CONTACTS AND CONTOURS
By A . H u bert F ee ,* B.A., D.D .S., Richmond, V a.
IN T R O D U C T IO N
N. JO H N S O N 1 once sa id :
The two terms, contact point and
* interproximal space, should be an
open book to any practitioner of dentistry.
. . . Nature has done her best in the way of
making an anatomic arrangement to avoid
trouble. . . . It remains for the dentist to as­
sist Nature by copying as best he may the
arrangement thus provided, when he attempts
to make fillings on the proximal surfaces.
N E C E S S I T Y F O R C O N S ID E R A T IO N
W h y has it been necessary for Dr.
Johnson, as well as m any other writers on
operative dentistry, to admonish us as to
the need for proper treatment o f the
proximal contours and their contact
points? Prime2 suggested that there are
only twenty occlusal, but sixty proximal,
surfaces in a full complement o f teeth.
Ferrier,3 surveying restorations made by
a gold foil study club, found that 41.47
per cent o f 12,000 fillings were o f the
proximal type. D a y and Sedwick,4 in a
survey of 11,058 teeth having 7,754 cavi­
ties, found that 28.5 per cent were on
proximal surfaces. These and other tabu­
lations show that nearly one-third of all
cavities which operative dentists are
called upon to restore are o f the proximal
type.
Prime,5 in his great story “ Is O pera­
tive Dentistry Failing?” challenged oper­
ative dentists to put forth their best
effort and take advantage of their knowl­
edge and ability. Aiguier6 states:
*Assistant professor of operative dentistry,
M edical College of Virginia.
R ead before the Section on Operative D en­
tistry at the Eighty-First Annual Session of the
American Dental Association, Milwaukee,
Wis., July 20, 1939.
Jour. A .D .A ., Vol. 27, July 1940
Predisposing factors to periodontoclasia are
fillings instead of restorations. . . . Any over­
hang will eventually cause destruction of sup­
porting tissues. . . . Often times, the inter­
proximal contact is neglected. This may
permit the packing of food into the inter­
proximal space, with its known result.
Spalding7 asserts :
The prevention of gingivitis may in some
instances consist of so simple a procedure as
the conscientious finishing of borders of plas­
tic fillings; the prevention of food impac­
tion; providing proper contact and contour
for restorations; etc.. . .
Salvas8 has found that pocket form a­
tion is most frequently found in the in­
terproximal spaces on the lingual surfaces
o f the teeth, especially o f the molar and
bicuspid teeth. (Figs. 1 and 2.)
These conclusions indicate that opera­
tive dentists have a responsibility to meet
in order to avoid continued criticism
from their specializing colleagues, as well
as from some of their own group. Some
need pay only a little more attention to
the application of their knowledge and
technic, while others must review funda­
mentals and catch up on the results of
modern research. W e have only to rec­
ognize the causes of our failures to realize
that these are the fundamentals upon
which our practices are built.
E A R L Y TREATM EN T
“ Contacts and contours” — location,
susceptibility to dental decay, treatment
and rôle in preventive dentistry— have
been considered in theory and practice
for centuries. As far back as 455 A . D.,
Aetius recorded his procedure of filing
contact points to eliminate proximal ca­
ries and separating the teeth to prevent
1035
1036 T h e J ournal of th e A m erica n D e n ta l A sso c ia tio n
its recurrence. Such a technic was prob­
ably justified when little was known o f
the basic sciences and technics o f han­
dling dental materials. T h e filing o f con­
tact points was practiced through the
centuries, with some rather futile at­
tempts to restore proxim al cavities with
tin and gold foils. In the middle of the
nineteenth century, dentists o f this coun­
try went to extremes and over-contoured
their fillings. In 1871, the eminent den­
tist Robert Arthur9 revolted against this
practice and attempted to discourage it in
his book “ Treatm ent and Prevention of
D ecay o f the Tooth.” H e advocated “ . . .
a new method of filing the contacts and
proximal contours to perm anently sep­
arate the teeth.” Although D r. Arthur
lost his cause, he succeeded in awakening
Fig. i.— Localized pocket formation from
overhanging margins.
the dental profession to the necessity of
treating contacts and contours in a more
scientific manner.
