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Dr. Nitin Sethi 1
Dr. Nitin Sethi 2
Aims & Objective of Teeth Selection & Arrangement -
Masticatory
Efficiency.Esthetic
s. Speech
Preservation of
Alveolar Ridge.
Retention & Stability during
function.
Health & comfort of
TMJ.
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SizeForm ( shape )
ShadeMaterial
Cusp form
Artificial teeth are selected on the basis of
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Anterior Teeth Selection (ATS )
Anterior teeth are selected mainly for esthetic, they are not subjected to heavy occlusal forces. the major criteria for selection of anterior teeth are
- Size- Form - Shade / Color
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Aids & Guides for SizePre extraction records Photographs with teeth showing (at rest or
at smiling). Casts- Can give an idea about size as well
as shape of teeth .Also helps to determine distance from labial frenum to incisal edge.
X-rays. Preserved extracted teeth Teeth of close relatives
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Post extraction – properly mounted casts, previous dentures.
Cuspid eminences When cuspid eminences are visible on cast, a line marking the distal of eminences coincide with distal margin of cuspids.
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Ala of nose – line dropped from the Ala passes through tip of canine. This gives an idea about relative width of 6 maxillary anterior teeth
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BIZYGOMATIC WIDTH
H.Pound’s formula Width of maxillary C.I.=Bizygomatic
width/16
width of 6 maxillary anterior teeth= Bizygomatic width/3.3
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Location of corner of mouth
Location of buccal frenum
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FORM OF ANTERIOR TEETHThe form of artificial anterior teeth
should harmonize with the shape of patient’s face. The form of teeth is selected based upon following criteria-
Patient’s facial formProfileDentogenic concept
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Facial Form Artificial teeth selected should be in harmony
with the form of face of the patient. Teeth that are in harmony with the outline form
of face will look good. According to Leon Williams, facial forms can be
–-square-tapering- ovoid or a combination of the above
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Profile of Face The labial surface of anterior
teeth from mesial should show a contour similar to patient’s face when viewed in profile.
E.g. straight or convex profile
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Labial surface of anterior teeth viewed from incisal should show a convexity or flatness similar to that seen when face is viewed from the top of the head or from below the chin.
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Dentogenic Concept or
SPA Factor Described by Frush & Fisher (1955). Teeth form is determined by sex,
personality and age of the patient.
Sex of patient- the shape of teeth differs in males and females.
-incisal edges are more rounded in females
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Cervical regions are prominent in females than males
Only mesial 1/3 of canine is visible in females from front view while in males, even the middle 2/3 is visible.
Incisal edges of C.I. & L.I. in females follow the curve of lower lip while in males incisal edge of C.I. is parallel to lower lip & laterals are above the occlusal plane
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Age Mandibular anterior teeth become more visible than
maxillary teeth because of reduced tonicity of lips.
Due to decrease in muscle tone, sagging of the cheeks and the lower lips occur. To prevent cheek biting (due to sagging), the horizontal overlap of the posterior teeth can be increased.
Old people usually have abraded teeth with worn out contacts.
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Old patients have gingival recession. More teeth exposed during carving to show Gingival recession.
Old people show a blunt smile line and pathologic migration of teeth.
The colour of the teeth also changes with age.
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Personality of patient The patient can be either vigorous or
delicate. More squarish, large teeth, worn incisal
edges, sharp line angles, darker shade teeth are selected for vigorous people.
For delicate personality, the teeth should be relatively smaller, Pale & Rounded and more symmetrically arranged
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COLOR/SHADE OF TEETH Young people have lighter teeth where the
colour of the pulp is shown through the translucent enamel.
Old people show dark and opaque teeth due to the deposition of secondary dentin
Teeth are more shiny in old people as they get polished due to regular wear of the teeth.
Teeth of older people obtain a brownish tinge because exposed dentin tends to stain.
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HabitsComplexion of faceColour of eyes,hair
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Selecting the Color of Artificial teeth:Observation of shade guide should be done at 3 different positions
1. Outside the mouth along the side of Nose.Establishes the basic hue, brilliance & saturation.
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2. Under the lips with only Incisal edge exposed.Reveals the effect of color of teeth when patient’s mouth is relaxed.
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3. Under the lips with only Cervical end covered & mouth open.Simulates exposure of teeth when smiling.
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Posterior teeth are selected based upon–
Buccolingual width, Mesiodistal length, Occlusogingival height, Shade, Form of the teeth, Material
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Buccolingual width
If the buccolingual width increases, the forces acting on the denture will also increase, leading to increase in the rate of ridge resorption
It should be such that the forces from the tongue neutralize the forces of the cheek.
