- The document describes a presentation on the operative considerations of tooth histology and physiology. - It discusses the histological structures of the tooth including enamel, dentin, and pulp. - For enamel, it describes the physical, histological, chemical, and mechanical properties including that enamel is semi-translucent, composed of enamel rods, and must be cleaned prior to shade matching for restorations.

1. Learn
D E N T A L S E R I E S
P R E S E N T S

2. Y A S S E R A L I A L M O R T A D A A L W A S I F I
B D S , M S C , D D S , P H D
P R E - C L I N I C A L O P E R A T I V E D E N T I S T R Y
OPERATIVE CONSIDERATIONS OF
TOOTH HISTOLOGY & PHYSIOLOGY
C O P Y R I G H T © 2 0 2 2 , A L W A S I F I , Y . A . A L L R I G H T S R E S E R V E D

3. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 3
- Egyptian dentist
- Researcher, Educator & International Lecturer
- Founder of LEARN - DENTAL SERIES @ YouTube
- Presentation skills coach
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- Life long learner -

4. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 4
D I S C L A I M E R
S T A T E M E N T I don’t receive fees, compensation or royalties from the sales of any of the
products shown or discussed. Also, I declare that I haven't any con
fl
ict of interest
with any of the discussed products and techniques.
All products, equipment and techniques presented are those most commonly
used in professional restorative clinical practice. Finally, this presentation has not
been sponsored by any company, agency or organization and is only prepared for
educational purposes.
Yasser Alwasifi

5. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 5
C O P Y R I G H T
Copyright © 2022. All rights reserved. No part of this presentation may be
reproduced, distributed, or transmitted in any form or by any means, including
copying, recording, or other electronic or mechanical methods, without the prior
written permission of the author.
Yasser Alwasifi

6. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 6
E X C E P E C T E D
O U T C O M E S By the end of this presentation, you are expected to:
1. Correlate the operative considerations of enamel and dentin to their physical,
histological, chemical and mechanical characteristics
2. identify the characteristics of dental pulp tissues and its operative
considerations
3. Identify the importance of proper restoration of tooth natural physiologic
forms

7. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 7
C O N T E N T S PART I: TOOTH HISTOLOGY 9
I.A. INTRODUCTION 10
I.B. HISTOLOGICAL TOOTH STRUCTURES
I.B.1. ENAMEL
I.B.2. DENTIN
I.B.3. PULP
12
13
41
72
Expected Time: 60 Min

8. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 8
C O N T E N T S PART II: TOOTH PHYSIOLOGY 75
II.A. PHYSIOLOGICAL TOOTH FORMS
II.B.1. PROXIMAL CONTACT
II.B.2. BUCCAL & LINGUAL CONTOURS
II.B.3.OCCLUSAL ANATOMY
76
76
86
91
Expected Time: 60 Min

9. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 9
TOOTH HISTOLOGY
PART I:

10. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 10
I.A. INTRODUCTION
I.B. HISTOLOGICAL TOOTH STRUCTURE
I.B.1. ENAMEL
I.B.2. DENTIN
I.B.3. PULP
I. T O O T H
H I S T O L O G Y

11. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A .
• Knowledge of the various structures of the tooth
(enamel, dentin, cementum and pulp) and their
relation to each other is necessary for better
performance of operative procedures
• A basic understanding of proper anatomical form is
essential for restoration of teeth, because function
depends on tooth form
11
I.A. INTRODUCTION

12. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 12
I.A. INTRODUCTION
I.B. HISTOLOGICAL TOOTH STRUCTURE
I.B.1. ENAMEL
I.B.2. DENTIN
I.B.3. PULP
I. T O O T H
H I S T O L O G Y

13. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 13
I.B.1. ENAMEL
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS
ENAMEL

14. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 14
1. PHYSICAL CONSIDERATIONS:
• Enamel is a semi-translucent material which
transmitted the color of underlying dentin but not
constituting the total color of the tooth
• The true color of the tooth is the color of dentin
transmitted through the semi-translucent enamel
I.B.1. ENAMEL

15. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 15
1. PHYSICAL CONSIDERATIONS:
• The actual or clinical color of the tooth is the color
of dentin transmitted through the semi-translucent
enamel and modi
fi
ed by the external surface stains
of enamel surface
• The clinical color of a tooth depends on:
1. Color of the underlying dentin
2. Thickness of the enamel
3. Amount of stain in the enamel
I.B.1. ENAMEL

16. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 16
1. PHYSICAL CONSIDERATIONS:
• Enamel translucency depends on degree of
mineralization:
1. Demineralized enamel color appears roughened
and chalky white
2. Dehydrated enamel is lighter in color
• When performing esthetic restoration or dealing
with the anterior region of the oral cavity:
1. the enamel of the tooth should be cleaned and
polished to remove any surface stains that
interfering with the exact color matching and
duplication between the tooth and the selected
restoration
2. Tooth should be moist
I.B.1. ENAMEL

17. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 17
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL
a) Before polishing b) After polishing
c) Shade Matching

18. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 18
I.B.1. ENAMEL
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS
ENAMEL

19. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 19
2. HISTOLOGICAL CONSIDERATIONS:
• The unit structure of enamel is the keyhole-like rods
and the less calci
fi
ed inter-rod substance
• Due to the inter-rod substance is less mineralized
than the rods itself, it is the site of entry or attack of
dental caries more than the rods
• Accordingly, it was said that caries travels from the
surface of enamel to the DEJ parallel to the enamel
rods in a cone shaped pattern with its base at the
DEJ
I.B.1. ENAMEL

20. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 20
A B
Colored SEM photograph of Enamel: A) Cross-section, B) Longitudinal section
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

21. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 21
A B
SE Micrograph of Enamel: A) Cross-section, B) Longitudinal section
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

22. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 22
A B
A) Healthy Enamel, B) Enamel attacked by caries through the inter-rod substance
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

23. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 23
Caries attack to enamel follows the direction of enamel rods A) Occlusal caries, B) Cervical caries, C) Proximal
caries
A B C I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

24. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 24
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

25. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 25
2. HISTOLOGICAL CONSIDERATIONS:
• The enamel rods run perpendicular to the outer
surface of enamel and to the DEJ at the same time
• When a cavity preparation was performed it is
proved that the strongest cavity wall is gained when
the enamel rods constituting the enamel wall of the
cavity, are in the full length
• So, the direction of enamel wall of the cavity should
be in the same direction of enamel rods
• The resultant directions of different prepared cavity
walls for brittle material will be either slightly
converging occlusally buccal and lingual walls,
slightly diverging occlusally mesial and distal walls
and slightly slanting gingival
fl
oor in an outward
direction
I.B.1. ENAMEL

26. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 26
Cavity wall should follow the direction of enamel rods A) Bucco-lingual converge occlusally, B) Mesio-distal
diverge occlusally
A B
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

27. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 27
Gingival
fl
oor slanted cervically to follow the direction of enamel rods
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

28. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 28
I.B.1. ENAMEL
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS
ENAMEL

29. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 29
3. CHEMICAL CONSIDERATIONS:
• Enamel composed of 95-97% inorganic structures in
the form of apatite crystals, 1% organic structure
and 2-4% water, by weight percent
• 88-90% inorganic structures, 2% organic structures
and 8-10% water, by volume percent
• The highest value of inorganic structure was shown
in the rods rather than the inter-rod substance
I.B.1. ENAMEL

30. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 30
Weight percent of enamel composition
Water
10%
Organic
2%
Inorganic
88%
Water
4%
Organic
1%
Inorganic
95%
Volume percent of enamel composition
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

31. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 31
3. CHEMICAL CONSIDERATIONS:
SOLUBILITY:
• Enamel is an acid soluble material, but the degree
of solubility differs from the rods to the inter-rod
substance
• This could be helpful when adhering resin based
restorative material to enamel
• The development of acid etching technique is
based on this information, where an inorganic acid
gel is applied on enamel it will lead to selective
demineralization of the rods more than the inter-rod
substance creating micro-pores
I.B.1. ENAMEL

32. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 32
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL
E n a m e l
A c i d
Etching

33. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 33
3. CHEMICAL CONSIDERATIONS:
PERMEABILITY:
• Enamel is a permeable to certain ions although it
is a very hard, dense structure
• The structural units that are hypo-mineralized and
rich in organic content, such as rod sheath, enamel
crack and other defects are the rout of passage of
such ions
• Water plays an important role as a transporting
medium through small inter-crystalline spaces
• Permeability of enamel decreases with age, which is
due to changes in enamel matrix; this decrease is
referred to enamel maturation
• This property is the corner stone in performing
fl
uoride therapy of the tooth that alters the enamel
crystalline structure
fl
uoro-apatite, which is more
resistant to acid dissolution
I.B.1. ENAMEL

34. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 34
I.B.1. ENAMEL
ENAMEL
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS

35. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 35
4. MECHANICAL CONSIDERATIONS:
• Enamel is the hardest structure in human body
with hardness number of 343 KHN
• The smallest size cutting tool should be selected to
penetrate the enamel to concentrate the cutting
force on a small surface area of enamel that allows
rapid gaining access to dentin
• The small size round bur will be the instrument of
choice
• Also, the enamel should be penetrate in the area of
the least thickness, so gaining access to dentin
through enamel starts in a defective fossa or
fi
ssure
where the least thickness of enamel was recorded
I.B.1. ENAMEL

36. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 36
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

37. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 37
4. MECHANICAL CONSIDERATIONS:
• Enamel is the most brittle structure that needs to
be supported against the occlusal force that may
lead to its fragmentation
• Various studies proved that the strongest enamel
wall should be in the same direction of enamel rods
making CSA of 90º with its full thickness and
supported by sound healthy dentin
I.B.1. ENAMEL

38. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 38
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
1. ENAMEL

39. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 39
CO N C LU S I O N S
- Enamel is semi-translucent and transmits the color of underlying dentin, ► ►
it should be cleaned and highly polished before the procedure of color matching
- Enamel rods are more mineralized than inter-rod substances, ► ► the inter-
rod is the route of entry or attack of acids by dental caries so, dental caries runs
parallel to the enamel rods in a cone shaped pattern with its base at the DEJ
- Enamel rods are perpendicular to both the outer enamel surface and DEJ, ► ►
cavity walls should be in the same direction of enamel rods to get the strongest
enamel wall

40. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 40
CO N C LU S I O N S
- Enamel is acid soluble material, ► ► Acid etching technique for adhesion with
enamel
- Enamel is permeable to certain ions, ► ► Fluoride therapy
- Enamel is the hardest structure, ► ► Use small round bur at defective fossa for
easy penetration
- Enamel is a brittle structure, ► ► The CSA should be 90º and the enamel wall
should be supported by sound dentin

41. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 41
I.A. INTRODUCTION
I.B. HISTOLOGICAL TOOTH STRUCTURE
I.B.1. ENAMEL
I.B.2. DENTIN
I.B.3. PULP
I. T O O T H
H I S T O L O G Y

42. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 42
I.B.2. DENTIN
DENTIN
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS

43. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 43
1. PHYSICAL CONSIDERATIONS:
• Dentin is usually distinguished from enamel by
color, re
fl
ectance, hardness and sound
• Dentin is normally yellow-white, darker, opaque
and dull being less re
fl
ective to light than similar
enamel surfaces
• By moving a sharp explorer over the tooth, enamel
surface provide a sharper, higher pitched sound
than dentin surfaces
I.B.2. DENTIN

44. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 44
1. PHYSICAL CONSIDERATIONS:
• The sensitivity of dentin is encountered whenever
odontoblasts and their processes are stimulated
during operative procedures, even though the pain
receptor mechanism appears to be within the
dentinal tubules near the pulp
• The hydrodynamic theory is the most accepted
theory of pain transmission
• Stimulation of the dentinal surface leads to outward
movement of the
fl
uid within the dentinal tubules
• Because of many of the tubules contain
mechanoreceptor nerve endings near the pulp,
rapid
fl
uid movement in the tubules stimulates the
nerve endings in the pulp
I.B.2. DENTIN

45. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 45
Hydrodynamic Theory
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

46. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 46
1. PHYSICAL CONSIDERATIONS:
• The most sensitive area is the DEJ due to
branching of the dentinal tubules, so cutting the
cavity depth should be beyond the DEJ to avoid
cutting at this sensitive area
I.B.2. DENTIN

47. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 47
I.B.2. DENTIN
DENTIN
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS

48. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 48
2. HISTOLOGICAL CONSIDERATIONS:
• Dentin is a living tissue, characterized by the
presence of multiple closely packed dentinal
tubules that traverse its entire thickness and contain
the cytoplasmic extensions of odontoblasts
• The cell bodies of the odontoblasts are aligned
along the inner aspect of the dentin where they also
form the peripheral boundary of the dental pulp
I.B.2. DENTIN

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Colored SEM Photograph of Dentin Structure
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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2. HISTOLOGICAL CONSIDERATIONS:
• The course of the dentinal tubules is a slight S-curve
in the tooth crown, but the tubules are straighter in
the incisal ridge, cusps and root areas
• Their ends are perpendicular to the DEJ
• Near the DEJ, the tubules divide into several
terminal branches
I.B.2. DENTIN

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2. HISTOLOGICAL CONSIDERATIONS:
• The number of tubules per square millimeter and
their diameter varies at different locations of the
crown
• The number is 45.000/mm2 and the diameter is
large near the pulp, 20.000/mm2 and the diameter
is small near the DEJ
I.B.2. DENTIN

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Diameter distribution of dentinal tubules
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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2. HISTOLOGICAL CONSIDERATIONS:
• The junction of enamel and dentin is called dentino-
enamel junction
• It is scalloped or wavy in outline, with the crest of the
waves penetrating toward the enamel
• The rounded projections of enamel
fi
t into the
shallow depression of dentin
• This inter-digitation may be the cause of the
fi
rm
attachment between enamel and dentin
I.B.2. DENTIN

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2. HISTOLOGICAL CONSIDERATIONS:
• The DEJ is a hyper-mineralized zone in relation to
dentin while it is hypo-mineralized in relation to
enamel
• This constitutes one of the explanations, why there is
a rapid lateral spread of the caries at the DEJ after
penetrating the enamel
• So, the routine cavity depth should be extended
beyond the DEJ specially that the caries follows the
direction of dentinal tubules in dentin with the base
at DEJ
I.B.2. DENTIN

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Lateral spread of caries at DEJ A) Occlusal caries, B) Cervical caries, C) Proximal caries
A B C I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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Lateral spread of caries at DEJ
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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2. HISTOLOGICAL CONSIDERATIONS:
• The permeability of dentin has been well
characterized, as a result of
fl
uid diffusion through
the D.Ts.
• The molecular weight of any material used on
dentin should be larger than the diameter of the
dentinal tubules to be considered as a
biocompatible material
• Dentin is able to repair as it is a vital structure with
its forming cells (odontoblasts) constitutes a cell rich
zone of the pulp
• Based on this information, a last affected layer of
dentin by acute caries could be left and lined by a
material that could initiate reparative dentin
deposition could be performed in cases with deep
carious lesion
I.B.2. DENTIN

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Lateral spread of caries at DEJ
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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I.B.2. DENTIN
DENTIN
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS

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3. CHEMICAL CONSIDERATIONS:
• Human dentin is approximately 70%-75% inorganic
materials, 20% organic materials and 5%-10% water
by weight percent
• 50% inorganic structures, 25% organic structures
and 25% water by volume percent
• Dentin is less mineralized than enamel but more
mineralized than bone and cementum
• The mineral contents of dentin increase by age
I.B.2. DENTIN

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Weight percent of dentin composition
Water
25%
Organic
25%
Inorganic
50%
Water
10%
Organic
20%
Inorganic
70%
Volume percent of dentin composition
I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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I.B.2. DENTIN
DENTIN
1. PHYSICAL CONSIDERATIONS
2. HISTOLOGICAL CONSIDERATIONS
3. CHEMICAL CONSIDERATIONS
3. MECHANICAL CONSIDERATIONS

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4. MECHANICAL CONSIDERATIONS:
• Hardness of dentin is 68 KHN, which is 5 times
lower than that of enamel
• Special precaution should be considered during
cutting in dentin in order to not easily expose the
pulp tissues
• So, cutting in dentin should be in lateral direction in
shallow cavities or parallel to the recessional lines of
the pulp when the caries is deeply extended
• Cutting in a pulpal direction should be avoided
I.B.2. DENTIN

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I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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I . B . H I S T O L O G I C A L
TOOTH STRUCTURES
2. DENTIN

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4. MECHANICAL CONSIDERATIONS:
• Vital dentin is considered as visco-elastic resilient
material that provides support to the overlying
brittle enamel
• This visco-elasticity also provides gripping action of
dentin that adds retention to condensable directly
constructed restorations
I.B.2. DENTIN

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CO N C LU S I O N S
- Dentin is darker than enamel ► ► Could be distinguished from enamel during
cavity preparation by its color
- Dentin is a sensitive structure with the most sensitive area at DEJ ► ► Avoid
cutting at the DEJ and the cavity depth should be extended beyond the DEJ
- Dentinal tubules increase in number and diameter in a pulpal direction ► ►
Avoid unnecessary cutting or increasing the depth as it leads to more irritation
to the pulp

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CO N C LU S I O N S
- DEJ is less mineralized than enamel, so it shows more lateral spread of caries ►
► The cavity depth should be extended beyond the DEJ to ensure involvement of
the area of maximum lateral spread of caries (DEJ) within the prepared cavity
- Dentin is permeable through the dentinal tubules ► ► The molecular weight of
the restorative material should be larger than the diameter of the dentinal
tubules to be considered as a biocompatible material
- Dentin is able to repair ► ► The last layer of only affected not infected dentin
could be left and lined with a material that induces reparative dentin formation

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CO N C LU S I O N S
- Dentin is 5 times less hard than enamel ► ► Cutting in dentin should be done in
lateral direction and parallel to the recessional lines of the pulp and cutting in a
pulpal direction should be avoided
- Vital dentin is visco-elastic ► ► Provides support to the overlying brittle enamel
and gripping action that adds retention

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I.A. INTRODUCTION
I.B. HISTOLOGICAL TOOTH STRUCTURE
I.B.1. ENAMEL
I.B.2. DENTIN
I.B.3. PULP
I. T O O T H
H I S T O L O G Y

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• The dental pulp is a typical connective tissue in
nature, but it differs from any human body
connective tissue in that:
1. It is totally surrounded by hard tissues of dentin
wall that does not allow tissue expansion,
reducing the pulp ability to tolerate edema
2. The lack of collateral circulation is a factor
limiting the pulp capacity for healing
3. It is the only organ that can produce reparative
dentin as a reparative or defensive mechanism
that leads to more narrowing of the pulp space
I.B.3. PULP

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• So, dental pulp is a highly specialized connective
tissue that needs special precautions when
performing a restorative treatment to avoid
irreversible damage of the pulp
• These precautions include:
1. The depth of prepared cavity
2. The heat generated with rotary instruments
3. The pressure applied with different hand
instruments
4. Removing of deep soft carious dentin in a
direction parallel to the recessional lines of the
pulp
5. The chemical make up of the different restorative
materials should be considered to avoid pulpal
irritation
I.B.3. PULP