From that time, we have gradually
progressed in knowledge and skill by us­
ing the findings of our own and asso­
ciated research workers.
W e have been unfortunate in that little
has been written concerning the charac­
teristics o f contacts and contours as ap­
plied to operative dentistry. O u r authors
were satisfied with stressing the impor­
tance o f properly restoring tooth surfaces,
with the result that little mention was
made o f anatomic characteristics. Still-
son10 and Schwartz11 m ade some stan­
dardizations o f those areas and attempted
to indicate, in general, the positions of
contact points. T h ey have shown trends
and consistency in the shape o f inter­
proximal spaces, in proximal contours
and in resulting embrasures. T h e great­
est bulk o f information on this subject,
however, comes from research workers in
the fields o f physics, embryology, perio­
dontia, physiology, anatomy, histology,
pathology, nutrition and caries. T h e oper­
ative dentist still needs much information
regarding this subject.
Rabkin12 states :
Genetically, the teeth and jaws retain the
physical and anatomic properties specific to
the individual, and departure from the phys­
ical constancy and physiologic requirements
Fig. 2.— Localized pocket formation from
overhanging margins.
usually leads to alterations of the dental ap­
paratus which is subject to degenerative
changes. The basic features retaining specific
identity of the original type of man are: large
skull, broad and fully rounded dental arches,
deep and heavy mandibles, thick and com­
pact bone, and sturdy masticatory apparatus
with a lesser tendency to dental disease.
The light-weight thin bone, irregular shaped
jaws, distorted arches and teeth are common
features of the contrasting type which yields
to dental complications.
There seems to be little doubt that
civilized races, which eat domesticated
foods, are showing traces of deviations in
their dentitions from the ideal just de­
scribed. Malocclusion, largely through
 F ee— C o n t a c t s a n d C o n t o u r s
tooth irregularity and jaw deformity, is
increasing in this country. Findings in
our Am erican clinics differ considerably
from those m ade by W augh and Price,
whose photographs o f natives clearly
show a trend toward the types o f jaws
and teeth found in primitive man.
(Figs. 3, 4 and 5.)
Stein13 writes: “ Through the loss of
differentiating features, the teeth o f man
are becoming more alike.” H rdlicka14
sa id :
Thus not only each individual jaw and
set of teeth, but each individual tooth and
feature of jaw or tooth, presents its own
problems that call for intelligent apprecia­
tion, and may affect your latitude in dealing
with them. It follows, except in a very gen-
Fig. 3.— Heavy, well-shaped arches of primi­
tive type.
eral way, that the jaws and teeth of any
given subject must, in the practice of den­
tistry, always receive individualized study and
attention.
W illiams15 went further, disproving the
relationship between tooth form and the
shape of the skull. H e classified teeth into
square, ovoid and tapering types.
Point contacts, with their radiating em­
brasures, when formed by the approxi­
mation o f two spheres, are ideal in form
to resist the inroads o f proximal decay.
Here, the contacts are really points, and
the diverging embrasures permit an easy
egress o f food particles, without danger
o f retention of remnants. E arly in life,
the masticatory apparatus begins to
break down from caries and loss o f teeth.
H irschfeld16 has traced eighty abnormali­
ties resulting from the loss of a single
tooth, through caries, and has found that
resultant drifting brings about changes
in contact relationship. Schour17 w rites:
Histologically the physiologic mesial drift
results, clinically, in the abrasion of contacts
with age and occlusal stress. When these
contact points are incorrectly placed, the
anterior component forces tend to rotate that
tooth out of the line of the arch.
Brodie18 says:
Any abnormality in tooth form that throws
into disharmony the relationship that should
Fig. 4.— Heavy, well-shaped arch of primi­
tive type.
normally exist between upper and lower
arches is very apt to cause malocclusion. A
tooth that is too large or too small either by
formation or poor dentistry is in the same
category. A poorly contoured or badly re­
stored filling may liberate forces, which in
turn create disturbances at remote points.
