1

GOOD MORNING

Institute Of Dental SciencesDr Jnana Ranjan Swain

2TOOTH NUMBERING SYSTEM

PRESENTED BY – Dr Jnana Ranjan Swain 1ST year PG trainee DATE- 25.07.16

1

2

3

4

5

9

87 4

1

0

7

5

5 00

5

33

1

9

3 CONTENT

HistoryIntroductionNomenclatureDental FormulaTooth Numbering SystemsReferences

4

HISTORYSeveral 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.

5The 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.

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.

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

8Each arch divided by an imaginary midline into :A right and left half called – QUADRANTS

Maxillary right/left quadrantsMandibular right/left quadrants

RIGHT LEFT

9

Humans have two sets of teeth in their lifetimeDeciduous teeth- 20Permanent teeth- 32

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

11Each 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.

12

Dental Formula For Primary/Deciduous Teeth:

I2/2 C1/1 M2/2 = 10

Incisors, two maxillary and two mandibularCanine, one maxillary and one mandibularMolars, two maxillary and two mandibular.Totally 10 on one side (right/left)

13Dental Formula For Permanent Teeth

I2/2 C1/1 P2/2 M3/3 = 16

Incisors, two maxillary and two mandibular Canine, one maxillary and one mandibular Premolars, two maxillary and two mandibularMolars, three maxillary and three mandibular .

Total -16 on one side(right/left)

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

15

WHAT IS TOOTH NUMBERING SYSTEM ???

16WHY 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.

17There are several numbering systems exists in the worldand THREE MAIN types of numbering systems are

commonly used

Universal Tooth Numbering System

Zsigmondy And Palmar Tooth Numbering System

FDI Tooth Numbering System

18

UNIVERSAL TOOTH NUMBERING SYSTEM

19UNIVERSAL NUMBERING SYSTEM

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.

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.

21

22As 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.

23UNIVERSAL SYSTEM FOR DECIDUOUS TEETH

A – Maxillary right second molar J – Maxillary left second molar

K – Mandibular left second molar T – Mandibular right second molar

24UNIVERSAL SYSTEM FOR PERMANENT TEETH

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.

26

AdvantagesSeparate number/ alphabet is given for individual tooth.

Easy to visualize.

27

DisadvantagesConfusing 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.

28

ZSIGMONDY / PALMAR TOOTH NUMBERING SYSTEM

29ZSIGMONDY 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.

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 .

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

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.

It requires a special software, a private processing editor (PCE), Microsoft access, and a specific font (palmer type) [Ferguson, 2005].

33

34

AdvantagesSystem is simple to use.

Easier for beginner due to less confusion as permanent teeth and deciduous teeth are indicated differently.

35

DisadvantagesThere 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

36

FDI TOOTH NUMBERING SYSTEM

37FDI TOOTH NUMBERING SYSTEMThe 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.

And 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.

38FDI notation for primary teeth The 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

39FDI 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

40Advantage It is very simple, accurate, and is easy to memorise.

It 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.

41Disadvantage 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.

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

43HILLISCHER SYSTEM 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.

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.

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.

45MONS DUBOIS SYSTEM The 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. Moreover, the use of decimals requires concentration and time to

dictate, write, type

.10 .8 .6 .4 .2 .1 .3 .5 .7 .9

46VICTOR 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

47For 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

48

Advantages This system is computer friendly.

And easy to understand.

49

Disadvantages It can be very confusing for recording mixed dentitions.

It is very difficult to dictate, so it cannot be used routinely.

50WOELFEL 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 It 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

51FRYKOLHM 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

52MICAP 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.

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 and 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

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.

55

Disadvantages The mid-sagittal line is difficult to enter in the computer

without a special software.

dictation is time consuming.

The symbols are very difficult to write on paper.

It looks more complicated to understand for a beginner.

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.

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

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.

59

NOTATION OF NUMERICAL ABNORMALITIES BY AN ADDITION TO THE FDI SYSTEM

60FUSED 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).

61GEMINATED 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.

62SUPERNUMERARY 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.

63Supernumerary 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)

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

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 .

66

67References 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.

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.

69

THANK YOU