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PART II: TOOTH PHYSIOLOGY

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II.A. PHYSIOLOGICAL TOOTH FORMS
II.A.1. PROXIMAL CONTACT
II.A.2. BUCCAL & LINGUAL CONTOURS
II.A.3. OCCLUSAL ANATOMY
II.T O O T H
PHYSIOLOGY

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DEFINITION:
• It is the height of contour of the proximal tooth
surfaces and touches the adjacent tooth
SIZE:
• When tooth erupts, its proximal surfaces initially
contact each other in a point, and this point
becomes area as it increases in size due to frictional
wear
• Posterior teeth contact each other in area about 1.5 -
2 mm, while the anterior teeth contact each other in
marble point
77
II.A. PROXIMAL CONTACT

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II.A. PHYSIOLOGICAL
TOOTH FORMS
1. PROXIMAL CONTACT
Proximal contact points that have progressed to
p rox i m a l c o n t a c t a rea s . A , M a x i l l a r y
teeth. B, Mandibular teeth. Facial and lingual
embrasures are indicated
Proximal contact areas. Black lines show positions of
contact

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LOCATION:
• For anterior teeth the contact point is located at the
incisal 1/3 of proximal surface and slightly labial
• In posterior teeth it is located at the area of
junction between middle, occlusal and buccal 1/3 of
the proximal surface
79
II.A. PROXIMAL CONTACT

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IMPORTANCE:
1. Protection of gingival and periodontal tissues
against irritation by directing the de
fl
ected food
buccally and lingually without retention or
impaction
This will decrease the chance for caries recurrence
and periodontal diseases
2. It prevents disruption of anterior components of
force, which is important for the growth of jaws and
production of normal occlusion
3. Proper contact and embrasures allow easy
maintenance of good oral hygiene by increasing the
accessibility for arti
fi
cial cleansing mechanisms
4. Essential feature for esthetic
5. Stabilization of arch integrity
6. Transmission of stresses along the whole arch
80
II.A. PROXIMAL CONTACT

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LOCATION:
• Embrasures are the V-shaped spaces that originate
at the proximal contact area between adjacent teeth
that allow escape of food from the occlusal surface
81
II.A. PROXIMAL CONTACT

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II.A. PHYSIOLOGICAL
TOOTH FORMS
1. PROXIMAL CONTACT
Embrasures

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FAULTY RESTORATION OF PROXIMAL CONTACT:
1. At a higher level may lead to increased stresses on
the restoration with subsequent marginal or isthmus
fracture
2. At a lower level will lead to neglecting of the
gingival embrasure with subsequent stagnation of
the food and recurrent caries
3. Open contact will lead to gingival trauma, food
stagnation and recurrent caries in addition to
altered esthetics in case of anterior teeth
restorations
4. Tight contact will lead to periodontal affection with
subsequent tooth mobility
83
II.A. PROXIMAL CONTACT

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II.A. PHYSIOLOGICAL
TOOTH FORMS
1. PROXIMAL CONTACT
E m b r a s u re f o r m . w , I m p ro p e r
embrasure form caused by over-
contouring of restoration resulting in
unhealthy gingiva from lack of
stimulation. x, Good embrasure form. y,
Frictional wear of contact area has
resulted in decrease of embrasure
dimension. z, When the embrasure form
is good, supporting tissues receive
adequate stimulation from foods during
mastication.

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II.A. PHYSIOLOGICAL
TOOTH FORMS
1. PROXIMAL CONTACT
Embrasure form. x, portion of the the
tooth that offers protection to
supporting tissue during mastication. y,
Restoration fails to establish adequate
contour for good embrasure form.