T h e deformities o f nature present one
set o f problem s; the inroads o f caries,
another; poor dentistry, a third. Bos-
sert19 has shown that where the index
o f cusp steepness in molars is less than
50, there is a prevalence o f decay in
36 per cent of the teeth; but where the
index is more than 50, 47 per cent o f the
1038 T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
teeth become carious. Doxtater20 asso­
ciated the occlusal cavity with the ap-
proximal one in the following statem ent:
If we have any susceptibility to approximal
caries it will be exaggerated in a mouth
where there are leaking occlusal fillings, and
the approximal caries will be more damaging
when associated with caries burrowing down
into the tooth from the leaking occlusal fill­
ing.”
Beust21 found th a t:
Interproximal caries in enamel begins, in
practically all cases, at the actual point of
contact of a tooth with its neighbor. . . . The
presence of an acid-secreting plaque or
colony at this point is environmentally and
mechanically impossible.
Fig. 5.— Heavy, well-shaped arch of primi­
tive type.
Bodecker22 proposes that teeth have a
variable resistance to attack. His supposi­
tions are based on finding 179 carious
lesions affecting only one of two contact­
ing teeth in 516 cases examined. M iller23
has w ritten :
Enamel of different persons, as well as the
different teeth of the same person, and differ­
ent parts of the same tooth, does show dif­
ferences in resistance to acid.
Although H rdlicka and others have dis­
sociated tooth form from that of the skull
and the dental arches, there seem to be
characteristics common to the three dif­
ferent types of teeth. W here there m ay
be great differences in the length and
breadth o f crowns and in labial, buccal
and lingual contours, it will be found that
teeth of each type have certain character­
istics in the shape o f the proximal sur­
faces and location o f contact points,
which are common to most teeth of that
type.
p h y s ic a l c h a r a c te r is tic s
T h e following descriptions are a cor­
relation o f previous studies with m y own
observations of approxim ately 12,000 pa­
tients during the past five years. In this
discussion, one should recall K loehn’s24
findings:
There is a definite relationship between
occlusal stress and tooth form . . . the human
dentition is the only one with continuous arch
form and full mutual contact.
ta p e r in g t y p e
Contacts o f m axillary central and lat­
eral incisors are nearly at the incisal
angles, and slightly labially of the incisal
edge. T h e cuspids are very angular in all
directions, with the mesial contacts close
to the incisal edges, and the distal con­
tacts near the center of the distal sur­
face. T h e tapering type o f bicuspids are
likewise angular, with wide crowns, nar­
row necks and long cusps. The latter
may form from one-third to one-half
the entire height o f the crown. As these
crowns taper lingually, the contacts are
forced buccally almost to the buccal line
angles. Since nearly all contact points
are approxim ately 1 mm. toward the
gingival line from the crest of the
marginal ridge, the bicuspid contacts of
this type o f tooth will be found just gin-
givally from the junction of the occlusal
and middle thirds o f the crown. Mesial
contacts o f the molars are almost out on
the mesiobuccal line angles, and from
one-third to one-half the distance from
the occlusal surface to the cervix. The
distal contacts shift lingually into the
middle thirds and are m idway o f the
 F ee — C o n t a c t s an d C o n t o u r s
height o f the crown. Lingual shifting of
the contacts is more noticeable in the
m andibular than in the m axillary mo­
lars. No definite position can be set for
the mesial contact o f the mandibular
second molar and the distal contact of
the approxim ating first molar owing to
the fact that the third buccal cusp of the
first molar presents many variations in
contour and position.
T h e proximal contours o f the tapering
type o f teeth have one feature in com­
mon. Starting at the cervix, these sur­
faces present concavities almost to the
contact points, and are decidedly convex
from there on to the crest of the marginal
ridges. These concavities are more pro­
nounced on the mesial than on the distal
Fig. 6.— Diagrammatic tapering teeth, showing locations of contact points and shapes of
embrasures.
surfaces, the latter often being diverging
planes. Buccolingual concavities occur
frequently on the mesial surfaces of teeth
having buccal and lingual roots.
T h e tapering type o f tooth presents
embrasures with greater variations in
shape than do any o f the other types.
Incisal and labial embrasures are almost
negligible. Gingival embrasures between
the anterior teeth are very high and wide
at the crest, while the lingual embrasures
are almost the full depth of the labio-
lingual diameter of the crowns, and as
wide as the distance from the center of
one tooth to the center o f its approxi-
1039
m ating one. These gingival and lingual
embrasures are the largest ones to be
found anywhere in the mouth. The buc­
cal embrasures are very small. Occlusal
embrasures are com paratively wide and
deep. Gingival embrasures are broad and
a little lower than those associated with
the other types of teeth. T h e lingual
embrasures are very long buccolingually,
but diverge somewhat more than those
found between teeth of the square type.
