown of the second molar of the lower jaw
and on one of them to form the carious cavity of the II class according
to Black.
14. To make preparation on a phantom carious cavity of the III class
according to Black.
15. To make two models of a crown of the upper canine and on one of
them to form the carious cavity of the III class according to Black.
16. To make preparation on a phantom carious cavity of the III class
according to Black.
17. To make two models of a crown of the upper central incisor and on
one of them to form the carious cavity of the IV class according to
Black.
18. To accomplish the preparation on a phantom carious cavity of the
IVclass according to Black.
19. To master and reproduce the technique of minorinvasion therapy on a
phantom (МІТ).
20. To master and reproduce the method of ART-tecnique on a phantom
(non-invasive).
21. To master and reproduce the method of the tunnel preparing on a
phantom.
111