1. Universal

2. Palmer

3. ISO (International Standards Organization System)

Permanent is #1-#32 

Primary is #A-#T

• Place and contour amalgam and other restorative materials 
• Perform coronal polishing, place sealants
• Place liners, bases, and bonding agents
• Perform fluoride treatments
• Place rubber dam and matrix systems
• Take impressions of teeth for athletic appliances

• Complete or limited exams, diagnosis and treatment planning
• Surgical or cutting procedures of hard or soft tissue
• Prescribe drugs, medications or worth authorizations
• Take impressions other than for study models, diagnostic casts or athletic appliances
• Final inspection and approval of restorative and other treatment which affects occlusion and any necessary occlusal adjustments
• Pulp capping, pulpotomy and other endodontic procedures
• Placement and intraoral adjustments of fixed and removable prosthetic appliances
• Administration of local anesthesia, paranteral and inhalational sedation or general anesthesia
• No turning off nitrous 

• CPR (American Heart Association or American Red Cross)
• Continuing education (10 hours)

- 50% in lecture or clinical presentations

- 50% may be taken online

• Evidence in legal settlement or lawsuit
• A reference tool for forensic cases
• A reference for appropriate third parties 

1. Date
2. Tooth number
3. Completed treatment
4. Signature

1. Primary
2. Mixed
3. Permanent

• Baby teeth
• Deciduous dentition

Permanent 8

Primary 5

1. Maxillary right posterior
2. Maxillary anterior
3. Maxillary left posterior
4. Mandibular right posterior 
5. Mandibular anterior
6. Mandibular left posterior 

1. Incisors
2. Canines
3. Premolars
4. Molars

#7, #8, #9, #10, #23, #24, #25, #26

• Single rooted teeth with relatively sharp, thin edges
• Designed to cut food without the application of heavy force
• Lingual is shaped like a shovel to help guide food into the mouth

#6, #11, #22, #27

• Also known as cuspids
• Located at the "corners" of the arch
• Designed for cutting and tearing food 
• Longest teeth in the human dentition
• Cornerstone of the dental arch

#4, #5, #12, #13, #20, #21, #28, #29

• Also known as bicuspids
• Cross between canines and molars
• Pointed buccal cusps hold the food while the lingual cusps grind it

#1, #2, #3, #14, #15, #16, #17, #18, #19, #30, #31, #32

• Usually have four or more cusps
• Function is to chew or grind food

1. Occlusal (Posterior) / Incisal (Anterior)
2. Lingual
3. Buccal / Facial
4. Mesial
5. Distal 

• Prevents food from being trapped between the teeth
• Stabilizes the dental arches by holding the teeth in either arch in positive contact with each other
• Protects the interporixmal gingival tissue from trauma during mastication 

The "buldge" or widest point on a special surface of the crown

• Contact areas on the mesial and distal surfaces are usually considered the height of contour on the proximal surfaces
• Facial and lingual surfaces also have a height of contour

Junction of 2 surfaces 

ML

Junction of 3 surfaces

MOL

• Apical (nearest the tip of the root)
• Middle
• Cervical (nearest the neck of the tooth)

• Occlusocervical division
• Mesiodistal division
• Buccolingual division 

• Class I - Normal
• Class II - Overbite 
• Class III - Underbite

1. Enamel
2. Dentin
3. Cementum
4. Dental Pulp

• Shortest root in the maxillary permanent dentition
• Labial (facial) surface is more rounded 
• Sharp MI angle, rounded DI angle

• Smaller then centrals, but roots are longer 
• Commonly missing

• Smallest teeth in the permanent dentition 
• Centered cingulum 
• Pointed MI edge

• Slightly larger than the mandibular centrals
• Incisal edge normally slopes towards the distal 
• The apex of the tooth can also be curved toward the distal 

Maxillary Canines #6, #11 

• Longest teeth in the dentitions
• Slows are almost even
• 2 well developed lingual fossas (Concaved to channel foods)

• Slopes are more uneven then maxillary 
• Not as well developed fossas
• Slopes to the distal 

1. Supplemental 
2. Central
3. Triangular 

• Only premolar with two roots
• Larger than the second premolars (#4, #12)
• Cusps are almost even in length
• Look from the buccal for the curve 

Maxillary Second Premolars #4, #12 

• Cusps are more equal in length
• One root
• Slight depression on the mesial of the root 

• Cusps are very uneven 
• Smaller and shorter than mandibular 2nd premolars 
• Can be mistaken for a canine 
• Look at the lingual 

Mandibular Second Premolars #20, #29 

• More grooves and longer roots than mandibular 1st premolars 
• Can have 2 or 3 cusps 

