anterior teeth selection

Anterior Teeth selection

Presented by- Dr. AJAY GUPTA2nd YEAR POST GRADUATE

Dr. Dilip Dhamankar - HOD Dr. Ravikumar C.M - ProfessorDr. D.R.V. Kumar - ReaderDr. Manish Chadha - Senior LecturerDr. Devendra Singh - Senior Lecturer

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Contents:

• Introduction• Goals • Anterior teeth selection - History - Golden proportion - Methods of anterior teeth selection - Dentogenics - Dynesthetics


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• Conclusion• References


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Introduction An acceptable cosmetic effect in any dental

restoration has always been regarded as a important to good dentistry. A well made prosthesis will fail if it is deficient in this respect.


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Teeth selection in complete denture process plays a huge role in great prosthetic success and a great patient – operator relationship.

Since ages various methods and guidelines are put forth to achieve the best prosthetic out come.


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GoalsFor this phase of therapy are to construct

complete dentures that (1) Function well,

(2) Allow the patient to speak normally, (3) Are esthetically pleasing, and (4) Will not abuse the tissues over residual

ridges.


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• Selection of artificial teeth is best understood if anterior teeth are considered separately from the posterior teeth as the anterior teeth are selected to satisfy esthetic requirement where as posterior teeth are selected to satisfy functional requirements.


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Anterior Teeth Selection


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History • During the ivory age and early porcelain

period ,teeth were selected or created mostly by dimensional measurements of the denture space and arch size with little regard to esthetics.


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The evolution …

• J W White in 1872 – projected correspondence and harmony theory, temperamental theory was fading out of medicine but white reached over and suggested that temperaments called for similarity of form in faces and teeth.

• The temperamental theory is a theory of fluids of the body, especially the blood ,the phlegm and the bile. It was conceived by the Hippocrates in 5th century BC and was used by the medical profession in diagnosis and treatment planning.


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• W.R. Hall in 1887 - projected Typal form concept , this was the initiation of geometric theory later. The basis of this classification

Major basis - a) Labial surface curvature b) Outline form and neck width of

the anteriors

Minor basis – Labiolingual inclination of the upper incisors in relation to the profile types.


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• Berry’s biometric ratio method (1906); projected that the outline form of the inverted central incisor tooth closely approximated the outline form of face . Hence the outline form of face indicated the outline form of the anterior teeth to be chosen .


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• Berry’s further investigation led to the finding of – Maxillary central incisor was 1/16th width of

the face and 1/20th length.


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• Since 1885 J. Leon Williams wanted revolution in teeth selection process , later in 1909 he proposed the technique to build wax occlusal rims of proper height and form, with patient’s lips at rest, marked the location of corner of mouth ,high lip line, lower lip line ,and after removing the occlusal rim the distal end of second molar is marked.


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• Using a fleximeter the distance between the markings were read.

• Although Hall had proposed earlier about Typal theory it was neglected for twenty five years , Williams did an extensive study in 1914 to give three basic typal forms – ovoid, tapering, square.


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• He studied in extracted human teeth and skulls .


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• According to him it was “combination forms”

tapering or ovoid or both inblended into square Square or ovoid or both inblended into tapering Square or tapering or both inbleded into ovoid



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• Valderrama’s “Molar tooth Basis” was projected in 1913. According to this method, the tooth size was measured on a one-fourth increment of the size of a Bonwill triangle, and is determined by measuring the edentulous mandible.

• “Clapp’s tabular dimension table method” – 1922.

Teeth were selected based on the overall dimension of six anterior teeth arranged on the Bonwill circle and the vertical tooth space available in the patient.


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• Young emphasized on teeth selection based on emotion, mental imagenary and stored knowledge.

• Nelson in 1920 projected a technique for selecting a tooth mould and he called it as ‘‘Maxillary Arch Outline Form,’’ This technique assumed that the arch outline form was the valid method.


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• “Wright’s Photometric method” proposed in 1936 was based on using a photograph of the patient with natural teeth and establishing a ratio by comparative computation of measurements of like areas of the face and photograph.

• Minute inaccuracies in measurements tended to diminish greatly the reliability of the technique.


