SELECTION OF TEETH FOR ESTHETICS AND FUNCTION

Teeth selection is not simply a mechanical procedure, but requires

dexterity and knowledge of biology.
Selection of teeth forms an important step before teeth arrangement.
Objective of teeth selection
It is to create a dentofacial harmony.
Methods of anteio teeth selection
I] Pre extraction records
a. Diagnostric casts : of patients natural teeth or restored teeth prior to
extraction of remaining teeth.
b. ecent photographs : They will often pro!ide general information
about the width of the teeth and possibly their outline form that is
more accurate than information from any other source.
c. adiograps of teeth : adiographs made before the natural teeth
were lost can supply information about the si"e and form of the
teeth to be replaced.
adiographic images are howe!er always enlarged and may be
distorted because of di!ergence of the x#ray.
II] Post-extraction examination
$. Si"e and form of edentulous foundation.
%. &atching teeth to faceforms and arch forms.
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'. If patient is already a denture wearer, mouth should be
examined with the dentures in the mouth gi!ing importance
to physiological and esthetic aspects.
Selection of anteio teeth
# Si"e.
# (orm
# Shape.
# )olour
Factos infl!encin" si#e and fo$ of anteio teeth%
$. Si"e of face.
%. *mount of a!ailable interarch space.
'. &easured distance between distal of right and left maxillary
cuspids.
+. ,ength of lips.
-. Si"e and relation of arches.
.. Sex of the patient.
&' Si#e of anteio teeth
# ,ength
# /idth
Len"th
# 0ormally necks of anterior teeth o!erlap the anterior
ridge by %#'mm cer!ically and incisal edges will
show below the relaxed lip.
# 'mm 1 in young patients
# 2alf of it 1 in old patient.
%
(idth
3i"ygomatic width 4 estimated width of maxillary central incisors.
$.
3i"ygomatic width 4 approximate width of six anterior teeth
'.'
$. &easuring width of anterior teeth
%. &ark corners of the mouth on the occlusal rim in the mouth and the
distal surface of the upper canines can be indicated by marks made
on the upper rim at the corners of the mouth. Then the distance
between the marks is measured around the labial surface of the
occlusal rim and anterior teeth of this width are arranged as
indicated by the occlusal rim.
)aiations de*ends !*on%
,ength of upper lip
&obility of upper lip.
5ertical height of occlusion.
5ertical o!erlap.
'
+' Fo$ of anteio teeth
a. Based on face form:
)lassification of face form by ,eon /illiams:
# It consists of two imaginary lines passing about
%.-cm infront of the tragus of the ear and through the
angle of the 6aw.
# ,ines almost parallel 1 square.
# ,ines di!erging at the chin#o!oid.
# ,ines con!erging at the chin#tapering.
b. Based on arch form
+
c. Based on profile of the face
The labial surface of the tooth !iewed from the mesial aspects
should show a contour similar to that when !iewed in profile.
The labial surface of the tooth !iewed from the incisal aspect should
show a con!exity or flatness similar to that seen when the face is !iewed
from under the chin or from the top of the head.
d. Relationship of upper arch and upper incisors
5 shaped arch 1 teeth narrower at the neck than the incisal edge.
ounded arch 1 o!oid teeth.
Squarish arch 1 parallel sided incisors.
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,' Colo! of teeth % * knowledge of physics, physiology, psychology of
colour is !aluable in the selection of teeth colour.
2ue.
Saturation.
)olour of Teeth
3rilliance.
Translucency
Factos infl!encin" H!e and -illiance
*ge
2abits
)ompletion
)olour of eyes
H!e : It is the specific colour produced by a specific wa!elength of light
acting on the retina.
The hue of teeth must be in harmony with the colour of patients
face.
Sat!ation : It is the amount of colour per unit area of an ob6ect.
-illiance : It is the lightness or darkness of an ob6ect.
7eople with fair complexion generally ha!e teeth with less colour
and the colours are less saturated.
Thus, the teeth are lighter and in harmony with the colours of the
face.
.
# 7eople with dark complexions generally ha!e darker
teeth that are in harmony with the colour of the face.
Chaacteistics of nat!al teeth%
# 0eck of tooth has more pronounced colour than
incisal edge.
# The incisal edge, if unworn is more translucent than
the body of the tooth.
# &axillary central incisors are lightest teeth in the
mouth, maxillary latrerals and mandibular incisors are slightly
darker. )anines are still darker.
