CONTENTS

IN TRO D U CTIO N

O BJE CTIV E S O F TE E TH S E L E CTIO N

CONCEP TS OF TEETH S ELECTION

A N TE RIO R TE E TH S E L E CTIO N

S I Z E

F O R M

S H A D E O R C O L O U R

C O M P O S I T I O N

P O S TE RIO R TE E TH S E L E CTIO N

S I Z E A N D N U M B E R O F T E E T H

F O R M

M AT E R I A L

RE F E RE N CE S.

o“Smile is the most visible record of a dentist care to an edentulous patient”.

oleft to the patient. Dentist should only assists

INTRODUCTION

oTeeth selection :-

1.Anterior teeth selection2.Posterior teeth selection

o Anterior teeth– for aesthetic

function

oPosterior teeth- for masticatory

function.

o six maxillary and mandibular teeth

are considered as anterior teeth.

OBJECTIVES OF TEETH

SELECTION

1. Function efficiently

2. Normal speech

3. Aesthetically pleasing

4. No tissue abuse

5. Should maintain the vertical dimension.

CONCEPTS OF TEETH

SELECTION

1. WHITE’S CONCEPT

2. H.POUND’S CONCEPT

3. DENTOGENIC CONCEPT

4. WINKLER’S CONCEPT

5. LEON WILLIAM’S CONCEPT

The Science of Anterior Teeth Selection for a Completely

Edentulous Patient: A Literature Review J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13

WHITE’S CONCEPT

• 5th century BC concept HIPPOCRATES.

• Temperamental types were (named for the physiologic functions of blood,

nerves(phlegm),yellow bile and

lymph(black bile) of the individual

)

1. Sanguine,

2. Nervous,(phlegmatic)

3. Billious (choleric)

4. Lymphatic(melancholic)

• Artificial teeth patient’s temperament.

• A ‘‘bilious’’

short, broad,

tapering incisor

teeth,

• A sanguineous long, thin,

and narrow teeth

H.POUND’S CONCEPT• Evaluates tooth width by ‘‘measuring the distance from

zygoma to zygoma

• Width of the central incisor=bizygomatic width/16

• Total width of anteriors=bizogymatic width/3.36

• Total width of lower anterior =3/4th width of upper anteriors

• Length of the central incisor=length of the face/16

• Width of upper central incisors=circumference of

head/13 Pound E (1954) Lost fine arts in the fallacy of ridges. J Prosthet

Dent 4:6–16

DENTOGENIC CONCEPT

•AGE, SEX AND PERSONALITY of the patient

• Frush and Fisher 1955.

Frush JP, Fisher DR (1955) Introduction to dentogenic restorations.

J Prosthet dent 5:586–595

WINKLER’S CONCEPT

•This concept emphasises on three points.

1.The biological- physiological,

2.Biomechanical

3.The psychological view- point.

Land LS (1996) Anterior tooth selection and guidelines complete denture esthetics. In: Winkler S (ed) Essentials of

complete denture prosthodontics, 2nd edn. Ishiyaku Euro America Inc., St. Louis, pp 200–216

•BIOLOGICAL-PHYSIOLOGICAL harmony of

the facial musculature and physiological

limit with teeth arrangement.

•BIOMECHANICAL mechanical limitations in

placement of anterior teeth.

• PSYCHOLOGICAL aesthetics and facial

appearance.

LEON WILLIAM’S CONCEPT

• William the law of harmony.

• inverted face form the form of maxillary

central incisor

• Three typal forms of teeth as

1. Square,

2. Tapering

3. Ovoid.

Williams JL (1914) A new classification of natural and

artificial

teeth. Dentists supply Co, New York City

FACTORS FOR

ANTERIOR TEETH

SELECTION

1.SIZE OF THE TEETH

2.FORM OF THE TEETH

3.COLOUR OF THE TEETH

4.COMPOSITION OF MATERIAL OF THE TEETH

SIZE OF THE TEETH

1.PRE EXTRACTION

2.POST EXTRACTION

1. PRE EXTRACTION RECORDS

•PHOTOGRAPHS•RADIOGRAPHS•EXTRACTED TEETH•PREVIOUS DENTURE•PATIENTS RELATIVES

2. POST EXTRACTION• EXTRAORAL FACTORS:-

1. SIZE OF THE FACE

2. THE LIPS

3. MAXILLO MANDIBULAR RELATION

4. NOSE WIDTH

• INTRAORAL FACTORS:-

1. SIZE OF MAXILLARY ARCH

2. INCISIVE PAPILLAE AND CUSPID EMINENCE

3. THE CONTOUR OF THE RESIDUAL RIDGE

4. VERTICAL DISTANCE BETWEEN THE RIDGES

1. SIZE OF THE FACE

• Average width of the maxillary central incisor = 1/16th of the

width of the face measured between

the zygoma.

• Combined width of the six maxillary anterior teeth = slightly less than

1/3rd of the bizygomatic breadth of

the face.

