Selection of Teeth for Complete Dentures

SELECTION OF TEETHSELECTION OF TEETH
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
The selection of teeth for completeThe selection of teeth for complete
dentures is best understood if the anteriordentures is best understood if the anterior
teeth are considered seperately fromteeth are considered seperately from
posterior teeth.posterior teeth.
The teeth are selected so as to rehabilitateThe teeth are selected so as to rehabilitate
the occlusion.the occlusion.

• Teeth should fulfill the following needs :
a. Function well
b. Allow the patient to speak normally
c. Esthetically pleasing
d. Does not abuse the tissues over residual
ridges

•Anterior teeth are primarily selected to
satisfy esthetic harmony, whereas the
posterior teeth are primarily selected to
satisfy masticatory requirements.
•Size, shape, form, colour and arrangement
of teeth should be associated with size,
shape, and form of the face.
•Physical features, age and sex of individuals
should also be considered

MOLD AND SHADEMOLD AND SHADE
IDENTIFICATIONIDENTIFICATION
(anterior teeth)(anterior teeth)
• Mold guides, mold selectors and shade
guides assist proper selection of complete
dentures
• Dentsply international inc. has TRUBYTEDentsply international inc. has TRUBYTE
bioform mold numbering systems whichbioform mold numbering systems which
uses two no’s and one letter on lower leftuses two no’s and one letter on lower left
of tooth mounting cardof tooth mounting card

•Lincoln dental supply company suggested a
system, LOGIC CODING SYSTEM in which
the universal coded no’s would be provided
for shade and mold of artificial teeth.
•Meyerson tooth corporation identifies mold
with number and letters.

Posterior teethPosterior teeth
Posterior teeth are often identified byPosterior teeth are often identified by
name of the particular tooth form.name of the particular tooth form.
Specific molds and shades are identifiedSpecific molds and shades are identified
by no’s that represent combined mesio-by no’s that represent combined mesio-
distal width of 4 posterior teeth and lettersdistal width of 4 posterior teeth and letters
to indicate occlusogingival height of tooth.to indicate occlusogingival height of tooth.

SELECTION OF ANTERIORSELECTION OF ANTERIOR
TEETHTEETHIt is the area of the prosthetic care inIt is the area of the prosthetic care in
which patient should be given a primarywhich patient should be given a primary
responsibility to determine estheticresponsibility to determine esthetic
outcome like..outcome like..
Find out what the patient’s teeth were like
Select the colour of teeth first
Select size of teeth second
Select mold of teeth third

Guides for selecting size of anteriorGuides for selecting size of anterior
teethteeth
Size of the faceSize of the face
Size of the maxillary archSize of the maxillary arch
Incisal papilla and canine eminences orIncisal papilla and canine eminences or
buccal frenumbuccal frenum
Maxillomandibular relationsMaxillomandibular relations
Contour of the residual ridgesContour of the residual ridges
Vertical distance between ridgesVertical distance between ridges
LipsLips

Size of the faceSize of the face
The average width of maxillary centralThe average width of maxillary central
incisor is estimated to be 1/16incisor is estimated to be 1/16thth
of width ofof width of
face between zygomaface between zygoma
The maxillary lateral incisors vary more inThe maxillary lateral incisors vary more in
size, form and colour thus allowingsize, form and colour thus allowing
freedom in selecting teeth from standardfreedom in selecting teeth from standard
moldsmolds
TRUBYTE tooth indicator determines sizeTRUBYTE tooth indicator determines size
of maxillary central incisorsof maxillary central incisors

Size of maxillary archSize of maxillary arch
Mold selector is used to makeMold selector is used to make
measurements of maxillary castsmeasurements of maxillary casts
Measurements are made from crest ofMeasurements are made from crest of
incisal papilla to hamular notches & fromincisal papilla to hamular notches & from
one hamular notch to oppositeone hamular notch to opposite
The combined length of three legs ofThe combined length of three legs of
triangle in mm is used on selectortriangle in mm is used on selector
Excessive loss of bone influence sizeExcessive loss of bone influence size
mostly lengthmostly length

Incisive papilla and canineIncisive papilla and canine
eminenceeminence
If Canine eminences are discernible, a lineIf Canine eminences are discernible, a line
can be placed on the cast distalcan be placed on the cast distal
termination of eminencetermination of eminence
If not discernible, attachment of buccalIf not discernible, attachment of buccal
frenum can be used.frenum can be used.
Another method to locate distal of canineAnother method to locate distal of canine
eminence is to use occlusal rim. Patient iseminence is to use occlusal rim. Patient is
asked to relax with lip touching afterasked to relax with lip touching after
placing rimplacing rim

A pointed instument passed on the lineA pointed instument passed on the line
parallel to pupils of eye & diatance isparallel to pupils of eye & diatance is
measured between the marks followingmeasured between the marks following
the contour of arch measured in mm.the contour of arch measured in mm.