# 7osterior teeth are usually uniform in colour and
slightly lighter than canines.
# Teeth darken with age.
Tansl!cenc. % It is the property of an ob6ect that permits the passage of
light through it but does not gi!e any distinguishable image.
S!""estions fo selectin" the teeth%
$. *lways moisten the shade guide because when in mouth, the teeth
are always moist and this has an effect on the reflection and
refraction of light and hence the colour.
%. *lways place the teeth in the shade of the upper lip in position they
are to occupy.
They will appear darker in this position than in hand.
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'. Select teeth under natural light.
+. *ttempts to look at the face as a whole rather than focus on teeth.
Selection of *osteio teeth%
The cuspal inclines for posterior teeth depend on the plan 9 scheme
of occlusion selected by the dentist.
)ommonly used posterior cuspal inclinations are '':, %;: and ;:.
The inclination is measured as the angle formed by the mesiobuccal
cusp of lower molar with the hori"ontal.
,,/ teeth 0
# They pro!ide maximum opportunity for a fully
balanced occlusion.
2owe!er the final effecti!e height of the cusp for a gi!en patient
depends the way the teeth are tipped and on the interrelation of the other
factors of occlusion.
+1/ teeth
# They are semianatomic in form.
# They are wider buccolingually than corresponding
'': teeth.
# They pro!ide less cusp height with which to de!elop
balancing contacts in eccentric 6aw positions than '': teeth do.
<
1/ teeth 0
They are non anatomic teeth.
They are ad!isable when only a centric relation record is being
transferred from the patient to the articulator and no effort is directed to
establishing a cross arch balanced occlusion.
Selection of *osteio teeth%
Selection includes
# Shade
# Si"e
$. 3uccolingual width
%. &esiodistal length.
'. 5ertical length.
# 0umber
# (orm
Shade%
# It should harmoni"e with the shade of the anterior
teeth.
# 3ulk influence the shade of the teeth and for this
reason it is ad!isable to select a slightly lighter shade for the
bicuspids if they are to be arranged for esthetics. They may be
slightly lighter than the other posterior teeth but not lighter than
anterior teeth.
=
Si#e and $e$be of *osteio teeth
# The si"e and number of posterior teeth are closely
related to usage. These characteristics are dictated by the
anatomy of the surrounding oral en!ironment and physiologic
acceptance of supporting tissues. The posterior teeth must
support the cheeks and tongue and function in harmony with the
musculature in swallowing and speaking as well as in
mastication.
-!ccolin"!al 2idth of *osteio teeth
# The buccolingual width of artificial teeth should be
greatly reduced from the width of natural teeth they replace.
# *rtificial teeth that are narrow in buccolingual
direction enhance the de!elopment of the correct form of the
polished surfaces of the denture by allowing the buccal and
lingual denture flanges to slope away from the occlusal surfaces.
This occlusal form permits forces from the cheeks and tongue to
maintain the dentures in position on the residual ridges.
# 0arrow occlusal surfaces with proper escapeways
for food also reduce the amount of stress applied on food during
mastication to the supporting tissues of the basal seat on the
other hand the posterior teeth should ha!e sufficient width to act
as table upon which to hold food during trituration.
Mesiodistal 2idth of *osteio teeth%
$;
The mesiodistal width of posterior teeth are determined by the
edentulous area between the distal of the mandibular cuspids and the
ascending area of the mandible. *fter the six mandibular anterior teeth
ha!e been placed in their final position a point is marked on the crest of the
mandibular ridge at the anterior border of the retromolar pad. This is the
maximum extent posteriorly of any artificial teeth on the mandibular ridge.
In well formed ridge the apex of the retromolar pad is taken as posterior
le!el and is resorbed ridges the point where retromolar pad turns upward.
)etical len"th of b!ccal s!face of *osteio teeth
# It is best to select posterior teeth corresponding to
the interarch space and to the length of the anterior teeth. The
length of the maxillary first premolars should be comparable to
that of the maxillary canines to ha!e the proper esthetic effect.
T.*e of teeth accodin" to $ateials
# &ost artificial teeth are made of air fired 9 !acuum
fired porcelain, acrylic resin or a combination of acrylic resin
and metal occlusals.
3ocelain Teeth
In anterior teeth metal pins are embedded into porcelain for
mechanical retention in denture base.
In posterior teeth diatric holes are present in the ridge lap, that when
filled with denture base resin retain teeth in denture base.