(Fig. 6.)
SQ U A R E T Y P E
T h e square type of tooth is bulky and
angular, with little in the way of rounded
contours. As the necks o f these crowns
are constricted very little, their proximal
surfaces are almost devoid of curves.
T h e incisor contacts are in a line with
the incisal edges and extend almost to
the incisal angles. These teeth are fre­
quently in contact with their neighbors
along a line instead of a point, which
varies from 0.5 to 3 mm. Cuspid con­
tacts are relatively close to the incisal
edges and in a line with them labio-
lingually. T h e posterior contacts are usu­
ally found to be surfaces on the square
type of teeth. As these teeth have rela­
tively short cusps, the occlusal margin of
the posterior contacts will be found in
the occlusal third o f the crown. T h e
1040 T h e J o u r n a l o f t h e A m erican D e n t a l A sso cia tio n
angularity o f the bicuspid and molar
teeth places the buccal margins o f the
contacts well out onto the buccal third.
T h e lingual extension o f the contacts of
the m axillary molars usually stops in the
middle third, while the gingival exten­
sion is seldom more than 1 mm. in height.
M esial contacts are nearer the buccal line
angles than the distal ones. M esial con­
tacts o f the mandibular molars m ay
measure from 1 to 4 mm. buccolingually
and from a mere line to h a lf the height
o f the crown occlusogingivally. T h ey
originate in the buccoclusal sector. The
distal contacts originate more in a lingual
direction. I f they are points, they will be
found at the midline of the crown in the
occlusal third. I f they are surfaces, they
Fig. 7.— Diagrammatic square teeth, showing locations of contact points and shapes of em­
brasures.
m ay occupy from one-third to two-thirds
of the buccolingual diameter, and extend
from the lower border o f the marginal
ridge to the cervix.
T h e incisal, labial, occlusal and buccal
embrasures are almost nil. T h e gingival
embrasures m ay be barely noticeable or
m ay extend about one-third the height of
the crown, and, when present, they are
very narrow and flat. T h e lingual em­
brasures m ay be long or short in their
lingual extensions and are found to nar­
row to mere slits as they approach the
contacts.
Proximal contours o f the square type
o f teeth have the tendency to become
planes instead o f curved surfaces. Bucco-
lingual concavities are found at times on
the mesial surfaces o f the m axillary first
bicuspid and first and second molars, and
on the mesial surface o f the mandibular
first molar. T h e distal surfaces are gen­
erally either flat or slightly convex from
the buccal to the lingual surfaces. The
convexity, which goes to make up the
marginal ridges, disappears at the con­
tact, and the remainder of the surface
in a gingival direction is usually rather
flat. (Fig. 7.)
O V O ID T Y P E
The ovoid type o f tooth seems to be
a transitional one, between the tapering
and the square types. Its surfaces are
principally convex, but some are concave.
T h e mesial contacts o f the incisors are
situated about one-fourth the height of
the crown from the incisal edge, and
slightly lingually from that edge. T h e
distal contacts of the incisors have the
same labiolingual positions, but m ay be
found from one-third to one-half the
height o f the crown from the incisal
edges. W hile ovoid posterior teeth have
com paratively short cusps, it will be
found that the convexity o f the marginal
ridges carries the contact points almost
to the middle o f the crown heights. T h e
 F e e — C o n t a c t s and C o n t o u r s
prominence o f the mesiobuccal cusps,
coupled with the buccolingual convexity,
places the mesial contacts at the junction
o f the buccal and middle thirds o f the
crowns. Buccolingually, the distal con­
tacts are found in a line w ith the central
grooves o f the crowns. There is a ten­
dency in all three types of teeth for the
distal contacts to work in a lingual direc­
tion as one progresses farther back in the
arch.
T h e labial, incisal and buccal embra­
sures situated between ovoid teeth are
larger and more extensive than those
found in corresponding sites in the other
types. Gingival embrasures are relatively
short and broad at their bases. Lingual
Fig. 8.— Diagrammatic ovoid teeth, showing location of contact points and shapes of em­
brasures.
embrasures are likewise comparatively
short and broad.
