Tooth numbering system

Tooth notation system in details

1. 1 GOOD MORNING Institute Of Dental Sciences Dr Jnana Ranjan Swain

2. TOOTH NUMBERING SYSTEM PRESENTED BY – Dr Jnana Ranjan Swain 1 ST year PG trainee DATE- 25.07.16 1 2 3 4 5 9 8 7 4 1 7 5 5 5 3 3 1 9 2

3. CONTENT History Introduction Nomenclature Dental Formula Tooth Numbering Systems References 3

4. HISTORY Several hundred years ago, in Europe, the notation of teeth was based on Latin and German and the names were very lengthy. An example of Latin notation is Mol.II Scup.Sin , the abbreviated form for Molaris Secundus Superior Sinister Later in 1861 Adolf Zsigmondy introduced a new dental coding system by preparing four sets of eight numbers with the Zsigmondy grid used for permanent dentition only. Years later this system was modified and used for the primary dentition . 4

5. The Hillischer system [ Hillischer , 1885] of notation refers to the tooth type, it is more logical but very confusing because of the use of colons and semi colons to distinguish primary and permanent teeth . The change found in the Mons Dubois system [How, 1890] is the use of even numbers and odd numbers, which represent the right and left quadrant respectively. The universal numbering system [ Parreidt , 1882; Cunningham, 1883] is the official tooth designation system in the USA, adopted by the American Dental Association since 1975. 5

6. The Woelfel system is similar to the universal numbering system . The Victor Haderup system [ Haderup , 1891] is similar to the Zsigmondy-Palmer’s notation . The Frykolhm and Lysell system [ Frykholm and Lysell , 1962 ] The MICAP Notation [ Akram et al., 2011] is a recently developed system The Federation Dentaire Internationale (FDI) system [ Viohl , 1966 ]. Novel " Havale’s Alphanumeric dental notation" system for primary teeth. 6

7. INTRODUCTION Teeth are arranged in the jaws forming two dental arches : Maxillary Arch(Upper Arch) Mandibular Arch(Lower Arch) Two arches together constitute the dentition 7

8. Each arch divided by an imaginary midline into : A right and left half called – QUADRANTS Maxillary right/left quadrants Mandibular right/left quadrants RIGHT LEFT 8

9. Humans have two sets of teeth in their lifetime Deciduous teeth- 20 Permanent teeth- 32 9

10. NOMENCLATURE AND DENTAL FORMULA Denomination and number of all mammalian teeth expressed by a formula called dental formula Each tooth represented by initial letter of its name : Eg : Incisor- I Canine- C Premolar- P Molar - M 10

11. Each letter followed by a horizontal line and the number of each type of tooth is placed : Above the line for maxilla or upper jaw below the line for mandible or lower jaw The formulae include one side only, with the number of teeth in each jaw being the same for humans. 11

12. Dental Formula For Primary/Deciduous Teeth : I 2/2 C 1/1 M 2/2 = 10 Incisors, two maxillary and two mandibular Canine, one maxillary and one mandibular Molars, two maxillary and two mandibular. Totally 10 on one side (right/left) 12

13. Dental Formula For Permanent Teeth I 2/2 C 1/1 P 2/2 M 3/3 = 16 Incisors, two maxillary and two mandibular Canine, one maxillary and one mandibular Premolars, two maxillary and two mandibular Molars, three maxillary and three mandibular . Total -16 on one side(right/left) 13

14. ANTHROPOLOGICAL STUDY In anthropological studies anthropologist use: di1, di2, dc, dm1, dm2 – deciduous dentition I1, I2, C, P1, P2, M1, M2, M3 – permanent dentition 14

15. WHAT IS TOOTH NUMBERING SYSTEM ??? 15

16. WHY DO WE NEED ?? System used by dentists to associate information to a specific tooth. In clinical practice some “ shorthand ” system of tooth notation is necessary for recording data. To do so efficiently, it is necessary to adopt a type of code or numbering system for teeth. 16

17. There are several numbering systems exists in the world and THREE MAIN types of numbering systems are commonly used Universal Tooth Numbering System Zsigmondy And Palmar Tooth Numbering System FDI Tooth Numbering System 17

18. UNIVERSAL TOOTH NUMBERING SYSTEM 18

19. UNIVERSAL NUMBERING SYSTEM The universal numbering system [ Parreidt , 1882; Cunningham, 1883] is the official tooth designation system in the USA . A dopted by the American Dental Association since 1975. It includes a sequence of Arabic numbers (1-32) for Permanent and the alphabet system (A-T) for Deciduous teeth, moving clockwise around the dentition . 19