Advanta"es%
# /ear is clinically insignificant.
$$
# &aintain comminuting efficiency for years.
# 3etter retention of surface polish and finishing.
Disadvanta"es%
# )ause dangerous abrasion to opposing gold crowns
and natural teeth.
# 2a!e sharp impact sound.
# 7otential for marginal staining due to capillary
leakage.
# )hipping of teeth.
# Difficulty in restoring surface polish after grinding.
# )annot be used in cases where a!ailable space is
minimal.
RESIN TEETH
Advanta"es%
$. 0atural appearance and sound.
%. >ase of ad6ustment.
'. 3reak and chip resistance.
+. )apability to bond to most denture base resins.
Disadvanta"es%
$. ,ess wear resistance.
%. Tendency to dull in appearance during use as a result of loss of
surface luster.
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'. )are should be taken when polishing the denture to pre!ent
undesirable modifications in tooth contour.
METAL INSERT TEETH%
Advanta"es%
$. Impro!ed wear resistance.
%. Impro!ed masticatory efficiency.
'. 0ot as sound producing as porcelain teeth.
Disadvanta"es%
$. Increased cost.
%. 0ot as esthetically accepted as other teeth.
TEETH ARRAN4EMENT
Definition
In prosthodontics the term ?arrangement@ would refer to a procedure
of locating, tilting, rotating and spacing an artificial tooth9teeth in relation
to the plane of reference and to each other with the ob6ect of creating a
natural appeal and based on biomechanical requirements of complete
denture treatment.
$. Aeneral position of each of the tooth is such that the imaginary root
passes through restored ridge contour of maxillary foundation.
%. elation of tooth to the frontal plane:
a. &axillary labial incisor.
# Slight labial inclination.
b. ,ateral incisors
$'
# e!eals a little more 9 relati!ely more labial
inclination compared to central incisor re!ealed by
cer!ical depression of the tooth.
c. )anine
# ,ocated in upright manner 1 cer!ical portion of the
tooth should be re!ealed in bold manner.
'. elation of tooth to clinical midline
a. )entral incisors.
# e!eals !ery slight mesial inclination.
b. ,ateral incisors
# Shows relati!ely more mesial inclination than central incisor.
c. &axillary canine
# Is placed in a upright manner.
+. elation of incisal edge to midsagittal plane BrotationC.
a. )entral incisor
# e!eals an angle a little less than =;: to the sagittal
plane.
b. ,ateral incisor
# e!eals an angle of ';: to sagittal plane.
c. )anine
# e!eals an angle of +-: to sagittal plane.
-. elation of incisal edge to occlusal plane.
a. )entral incisor
$+
# Is in contact with occlusal plane.
b. ,ateral incisor
# emains D # $mm away from the occlusal plane.
c. )anine
# )anine tip remains in contact with the occlusal
plane.
Advanta"es of c!s* *osteio teeth
$. They are considered more efficient in cutting of
food, thereby reducing the forces that are directed at the support
during masticatory mo!ements.
%. They can be arranged in balanced occlusion in
the eccentric 6aw positions.
'. /hen the cusps are making contact in the
fossae at the correct !ertical dimension of occlusion with the
6aws in !ertical dimension, the position is comfortable. This
position is a definite point of return, as through proprioception
the 6aws will return to this position.
+. They look more like natural teeth and therefore
are acceptable esthetically.
-. The contours are more like natural teeth,
therefore they will be more compatible with the surrounding oral
en!ironment.
$-
.. *n attempted occlusion without cusps is
disorgani"ed because occlusion has depth, it is not a sudden
closure of flat surfaces.
Aan"e$ent of $andib!la anteio teeth
# ,ower central and lower anterior teeth are placed
upright.
# ,ower canines are mesially tilted 1sleeping canines.
# The lower anterior teeth are placed in a mesial
relation to the upper anterior teeth.
# There is hori"ontal o!erlap of about %#'mm.
# There is a !ertical o!erlap of about $#%mm.
ARRAN4EMENT OF 3OSTERIOR TEETH
Relationshi* of teeth to cast%
# In mandible bone loss occurs from both buccal and
lingual sides in downward direction, since natural posterior teeth
are lingually inclined, the artificial teeth can be set right o!er the
lower ridge without encroaching on the space occupied by the
cheek 9 tongue.
# In maxillae, the loss is entirely from buccal and
labial surfaces and hence the residual ridge lies slightly more
palatally all round.
$.