• The face bow bizygomatic width

• The TRUBYTE® TOOTH INDICATOR size

of maxillary central incisors

2. SIZE OF MAXILLARY ARCH

• The mould selectors are used to make measurements of the maxillary cast.

• crest of the incisive papilla hamular

notches,hamular notch opposite side hamular

notch.

• The combined length of the three legs of the

triangle in millimetres is used.

3.PAPILLAE AND CUSPIDEMINENCE

• Canine eminence…

• A flexible ruler is used and the distance between the two canine

eminences at their distal side

through the anterior of the incisive

papilla is measured in millimetres.

• This measurement gives the combined width of the six

anterior teeth.

• Another method with occlusal rim

• The vertical line drawn from this mark coincides with the pupil of

the eye.

• The distance between the marks following the contour is the toal

width of anteriors.

4. MAXILLO MANDIBULAR RELATION

• Any disproportion in size between the maxillary and mandibular arches influences

the length, width and position of the

teeth.

• This is of importance in class ii and

class iii maxillomandibular relations.

5.THE CONTOUR OF THE RESIDUAL RIDGE

• The artificial teeth shouldfollow the

contour of the residual ridges that existed

when natural tooth were present.

• As resorption occurs there is alteration in the contours of the ridge.

6.VERTICAL DISTANCE BETWEEN THE RIDGES

• The length of the teeth is determined by the available

space between the existing

ridges.

• It is advisable to use a

tooth long enough to

eliminate the display of the

denture base.

7. THE LIPS

• Labial surfacesupports the

relaxed lip.

• Incisal edges extends inferior to

or slightly below the lip margin.

• Labial incisal third of the

maxillary anterior teeth

superior border of the lower lip

in speech.

• Incisal edges of maxillary an

teeth junction of the moist and

dry surfaces of the vermilion

border

WIDTH OF NOSE

C L C=L

Boucher and Hoffman et al.referred to the nasal indexwidth of nose =width of anteriors from central to centre of canine

Hoffman W Jr, Bomberg TJ, Hatch RA (1986) Interalar width as

guide in denture tooth selection. J Prosthet Dent 55:219–221

FORM OF TEETH

1. FORM AND CONTOUR

2. PROFILE

3. SEX

4. AGE

5. PERSONALITY

1.FORM AND CONTOUR

• The shape of the artificial tooth

should harmonise with the patient’s

facial form .

• By Leon Williams,

• Not scientifically correct, is

undoubtedly the simplest and the most

useful guide.

• Shape of the upper incisorsthe shape

of the face.

• He classified the form of the human

face into three types: square,

tapering and ovoid forms.

• THE FACIAL FORM IS DETERMINED BY USE OF TRUBYTE INDICATOR

2.FACIAL PROFILE

• THE FACIAL PROFILE IS DETERMINED BY THREE POINTS.

1. THE FOREHEAD,

2. THE BASE OF THE NOSE AND

3. THE PROMINENT POINT OF THE CHIN

• TOOTH FORM CAN ALSO BE SELECTED BASED ON THE ARCH FORM OF THE PATIENT

3.SEX

• Curved facial features are associated with femininity and square features are associated with

masculinity

MASCULINITY FEMININITY

Prominent teeth Smaller teeth

Square arch form Curved contours and arch form

Square labial surface Curved labial surface

Square incisal edges and corners

Round incisal edges and corners

Darker shade Delicate appearance

Flat smile line Curved smile line

Canine- cervical area is more prominent and visible

Canine-mesial 3rd only visible

4. AGE

YOUNGER PEOPLE OLDER PEOPLE

Lighter shade Darker shade

More incisaltranslucency

Less incisal translucency

Minimal wear of incisaledges

Increased wear of incisaledges

Curved smiling line Flat smiling line

Pointed canines Loss of tip of canines

PERSONALITY

• Teeth should be selected according to the patients

personality

• The patients

• vigorous

• delicate.

• More squarish and large teeth vigorous people.

• The anteriors should be in flat plane for executive

people

• For executives teeth should be relatively smaller and

more symmetrical

COLOUR OR SHADE OF

THE TEETH

• The shade of the central incisor is selected from an appropriate shade

guide.

• In choosing this shade, the dentist should consider

1. The age of the patient,

2. The individual complexion pattern

3. The patient’s desires.

4. The colour of hair and eyes

5. Habits of patient

• Colour is described by means of hue, value and chroma.

• Whenever possible it is advisable to record the size form and colour of natural teeth before extracting

them.

• It is because patient have very poor memories of their natural teeth.

• Many patient remember that there teeth where small white and arranged in a straight line.

COMPOSITION OF

MATERIAL OF ANTERIOR

TEETH

•Usually only two types of materials are used 1.Porcelain

2.Acrylic

• HMW resin because of

• Exceptional hardness

• Stable colour.