20. Alternate system for Primary Dentition upper right upper left 1d 2d 3d 4d 5d 6d 7d 8d 9d 10d 20d 19d 18d 17d 16d 15d 14d 13d 12d 11d lower right lower left 20

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22. As specific numbers are employed for each tooth, it reduces the risk of mistakes. Data can also be easily entered in the computer, but there is no anatomic reference in this system and matching the specific teeth and quadrants can be confusing . So it is difficult to follow for beginners, and needs extra training to practice. It is easy to communicate. 22

23. UNIVERSAL SYSTEM FOR DECIDUOUS TEETH A – Maxillary right second molar J – Maxillary left second molar K – Mandibular left second molar T – Mandibular right second molar 23

24. UNIVERSAL SYSTEM FOR PERMANENT TEETH 24

25. In this system, the teeth that should be there are numbered. If the wisdom teeth is missing Missing , then first number will be 2 instead of 1, acknowledging the missing tooth . If the teeth had Removed or teeth are missing, the missing teeth will be numbered as well . 25

26. Advantages Separate number/ alphabet is given for individual tooth. Easy to visualize. 26

27. Disadvantages Confusing when comparing with palmar notation system. Cannot be coded by computer. Confusing and difficult to remember. It does not consider the jaw quadrant clearly, thus similar teeth are given various numerous in different quadrant. 27

28. ZSIGMONDY / PALMAR TOOTH NUMBERING SYSTEM 28

29. ZSIGMONDY AND PALMAR NOTATION In 1947 a committee at the American Dental Association(ADA) recommended the symbolic (Zsigmondy/Palmar ) system as the numbering method of choice. originally called the Zsigmondy system by an Austrian dentist Adolf Zsigmondy who developed the idea in 1861 The Zsigmondy-Palmer system [ Zsigmondy , 1861; Palmer , 1891] , called “eight numerical quadrant system” (1 through 8) , is meant for permanent dentition only . 29

30. Initially it was not designed for primary teeth, but in 1874 it was adopted for the primary dentition . This is one of the oldest and most widely used systems of dental notation . This method used by orthodontists, dental students and practitioners in the  United Kingdom . 30

31. The Palmer notation consists of a symbol ( ┘└ ┐┌ ) designating in which quadrant the tooth is found and a number indicating the position from the midline . DECIDUOUS PERMANENT 31

32. Zsigmondy used the “Zsigmondy cross (grid)” to record quadrants of tooth positions, where primary teeth are coded by means of Roman numerals I, II, III, IV, V from the midline to distally . Palmer changed and substituted this by upper case letters A , B, C, D, E But the main disadvantage is that it is difficult to dictate and digital encoding of non numerical symbols, such as crosses or corners and angles (L) , can be a problem . I t requires a special software, a private processing editor (PCE), Microsoft access , and a specific font (palmer type) [Ferguson, 2005] . 32

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34. Advantages System is simple to use . Easier for beginner due to less confusion as permanent teeth and deciduous teeth are indicated differently. 34

35. Disadvantages There is no differentiation between right upper, right lower , left upper and left lower . Segments has only one number and used to designate particular tooth . No provision to identify supernumerary tooth Difficult for verbal transmission 35

36. FDI TOOTH NUMBERING SYSTEM 36

37. FDI TOOTH NUMBERING SYSTEM The Federation Dentaire Internationale (FDI) system. It is a two-digit system. It has been accepted and in 1970 by the FDI and adopted by WHO and International Association for Dental Research . A nd in October 1994 adopted by the International Standard Organization (ISO ) [American Dental Association current policies (A and B), 1994 ]. This dental notation meet all the basic requirements set by a FDI special committee. 37

38. FDI notation for primary teeth T he first digit indicates the quadrant (5 through 8) and the second digit indicates the tooth type (1 through 5 ) . 5 – maxillary right 6 - maxillary left 7 - mandibular left 8 - mandibular right 38

39. FDI notation for permanent tooth The first digit indicates the quadrant (1 through 4) and the second digit indicates the tooth type (1 through 8) 1 - maxillary right 2 – maxillary left 3 – mandibular left 4 – mandibular right 39

40. Advantage It is very simple, accurate, and is easy to memorise. I t is user friendly, and prevents errors in differentiating left and right, upper and lower arches, and tooth type. Simple to teach and easy to understand. Simple to translate into computer input. Simple in conversation and direction. Readily communicable in print. 40

41. Disadvantage In the case of deciduous teeth, there can be confusion and it is difficult to memorise. For specialists other than pedodontists , it can be difficult to understand or to define teeth. For example of 64, 85……. It is the combined use of the Palmer and the FDI systems may be accurate and creates no confusion, but it is time consuming, needs much concentration. It is difficult to enter multiple teeth in different arches and it would be too long to use routinely. 41