The maxillary posteriors are placed slightly lateral to the crest. In
order to reduce the tipping forces on the lower denture, a compromise is
done by not placing the upper teeth on the crest of the ridge which would
otherwise result in discrepancy in occlusion.
DENTO4ENICS
Se5 Facto
>xpression of feminine characteristics
?(rom her finger tips to her smile #####* woman is feminine.
*n excellent beginning is to select initially a mold which express
soften anatomics characteristics or one which is highly adaptable to being
shaped and formed into a dictate type of tooth by certain grinding
procedures.
# The interpretation of feminity will keep to the
spherical form instead of circular so as to identify the third
dimension.
# The basic feminine form should howe!er be
harmoni"ed with the indi!idual patient.
# The indi!idual is accomplished by definite grinding
procedures where the incisal edges must follow a cur!e rather
than a straight line.
E5*ession of $asc!line chaacteistics%
# (rom his fists to his mouth. * man is masculine.
$8
# * basic tooth form which expresses masculine
characteristics shows !igor, boldness and hardness.
3esonalit.
2e should be concerned with the personality of a patient when
constructing a denture because this is our best measure of his priceless
indi!iduality and the most reliable source of knowledge by which we may
express his dignity through prosthodontic methods. The comprehensi!e use
of personality depends upon our manipulation of tooth shapes BmoldsC,
tooth colors, tooth posterior and the matrix B!isible denture baseC of these
teeth.
A"e factos
There is beauty in age as well as in youth, but in fact age has the
edge.
# It is routine first to consider light shades for young
people and darker shades for older ones.
# *ge in the artificial tooth must also be accompanied
by mold refinement.
# In the artificial tooth, we may reflect the appropriate
age effects by such means as grinding the incisal edges and
remo!ing the incisal enamel at such an inclination and to such
depth as to con!ey reality to the composition.
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# The sharp tip of cuspid suggests youth and as age
increases it should be 6udiciously shaped, not abruptly ground so
as it imply abrasion against opposing teeth.
# The erosion imparted to artificial teeth by careful
grinding and polishing !ery efficiently con!eys the illusion of
!igour and ad!anced age.
Advanta"es of Mono*lane teeth
$. /hen teeth are contacting in non masticatory
mo!ements as in brusixm, the flat polished surfaces offer less
resistance, therefore less force is directed to the support.
%. /hen monoplane teeth are arranged to pro!ide
balanced contacting bilaterally with the !ertical dimension of
6aw separation in harmony with the 6aws in centric relation, this
position is comfortable.
'. In cases of resorbed ridges dislodgement by
hori"ontal 9 torquing forces can occur. &onoplane teeth offer
less resistance to these forces.
+. These teeth will allow a greater range of
mo!ement which is necessary in patients with increased 6aws.
-. /here neuromusculature controls are
uncoordinated that 6aw relation records are not repeatable and
cusp tooth cannot be balanced.
$=
.. in case of diabetic patients where underlying
bone is !ulnerable to damage.
3oble$s 2ith anato$ic tooth fo$s
$. The use of an ad6ustable articulator is mandatory.
%. &esiodistal interlocking will not permit settling of the base without
hori"ontal forces de!eloping.
'. 2armonious balanced occlusion is lost when settling occurs.
+. The bases need prompt and frequent relining to keep the occlusion
stable and balanced.
-. The presence of cusps generates more hori"ontal force during
function.
3oble$s 2ith non6anato$ic teeth
$. They occlude in only two dimensions Blength and widthC but the
mandible has an accurate three dimensional mo!ement due to its
condylar beha!ior.
%. The !ertical component present in mastication and non#functional
mo!ements is not pro!ided for so that this from loses shearing
efficiency.
'. 3ilateral and protrusi!e balance is not possible with a purely flat
occlusion. 0on anatomic teeth set on inclines for balance require as
much concern as anatomic for 6aw mo!ements.
%;
+. The flat teeth do not function efficiently unless the occlusal surface
pro!ides cutting ridges and generous spillways.
-. They cannot be corrected by much occlusal grinding without
impairing their efficiency.
.. 0on#anatomic teeth appear dull and unnatural to some patients
which may create a psychological problem concerning function.
Concl!sion
There are no definite guidelines for selection of posterior teeth. 3ut
it mainly depends on the type of patient and the condition of the supporting
tissues. *nd hence, the selection of teeth is the responsibility of the dentist
which he acquires through knowledge and experience.
%$