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• Multiple choice method by Myerson in 1937 • This was based on a need for a selective range

in labial surface characteristics of transparent labial and mesial surfaces, varying surface color tone, and characterizations of teeth by time, wear.


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• “Anthropometric – cephalic index method” projected by Sears in 1941, was based on the fact that the width of the upper central incisor could be determined by dividing either the transverse circumference of the head by 13 or bizygomatic width by 3.3. .


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• and 3 dimensional harmony of tooth form and face form “Bioform technique” proposed by the Dentist ‘s supply company in 1950, was based on the geometric outline forms of face and teeth –the ‘House’ classification for 4 basic , 3 combination typal forms were considered.


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• The “Trubyte mould selector” method was advocated by the Dentist’s supply company.


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THE GOLDEN PROPORTIONIf we study the beauty of nature, teeth, or art we will discover a common principle running throughout. This

common principle is the universal recognition of pleasant proportion of 1 : 0.618


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• Dr McArthur 1985 wrote an article "Maxillary and Mandibular Teeth Widths" in which he explains that the average ratio of upper central incisor to lower central incisor is 1.62

• Golden Proportion phenomenon applies to the widths of teeth as seen from the front and not the actual widths as measured.


• The space between the bottom of the nose and the bottom of the chin is divided by the lip line into a "chin to lip line" (the larger part) and a smaller part the "lip line to under the nose"

• The smaller to the larger is in the Golden Proportion as illustrated above.

Eddy levin28


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Methods of teeth selection Pre Extraction Guides:

1.Photographs: Information about width of the teeth

and their outline form.

2.Diagnostic casts: Reliable guide for arranging the

teeth.

3. Radiographs: Information about the size and

form of the teeth.


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4. Teeth of close relatives :Tooth size , colour

and arrangement is effectively used in selecting

and arranging the teeth.

5. Extracted teeth : Excellent information about

the size and form of the teeth.


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Teeth selection

The following factors are considering during the selection of anterior teeth…..

• 1. Size of the teeth• 2. Form of the teeth• 3. Color/Shade of the teeth


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1. Size of anterior teeth :

• Size of the teeth should be in proportion to the size of the face and head.

• Anatomic entities used as guide to select anterior tooth size are :

i. Size of faceii. Size of maxillary archiii. Incisal papilla and canine eminence or the

buccal frenum


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4. Maxillomanibular relations 5. Contour of the residual ridges 6. The lips

7. Vertical distance between the ridges


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i) Size of the face:

Bizygomatic width = estimated width of maxillary 16 central incisors.

Bizygomatic width = approximate width of six 3.3 anterior teeth


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ii)Size of maxillary arch: Make the measurements from the crest of

incisal papilla to the hamular notches and from one hamular notch to the opposite notch.


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• The combined length of the triangle gives the combined width of all posterior and anterior teeth of maxillary arch.


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iii) Incisal papilla and canine eminence/buccal frenum:


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iv) Maxillomandibular relation..

Any disproportion in the size between the

maxillary and mandibular arches influences

the length, width and position of the teeth.

If mandible is protruded; anterior teeth are

larger, if mandible is retruded; anterior teeth

are smaller.


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v) Contour of the residual ridge

Teeth should be placed in relation to follow the contour of the residual ridges that existed when natural teeth were present.


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vi) Vertical distance between the ridges According to the available inter-arch space,

length of the teeth can be selected. Minimal of the denture base should be visible in the final prosthesis.

When the space is available, it is more esthetically acceptable to use tooth long enough to eliminate the display of the denture base.


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Denture bases that simulate the oral mucosa are referred to as characterized, personalised or natural appearing.


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vii) Lips During relaxed state the labial surface of the

maxillary anterior teeth support the upper lip. When the teeth are together the incisal edge of

the maxillary incisors supports the superior border of the lower lip

In speech anterior teeth contact the lower lip at the junction of the moist and dry surfaces of the vermillion border .


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2) Form of the anterior teethi)Form and contour of the

face: From the frontal aspect the shape

of the face can be classified as –

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Anterior Teeth Selection

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2) Facial profile can be classified as:

• Straight• Concave• Convex

The labioincisal contour of the teeth usually conforms to the profile of the individual


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3) Based on arch form


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DENTOGENICS Sex - Personality – Age

• “Dentogenics,” means the art, practice, and techniques used to achieve that esthetic goal in dentistry.