The buccolingual width of the artificial teeth should be decreased as compared to natural teeth.
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Broader teeth encroach into the tongue space leading to instability of the denture.
the teeth should not encroach into the buccal corridor space to avoid cheek biting
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Mesiodistal length
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Occlusogingival height Determined by the available inter-arch
distance.
The occlusal plane should be located at the midpoint of the interocclusal distance
Altering the thickness of the denture base can also be done to accommodate large teeth.
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Form of posterior teethFactors that govern the form of
posterior teeth are-Condylar inclinationHeight of residual ridgeAgeRidge relationship
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Morphologically teeth can be
classified as: Cusp teeth - Anatomic teeth - Semi-anatomic or modified cusp or
low cusp teeth Cuspless teeth Special forms
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Types of posterior teeth1. An anatomic tooth is one that is designed to
simulate the natural tooth form. The standard anatomic tooth has inclines of approximately 33 degree or more.
2. when the cusp incline is less steep than the conventional anatomic tooth of 33 degree it can be classified as a modified or semianatomic tooth. It can be considered basically anatomic and will articulate in three dimensions.
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. A nonanatomic tooth is essentially flat and has no cusp heights to interdigitate with an opposing tooth and has sulci to enhance its comminuting effect on food.
They articulate in only two dimensions.
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Advantages of anatomic teeth- Closely resembles natural teeth Proper contours for crushing and triturating. Presence of adequate sluiceways. Greater chewing efficiency, excessive
chewing pressure is minimized. More vertical chewing stroke. Cuspal inclines provide a depth to obtain
eccentric balance.
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Disadvantages More difficult and time consuming to
obtain balanced occlusion. Settling results in more damaging
interferences. Possibilities of more lateral stress in
function. Settling will lead to residual ridge
resorption
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INDICATIONS : • When sufficient inter-arch space is available. • Well formed ridges.
• Superior esthetics is required.
CONTRAINDICATIONS : Poor mandibular ridges.
Opposing natural teeth / crowns / bridges are present.
PORCELAIN:
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ADVANTAGES :
Very Esthetic.
Greater wear resistance than acrylic resin teeth.
Maintains Vertical dimension for years.
Maintains masticatory efficiency for years
Better retention of surface polish & finishing.
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DISADVANTAGES :
Bonding to denture base resin is mechanical, by Pins / Channels.
Being Brittle, it is prone to chip / break.
Cannot be used in areas with reduced inter-arch space,as it is difficult to adjust.
Difficult to restore polish after grinding.
Abrades opposing natural teeth or resin teeth.
Produce a noticeable clicking sound when in function.
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Acrylic Resin:ADVANTAGES : Inexpensive & easily available.
Natural appearance & sound.
Easy to do adjustment.
Bonding to denture base resin is Chemical.
Does not wear opposing natural teeth / crowns / bridges.
Softer impact sound.
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INDICATIONS :
• Opposing dentition consists of natural teeth / gold crowns or bridges.
• Reduced inter-arch space – easy to grind & fit the reduced space.
• RPD s – teeth in contact with clasps may require grinding.
DISADVANTAGES :
Less wear resistant – loss of Vertical dimension.
Becomes dull in appearance due to loss of surface lustre with use.
Loss of efficiency with time.
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Artificial teeth with Metal Occlusals:
Excellent wear resistance & durability of Occlusal contours.
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The arrangement of teeth must bePhysiologically And esthetically acceptable.Physiologically, They must be in a positioncompatible with the lips, Tongue, and cheeks whether the mandible is in a Relaxed position or in motion.
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Preservation of Alveolar Ridge.
Esthetics Masticatory Efficiency Retention & Stability during function.
Health & comfort of TMJ.Teeth should be set /placed close to the Position occupied by the natural teeth & compatible to the surrounding musculature.
Aims & Objectives of Teeth Setting
Position of Teeth
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Factors Governing Position of Teeth
Horizontal relation to the ridge.Vertical position of occlusal surfaces
&incisal edges b/w ridges.Esthetic requirement.Inclination for occlusion.
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Horizontal positions Involves placing the teeth
anteroposteriorlyand mediolaterally(1) To provide stability,(2) To direct the forces of mastication toareas most favorable for support, (3) To support the lips and cheeks for
esthetics, (4) To be compatible with the functions
of the surrounding structures.
