Dr.

Nitin Sethi

Aims & Objective of Teeth Selection & Arrangement Masticatory Efficiency.

Esthetics.

Speech

Health & comfort of TMJ.

Retention & Stability during function.

Preservation of Alveolar Ridge.

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Artificial teeth are selected on the basis of

Size Form ( shape )

Shade
Material

Cusp form
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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 Size

Pre 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.Pounds 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 TEETH

The form of artificial anterior teeth should harmonize with the shape of patients face. The form of teeth is selected based upon following criteria Patients facial form Profile Dentogenic 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 patients 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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Described by Frush & Fisher (1955). Teeth form is determined by sex, personality and age of the patient.

Dentogenic Concept or SPA Factor

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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Habits Complexion of face Colour 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 patients 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
The

buccolingual width of the artificial teeth should be decreased as compared to natural teeth.

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.

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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 teeth

Factors that govern the form of posterior teeth are Condylar inclination Height of residual ridge Age Ridge 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 teeth

1.

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. 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.

2.

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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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PORCELAIN:
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.

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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 be Physiologically And esthetically acceptable. Physiologically, They must be in a position compatible with the lips, Tongue, and cheeks whether the mandible is in a Relaxed position or in motion.

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Aims & Objectives of Teeth Setting

Preservation of Alveolar Ridge. Esthetics Masticatory Efficiency Retention & Stability during function. Health & comfort of TMJ. Position of Teeth

Teeth should be set /placed close to the Position occupied by the natural teeth & compatible to the surrounding musculature.
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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 anteroposteriorly and mediolaterally (1) To provide stability, (2) To direct the forces of mastication to areas 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

Incisal two-thirds of labial surface of teeth supports the lips.
If

set too far posteriorly

Lip looks unsupported. Vermilion border would not be visible.

If

set too far anteriorly

Lip would taut & stretch. Nasolabial fold may fill out.
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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 Dr. Nitin Sethi 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.

Labial sounds :

B,P&M

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.
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Labio-Dental sounds :

F & V

On pronunciation of labiodental sounds f & v, vermilion border of lower lip contacts the incisal edges of Max. Incisor teeth.

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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Vertical position of Anterior teeth during pronunciation of Sibilants.

A Correct position. B Excessive vertical overlap. C Inadequate vertical overlap.

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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 Tuberosity
Teeth 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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Stensons 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 Limit
Lingual 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 Relationship

Mesial slope of cusp of upper canine opposes the distal slope of Lower canine cusp. OR Distal 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 Corridor
Space 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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Antero-posterior Curve / Curve of Spee :

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.

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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Christensen's phenomenon
Space that occurs between opposing occlusal surfaces during mandibular protrusion.

Protrusion with a condylar path sloped at an angle to occlusal plane : Contact lost posteriorly.
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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 Curve :
In natural dentition there are 2 lateral curves One involving molar teeth (curve of Monson). 2nd involving teeth anterior to 2nd molar.

Lateral Compensating Curves :

a. Molar curve b. 2nd Premolar curve. c. 1st Premolar curve.

2nd Premolar are not involved in any curve, as they lie on horizontal curve.
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Mediolateral curve / Curve of Wilson :

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.

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 .

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 Individual

Orientation of Anterior Teeth:

Individual Orientation of Anterior Teeth:

Maxillary Central Incisor
Facial : 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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