The maxillary molars are the largest teeth in the maxillary arch. Their crown is usually shorter occlusogingivally than the crowns of the teeth anterior to them, but it is much larger in all other measurements. Normally, the first molar is the largest in size, and the second and third molars are progressively smaller.
B. Features of maxillary molars which aid in differentiating them from other permanent teeth, particularly mandibular molars, include:
1. Crowns which are wider buccolingually than mesiodistally. Mandibular molars are wider in the mesiodistal dimension.
2. The presence of four cusps in most specimens, of which the size of the two lingual cusps differs greatly. Some mandibular molars display four cusps, but the two lingual cusps are approximately equal in size.
3. The presence of an oblique ridge and a distolingual groove on the occlusal surface. No comparable structures are found on the mandibular molars.
4. Crowns which are rhomboidal or heart-shaped from the occlusal aspect. Mandibular molars exhibit a rectangular or pentagonal outline from this aspect.
5. Crowns which are trapezoidal in outline from the mesial or distal aspect. Mandibular molars are rhomboidal and inclined to the lingual in a proximal view.
6. The presence of three root branches in most cases. Mandibular molars normally exhibit two roots.
C. Permanent Maxillary First Molar:
1. General characteristics:
a. Arch position - The permanent maxillary first molar is the sixth tooth from the midline in each maxillary quadrant. It has a mesial contact with the second deciduous molar, until that tooth is exfoliated. The mesial contact is then shared with the permanent second premolar when it erupts at about age 12. There is no distal contact until the permanent second molar erupts sometime around the age of 12. Permanent molars do not replace deciduous teeth, hence are not succedaneous.
b. Universal number: Maxillary right first molar - #3 Maxillary left first molar - #14
c. General form and function - The maxillary first molar is the largest tooth in the maxillary arch, and in fact, has the largest crown in the mouth. It is much more complex than the maxillary premolars in both crown and root form. Of all the maxillary molars, the first molar is the least variable in anatomic form, and is thus the standard to which the other maxillary molars are compared.
The crown is wider buccolingually than mesiodistally. It is shorter occlusogingivally than the maxillary premolars, the only dimension in which it is less. All four vertical crown surfaces exhibit a trapezoidal outline. The occlusal aspect is similarly foursided, but in a unique, rhomboidal configuration.
Normally, there are three roots, two buccally located, and one lingually placed.
As with all the molars, the main masticatory function is grinding.
2. Development Table: (Maxillary First Molar)*
Initiation of calcification at birth
Completion of enamel 3 to 4 years
Eruption 6 to 7 years
Completion of root 9 to 10 years
3. Buccal aspect:
a. General considerations - From the buccal aspect, the general shape of the tooth is trapezoidal, with the longer parallel side at the occlusal. The buccal surface is much larger than that of the premolars, despite the fact that the occlusogingival dimension is slightly less. Because of the rhomboidal crown form, a portion of the distal surface is visible from this aspect. Also visible are the tips of all the major cusps, except the distolingual.
b. Mesial outline - The mesial outline is flat from the cervical margin occlusally to the contact area, which is the height of contour, and is located at the junction of the occlusal and middle thirds. Occlusally from the contact area, the mesial margin is convex, and joins the occlusal margin in a slightly rounded, but well defined mesio-occlusal angle.
c. Distal outline - The entire distal outline is convex occlusogingivally, with the height of contour associated with the contact area in the middle third. The disto-occlusal angle is more rounded than the mesio-occlusal angle.
d. Cervical outline - The cervical line is slightly and irregularly curved apically with much less curvature than is found in anterior teeth or premolars. However, there may be a sharp dip, or point, in this margin, just occlusal to the furcation area.
e. Occlusal outline - The occlusal margin is divided into two parts by the concavity of the buccal groove. These two portions outline the two buccal cusps, the mesiobuccal cusp and the distobuccal cusp. The outline of the
M rfiesiobuccal cusp is wider, but the distobuccal cusp tip is sharper. The two buccal cusps are approximately the same height, and the mesiolingual cusp tip is visible between them.
f. Other considerations - In the occlusal portion of the buccal surface, the buccal groove occupies a shallow occlusogingival concavity, which extends apically about halfway to the cervical margin. There it most often fades out, but it may end in a buccal pit, or terminate by splitting into two slanting grooves, which extend a short distance before fading out. The buccal ridges of the two buccal cusps are convex areas on the buccal surface which extend cervically about half its length. They lie on either side of the occlusocervical concavity containing the buccal groove.