42. Other tooth numbering systems HILLISCHER TOOTH NUMBERING SYSTEM MONS DUBIOS SYSTEM VICTOR HEDERUP SYSTEM WOELFEL SYSTEM FRYKOLHM AND LYSELL SYSTEM MICAP Notation HAVALE’S ALPHANUMERIC DENTAL NOTATION 42

43. HILLISCHER SYSTEM The Hillischer system [ Hillischer,1885 ] of notation refers to the tooth type, it is more logical but VERY CONFUSING . B ecause of the use of colons and semi colons to distinguish primary and permanent teeth . It requires keen observation to differentiate the right side and the left side, drawing horizontal lines above the number and below the number which represents upper teeth and lower teeth respectively . 43

44. 7 :, 6:, 3:, 2:, ,1 : : 1, :2, :3, :4, :5 , 7 :, 6:, 3:, 2:, ,1 : :1, :2, :3, :4, :5 , THIS SYSTEM ONLY DESIGNED FOR DECIDUOUS AND MIXED DENTITION Therefore , it is more cumbersome and difficult to communicate, write and type, and requires much concentration and patience. It is confusing using the same teeth numbers 6 and 7 in primary as well as in permanent teeth in a mixed dentition Stage. 44

45. MONS DUBOIS SYSTEM T he Mons Dubois system [How, 1890] is the use of even numbers and odd numbers , It Represents The Even Number For Right Side And Odd Number For Left Side. However, it creates confusion regarding the use of horizontal lines in the lower arch and not in upper one. M oreover , the use of decimals requires concentration and time to dictate, write, type .10 .8 .6 .4 .2 .1 .3 .5 .7 .9 45

46. VICTOR HEDERUP SYSTEM The Victor Haderup system [ Haderup , 1891] is similar to the Zsigmondy-Palmer’s notation . Here for Primary Dentition, Zero Is Added (Prefix) To The Left Side Of The Numerals. The upper and lower quadrants are denoted with plus (+) and minus (-) signs, respectively . For the right and left quadrants “+” or “–” sign placed on the right side for the right quadrant “+” or “–” sign placed on the left side for the left quadrant 46

47. For permanent dentition 8+ 7+ 6+ 5+ 4+ 3+ 2+ 1+ +1 +2 +3 +4 +5 +6 +7 +8 8- 7- 6- 5- 4- 3- 2- 1- -1 -2 -3 -4 -5 -6 -7 -8 47

48. Advantages This system is computer friendly. And easy to understand. 48

49. Disadvantages It can be very confusing for recording mixed dentitions. It is very difficult to dictate, so it cannot be used routinely. 49

50. WOELFEL SYSTEM The Woelfel system is similar to the universal numbering system . In this system instead of continuous sequencing of upper case letters to denote primary teeth, suffix upper case letter “D” alone to sequential numerals. There is no anatomic reference in this system I t is difficult to learn and match the specific teeth, there can be confusion of quadrants. It requires much concentration while recording the mixed dentition stage. Upper right Upper left 1D 2D 3D 4D 5D 6D 7D 8D 9D 10D 20D 19D 18D 17D 16D 15D 14D 13D 12D 11D Lower right Lower left 50

51. FRYKOLHM AND LYSELL SYSTEM The Frykolhm and Lysell system [ Frykholm and Lysell , 1962] is a variant of the Palmer notation. The ‘suffix ‘m’ (lower case letter ) is added to the numerals to denote milk teeth . This will not be confusing while recording the mixed dentition 5m, 4m, 3m, 2m, 1m 1m 2m , 3m, 4m, 5m , 5m, 4m, 3m, 2m, 1m 1m 2m, 3m, 4m, 5m , Upper right Upper left Lower right Lower left 51

52. MICAP NOTATION SYSTEM The MICAP Notation [ Akram et al., 2011] is a recently developed system. It denotes the Deciduous Dentition , with the lower case letter ‘d’ always written on the left side, after the sign # , of each ANAASEA letter ( dI , dC , dM . ) The TOT digits (1,2,3) are mentioned on both sides of a particular ANAASEA letter with a superscript (upper corner) and subscript (lower corner) number The right/left and upper/lower corner numbers ( ToT digits) indicate quadrants, tooth type, and arches respectively. 52

53. This system is based on the first letter of each tooth class, M- molar, I – incisor, c – canine and P – premolar termed as ANAASEA letters a nd digits (1,2,3) termed as TOT digits. The letter “d” is written along with the ANAASEA letters used for deciduous class. For permanent dentition the letters used are I C P M And for deciduous dentition letters used are I C M 53