• Abrasion resistance

• Less retention of plaque

ACRYLIC TEETH PORCELAIN TEETH

Wear is clinically significant

Wear is clinically insignificant

Loss of vertical dimension No significant loss of vertical dimension

Have a soft impact sound Have a sharp impact sound

Easy to grind and alter Difficult to grind and fit into close interarch space

Chemically bonds to the denture base material

Does not bind to denture base material need to create holes or pins

Does not cause abrasion of opposite natural teeth

Causes abrasion of opposite natural or gold teeth

POSTERIOR TOOTH SELECTION

1.SHADE OF POSTERIOR TEETH

2.SIZE AND NUMBER OF POSTERIOR TEETH

3.FORM OF POSTERIOR TEETH

1.SHADE OF POSTERIOR TEETH

• The shade of posterior teeth should harmonize to shade of anterior teeth

• As bulk influences shade of teeth

• So lighter shade for bicuspids if it is used as aesthetic purpose.

• Slightly lighter than posterior teeth but not lighter than anterior teeth.

2.SIZE AND NUMBER OF POSTERIOR TEETH

• The size and number are closely

related to usage

• Buccolingual dimension should be

less than natural teeth

• Anterio posterior dimension is

determined by the edentulous area

between cuspids and the area

slightly anterior to retromolar

area.

• Not necessary to have the same

number of teeth as in natural

dentition.

3. FORM OF POSTERIOR TEETH

• Occlusal form decided on the type of occlusion.

• Types of teeth to be used :-1. Balancing in centric and

eccentric cusp form tooth

2. Disocclude during eccentric jaw

movements cusp or monoplane

teeth

3. Arranged in a plane and balanced

only in centric monoplane is

used

• Advantages of anatomic teeth1.Aesthetically acceptable2.More efficient there by reducing the

forces

3.They can arranged in balance

• Disadvantages of anatomic teeth1.More horizontal forces during function2.Fast bone resorbtion3.Cannot be used in severly resorbed cases

• Advantages of non anatomic teeth1.Comfortable2.Greater range of motion (in

parafunctional jaw habits)

3.Less horizontal and or torqueing forces

4.Can be used in severely resorbed ridges and patients with poor neuro

muscular coordination

• Disadvantages of non anatomic teeth1.They look unnatural2.Less cutting efficiency

4. MATERIAL COMPOSITION OF POSTERIOR TEETH

• Both porcelain and acrylic are used • Upper and lower posterior teeth can be

• Both porcelain

• Both acrylic

• A combination of porcelain and acrylic

teeth on opposing dentures can be

used. It softens the sound, reduces

friction and eliminates chipping

• Acrylic teeth is used in following situations:-

1.Limited interarch distance

2.Maxillary single denture against

natural dentition

3.Maxillary single denture

opposing partial denture

4.Opposing natural teeth with gold

occlusal surfaces.

• Porcelain teeth;-• They have vey good esthetics• High translucency• Does not wear • Long life

• SINGLE MAXILLARY COMPLETE DENTURE:-• TEETH SET USED ARE ACRYLIC TEETH OPPOSING NATURAL

DENTITION

• GOLD TEETH OR INSERTS CAN ALSO BE USED BUT PORCELAIN

IS NEVER USED.

• HIGHLY RESORBED RIDGES:-• MONOPLANE TEETH OR NON ANATOMIC TEETH IS USED

Single maxillary complete denture

Carl F. Driscoll, DMD*, Radi M. Masri, BDS, MS Dent Clin N Am 48 (2004) 567–583

ACRY ROCK TEETH SET

CONCLUSION

“There are two worlds; the world we can

measure with line and ruler, the world that we

can feel with ours hearts and imagination”

Leigh Hunt

REFERENCES

• HEARTWELL CM, ROHN AO (2002) TOOTH SELECTION. IN: TEXTBOOK OF COMPLETE DENTURES, 5TH

ED. BC DECKER, PP 305–319

• FRUSH JP, FISHER RD (1958) THE DYNESTHETIC INTERPRETATION OF DENTOGENIC CONCEPT. J

PROSTHET DEN 8:558–581

• YOUNG HA (1954) SELECTING THE ANTERIOR TOOTH MOULD. J PROSTHET DENT 4:748–760

• THE SCIENCE OF ANTERIOR TEETH SELECTION FOR A COMPLETELY EDENTULOUS PATIENT: A

LITERATURE REVIEW J INDIAN PROSTHODONT SOC (JAN-MAR 2011) 11(1):7–13

• HOFFMAN W JR, BOMBERG TJ, HATCH RA (1986) INTERALAR WIDTH AS GUIDE IN DENTURE TOOTH

SELECTION. J PROSTHET DENT 55:219–221

• ZARB GA, BOLENDER CL, HICKEY JC, CARLSSON GE (1998) SELECTING ARTIFICIAL

TEETH FOR THE EDENTULOUS PATIENT. TEXTBOOK ON BOUCHERS PROSTHODONTIC

TREATMENT FOR THE ELDERLY, 10TH EDN. BI PUBLICATIONS PVT LTD, NEW DELHI, PP

330–351

• SINGLE MAXILLARY COMPLETE DENTURE CARL F. DRISCOLL, DMD*, RADI M. MASRI, BDS,

MS DENT CLIN N AM 48 (2004) 567–583