In a limited number of specimens, a buccogingival (buccocervicaP ridge is found. It is a convexity which extends horizontally, from mesial to distal, in the entire cervical third of the buccal surface, but is most prominent in the mesial portion.
There may be a shallow concavity which extends mesiodistally in the middle third of the surface. When present, it is located just cervical to the buccal ridges, and includes the termination area of the buccal groove. The height of contour of the buccal surface is located in the cervical third. 4, Lingual aspect:
a. General considerations - The lingual surface is about as wide mesiodistally as the buccal surface, and it is also trapezoidal. The lingual surface shows a more general convexity occlusogingivally than does the buccal surface.
b. Mesial outline - The mesial outline is similar to the buccal aspect.
D c. Distal outline - The distal margin is also similar to the buccal aspect, except it is shorter and the disto-occlusal angle is more rounded, since the DL cusp is much smaller than the DB cusp.
d. Cervical outline - The CEJ is slightly and irregularly convex toward the apex.
e. Occlusal margin - As on the buccal surface, a groove (the distolingual groove) separates the occlusal margin into two unequal portions. The mesiolingual cusp outline is much longer and larger, but blunter than the outline of the distolingual cusp. In fact, the mesiolingual cusp is normally the largest and longest cusp on this tooth.
f. Other considerations - The distolingual groove originates on the occlusal surface, and crosses onto the lingual surface distal to the midpoint of
D the occlusal outline. After slanting mesially and cervically, it normally terminates in a lingual pit but may simply fade out. The termination is at a point which is approximately the middle of the lingual surface.
The lingual ridges of the two lingual cusps lie mesial and distal to the concavity containing the distolingual groove. The lingual ridge of the mesiolingual cusp is much the larger and bulkier of the two.
Arising from the lingual portion of the mesiolingual cusp is a tubercle or minicusp that is known as the cusp of Carabelli. A groove normally separates the cusp of Carabelli from the mesiolingual cusp, and is appropriately named the cusp of Carabelli groove. The prominence of the cusp of Carabelli and its accompanying groove varies greatly from tooth to tooth, but most specimens show at least a trace of the trait.
The height of contour is located in the middle third of the lingual surface. 5. Mesial aspect:
a. General considerations - The mesial surface exhibits a roughly trapezoidal shape that is wider at the cervical than at the occlusal, which is the reverse of the buccal and lingual surfaces.
b. Buccal margin - Beginning at the cervical line, the buccal outline is convex in the cervical third, especially so if there is a buccogingival ridge. Then it is flat to slightly concave for a short distance in the middle third. From this point to the cusp tip, the outline is straight, or slightly convex. The height of contour is in the gingival third.
c. Lingual margin - The lingual outline is convex throughout its length, but may be irregular if the cusp of Carabelli is prominent. The height of contour is located in the middle third.
d. Cervical margin - The cervical line is shallow, and irregularly curved toward the occlusal.
e. Occlusal margin - The only cusps which are visible are the two mesial cusps. The outline of the mesial marginal ridge curves irregularly toward the cervical line. There is normally a mesial marginal groove notching the marginal ridge outline about midway along its length.
f. Other considerations - The mesial surface is wider at the cervical than at the occlusal, due to the general convergence of both the buccal and lingual surfaces toward the occlusal.
The contact area varies from round to somewhat ovoid, and is situated slightly to the buccal, at the junction of the occlusal and middle thirds. The occlusal half of the surface is convex, but there is usually a buccolingual flattening, or even a slight concavity, located cervical to the contact area.
a. General considerations - The distal resembles the mesial surface, but with slightly lessened dimensions. The trapezoidal outline is not as pronounced either, because on the distal surface the cervical width is more nearly equal to the occlusal width.
b. Buccal, lingual, and cervical outlines - All of these outlines are similar to their description for the mesial aspect.
c. Occlusal outline - The mesial cusp tips are visible projecting beyond the outline of the distal cusps. The distal marginal ridge is less prominent and dips farther cervically than on the mesial, thus allowing more of the occlusal surface to be seen. There is usually a distal marginal groove situated about midway along its extent.
d. Cervical outline - The cervical line reveals very little curvature occlusally, and may approach a straight line in some specimens.
e. Other considerations - Because of the crown's rhomboidal shape, much of the buccal surface can be seen from the distal.