Proximal contours o f the anterior teeth
are decidedly convex from the incisal
angles to the cervix. Bicuspids o f this
type are frequently bell-shaped, with the
convex surfaces running from the crests
of the m arginal ridges almost to the
cervix, where they merge into slightly
concave surfaces to a pleasing union with
the root. T h e bicuspids are likewise con­
vex from the buccal to the lingual line
angles. T he mesial surfaces o f the molars
present convex areas which are less ex­
tensive than those found on the distal
surfaces. T h e latter are usually convex in
all directions. (Fig. 8.)
r e c o n str u c tio n considerations
Ideal conditions, such as those de­
scribed, are lost to some degree when the
contact points wear down through abra­
sion. T h e total mesiodistal diameter of
all the teeth as measured through the
contacts m ay decrease as much as i cm.
through abrasion. I f this process is more
rapid in one arch or in different parts
o f both arches, malocclusion, with its
m any ramifications, will result. Flattened
contacts, with their narrowed buccal and
lingual embrasures, are ideal sites for
the retention of débris.
W hat is to be done about those worn
contacts ? G. V . Black25 wrote : “ I f we are
to provide for the future health of the
teeth, with worn contacts, we must re­
store those flattened surfaces with points
o f contact.” This assertion might be
somewhat controversial today. Beust’s evi­
dence o f the incidence o f decay at the
contact point indicates the necessity of
restoring the contact to a point o f mini­
mum size.
W hat is to be done about the restora­
tion o f point contacts on those teeth
which have had flat contacts ever since
they assumed their positions in the dental
arches? Roentgenograms show that the
investing tissues have usually accom ­
modated themselves to this condition. Bo-
decker states:
The crowns of teeth of old people are
1042 T h e J ournal of th e
relatively immune to caries. . . . Roots are
frequently denuded due to lack of contour
and flat contacts with proximal root caries
developing. Food impaction is the external
cause forcing the gingiva from the tooth cer­
vix.
These findings seem to indicate the
restoration o f such teeth with point con­
tacts. W here the flattening of contacts
has forced the interseptal tissues in a
buccal and lingual direction, there to be
Fig. 9.— Extreme contact and occlusal abra­
sion.
Fig. io .— Spaced teeth having normal perio­
dontal tissues.
irritated during mastication, these tis­
sues have been found by clinical exami­
nation to be restored to normal color
and consistency when the contact point
has been rebuilt. (Fig. 9.)
Frequently, one tooth will drift into the
proxim al cavity o f its neighbor from 1 to
A m er ic a n D e n t a l A sso c ia tio n
3 mm., the distance depending on the
depth o f the cavity. These teeth can be
returned to their correct functional posi­
tions, and a good cavity preparation can
be m ade only after the teeth have been
moved by slow separation or by means
o f an orthodontic appliance.
Fig. 11.— a, normal proximal contour of
mesioclusodistal inlay, b, contacts dropped
gingivally and contours convex, c, deficient
contacts and straight proximal contours, d,
protruding gingival margins that irritate tis­
sues.
Fig. 12.— First molar having fair contour;
second molar, poor contour.
W hen spaces normally exist between
the teeth, and the investing tissues are
clinically and roentgenographically nor­
mal, the best one can do is to restore a
carious tooth to the contours which are
 Fee— C o n t a c ts
normal for that individual tooth. Nature
seems to have a w ay of caring for some
o f these malformations more capably
than the dentist can. Stuart26 offered an
explanation for this when he sa id : “ M e­
chanical oral movements and the flow
o f saliva, together with expectoration and
Fig. 13.— Esthetic values destroyed by in­
correctly contouring proximal fillings in an­
terior teeth.
Fig. 14.— a, result of failure to use wedge
to confine amalgam at gingival aspect, b,
wedge protruded into cavity, c, deficient con­
tours from adapting matrix too tightly, d, mar­
ginal ridge and contact at same site.
swallowing, are means o f cleansing the
oral cavity.” T he self-cleansing agencies
and C ontours
of the mouth can function best when the
contacts, proximal contours and gingival
tissues are in a normal condition. (Fig.