• Integrated toward a system of esthetics.

• J. P. Frush and R. D. Fisher (1956)


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Dentogenic concept A woman is a woman from her finger tips to her smile,and a man is a man from his fists to smile .

The purely mechanical and mathematical approach to tooth selection is largely responsible for the neuter gender “denture look”


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Dentogenic and sex factor• Frush and Fisher in 1955 were the first to

introduce “dentogenic restoration” to dental community.

• Dentogenics described a denture that is eminently suitable to the wearer in that it adds to the person’s charm, character, dignity or beauty in a fully expressive smile.


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• According to the authors sex identity in dentures carried a greater significance in achieving better esthetics.


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• Feminine form is characteristically spherical with a roundness, smoothness and softness, whereas the masculine form is cuboidal , with hard, muscular, vigorous.


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• The procedure therefore is to select a basically feminine or masculine mould and then harmonize it to the individual patient depending upon the personality and age factors by modifying individual teeth

A curve suggests softness. Grinding of the incisal line to create this curve express faminity


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When the dentogenic concept evolved , the full meaning of esthetics was carried into the 3rd dimension :

• The wearer of a dentogenic restoration must have inner sensibility of well being.

• The viewer of the dentogenic restoration must perceive beauty or a fulfillment of the wearer’s personality in his smile .

• Then the dentists who created the dentogenic restoration would feel deeply rewarded. 52/100Anterior Teeth Selection

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• When the laterals are nearly as broad as the other front teeth the denture is said to have strong or masculine appearance , when the laterals are narrower then it depicts feminine or delicate.


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• Lateral incisor – if rotated to show its mesial surface gives softness and youthful appearance to the smile. If rotated mesially the effect of smile is hardened.


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The Cuspid teeth-• Position-• 1. Out of the

cervical end as seen from front

• 2. Rotated to show the mesial face

• 3. Almost vertical as seen from the side


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• The authors described a procedure called depth girnding, which involves the accentuation of the third dimensional depth to eliminate the flat appearance of the artificial upper anterior teeth.


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• The depth grinding is done on the mesial surface of the central incisors only .They are the widest , longest and most noticeable in the six anterior teeth.


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• With a soft stone , the mesiolabial line angle of the central incisor is ground in a definite and flat cut , following the same curve as mesial contour of the tooth in order to move the deepest visible point of the tooth further lingually .after this cut has been made careful rounding and smoothing of the sharp line angle is made.

• It is necessary to develop the desired effect in depth grinding by a consideration of these main factors – a flat thin narrow tooth is delicate looking and fits delicate woman.


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• And involves little depth grinding , wheras a thick , bony , big sized tooth, heavily carved on its labial face is vigorous and is to be used exclusively for men.


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• Depth grinding reduces the width of the central incisors according to the severity of grinding accomplished . Therefore to maintain, the normal harmony of contrast in size between the six anterior teeth, a larger central incisor of the same mold should be selected.


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Dentogenics and personality factor

In 1956 , Frush and Fischer discussed another aspect of dentogenic – the personality of the patient .

Authors stated that foundation for the dentogenic restoration is the personality of the patient – simply because the male and female tooth form is a refinement of that tooth form which has its inception in the personality factor.

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Authors devised the personality spectrum and explained the precise prosthodontic application of the otherwise abstract word personality – by 3 divisions of the personality spectrum.

1. Delicate – fragile, frail , opposite of robust2. Medium pleasing – normal, moderately robust,

healthy and intelligent appearing.3. Vigorous- the opposite of delicate, hard ,

aggressive, muscular type.


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• The personality spectrum can be used in our artistic endeavor to inject a variety of tooth form and tooth position, at the comprehensive level of individual patient personality analysis.


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• The use of dentogenic concept has made easier, by considering the smile as the primary objective . The smile, personality trait and the personality spectrum is used in selection of the mould category.