The distal contact area is larger than the mesial contact area, and irregularly long buccolingually, and narrow occlusogingivally. It is located in the middle third, about midway between the buccal and lingual margins.
There may be a slight flattening or concavity in the cervical third, but when present it is never as pronounced as on the mesial. Occlusal aspect:
a. General form - From the occlusal aspect, this tooth has a novel rhomboidal form. This shape creates mesiobuccal and distolingual line angles which are acute, and mesiolingual and distobuccal line angles that arejib-^ tuse. The outline is wider buccolingually than mesiodistally, although these dimensions are more nearly equal than in any of the other maxillary posterior teeth.
b. Mesial and distal outlines - The mesial and distal marginal grooves divide these outlines approximately in half.
c. Buccal margin - The facial outline is divided into two parts by the buccal groove, and the mesial portion is longer than the distal portion.
d. Lingual margin - The lingual margin is also divided into two convex portions by the distolingual groove, and the mesial portion is longer and less convex than the distal portion.
e. Boundaries - The occlusal table is bounded mesially and distally by the marginal ridges, and on the buccal and lingual by the mesial and distal cusp ridges of the four major cusps.
Components of the Occlusal Table:
a. Cusps - There are four major cusps and one minor, sometimes indistinct cusp, which is the cusp of Carabelli.
i. Mesiobuccal cusp - It is quite sharp, and the second largest in size. Its four cusp ridges are named according to the direction they extend from the cusp tip similar to those of other posterior teeth. They are described anatomically as follows:
Buccal cusp ridge - The buccal cusp ridge extends from the cusp tip about halfway toward the cervical margin on the buccal surface.
Lingual cusp ridge - It extends lingually from the cusp tip to the mesial portion of the central groove, where it meets the buccal cusp ridge of the
ML cusp to form a transverse ridge. It is also known as the triangular ridge of the MB cusp.
Mesial cusp ridge - The mesial cusp ridge extends from the cusp tip mesially to the mesiobucco-occlusal point angle.
Distal cusp ridge - It extends from the cusp tip distally to the buccal groove.
Inclined planes - The MB cusp has four inclined planes. The two that are functional are associated with the lingual ridge of the cusp, and are named the mesiolingual and distolingual inclined planes.
ii. Distobuccal cusp - The DB cusp is the sharpest and third largest of M the four major cusps. The cusp ridges and inclined planes are named similarly to those of the MB cusp and only the two lingual inclined planes are functional. Its lingual cusp ridge or triangular ridge forms the buccal portion of the oblique ridge of the tooth.
iii. Mesiolingual cusp - The ML cusp is the largest cusp, but its tip is rounded and blunt. The cusp ridges are similar to those of the other cusps, except the distal cusp ridge. It extends from the ML cusp tip in a distobuccal direction, where it meets the lingual cusp ridge of the DB cusp to form an oblique ridge. The distal cusp ridge is the fifth triangular ridge on the occlusal table, and is thus the only triangular ridge which is not a buccal or lingual cusp ridge. In addition, the buccal cusp ridge forms the lingual portion of the transverse ridge. All four of the ML cusp's inclined planes are functional.
iv. Distolingual cusp - The DL cusp is the smallest and most variable of the four major cusps. Its four cusp ridges and four functional inclined planes are similar to those of other posterior teeth although the buccal cusp ridge extends mesiobucally and the distal cusp ridge extends distobuccally.
v. Cusp of Carabelli - The cusp of Carabelli has been previously discussed.
b. Transverse ridge - The buccal cusp ridge of the mesiolingual cusp and lingual cusp ridge of the mesiobuccal cusp form a transverse ridge.
c. Oblique ridge - An oblique ridge is created by the union of the distal cusp ridge of the mesiolingual cusp and the lingual cusp ridge of the distobuccal cusp.
d. Marginal ridges - The two marginal ridges are named mesial and distal marginal ridges like those of other posterior teeth. They enclose the occlusal surface at these two margins. The mesial marginal ridge is longer and more prominent.