10.)
r e s t o r a t io n o f c o n t a c t a n d c o n t o u r
GOLD IN L A Y S
A n accurate w ax pattern will restore
Fig. 15.— Variations in amount of inter-
septal space occupied by filling material (max­
illary bicuspids).
Fig. 16.— Straight contours and overhanging
filling showing lack of use of gingival wedges
and carving instruments.
all the lost structure so that the tooth
will again have its normal contacts and
contours. Sometimes, it becomes neces­
sary to build up a contact point with
1044 T h e J ournal of th e
solder. Care should be taken to properly
locate such a contact. (Figs. n and 12.)
GO LD F O IL
A properly condensed, contoured and
polished foil is more compatable with
the gingival tissues than any other resto­
ration we can produce. Linen strips, when
used alone to finish the proximal surface
o f a foil filling, will invariably leave a
convex gingival margin. Gold knives and
files are necessary for the correct con­
touring and finishing o f proximal gold
foil fillings. A corresponding tooth in the
opposite side o f the arch serves as an
excellent guide in the restoration o f es­
thetic contours. T h e contours o f line
angles can best be observed by viewing
Fig. 17.— Straight contours and overhanging
filling showing lack of use of gingival wedges
and carving instruments.
the restoration from the incisal aspect
by the use of a mirror. O nce the line
angle contours are established, the proxi­
mal and labial surfaces assume their
shapes very readily. (Fig. 13.)
S ILIC A T E CEM EN TS
Silicious cements tend to wash out of
that portion o f the cavity which extends
beneath the free gum margin. T h ey wear
away rapidly when used to restore con­
tacts, a closure of the contact resulting.
Proximal contours can be established
in silicate restorations when the material
is packed into the cavity in small quan­
A m erica n D e n t a l A sso c ia tio n
tities, and the m atrix is adapted loosely
as a confining measure. Contours are
altered when m atrix pressure is used to
adapt the material to the cavity, as such
a procedure produces a flattened sur­
face between the labial and lingual cav­
ity margins. Silicates can be contoured
and polished reasonably well with lubri­
cated linen strips and fine stones.
AM ALG AM S
Am algam can be manipulated in such
a manner as to eliminate deficient con­
tacts, overhanging margins and im-
Fig. 18.-— Straight contours and overhanging
filling showing lack of use of gingival wedges
and carving instruments.
properly contoured surfaces, by following
any of the accepted technics. Such dif­
ficulties are lessened by using a well-
constructed m atrix and a gingival wedge
in proximal restorations. These appli­
ances can be so m anipulated as to pro­
vide adequate space for the full restora­
tion o f contacts and contours.
In amalgam restorations, carving and
contouring are just as essential as in any
other restorations. Perhaps a psychologist
 F ee — C o n t a c t s an d C o n t o u r s
can answer the following question: W hy
is it that the average general practitioner
of dentistry will spend an hour or more
glazing the tiny tissue-bearing tip of a
bridge pontic and then omit the polishing
of the proximal surface of an amalgam
filling when that surface m ay have
double the tissue-bearing area that the
pontic had? A recent check o f 2,000
proxim al amalgam fillings showed that
only twenty-four gave evidence that their
proximal surfaces had been polished.
(Figs. 14, 15, 16, 17 and 18.)
CO N CLUSIO N
From the foregoing, we can readily
understand w hy operative dentists have
been so severely criticized by their spe­
cializing colleagues. W e have some evi­
dences o f our shortcomings, our incon­
sistency and our inaccuracy in restoring
proximal contacts and contours. Infor­
mation regarding standardization o f the
physical shapes and locations o f contacts,
and o f contours, has been presented in
this paper that we might have some
basis on which to make necessary modi­
fications. M ore information is needed
regarding these vulnerable areas, and
these data can be gathered only by each
one o f us recording his individual find­
ings.
W e have been justly challenged for
our failure to produce the type o f dental
work that we are capable of. W e can
meet this criticism by fully utilizing our
widened knowledge and improved tech­
nics. O perative dentistry must not lag in
the forward m arch o f our profession. We
must take our place in the nation-wide
program of preventive dentistry.
B IB LIO G R A PH Y
1. J o h n s o n , C. N .: Operative Dentistry.
N ew York: National M edical Book Co., 1938.
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