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Delicate contours of the sculputred

giraffe and the same Delicate

contours of the teeth

Medium character in the personality in the sculpture

llama , Same medium

pleasing character of these teethVigorous type of sculpting as

represented by the bull and

The teeth of the same vigorous

quality

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Dentogenic – age factor• It was considered in 1957 by Frush and

Fischer

• The dignity of the advancing age must be appropriately portrayed in the denture by careful tooth color selection and mould refinement.


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• Lighter shades are considered appropriate for young people and darker shades are considered for older people.

• Also bluish incisal tinges are preferred for the young people and grayish shades for the older.


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The environment of the tooth were arranged is also important, the matrix of the artificial tooth should be meaningful and not repetitive and inartistic. interdental papillae above, of youth;

center, of middle age; below, of advanced age.


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• With very life like material available ,we can even feature the interdental papillae in a realistic manner.


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Changing cuspid tip with age

Mould refinement is done by producing worn incisal edges and cuspid tips, attritional and

abrasional facets, development of diastemas to indicate tooth loss and subsequent drifting.


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In 1958 Frush and Fisher propounded the Dynesthetic interpretation of the dentogenic concept.Dynesthetics is a compound word, ‘dyn’ is from the greek word ‘dynamis’ meaning power. It implies movement ,action ,change ,and progression in the esthetic phase of prosthodontics.

Dynesthetic interpretation of the dentogenic concept.


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The application of dynesthetics allows a denture to be a work of art rather than an artifact.It concerns the three important division of denture fabrication------- The teeth, Its Position and Its Matrix.


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Dynesthetics outline:

1. Mold2. Physiologic shade selection3. Lip support4. Midline 5. Labioversion6. Speaking line7. Smiling line8. Position of incisors and cuspids9. Spaces between teeth10. Buccal corridor

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Considerations in Dynesthetics

MOLD: selection of an acceptable personality mold involves its subsequent treatment for abrasion, erosion, depth grinding, masculinity, or feminity, shaping and polishing

Progressive abrasion of artificial tooth As Age progresses, cut made for

normal abrasion

Depth perception increased by depth grinding , cut made On the labial mesial

line angle of the artificial teeth


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Tooth modified to simulate erosion

Masculine feminine


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Physiologic shade selection-

As age advances there is accumulation of tobacco tar, food pigments, and bacterial discoloration. As this occurs ,various degree of color texture changes occur in the incisal edges, therefore in creating the illusion of natural dentition for a older patient ,a darker shade is preferred.

But this does not imply in all cases, since few people might not smoke , take light pigmented foods, in such case shade should be selected lighter.



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Midline : Face usually slant one way or another and it is

difficult to see a true midline in a dentition. Therefore an eccentric midline in denture , if not too

exaggerated , is acceptable and may lead to the illusion of the natural dentition.


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An acceptable midline (solid line). B, An error in composition which results when the mid-axis of the central incisors (solid line) is not vertical.


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LIP SUPPORT: This is the bodily anteroposterior position of the teeth which adequately support the upper lip in a natural and pleasing manner

Position A is for maximummechanical stability.

Positions B, C, and D represent the progressive dynesthetic positioning of

the central incisors for pleasing lip support.


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Labio version : most pleasing effect is obtained when the long axis of the central incisors are either vertical or with slight labial inclination, this determination is made when the patient is standing in normal posture.

Speaking line: it is the incisal length or vertical composition of the anterior teeth, it should be noticed when the patient is speaking .


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A guide to vertical composition using the incisal edges in relation to lip line at rest is

a) young woman (3mm below lip line at rest)

b) young man (2mm below lip line at rest)

c) middle age (1.5 mm below lip line at rest)

d)old age ,senility (0mm below lip line at rest to 2mm above lip line at rest))


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Smiling line : is a curve following the incisal edges of the central incisors up and back to the incisal edges of the lateral incisors to the tips of the cuspids.

It is determined by the age and decreases with age.

The sharp curve of this smiling line is youthful

The broader curve of this smiling line indicates an older dental composition


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Central incisor position: Their placement control’s :1-midline 2-speaking line 3-lip support 4-labioversion 5-smiling line composition• Their shape is controlled by the personality of the patient, their

position determines the strength and action of the dentogenic composition


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Lateral incisor position: Its rotation will either harden or soften the dental composition

-It should be positioned that a part of it shows when pt speaks

-it’s the personality tooth, sex determination comes from either rounding the incisal edge for feminine or squaring the incisal edge for masculine effect.