e. Fossae - There are four fossae, and they are named as follows:
i. Central fossa - The central fossa is roughly triangular in shape, and located mesial to the oblique ridge and distal to the transverse ridge in the central portion of the occlusal table. It is bounded by the mesial cusp ridge of the DB cusp, the distal cusp ridge of the MB cusp, the oblique ridge, and the transverse ridge. The central fossa is the largest and deepest of the four fossae.
ii. Distal fossa - The distal fossa is more or less linear in shape, and located directly distal and parallel to the oblique ridge. It is continuous with the distal triangular fossa in its distobuccal portion, and is otherwise bounded by the oblique ridge on the mesial, and the mesial and distal cusp ridges of the DL cusp on the distal.
iii. Mesial triangular fossa - This fossa is triangular in shape, and is located just distal to the mesial marginal ridge. It is bounded by the mesial marginal ridge, the transverse ridge, and the mesial cusp ridges of the MB and ML cusps.
iv. Distal triangular fossa - This fossa is also triangular in shape, and is located just mesial to the distal marginal ridge. It is continuous with the distal fossa in its mesial portion, and is bounded on the distal by the distal marginal ridge.
. Pits and Grooves:
i. Central pit - The central pit is located in the deepest portion of the central fossa at about the center of the occlusal surface. This pit is the junction of two primary developmental grooves:
Buccal groove - The buccal groove extends from the central pit in a buccal direction until it passes onto the buccal surface.
Central groove - The central groove extends in a mesiodistal direction connecting the mesial and distal pits. It is composed of a mesial portion which extends mesially from the central pit to the mesial pit, and a distal portion which passes distolingually from the central pit, where it crosses the oblique ridge, to the distal pit.
ii. Mesial pit - The mesial pit is located halfway buccolingually, and just distal to the mesial marginal ridge in the deepest portion of the mesial triangular fossa. It is the junction of four primary developmental grooves.
Central groove (mesial portion) - This groove has been previously described.
Mesiobuccal triangular groove - This groove extends a short distance from the pit toward the mesiobuccal line angle where it fades out.
Mesiolingual triangular groove - This groove extends from the pit toward the mesiolingual line angle a short distance where it fades out.
Mesial marginal groove - It extends mesially over the marginal ridge onto the mesial surface.
iii. Distal pit - The distal pit is located midway buccolingually, and just mesial to the distal marginal ridge. Because the distal pit is located in the area where the distal fossa and distal triangular fossa are confluent, it is a component of both of them. It is the junction of five primary developmental grooves:
Central groove (Distal portion) - This groove has been previously described.
Distolingual groove - The DL groove extends obliquely onto the lingual surface, paralleling the oblique ridge to its distal. Distobuccal triangular groove - This groove extends a short distance from the distal pit toward the distobuccal line angle, where it fades out.
Distolingual triangular groove - It extends a short distance from the distal pit toward the distolingual line angle, where it fades out.
Distal marginal groove - The distal marginal groove extends distally from the distal marginal ridge onto the distal surface.
a. The root trunk trifurcates into three well developed root branches, which are named by their location. The two buccal roots are termed mesiobuccal and distobuccal roots, while the one root at the lingual is termed simply, the lingual root.
i. Lingual root - This root is the largest, longest, and strongest of the three roots. It inclines mostly in a lingual direction from the trifurca-tion. It is wider mesiodistally than buccolingually, a feature which is unique to this root. From the buccal aspect, it is visible between the two buccal roots, and the apex is normally located almost directly under the buccal groove.
ii. Mesiobuccal root - The MB root is the second largest and longest of the roots. It inclines mesially and buccally to the apical third, where it curves distally. It is thicker buccolingually, than mesiodistally, and it has a somewhat blunted apex.
iii. Distobuccal root - The DB root is the smallest, shortest, and weakest branch. It inclines distally and buccally to the apical third, where it curves mesially. It is a little thicker buccolingually than mesiodistally, and tapers to a fairly sharp apex.
iv. Mid root section - In cross section at the midroot level, the root outlines of all three branches are roughly ovoid. The two buccal roots are wider buccolingually, while the lingual root is wider mesiodistally. The lingual root outline is generally the largest, followed closely by the MB root outline, while the outline of the DB root is the smallest.
