Tooth numbering system

TOOTH
NUMBERING
SYSTEM
PRESENTED BY – Dr Jnana Ranjan Swain
1ST year PG trainee
DATE- 25.07.16
2

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

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

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

 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

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

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

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

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

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

Dental Formula For Primary/Deciduous Teeth:
I2/2 C1/1 M2/2 = 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

Dental 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 mandibular
Molars, three maxillary and three mandibular .
Total -16 on one side(right/left)
13

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

WHAT IS TOOTH
NUMBERING
SYSTEM ???
15

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

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

UNIVERSAL 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.
19

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

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

UNIVERSAL SYSTEM FOR PERMANENT TEETH 24

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

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

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

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

 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

 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

 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].
32

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

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

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.
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.
37

FDI 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
38

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

Advantage
 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.
40

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

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

HILLISCHER 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.
43

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

MONS 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
45

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

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

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

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

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
 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
50

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

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

 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
53

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

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.
55

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

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

 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

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

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

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

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

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

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

 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

References
 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

 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

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