|Year : 2012 | Volume
| Issue : 3 | Page : 192-194
Variation in buccal surface morphology of deciduous first molars
M Simratvir1, G Moghe2, D Singh3, K Dhillon4
1 Department of Pediatric Dentistry, S.K.S.S. Dental College, Sarabha, Ludhiana, India
2 Research associate, Smile Train Project, Hyderabad, India
3 Department of Pediatric Dentistry, ITS Dental College, Greater Noida, India
4 Department of Prosthodontics, S.K.S.S. Dental College, Sarabha, Ludhiana, India
|Date of Web Publication||21-Dec-2012|
60-A, Sargodha Colony, Pakhowal Road, Ludhiana - 141 001., Punjab
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The buccal bulge of the deciduous first molars has always been a restorative challenge to the pediatric dentist. Morphologically it may vary from a slight prominence to a well-developed cusp-like structure. Aim: This study was conducted to determine the variable buccal surface morphology of deciduous first molar and its clinical relevance. Materials and Methods: A prospective study was conducted whereby 2016 patients visiting the outpatient clinic of dental hospital over 1 year were evaluated. Any variation in buccal surface morphology of the deciduous first molars was recorded photographically or by replicating in dental stone. Results: Varied morphological patterns on buccal surface were observed for which a new classification scheme has been proposed. Conclusion: The surface morphology of deciduous teeth crowns must be studied carefully as it may be indicative of pulpal extensions and accessory roots, requiring consideration during restorative treatment planning.
Keywords: Buccal bulge, deciduous first molar, morphology
|How to cite this article:|
Simratvir M, Moghe G, Singh D, Dhillon K. Variation in buccal surface morphology of deciduous first molars. J Indian Soc Pedod Prev Dent 2012;30:192-4
|How to cite this URL:|
Simratvir M, Moghe G, Singh D, Dhillon K. Variation in buccal surface morphology of deciduous first molars. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Nov 20];30:192-4. Available from: http://www.jisppd.com/text.asp?2012/30/3/192/105009
| Introduction|| |
Deciduous first molar is the first multi-cusped multi-rooted tooth that erupts in the oral cavity of the child by the age of 16 months. Variable occlusal anatomy that accounts for deep grooves and fissures, thin enamel overlying the dentin, longer exposure to the oral environment, and limited oral hygiene practices make it one of the most vulnerable teeth to dental caries.
Carious involvement demands early restoration using amalgam, GIC, or stainless steel crowns. However, preparation of tooth for these restorations requires detailed account of anatomy to avoid iatrogenic pulpal exposure and facilitate proper seating of stainless steel crowns.  This study was conducted to study determine the variable buccal surface morphology of deciduous first molar. The paper proposes a classification scheme for the variable buccal bulge morphology of deciduous first molar and its clinical relevance as observed by the author.
| Materials and Methods|| |
A prospective study was conducted whereby 2016 patients visiting the outpatient clinic of dental hospital over 1 year were evaluated. Any variation in buccal surface morphology of the deciduous first molars was recorded photographically or by replicating in dental stone.
| Results|| |
Results revealed variable morphological patterns of deciduous first molars.
Classification scheme for variable buccal bulge morphology of deciduous first molars
Type A : Bulge in smooth continuity with the buccal surface
Type B : Prominent bulge in the cervical third separated from the buccal surface by a well-demarcated groove [Figure 1].
|Figure 1: Intraoral photograph showing prominent bulge in the cervical third separated from the buccal surface by a well‑demarcated groove|
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Type BO : Prominent bulge almost reaching the occlusal table separated from the buccal surface by a well-demarcated groove [Figure 2].
|Figure 2: Study model showing prominent bulge almost reaching the occlusal table separated from the buccal surface by a well‑demarcated groove|
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Type C : Distinct cusp-like structure in the cervical third on the buccal surface [Figure 3].
|Figure 3: Study model showing distinct cusp‑like structure in the cervical third on the buccal surface|
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Type CO : Distinct cusp-like structure almost reaching the occlusal table on the buccal surface [Figure 4].
|Figure 4: Study model showing distinct cusp‑like structure almost reaching the occlusal table on the buccal surface|
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| Discussion|| |
Several classification schemes have been proposed for Carabelli's anomaly like pronounced tubercle, slight tubercle, and groove by Kraus.  Dahlberg has divided it into seven classes ranging from completely smooth, uninvolved surface to a single furrow, a pit, double furrow.  Dietz  has four gradations: Cuspoid, lobular tubercle, ridge, and pit, while Jorgensen  distinguished it as type a, b, c, and furrow, cusp, welt, and pit. However, there is little literature on morphological aberrations in deciduous teeth. ,,
In our study, the Type B morphological pattern was usually observed bilaterally in patients. This might be accounted for by the difference in genetic pattern of individuals, which may be responsible for difference in morphology. The protuberance may be cone/semilunar in shape and is separated on its top from its enamel basis by a groove. It usually does not have a pulpal extension and may occur due to difference in pattern of ameloblast retraction. In cases where this projection is similar to a wrinkle bordered by a semilunar trench and has no groove (because the enamel here has no dentin basis and is therefore only a thin protuberance), such a phenomenon could be called an enamel wrinkle.  These teeth may require excessive reduction before placement of stainless steel crown, which leads to iatrogenic pulpal exposure.
Type C, called by Bolk as tuberculum paramolare in permanent teeth  and referred by Kallay J as tuberculum pulpale, are very well developed cusps standing independently and well separated from buccal surface by a distinctly expressed groove. It cannot always be determined with accuracy that every so-called tuberculum pulpale really has a pulp. X-ray is not always diagnostic. If there is no pulp, -the structure may be better referred to as protuberantio apulpalis. 
When the protuberance almost reaches the occlusal surface, there might be a possibility of formatio supradentalis which might have its own pulpal extension and a separate root.
The formation of these superstructures has been explained by Kallay  as follows:
Thus, Type C morphological pattern with no radiographic evidence of extra root is mostly protuberantio apulpalis which can be reduced without the fear of pulpal exposure, while teeth with Type CO morphological variation which exhibits formatio supradentalis pattern requires endodontic treatment before placement of crowns to facilitate proper reduction.
- Formatio supradentalis : A form that exhibits a cusp on the tooth, termed supernumerary cusp, and includes not only the tuberculum but also a supernumerary root connected with that cusp, both of which have a pulp. The development may be imagined as lateral coalescence of tooth with independent formatio paradentalis.  These elements are a consequence of super production of germinal tissue.
- Protuberantio apulpalis which is the product of tooth itself. It is not the product of dental lamina. It is built either exclusively of enamel or also of dentine, thus reflecting a developmental aberration during morphogenetic stage of tooth development.
| Conclusion|| |
The surface morphology of deciduous teeth crowns must be studied carefully as it may be indicative of pulpal extensions and accessory roots, requiring consideration during restorative treatment planning.
| References|| |
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|10.||Bolk L. Uberzahlige Zahne in der Molargegend des Menschen. Disch Monatsschr Zahnheilk 1914;32:197. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]