Variations and anomalies:
a. For the most part, crown variations are slight. However, the cusp of Carabelli varies greatly in prominence, and is well defined in something less than half the first molars. Even though there may not be much of a cusp, there is usually at least a trace of the cusp of Carabelli groove in almost all specimens, unless attrition has obliterated it.
b. A sharp projection of enamel into the bifurcation area on the facial surface is a variation found in 17% of the maxillary molars, according to one study. This feature affects the curvature of the cervical line, and may be a factor in periodontal disease in this area.
c. The mulberry molar, which is the posterior counterpart of Hutchinson's incisor, due to the similar etiology of congenital syphilis, is occasionally. found. The cusps of the mulberry molar are more centrally located than in the normal molar, and the occlusal enamel appears gnarled.
d. Root variations are most often manifest in partial fusion of the root branches, especially of the buccal roots, and by abnormal lengths and curvatures.
e. As with other maxillary posterior teeth, root branches of the first molar may penetrate the maxillary sinus.
D. Permanent Maxillary Second Molar: 1. General characteristics:
a. Arch position - The maxillary second molar is the seventh tooth and second molar from the midline, in each upper quadrant of the permanent dentition. It has a mesial contact with the permanent first molar, and a distal contact with the permanent third molar, if and when that tooth erupts. It is not a succedaneous tooth.
b. Universal number:
Maxillary right second molar - #2 Maxillary left second molar - #15
c. General form and function - The crown is similar in form to the maxillary first molar, but is generally smaller, especially in the distolingual area. The buccolingual dimension of the second molar is about the same, but mesiodistally it is noticeably narrower. It is also shorter occlusogingivally. The roots, however, are as long as those of the first molar. Its grinding function supplements that of the other molars. Development Table: (Maxillary Second Molar)*
Initiation of calcification 2 1/2 to 3 years
Completion of enamel 7 to 8 years
Eruption 12 to 13 years
Completion of root 14 to 16 years
This tooth so closely resembles the first molar, only differences will be described. Buccal aspect:
a. The crown is narrower both occlusogingivally and mesiodistally.
b. The buccal groove is located farther to the distal, resulting in a relatively larger mesiobuccal cusp, and a distobuccal cusp which is relatively sharper, but is smaller both in size and height.
c. Due to the diminished size of the distobuccal cusp, portions of the distal marginal ridge and distolingual cusp may be visible from the buccal aspect on some specimens. Lingual aspect:
a. The distolingual cusp is much smaller in all dimensions than in the first molar. This feature allows much of the distobuccal cusp to be seen from the lingual. Occasionally, the distolingual cusp is entirely missing.
b. There is no cusp of Carabelli.
c. The distolingual groove does not extend so far mesially or cervically, thus terminating at a point which is occlusal and distal to the center of the lingual surface. On occasional specimens, the groove does not even extend onto the lingual surface.
a. Occlusogingival crown length is less, but the buccolingual dimension is about the same as in the first molar.
b. The contact area is larger, because it is shared with a molar instead of a premolar. It is irregular, although somewhat ovoid, and wider buccolingually.
c. The cervical flattening or concavity seen on the first molar is never as pronounced, and is most often absent.
a. Due to the shorter and smaller distobuccal and distolingual cusps, more of the mesiobuccal and mesiolingual cusps is visible.
b. The cervical flattening or concavity is not normally present.
a. The crown is about the same width buccolingually, but is narrower mesiodistally which is at the expense of the distal structures.
b. There are two major types of crown form.
i. Rhomboidal - The rhomboidal type looks much like the first molar, except the rhomboidal outline is more accentuated. This is the most common form.
ii. Heart-shaped - This type is similar to a typical third molar, with a very small distolingual cusp, and short distolingual groove. Sometimes the DL cusp is completely absent, and the distolingual groove is confined to the occlusal surface.
c. Cusps, grooves, pits, etc. - With the exceptions previously noted, they are similar to, and named like those of the first molar. There are often more secondary grooves on the occlusal table of this tooth, however.
a. Root numbers and contours are similar to those of the first molar, and total root length may be equal to, or even greater, than in the first molar.
b. The two buccal roots are about the same length as each other, closer together, and more nearly parallel than in the first molar. They also exhibit more distal inclination, and there is a greater chance of their fusion.
c. The lingual root does not flare so much as in the first molar. Variations and anomalies:
a. The heart-shaped occlusal form is the most common crown variation, and in this situation it is not unusual for the DL cusp to be absent.
b. Occasionally, a tubercle is found on the buccal surface.
c. The two buccal roots are sometimes fused together. Deflections and root curvatures are occasionally severe.