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Guidelines for horizontal Placement of Anterior Teeth
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Role of incisive papilla & mid palatal suture
It is found in Lingual embrasure b/t Maxi.C.I.
Labial surface of maxillary incisors is approx. 8 to 10 mm anterior to incisive papilla.
A transverse line bisecting the middle of I.P. passes through the tip of canine.
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Cuspid eminences When cuspid eminences are visible on cast,
a line marking the distal of eminences co-incide with distal margin of cuspids.
Relation to residual alveolar ridge
Max. Anterior teeth are placed anterior to residual ridge, depending upon amount of resorption.
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Arch Form And Shape
Square arch – C.I. in line with the canine
Tapering arch – C.I. at a greater distance forward than canine
Ovoid arch - in between
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Esthetics Vermilion border of upper
lip.
Mento-Labial & Naso-Labial groove.
Everted upper lip.
Corner of mouth (no drooping appearance)
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RELATION WITH THE UPPER LIP
If set too far posteriorly
Lip looks unsupported.Vermilion border would not
be visible.If set too far
anteriorlyLip would taut & stretch.Nasolabial fold may fill out.
Incisal two-thirds of labial surface of teeth supports the lips.
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Ridge relationship In normal class I –normal overjet &
overbite. Class III-edge to edge or reverse overjet. Class II- more overjet. But physiological resorption pattern should be taken
into consideration.
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MEDIO- LATERAL POSITION Midline – midline of face
passes between 2 upper & lower central incisors.
Ala of nose – line dropped from the Ala passes through tip of canine.
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Guidelines for vertical Orientation of Anterior Teeth
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Role of upper lip Visibility of upper
anterior teeth Incisal edges are visible
by 1 to 2 mm below the upper lip at rest.
Short or long or incompetent lip influences the amount of teeth visibility.
Some racial types have fuller lips, others have thinner.
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Effect of aging In young pt, Incisal edges are visible by 1 to 2 mm
below the upper lip at rest.
While smiling or during speech,incisal & middle 1/3 are visible in normal person.
With aging, tone of upper lip decreases, lesser amount of maxillary teeth visible and more of mandibular teeth become visible.
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Relationship of lower lip to anterior teeth
Lower canine & Ist premolar should be even with lower lip at the corner of mouth.
If lower teeth are high-Anterior plane of occlusion
may be too high-excessive VDO-Excessive vertical overlap reverse is true if mandibular teeth are
below lower lip at corner of mouth.
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Sounds made by the patient at the time of tryin can never be as accurate as when permanent denture bases resin has been substituted for trial bases & the patient has become accustomed to the dentures.
Speech sounds are not a safe guide to position of teeth. Dentist should watch carefully the relationship of lips & tongue, paying minimal attention to the sounds of speech.
Sounds are made at the lips.Air pressure is build up behind the lips & released with or without a voice sound. Insufficient support of the lips by teeth & denture base causes these sounds to be defective.
Labial sounds : B , P & M
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On pronunciation of labiodental sounds ‘f ’ & ‘v’, vermilion border of lower lip contacts the incisal edges of Max. Incisor teeth.
Labio-Dental sounds : ‘F’ & ‘V’
If Max Anterior teeth are set too short (Set too high), ‘v’ will sound like an ‘ f ’.
If they are set too long (Set too far down), ‘ f ’ will sound like a ‘v’.
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Dental sounds : ‘ th ’
Sounds are made with the tip of tongue extending slightly b/w Upper & Lower teeth.
This , That , These & Those .If about 1/8 inch ( 3mm ) of tip of tongue is not visible, Anterior teeth are probably too far forward OR there may be an excessive vertical overlap that does not allow sufficient space for tongue to protrude b/w Anterior teeth.If more than 1/4 inch ( 6mm ) of tongue extends b/w teeth, teeth are probably too far Lingual.
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Alveolar sounds : S , z , ch & j
‘Sibilant’ sounds are Alveolar sounds, because tongue & alveolus form the controlling valve. Upper & Lower incisors should approach end to end but not touch.
‘ I went to Church to see the Judge ’1. Most people make the sound with tongue against the alveolus in the area of Rugae, with a small space for Air to escape b/w tongue & alveolus.
If the space is too small, a whistle will result.If the space is too broad & thin , ‘s’ sound will be developed as a ‘sh’, somewhat like a lisp.
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If lower Anterior teeth are too far back, tongue will be forced to Arch itself up to a higher position & the airway will be too small.
If the Lingual flange of lower denture is too thick in Anterior region, result will be a faulty s sound.