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II.T O O T H
PHYSIOLOGY
II.A. PHYSIOLOGICAL TOOTH FORMS
II.A.1. PROXIMAL CONTACT
II.A.2. BUCCAL & LINGUAL CONTOURS
II.A.3. OCCLUSAL ANATOMY

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II.B. BUCCAL & LINGUAL CONTOURS
LOCATION:
• For anterior teeth, the correct height of contour is
in the gingival 1/3 of both labial and lingual or
palatal surfaces, but at more incisal level in palatal
rather than labial
• For posterior teeth, the correct height of contour is
in the gingival 1/3 of the buccal surfaces and on the
middle 1/3 of the lingual or palatal surfaces

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II.B. BUCCAL & LINGUAL CONTOURS
IMPORTANCE:
• The normal location of the height of contour will
guide the de
fl
ected food during mastication in a
direction parallel to the gum tissues and this will
serve to:
1. Massage the gingival tissues
2. Stimulate circulation of gingival tissues
3. Clean the tooth surface

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FAULTY RESTORATION OF BUCCAL & LINGUAL
CONTOURS:
1. Flat surface or too low height of contour will direct
the food during mastication to impinge onto the
gingival margins leading to gingival and
periodontal affection
2. Too convex surface or too high height of contour
deprives the gingival tissues from normal
massaging action of de
fl
ected food. Also, a
decreased cleansing action with increased
susceptibility to caries and periodontal problems
will result
89
II.B. BUCCAL & LINGUAL CONTOURS

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II.A. PHYSIOLOGICAL
TOOTH FORMS
2. BUCCAL & LINGUAL CONTOURS
Contours. Arrows show pathways of food passing over facial surface of mandibular molar during mastication.
A, Over-contour de
fl
ects food from gingiva and results in under-stimulation of supporting tissues. B, Under-
contour of tooth may result in irritation of soft tissue. C, Correct contour permits adequate stimulation and
protection of supporting tissue

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II.T O O T H
PHYSIOLOGY
II.A. PHYSIOLOGICAL TOOTH FORMS
II.A.1. PROXIMAL CONTACT
II.A.2. BUCCAL & LINGUAL CONTOURS
II.A.3. OCCLUSAL ANATOMY

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II.C. OCCLUSAL ANATOMY
IMPORTANCE:
• The teeth are normally provided with various
anatomic markings on their occlusal surfaces to
serve many functions including:
1. Mastication of food
2. Stabilization of the jaws in their different
positions
3. Maintenance of inter-arch relationship

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II.A. PHYSIOLOGICAL
TOOTH FORMS
3. OCCLUSAL ANATOMY
A, Typical pattern of occlusal contacts when tripodization is utilized
B, Each centric cusp contacting an opposing fossa has three reciprocating contact areas

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II.A. PHYSIOLOGICAL
TOOTH FORMS
3. OCCLUSAL ANATOMY
A, Typical pattern of occlusal contacts when the areas from cusp tip to
fl
at surface are utilized
D, Each centric cusp tip has a contact that opposes a
fl
at surface

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II.C. OCCLUSAL ANATOMY
FAULTY RESTORATION OF OCCLUSAL ANATOMY:
1. Restoration with supra occlusion (premature
contact) will add extra force on the restored tooth
that will affect the periodontal support of the
restored tooth. Fracture of restoration may also
result if the extra stresses applied on the restoration
exceed its strength limits
2. While restoration with infra occlusion will result in
improper mastication and increase the liability of
food stagnation with subsequent recurrent caries

96. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 96
• The greatness of GOD creativity in the tooth structure and forms should be considered
respectfully during designing a cavity preparation and restoration
T A K E H O M E
M E S S A G E
RESPECT THE TOOTH
STRUCTURE & FORM

97. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 97
S U G G E S T E D
R E A D I N G S

98. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 98
Your questions are welcomed

99. O P E R AT I V E C O N S I D E R AT I O N S O F T O O T H H I S T O L O GY & P H Y S I O L O GY - C o p y r i g h t © 2 0 2 2 , A l W A S I F I , Y. A . 99
Yasser Alwasifi
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