Masculine feminine85/100Anterior Teeth Selection

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Cuspid position: It supports the anterior arch form in its widest part and controls the size of buccal corridor

-It should dominate the lateral incisor and complete the upward curve of the smiling line

-It should be abraded to convey the physiologic age of the patient


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• Spaces : between the anterior and posterior teeth is extremely effective , but their size must be artistically and hygienically formed or they will become unsightly repositories for food , plaque and calculus.


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• Rules to be observed while giving spaces are : a) all spaces must be V – shaped to shed food b) a diastema between central incisors is

unsightly and should be avoided in aged patients.

c) diastemas should be asymmetrically placed on either side of the dental arch.

d) the width of the diastema should be controlled , so as not to appear unsightly at any instance.


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Buccal corridor – It is a space created between the buccal surface of the posterior teeth and the corner of the lips when the patient smiles.

It begins at the cuspid , and its size and the shape are controlled by the position and slant of the cuspid even though the actual corridor exist posterior to the cuspid tooth.

Its use prevents the “molar to molar” smile which is often characteristic of a denture.


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Color of anterior teeth• Three Attributes of Color

1. Hue: Variety of color (red, green, yellow, etc.)

2. Chroma :The intensity or saturation of a hue

3. Value:The relative darkness or lightness of a color, or brightness of an object [Range = 0-10 (0=black, 10 = white)]

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Two principal colors are – • Yellow – more prominent in gingival third

• Gray – incisal third

• With thin incisal edges the yellow disappears and the edge appears blue-gray.

• The patients mouth should not be opened too wide but should remain a dark cavity as in ordinary conditions .

• Eyes fatigue to color perception very rapidly and for this reason they should not be focused on a tooth more than a few seconds.


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Observations of the shade guide teeth should be made in three positions:

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Additional considerations in anterior teeth selection

• Highly visible gingiva- select squarer teeth with a long contact point rather than highly tapered teeth. This will minimize the display of pink gingival acrylic.

• .


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• Characterization of selected teeth – changes in color and position , individual grinding , placement of restorations and worn appearance and natural proportion and subtle variations in positions . Denture teeth, base material , and gingival tints can be used to precisely match the form and color of the tissue being replaced.


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Conclusion: Teeth selection is an important part of denture

fabrication, although various techniques is advised ,it is necessary to develop a esthetic sense by the observer so as the artificial teeth will nearly look like a natural dentition (living thing) rather than artifacts that are poor replicas of what has been lost.


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REFERENCES• Winkler’s Essentials of complete denture

prosthodontics - 2nd edition• Textbook of complete denture- A.O.Rahn, C.M.

Heartwell - 4th edition • Boucher’s prosthodontic treatment for

edentulous patients - 9th edition• Complete denture prosthodontics John J.

Manappallil 2nd ed.


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• The Science of Anterior Teeth Selection for a Completely Edentulous Patient: A Literature Review M. Vasantha Kumar • S. C. Ahila • S. Suganya Devi. J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13

• Frush and Fisher : How Dentogenic restorations interpret the sex factor, J. Prosthet. Dent. 1956;6 :160-172

• Frush and Fisher : How Dentogenic restorations interpret the Personality factor, J. Prosthet. Dent. 1956;6 :441-449


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Frush and Fisher :The Age factor in Dentogenics, J. Prosthet. Dent. 1957;7 :441-449

Frush and Fisher : How Dentogenic restorations interpret the sex factor - Jpd(6) 160:1956

Frush and Fisher: The Dynesthetic interpretation of dentogenic concept, J Prosthet Dent : 1958;8;558


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• Dynesthetic interpretation of esthetics in complete denture IJDS

• Dental esthetics and the golden proportion Edwin . Levin September 1978 VOLUME 40 NUMBER 3

• The updated application of the golden proportion to dental aesthetics Aesthetic dentistry today May 2011 Volume 5 Number 3


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anterior teeth selection