This can be corrected by placing the artificial teeth in same position as natural teeth & also making the lingual flange such that it does not encroach on tongue space.
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A – Correct position.B – Excessive vertical overlap.C – Inadequate vertical overlap.
Vertical position of Anterior teeth during pronunciation of Sibilants.
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Guides to position of posterior teeth
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Most texts describe setting the Maxillary posterior teeth first.However, this procedure may require many adjustments when lower teeth are set.
It is recommended to set the Mandibular teeth first.
Lower ridge & surrounding structures offer reliable landmarks for setting posterior teeth.
Lower denture is less stable & has less support.
More critical limitations on position of lower teeth.
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Retromolar pad
The maximum extension posteriorly of any artificial tooth is anterior border of Retromolar pad. to avoid having a tooth over an incline which results in denture sliding.
Sometimes space is available for only 3 mandibular posterior teeth, then drop Ist premolar.
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Retromolar pad
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Maxillary TuberosityTeeth should not be set on the Tuberosity
as it can lead to lever imbalance and might lead to cheek bite in posterior region.
When space permits,4 maxillary posterior teeth can be placed opposing 3 mandibular posterior teeth, to provide support to cheeks
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OCCLUSAL PLANE Anterior occlusal plane parallel to interpupillary
line & at the level of
commissure.
- posterior occlusal plane should be at the level of 2/3 the height of retromolar pad
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Stenson’s duct –it exits at Bu mucosa in the region of 2nd Molar. Occlusal plane is located of 1/8 of an inch below this.
With these anterio-posterior guidelines,occlusal plane is made parallel to lower mean foundation plane and Ala-Tragus plane.
Height of occlusal plane is also influenced by-
-length of lips-Ridge height-Amount of maxillomandibular space
available
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Relationship with tongue
Occlusal plane should be located in relation to lateral surface of tongue near demarcation zone b/w Dorsal keratinized mucosa & ventral nonkeratinized mucosa.
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Buccal Limit Teeth should not be set too
far off the ridge. Placing too far Buccally can
cause:- Cheek Biting- Esthetic problems due to
obliteration of Buccal corridor.
- Denture instability due to lever imbalance & muscle function.
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Lingual LimitLingual cusps of molars are in
alignment with Mylohyoid ridge.
Placing too far lingually can cause Crowding of tongue. Tongue biting. Imbalance due to tongue
function.
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Overjet & Overbite
Class I – Normal , Class II – Retruded , Class III - Protruded
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Canine & Molar RelationshipMesial slope of cusp of upper
canine opposes the distal slope of Lower canine cusp.
ORDistal surface of lower canine
is in line with tip of upper canine. M.B cusp of upper 1st
molar opposes the Buccal groove of lower 1st molar.
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Buccal CorridorSpace b/w buccal surface of posterior teeth & inner surface of cheeks.
Excessive buccal corridor results when posterior teeth are set too far ligually.Resulting dark space appears excessive & unaesthetic.
Inadequate buccal corridor occurs when posterior teeth are placed too far buccally, causing obliteration of buccal corridor.
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COMPENSATING CURVES :Compensating curves are the artificial curves
introduced into dentures inorder to facilitate the production of balanced occlusion.They are the artificial counterparts of curve of Spee & Monson that are found in natural dentition.
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The anatomic curve established by the occlusal alignment of the teeth, as projected onto the median plane, beginning with the cusp tip of the mandibular canine & following the buccal cusp tips of premolar & molar teeth, continuing through the anterior border of the mandibular ramus, ending with the anterior most portion of the mandibular condyle.
Antero-posterior Curve / Curve of Spee :
Curve of Spee of Natural Dentition.
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Retruded contact position.
Protrusion with a condylar path parallel to occlusal plane : contact maintained.
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Protrusion with a condylar path sloped at an angle to occlusal plane : Contact lost posteriorly.
Space that occurs between opposing occlusal surfaces during mandibular protrusion.
Christensen's phenomenon
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a. Retruded contact position with an occlusal surface which is an arc of the circle, of which condylar path is also an arc.
b. In protrusion, contact is maintained.
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Lateral Compensating Curves : a. Molar curve
b. 2nd Premolar curve.
c. 1st Premolar curve.
Lateral Curve :In natural dentition there are 2 lateral curves
• One involving molar teeth (curve of Monson).• 2nd involving teeth anterior to 2nd molar.
2nd Premolar are not involved in any curve, as they lie on horizontal curve.
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In the mandibular arch, that curve (viewed in the frontal plane) which is concave above & contacts the Buccal & Lingual cusp tips of the Mandibular molars.