Maxillomandibular relationsMaxillomandibular relations
Any disproportion in size of mandibular &Any disproportion in size of mandibular &
maxillary arches influence length, width &maxillary arches influence length, width &
position of teethposition of teeth
In protruded mandibles, face is longer thusIn protruded mandibles, face is longer thus
requires longer teethrequires longer teeth
In retruded mandible the mandibularIn retruded mandible the mandibular
anterior teeth are smalleranterior teeth are smaller

Contour of residual ridgesContour of residual ridges
Artificial teeth should be placed to followArtificial teeth should be placed to follow
the contour of residual ridges that existedthe contour of residual ridges that existed
when natural teeth where presentwhen natural teeth where present
Resorption of the maxillaResorption of the maxilla
AnteriorAnterior - vertical & palatal direction- vertical & palatal direction
posteriorposterior - vertical & medial direction- vertical & medial direction
Resorption of the mandibleResorption of the mandible
AnteriorAnterior - vertical & lingual direction- vertical & lingual direction
posteriorposterior - vertical & slightly lingual- vertical & slightly lingual

Vertical distance between theVertical distance between the
ridgesridges
The length of teeth is determined byThe length of teeth is determined by
available space between existing ridgesavailable space between existing ridges
Denture bases that simulate oral mucosaDenture bases that simulate oral mucosa
are referred to as characterized,are referred to as characterized,
personalised or natural appearingpersonalised or natural appearing

The lipsThe lips
When lips are relaxed & apart, labialWhen lips are relaxed & apart, labial
surfaces of maxillary anterior teeth supportsurfaces of maxillary anterior teeth support
the upper lipthe upper lip
When teeth are in occlusion & lips areWhen teeth are in occlusion & lips are
together, the labial, incisal third oftogether, the labial, incisal third of
maxillary anterior teeth supports themaxillary anterior teeth supports the
superior border of lower lipsuperior border of lower lip

In speech, the incisal edges of maxillaryIn speech, the incisal edges of maxillary
anterior teeth contact the lower lip at theanterior teeth contact the lower lip at the
junction of moist & dry surface ofjunction of moist & dry surface of
vermillion border & can be bestvermillion border & can be best
demonstrated when letter “F” as in “fiftydemonstrated when letter “F” as in “fifty
five” is pronouncedfive” is pronounced
The properly contoured maxillary occlusalThe properly contoured maxillary occlusal
rims will include this position as incisalrims will include this position as incisal
edge position & will aid in determiningedge position & will aid in determining
length of teethlength of teeth

FORM OF ANTERIOR TEETHFORM OF ANTERIOR TEETH
FORM AND CONTOUR OF FACEFORM AND CONTOUR OF FACE
SEXSEX
AGEAGE

Form and contour of faceForm and contour of face
The form of tooth should conform to theThe form of tooth should conform to the
contour of face as considered from labial,contour of face as considered from labial,
mesial, distal & incisal aspectsmesial, distal & incisal aspects
Tooth viewed from frontal aspect shouldTooth viewed from frontal aspect should
conform general outline of face whereasconform general outline of face whereas
viewed from mesial or distal shouldviewed from mesial or distal should
conform to the contour of profileconform to the contour of profile

 Indicator may be used to establish facialIndicator may be used to establish facial
outline as follows ;outline as follows ;
a)a) Place the tooth indicator on thePlace the tooth indicator on the
patient’s face allowing the nose to comepatient’s face allowing the nose to come
through the center of trianglethrough the center of triangle
b)b) Centre pupils of eye & all the indicatorCentre pupils of eye & all the indicator
with center line coinciding medial line ofwith center line coinciding medial line of
faceface
 In square form the sides of face willIn square form the sides of face will
follow vertical lines of indicatorfollow vertical lines of indicator
 In tapering face, sides of face fromIn tapering face, sides of face from
forehead to the angle of jaw will taper atforehead to the angle of jaw will taper at
an inward diagonal.an inward diagonal.www.indiandentalacademy.comwww.indiandentalacademy.com

To determine facial profile, observeTo determine facial profile, observe
relative straightness or curvature of profilerelative straightness or curvature of profile
by checking forehead, base of nose &by checking forehead, base of nose &
point of chin.point of chin.
If these points are in a line, profile isIf these points are in a line, profile is
straight.straight.
If these points are recessive profile isIf these points are recessive profile is
curvedcurved

SEXSEX
Curved facial features are associated withCurved facial features are associated with
feminity & square with masculinityfeminity & square with masculinity
Form of teeth vary as features varyForm of teeth vary as features vary

AGEAGE
Lips lose their curves and cupids bow andLips lose their curves and cupids bow and
teeth wear at the incisal edges &teeth wear at the incisal edges &
interproximal surfaces.interproximal surfaces.