E. Permanent Maxillary Third Molar:
1. General characteristics:
a. Arch position - The upper third molar is located eighth and last from the midline in each maxillary quadrant of the permanent dentition. This tooth has a mesial contact with the permanent second molar, and no distal contact. It is not a succedaneous tooth.
b. Universal number: Maxillary right third molar - #1 Maxillary left third molar - #16
c. General form and function - The crown of the third molar is generally smaller in all dimensions than the second molar, and it exhibits more rounding.
This is normally the smallest molar in the mouth, and the most variable tooth in the maxillary arch. The most common occlusal form is similar to the heart-shaped second molar.
The roots are normally shorter than those of the second molar, and are often partially, or fully fused.
Its function complements the other molars in grinding.
2. Development Table: (Maxillary Third Molar)*
Initiation of calcification 7 to 9 years
Completion of enamel 12 to 16 years
Eruption 17 to 21 years
Completion of root 18 to 25 years
3. Crown form:
a. When compared to the second molar, the crown is smaller in all dimensions, especially occlusocervically and mesiodistally.
b. This tooth varies so greatly that it is difficult to describe a standard, or typical third molar. Nevertheless, the heart-shaped form is the most common. The distolingual cusp is greatly diminished in size, or is absent, leaving only three functional cusps, and in many cases no distolingual groove. The groove pattern is variable, and often reveals many supplemental grooves.
c. Despite the variability in crown form, maxillary third molar specimens are almost always wider buccolingually than mesiodistally.
a. Like crown form, root numbers and morphology are extremely variable. Root dimensions are normally the smallest of any maxillary molar.
b. The most common root type, usually in conjunction with the heart-shaped crown form, is three roots, which are often partially or wholly fused together.
5. Variations and Anomalies:
a. This tooth exhibits the most divergence in crown and root form of any maxillary tooth.
b. The crown varies in size from a simple, and tiny one cusp form, which is often devoid of grooves and pits, and is known as a peg third molar, to a large crown with numerous cusps, or tubercles, and an excessive number of randomly placed pits and grooves.
c. The number of root branches may vary from one, to as many as seven or eight. Root length and curvatures are also quite discrepant, and deflections at odd angles are common.
d. Third molars of both arches are often congenitallv missing or impacted.
e. Supernumerary teeth - Although rare, supernumerary (extra) teeth are sometimes found just distal to the third molar area. When present, they are usually impacted.
OCCLUSAL (Heart Shaped)
I. Reading Assignment:
Unit # 8 (The Permanent Mandibular Molars)
II. Specific Objectives:
At the completion of this unit, the student will be able to:
A. List the appropriate age(s) concerning developmental chronology of the mandibular molars found in the development tables, or select the appropriate age(s) from a list, when given a certain developmental feature. The student should also be able to compare these ages among the mandibular molars.
B. Demonstrate a knowledge of the morphology of each surface of the crown, as well as the root, of each permanent mandibular molar by:
2. selecting the correct information from a list,
3. or interpreting a diagram to identify or name any of the following features:
a. Contours of any surface, or margin of any surface.
b. Structural entities such as grooves, pits, ridges, inclined planes, cusps, fossae, lobes, etc.
c. Height of contour and contact areas.
d. Relative dimensions and shape.
e. Any other surface feature.
Furthermore, the student will be able to make comparisons of any of the above features between mandibular molars.
C. Make comparisons between permanent mandibular molars and other permanent teeth, where appropriate, by selecting the correct response from a list.
D. Make comparisons of the general characteristics of the mandibular molars, including function, arch position, distinguishing features, etc., by describing them, or selecting the correct response from a list, when given the tooth (teeth), or a description of the general characteristic(s).
E. Determine from a diagram or description whether a given permanent mandibular molar is first, second, or third, or right or left.
F. Determine the correct universal number or Palmer notation for a given diagram or description of any permanent mandibular molar.
G. Demonstrate a knowledge of any of the new terms in this unit, by defining them, or selecting the correct definition, or application thereof, from a list, when given the term, or any of its applications.
H. Demonstrate a knowledge of any of the variations or anomalies in this unit by describing them, or selecting the correct response from a list, when given the particular tooth (teeth), the anomaly, or any of its features or applications.
The student is also responsible for any material which was to have been mastered in previous units.
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