In the maxillary arch, that curve which is convex below & contacts the Buccal & Lingual cusp tips of the Maxillary molars.
Mediolateral curve / Curve of Wilson :
The curvature in the lower arch is affected by an equal lingual inclination of the right & left molars so that the tip points of the corresponding cross-aligned cusps can be placed into the circumferences of a circle.
The transverse cuspal curvature of the upper teeth is affected by the equal buccal inclinations of their long axes.
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Curve of Monson:eponym for a proposed ideal curve of occlusion in which each cusp and incisal edge touches or conforms to a segment of the surface of a sphere 8 inches in diameter with its center in the region of the glabella
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If teeth are set on a horizontal plane, non-working side will loose contact, due to the downward movement of condyle on that side.
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If teeth are set to confirm to a curve, steepness of which relates to steepness of condylar path, then teeth will remain in contact during lateral & downward movement.
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Canine-retromolar Pad Reference Line
From tip of Canine to center of Retromolar pad. This designates centre of mandibular Ridge.
Central fossae of mandibular Posterior teeth should coincide with this line OR
This in turn corresponds to maxillary palatal cusps .
Individual Orientation of Anterior Teeth:
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Individual Orientation of Anterior Teeth:
Maxillary Central IncisorFacial : Long Axis is straight.
Proximal : Long axis inclines labially ( 8-10 degrees )Occlusal : Incisal edge contacts horizontal plane
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Maxillary Lateral Incisor Facial : Long axis slopes mesially. Proximal : Long axis inclines more labially than C.I. (15-20
degrees ) Occlusal : Incisal edge is 0.5-1 mm short of Occlusal plane.
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Maxillary Canine Facial: Long axis is vertical OR slightly inclined Mesially. Proximal : Long axis is parallel to the vertical, making the
cervical portion of Labial surface more prominent. Occlusal : Incisal edge is in contact with occlusal plane. In frontal view,only mesial 2/3 surface is visible
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MandibularCentral Incisor Facial : Long axis slopes slightly
towards vertical axis. Proximal : Tooth is labially inclined
when viewed from side. Occlusal : Incisal edge is approx.1-
2mm above Occlusal plane.
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Mandibular Lateral Incisor Facial : Long axis is slightly
mesially inclined. Proximal : Labial inclination is
slightly less than C.I. Occlusal : Incisal edge is approx.1-
2mm above occlusal plane.
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Mandibular Canine Facial : Long axis is slightly
inclined mesially. Proximal : Tooth is straight when
viewed from side. Occlusal : Incisal edge is slightly
higher than L.I.
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Maxillary Ist Premolar Facial : Long axis is parallel to vertical axis. Proximal : Long axis is slightly tilted towards
palatal . Occlusal : Bu cusp contacts the occlusal plane,
while Li cusp is approx. 1mm short.
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Maxillary 2ed Premolar Facial : Long axis is parallel to vertical axis. Proximal : Long axis is parallel to vertical axis . Occlusal : Both Bu & Li cusps contact the
occlusal plane
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Maxillary 1st Molar
Facial : Long axis inclines Distally when viewed from side.
Proximal : Long axis inclines Buccally when viewed from front.
Occlusal : Only Mesio-Palatal cusp contacts Occlusal plane.
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Maxillary 2ed Molar
Facial : Long axis slopes distally more than in 1st molar, When viewed from front.
Proximal : Long axis slopes buccally more than in 1st molar, when viewed from side.
Occlusal : None of the teeth contact the occlusal plane, but Mesio-Palatal cusp is closest to it.
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Mandibular Ist Premolar Facial : Long axis is parallel to vertical plane. Proximal : Long axis is parallel to vertical plane. Occlusal : Bu cusp is above the occlusal plane,
whereas Li cusp is below occlusal plane.
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Mandibular 2ed Premolar Facial & Proximal : Long axis is vertical from both
views. Occlusal : Both cusps are about 1-2mm above
Occlusal plane
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Mandibular 1st Molar
Facial: Long axis leans mesially, when viewed from side.
Proximal : Long axis inclines Lingually, when viewed from front.
Occlusal: Buccal cusps are higher than Lingual cusps.Distal cusps are higher than Mesial cusps.
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Mandibular 2ed Molar
Facial : Mesial inclination is more than 1st molar. Proximal : Lingual inclination is slightly more
than 1st molar. Occlusal : Buccal cusps are higher than Lingual.
Distal cusps are higher than Mesial.
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