- Bicanineate - two cusp type U/C or H shape pattern 

- Tricanineate - three cusp type Y shape pattern (Very rare)

• Largest root in the permanent dentition 
• 3 roots
• Four well-developed cusps with a 5th cusp on the lingual surface known as the cusp of carabelli 
• MB cusp is bigger 

• 4 cusps
• 3 roots that begin to get closer together
• Crown is shorter than the first molar crown 

• Not well developed
• Fused or touching roots 
• Occlusal table looks squished
• Tons of supplemental grooves
• AKA wisdom teeth 

• 2 roots
• 5 cusps - 3 buccal & 2 lingual
• Roots are mostly the same length
• MB cusp is the largest cusp

• 4 well developed cusps - almost equal in size 
• Smaller crown than the 1st molar 
• 2 roots
• Roots are closer together 
• Very symmetrical tooth 

• Occlusal table is more oval due to the mandibular jaw is more dense
• Crown tapers distally 
• Roots are fused, shorter, and curved 

• "Chicklet teeth"
• Mamelons
• Deep lingual fossa
• Large cingulum 
• Wide incisal edge

• Incisal edge is rounder than the central incisor
• Long and skinny tooth 

• Very symmetric (If you drew a line down the middle & folded it, it would be equal)
• Slight fossa, smaller cingulum
• Mesial and distal tapers evenly in contact areas

• Wider and longer than centrals
• 2 Landmarks

1. Slopes distal with the apex

2. Fossa very shallow/nonexistent

• Longer and sharper cusp with even cusp slopes
• Well developed cingulum 
• Slender root 

• Cusps slopes are more uneven 
• Shallow fossa
• Root is more tapered than the maxillary 

• 3 or 4 cusps
• H-shaped groove pattern 
• 3 roots, flared

• Larger than primary first molar
• Usually has a cusp of carabelli 
• Very flared roots 

• Rounder crown than other molars
• 2 roots
• 4 cusps

• Larger than the primary first molar
• Resembles permanent mandibular 1st molar
• 5 cusps
• Oval occlusal shape 

• Prepares the teeth for placement of dental sealants, and orthodontic brackets and bands
• Smooth tooth surfaces are easier for the patient to keep clean 
• The formation of new deposits is slowed
• Patients appreciate the smooth feeling and clean appearance

1. A stain adheres directly to the surface of the tooth
2. A stain is embedded in calculus and plaque deposits
3. A stain is incorporated into the tooth's structure

Originates outside the tooth in response to environmental agents, subdivided into extrinsic or intrinsic

Extrinsic - stains on the exterior of the tooth that can be removed (Food, drink, tobacco)

Intrinsic - stains caused environmentally but cannot be removed because the stain has become incorporated into the structure of the tooth (Tobacco stains from smoking, chewing/dipping, dental amalgam)

• Most common technique for removing stains and plaque and polishing teeth 
• Rotated slowly and carefully by a prophylactic angle attached to a slow-speed handpiece 

• Doctor has to do it
• Use of a specially designed handpiece with a nozzle that delivers a high-pressure stream of warm water and sodium bicarbonate

• The more agent used, the greater the degree of abrasion
• The lighter the pressure, the less abrasion
• The slower the rotation of the cup, the less abrasion

1. Fill prophy cup with polishing agents and spread it over several teeth in the areas to be polished
2. Establish a fulcrum and place the cup almost in contact with the tooth 
3. The stroke should reach from the gingival third to the incisal third of the tooth 
4. Using the slowest speed, lightly apply the revolving cup to the tooth surface for 1 to 2 seconds each stroke
5. Use light pressure to make the edges of the polishing cup flare slightly (Tissue will blanch, turn white)
6. Use a patting, wiping motion and an overlapping stroke 

Mandibular arch - patient's head with the chin down 

(When the mouth is open, the lower jaw should be parallel to the floor)

Maxillary arch - position the patient's head with the chin up

• Dentist (DDS/DMD)
• Hygienist (RDH)
• Expanded Functions Dental Assistant (EFDA)

Slows demineralization and ehances remineralization of tooth surfaces 

The re-hardening of the enamel rods 

1. Systemic - ingested in food, beverages, or supplements

2. Topical - applied directly to the teeth through the use of fluoridated toothpastes, mouth rinses, and topical applications of rinses, gels, foams, and varnishes

1. Preeruptive development - before a tooth erupts a fluid-filled sac surrounds it. Systemic fluoride is present in this fluid to help strengthen enamel of the developing tooth and makes it more resistant to acid

2. Posteruptive development - after eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals. These fluoride-enriched crystals are less acid soluble than the original structure of the enamel