54. Advantages The identification of and communication about human teeth by MICAP system is very simple And this system is error free and user friendly. 54

55. Disadvantages The mid-sagittal line is difficult to enter in the computer without a special software. dictation is time consuming. T he symbols are very difficult to write on paper. I t looks more complicated to understand for a beginner. 55

56. HAVALE’S ALPHANUMERIC DENTAL NOTATION This system is designed only for Deciduous Teeth. Currently great importance is given to preservation of primary teeth for a pleasant smile, in order to preserve the space for the permanent dentition, and also for general health benefits for the child. The novel dental notation for primary dentition is an alphanumeric system . In this system numbers indicate the quadrant , while low case letters designate the tooth type . 56

57. The first digit indicates the quadrant (1 through 4) and the alphabets(lowercase) indicates the tooth type (a through e) 1 - maxillary right 2 – maxillary left 3 – mandibular left 4 – mandibular right 1e 1d 1c 1b 1a 2a 2b 2c 2d 2e 4e 4d 4c 4b 4a 3a 3b 3c 3d 3e 57

58. In mixed dentition stage, this alphanumeric dental notation can be used together with FDI notation . An example of this can be …. 11, 12, 1c, 1d, 1e, 16, 21 2b, 2c, 2d, 2e, 26 . This combination is easy to use. and does not generate confusion regarding quadrant and permanent and primary teeth. It is also early speed of recall, and entering data in a computer is an easy and fast process. It is also compatible with the new proposed Leo Toureno system [ Toureno , 2012] for designation of supernumerary teeth. 58

59. NOTATION OF NUMERICAL ABNORMALITIES BY AN ADDITION TO THE FDI SYSTEM 59

60. FUSED NORMAL TEETH The first digit specifies the quadrant in accordance with the present FDI system . The second digit indicate the mesial tooth that participate in the fusion. And the third digit indicates the distal tooth of the fusion. Example The fusion of each primary mandibular lateral incisor with its adjacent canine …this tooth will be count as 723(left) and 823(right) And for permanent teeth that is 323(left) and 423(right). 60

61. GEMINATED TEETH Gemination is results from the fusion of normal tooth and a supernumerary tooth. This tooth is represented as 9 . The first digit indicates the quadrant . The second and third digit numbered respectively normal tooth participating in gemination and 9. Eg . 129- maxillary right lateral incisor fused with a supernumerary incisor. 61

62. SUPERNUMERARY TEETH Supernumerary tooth are noted by a letter of alphabet . A capital letter is used if the supernumerary tooth is a normal one. A lower case letter is used, if the tooth is abnormal one. 62

63. Supernumerary Tooth Present Outside The Dental Arch( buccally / Lingually ) A V ( a v in case of abnormal supernumerary teeth) is used, if supernumerary tooth present buccally . If more than one tooth present buccally from mesial to distal, then V, E, S, T are used respectively. An L (l) is used for lingual positioning of supernumerary teeth And for more teeth L, I, N, G are used mesiodistal direction Example….for two maxillary left supernumerary molars positioned buccally to the dental arch, then it become 2v8(mesial) and 2e8(distal) 63

64. Supernumerary teeth placed within the dental arch (proximal to a normal tooth or a tooth of reference) The letter P, R, O, X are used . The letter is placed as a third digit , when the super numerary tooth is distal to the tooth of reference. The letter P R O X are used respectively in mesiodistal direction. The appropriate is placed as a first (digit) when the supernumerary tooth is mesial to the tooth of reference. Eg . For maxillary mesiodens ….the tooth named as P11 or P21 and p11 or p21 is used , when the mesiodens is conical shape 64

65. Eg ….for maxillary right hypoplastic molar which is called tooth 18p and for left 28p. If 2 maxillary right hypoplastic molars are present then it called as 18p, 18r . 65

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67. R eferences Akram A, Zaki AB, Razak J, Hock TT . MICAP: novel system for identification and communication of dental problems. Int Dent J 2011;61:31-36. Edwars F. Harris, tooth coding systems in the clinical dental setting 2005;18:43-49. International dental journal 2011;61:31-36. R.Havale , B.S. Sheetal , R. Patil , R.Hermant Kumar, R. T. Anegundi , K. R. Inushekar : Dental Notation For Primary Teeth. Euro J paediatric den2015;16:1-5. 67

68. Hillischer HTh. Hillischer’s Dental Notation. Dent Cosmos 1885; 27(4): 253-255 . Ash M M , Stanley JN. Wheeler’s dental anatomy, physiology, and occlusion. 8th ed. Saunders Elsevier publication, reprint 2005 :1-27. 68