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Objectives: 1. Esthetics 2. Masticatory function 3. Correction of speech defects 4. Preservation of the remaining tissue and muscle tone - Primary selection of the teeth must be carried out at the first appointment.
Guides for the anterior teeth selection 1. Pre-extraction guides a. Study cast b. Photographs c. Radiographs d.Extracted teeth
2.Post extraction guides - Selection of size (width and length) a. Size of the face and head b. Size of the contour of the maxillary arch c. Maxillomandibular relations i. In class I Normal relationship, the teeth in one arch are compatible with the teeth in the other arch. ii. In class II The mandible is retruded and the mandibular teeth are frequently smaller iii. In class III The mandibular teeth are frequently larger than normal
- Width of the anterior teeth a. Bizygomatic width The average width of the
maxillary central incisor is estimated to be 1-16 of the bizygomatic width that is, the distance between the cheek bones measured just in front of the ears.
b. The width of the nose An estimation of the
position of the apex of the upper natural canine can be found by extending parallel lines from the lateral surface of the ala of the nose onto the labial surface of the upper occlusion rim.
c. Corners of the mouth The distance measured between the two commisures (angles of the mouth ) will represent the width of the upper six anteriors from the distal surface of the canine to the distal surface of the other canine. d. Canine eminence e. Cranial circumference
line bisecting the incisive papilla will pass through the middle of the upper canines. The necks of the upper anterior teeth overlap the anterior ridge by 12 mm cervically, and the incisive edges of the centrals must show below the relaxed lip by 1-2 mm in a young person and less than half that amount in an elderly patient.
Selection of the form - Guides for selecting the form of anterior teeth. - Shape of the arch.
Tooth form in relation to arch form - Shape of the face Selection of shade - Color and shade of tooth The shade consist of: a. Hue i.e specific color b. Saturation [chroma] i.e. amount of color per unit area. c. Translucency [value] i.e ability of color to permit light to pas through it.
Patients age With age, darker, while lighter teeth are suitable for young patients. Patients complexionlight teeth for fair skin, blue eyes, dark teeth usually for dark skin and black eyes.
The following facts are true for nearly all natural teeth: a. The neck of the tooth has a more pronounced color than the incisive edge. b.The incisive edge if not worn, is more transluscent that the body of the tooth and is usually of a bluish shade (composed entirely of enamel)
c. The upper central incisors are lightest teeth in the mouth followed by the laterals and canines. Posterior teeth are usually uniform in color. d.Teeth darken slightly with age. - Aid for selecting the shade Shade guides The shade guide tooth should be moistened and selection made in the normal light. a. Outside the mouth along the side of the nose. b.Under the lip with the incisal edge exposed c. Under the lip with only the cervical end covered and the mouth open.
The color should be matched with the skin of the cheeks. General consideration for selection of anterior teeth 1. Sex a. Females All teeth are more curved, rounded line and point angles, the teeth more ovoid or tapeing than square. b.Male The teeth are larger with sharp line and point angles, the teeth more square than ovoid or tapeing. 2. Age 3. Personality
Posterior teeth selection Posterior teeth should have a small bucco-lingual width to keep forces on the supporting structure to a minimum. The mesiodistal measurements of the upper posterior teeth is taken from the distal surface of the canine to the prominence of the tuberosity. The total mesiodistal width of the four posterior teeth is often used as a mould number. The lower posterior teeth should not extend posterior to the mesial border of the retromolar pad.
It is advisable to select upper posterior teeth as long as possible so that the premolars will be esthically in harmony with the canine. Actually there are long, medium and short posterior teeth.
Anatomic teeth
- Balanced occlusion - Young healthy patients - Good ridges
Disadvantages of non anatomic teeth. 1. They are of unnatural look 2. Less cutting efficiency 3. The flat teeth occlude in two dimensions only, but the mandible has 3 dimension movements.
Porcelain teeth - Wear is clinically insignificant over a long period of time - No significant loss vertical dimension - Allow for the total rebasing procedures - Maintain communicating efficiency - Difficult to grind and fit into a close inter-ridge space - Cause dangerous abrasion to opposing gold crown and natural teeth. - Have a sharp impact sound - Will not bond to the base material except with mechanical means. The anterior porcelain teeth have pins at the back, while the posteriors have holes.
Acrylic resin teeth. - Wear is clinically significant - Loss of occlusal vertical dimension due to wear. - Occlusal surface is altered by wear. - Do not chip, and have softer impact sounds - Easy to adjust and polish - Easy to grind into close inter ridge space - Will bond to base material by chemical union. - Minimal wear to opposing natural teeth and gold crowns. This is a definite indication for their use
Acrylic teeth are used in the following situations 1. Limited inter-arch distance 2. Maxillary single denture against natural dentition. 3. Maxillary single denture opposing partial denture 4. Opposing natural teeth with gold occlusal surfaces