• Spread out over time
• Can result in dental fluorosis in children younger than 6 years with developing teeth

• A lot in a small amount of time
• Can result in poisoning or even death
• Very rare 

1 part per million (ppm) 

(Approx. 1 drop in a bathtub of water)

• Toothpastes
• Mouth rinses
• Gels
• Varnishes
• Professional applications 

1. Outline form - design and depth of the prep

2. Resistance form - shape and placement of the walls

3. Retention form - securing the restoration 

4. Convenience form - accessibility 

• Removal of enamel or dentin in preparation 
• Insert additional retention notches
• Place protective materials (liners, bases)

• Replaces a missing cusp
• Gives more retention/strength

• To determine the health of the tooth
• Waiting for the permanent restoration 
• Financial reasons

Tooth - to - tooth contact (the way the teeth fit together)

Also known as intercuspal position (ICP) or maximum intercuspation (MIP)

Movement out of intercuspal position

• Lateral excursions - movement of the jaw to the right or left
• Protrusive movement - movement of the jaw straight forward 

Marks that appear dense, halo, and/or donut shaped 

• Posterior marks should appear as dots

• Tooth wear
• Pain or sensitivity, especially while chewing
• Fracture of tooth or restoration
• Movement (shifting)
• Loosening of interferences with TMJ and muscles of mastication 

• Stress
• Friction
• Corrosion 

These three mechanisms generally overlap and cause accelerated deterioration of the teeth

Cervical third can be erosion (acids) or abrasion (brushing)

Abfractions 

• Silver
• Tin
• Copper
• Zinc

• Combines easily with mercury
• Requires slightly longer amalgamation
• Sets quickly
• Tarnishes easily 

• Aids in combining the mercury with alloy 
• Reduces strength
• Sets slowly
• More susceptible to corrosion 

• Adds strength and decreases expansion of amalgam 
• Resists corrosion
• Helps to reduce marginal failure 

• Prevents oxidation during manufacturing process 

1. Lathe cut (Conventional)
2. Spherical cut
3. Mixture 

• Three sizes: regular, fine, micro cut
• Fine and micro harden faster 

• Round
• Lower mercury to alloy ratio
• Harder to place
• More expensive 

• Add mixed, blended, or dispersion 
• Used to control the structure of amalgam 
• More commonly used 

• It is used in the mixing process to form the amalgam restoration 
• It is a metal in liquid form used to wet dry alloy particles 
• Only wet component

• Higher the % of mercury in the amalgam, the easier to mix and the slower to set 
• High % weakens the amalgam and makes polishing more difficult 

Most mercury to alloy ratios are less than 54% because minimum mercury produces a stronger alloy (setting time is quicker 2.5 min)

• Increased retention
• Decreased marginal leakage 

When dissimilar (2 different) metals touch in the mouth. (An electric current resulting in pain)

Occurs especially when amalgam is first placed

EX: Foil from gum wrapper on a new amalgam filling 

• Strain or deformation that is produced by stress 
• Can cause an amalgam restoration to extend out of the cavity prep 

• Too much material
• Can be adjusted with finishing and polishing 
• XL to LG

• Not enough material 
• Only way to fix is to remove and replace 

1. Sealers
2. Reinforcers
3. Insulators
4. Obtundants
5. Pulp Stimulators 

• Seals off cavity preparation 
• Seals off dentinal tubules
• Seals off the microscopic space between the tooth surface and restoration (helps to prevent post op sensitivity)
• Cannot be thermal insulators 

Ex: Copolite

• Bases used to protect the pulp from the pressures exerted on it during condensing 
• Materials can be a reinforcer and an insulatore
• Can be placed in a thick (base) or thin layer 

Ex: Dycal 

• Also referred to as a base (cements in a thick layer)
• Placed to insulate the pulp from thermal irritation 

Types

- Zinc oxide-eugeonol (ZOE)

- Zinc phosphate cement 

- Zinc polycrylic/carboxylate/polycarboxylate cement (Dycal, Limelight)

• They have the ability to soothe the sensitive pulp or reduce the irritability of a pulp 

EX: IRM (eugenol, oil of cloves)

• Used in deep cavity preparations where the remaining layer of dentin over the pulp is very thin in order to stimulate a thickening of the dentin layer
• Stimulated the pulp to form a layer of secondary reparative dentin 

EX: Dycal, limelight 

• Indirect pulp cap - over a near pulpal exposure
• Direct pulp cap - over an area of exposed pulp (may see bleeding)
• Direct pulp caps needs to be placed by the dentist

1mm into dentin but more than 0.5mm from the pulp 

Calcium hydroxide needed 

• Outer knob - used to tighten or loosen the spindle within the diagonal slot; this holds the matrix band securely in the retainer
• Inner knob - used to increase or decrease the size of the matrix band loop
• Spindle - internal screwlike pin that fits into the diagonal slot to secure the ends of the matrix band
• Diagonal slot - slot within the main body of the retainer that is used to position the ends of the matrix band into the vise
• Guide slots - slots used to position the matrix band for either the left or the right quadrant

1. Universal band - used with the proximal box is prepared to a minimum depth and width and the cusps are intact
2. Extension band - selected for deep Class II preparation requiring gingival extensions 

• Can result in an overhang or in cupping 
• Causes food traps
• Causes irritation, recession, possible abcess

• The seated band extends approx. 1mm below the gingival margin of the prep
• The seated band extends no farther than 1.5 to 2mm above the occlusal surface of the tooth 

1. T- band
2. Spot-welded band

Cotton rolls 

• Advantages - easy application, flexibility, do not need additional equipment
• Disadvantages - does not provide complete isolation, must be removed properly or can be damaging, must be replaced frequently, limited retraction 

• Easy to apply 
• Protective of hard and soft tissues
• Comfortable for the patient 
• Retraction 
• Prevent moisture contamination 

• Protects patient from aspiration and contact with dental materials 
• Protects tooth from moisture contamination 
• Application of medicaments (bleach)
• Improves access and retraction of soft tissue
• Improves properties of dental materials
• Better visibility, and also dry and clean 
• Economical 

• Plastic - placed under the dental dam (Not pretty)
• Stainless steal - placed over the dental dam (Pretty)

• Doctor
• EFDA

1. One-step method - placed on all at once
2. Two-step method - Clamp is placed first and then dam is stretched over top 

Bisphenol A + Glycidylmethacrylate = BIS-GMA (resin matrix)

Resin matrix + inorganic fillers = composite resin 

Ceramic materials

• Quartz or silica
• Lithium aluminum silicate
• Barium glasses 

These inorganic fillers strengthen the materials reducing thermal expansion 

Name advantages of composite 

• Resists solubility, dehydration, disintegration and abrasion
• Better compressive strength (chewing) and hardness
• Thermal expansion is only 3 times that of tooth structure = lower expansion and contraction = reduction in percolation and marginal staining 
• Excellent marginal adaptation with the use of etchant and bond 
• Improved marginal seal between composite and enamel
• Better color stability 
• Has both mechanical and chemical retention 

1. Conventional 
2. Micro-filled
3. Hybrid
4. Micro hybrid

• Also known as macrofilled 
• 75-80% inorganic filler 
• Large particle size
• Has a rough surface texture
• More susceptible to discoloration from extrinsic stains
• Some fillers make it easier to distinguish caries under a filling on a radiograph 
• Roughest, not used in anterior 

• 35-50% inorganic filler
• Polishable
• Designed to improve the rough surface characteristics of the conventional composites to resemble the tooth enamel
• Very small (submicron) particles of collidal silica result in a very polishable surface
• More susceptible to wear, increase water absorption
• Good for anteriors only

• 70-80% inorganic material 
• Submicron particles mixed with larger particles
• Developed to combine good physical properties of conventional composites with smooth surface microhybrids 
• Best of old and new to be used everywhere 

• Mix of partical size and most popular 
• Combine properties of micro filled with hybrids to create a polishable strong system 
• Esthetics is superb
• Very broad range of shades and opaqueness so that the tooth shade can be duplicated 

• Has a lower viscosity (runny)
• Doesn't have the fillers
• Typically used in the first increments of a composite to fill up the pulpal floor it is some what cushiony. Then covered by a hybrid composite 
• For a tiny prep from air abrasion
• Use for class I smaller preps and sealants (not in occlusion)
• Class II under the hybrid layer 

1. Conventional types - prepped using only carbide burs and hand instruments. Acid etching improves the marginal seal and reduces the marginal discoloration with resin materials 
2. Modified type - similar to conventional but they do not normally extend into the dentin. Diamond burs can be used to put in a bevel on the enamel. Allows for more end on etching of the enamel rods  

• Dental resins applied to the pit and fissure area of teeth to prevent tooth decay
• Fill in the areas of the tooth that are susceptible to carries
• A barrier that prevents bacteria and carbs from creating acids that cause decay in the inaccessible areas of the teeth 

• Occlusal surfaces of molars and premolars
• Lingual pits and grooves of maxillary molars and incisors
• Buccal pits of mandibular molars

1. Chemical cured - have a liquid 
2. Photopolymerized - light cured 

or small particles and mixed particles 

1. Ultra-violet light
2. Chemical self cured
3. White or visible light cured