Colour or shade of anteriorColour or shade of anterior
teethteeth
Colour is the sensation resulting fromColour is the sensation resulting from
stimulation of retina of eye by light wawesstimulation of retina of eye by light wawes
of certain lengthof certain length
Shade is degree of darkness of a colourShade is degree of darkness of a colour
with reference to its mixture with blackwith reference to its mixture with black
Two principal colours yellow & grey areTwo principal colours yellow & grey are
evident.evident.
Yellow is evident in gingival third & grey inYellow is evident in gingival third & grey in
incisal thirdincisal third

The position of patient & source of lightThe position of patient & source of light
are important factors in colour selectionare important factors in colour selection
Teeth should be observed from differentTeeth should be observed from different
angles to make certain that shadows doangles to make certain that shadows do
not influence colournot influence colour
Patients mouth should not be opened tooPatients mouth should not be opened too
widewide
White light is suitableWhite light is suitable

If proper shade is hard to establish theIf proper shade is hard to establish the
tooth & shade guide shoud be viewedtooth & shade guide shoud be viewed
from a distance of 6 to 8 feetfrom a distance of 6 to 8 feet
Harmony should be there between colourHarmony should be there between colour
of teeth & colour of skin, hair & eyesof teeth & colour of skin, hair & eyes
If teeth are allowed to remain in guideIf teeth are allowed to remain in guide
holder held to one side of nose of patientholder held to one side of nose of patient
the that is in harmony wii be recognisedthe that is in harmony wii be recognised

Posterior teeth selectionPosterior teeth selection
Selection of posterior teeth is made inSelection of posterior teeth is made in
such a way so that it fulfills the followngsuch a way so that it fulfills the followng
requirements:requirements:
1. Permits the tongue & cheeks to function1. Permits the tongue & cheeks to function
effectively during speech and msticationeffectively during speech and mstication
2. More acceptable esthetically2. More acceptable esthetically
3. Make it easy for patients to get adapted3. Make it easy for patients to get adapted
to denturesto dentures

4. Fulfills requirement neutral zone, which is4. Fulfills requirement neutral zone, which is
a space resulting from the removal ofa space resulting from the removal of
posterior teeth & loss of bone fromposterior teeth & loss of bone from
residual ridgesresidual ridges

ShadeShade
The shade of posterior teeth shouldThe shade of posterior teeth should
harmonize with the shade of anterior teethharmonize with the shade of anterior teeth
It is advisable to select slightly lighterIt is advisable to select slightly lighter
shade for the premolars if they areshade for the premolars if they are
arranged estheticallyarranged esthetically

Size and numberSize and number
The size & number of posterior teete areThe size & number of posterior teete are
closely related to usageclosely related to usage
The buccogingival dimension of artificialThe buccogingival dimension of artificial
teeth should be less than that of naturalteeth should be less than that of natural
teeth to reduce size of food tableteeth to reduce size of food table
The anterioposterior dimensions ofThe anterioposterior dimensions of
posteriors are determined by edentulousposteriors are determined by edentulous
area between distal of mandibular cuspidsarea between distal of mandibular cuspids
& ascending area of mandible& ascending area of mandible

FormForm
The proximal, lingual & buccal surfacesThe proximal, lingual & buccal surfaces
should be contoured like natural teethshould be contoured like natural teeth
When eccentric jaw movementsWhen eccentric jaw movements
occurs,either cusp or monoplane teethoccurs,either cusp or monoplane teeth
can be usedcan be used

Materials for artificial teethMaterials for artificial teeth
Porcelain teethPorcelain teeth
Porcelain teeh has greater wearPorcelain teeh has greater wear
resistanceresistance
Porcelain teeth has better retention ofPorcelain teeth has better retention of
surface polish & finishsurface polish & finish
Porcelain teeth do not bond to denturePorcelain teeth do not bond to denture
base resinbase resin
Porcelain teeth may produce click inPorcelain teeth may produce click in
function & can accumulate stain aroundfunction & can accumulate stain around
gingival margingingival margin

Resin teethResin teeth
Resin teeth has natural appearanceResin teeth has natural appearance
Resin teeth has the capablity to bond toResin teeth has the capablity to bond to
most heat cured denture base resinsmost heat cured denture base resins
Resin teeh has less wear resistance,whichResin teeh has less wear resistance,which
can result in reduced vertical dimension ofcan result in reduced vertical dimension of
occlusionocclusion

Metal-inert teethMetal-inert teeth
Metal-insert teeth has improved occlusalMetal-insert teeth has improved occlusal
wear resistancewear resistance
Metal-insert teeth are not noisy asMetal-insert teeth are not noisy as
porcelain teethporcelain teeth
Metal-inserted teeth are costly, and theyMetal-inserted teeth are costly, and they
may not be as esthetic as other artificialmay not be as esthetic as other artificial
teethteeth

TYPES OF TEETHTYPES OF TEETH
Anatomic teethAnatomic teeth
Anatomic teeth are artificial teeth thatAnatomic teeth are artificial teeth that
closely resemble the anatomic form ofclosely resemble the anatomic form of
natural unabraded teethnatural unabraded teeth

Non-anatomic teethNon-anatomic teeth
Artificial teeth in which the occlusalArtificial teeth in which the occlusal
surfaces are not copies from natural form,surfaces are not copies from natural form,
but are given forrms that,seem morebut are given forrms that,seem more
nearly to fulfill the requirements ofnearly to fulfill the requirements of
mastication,tissue tolerance etcmastication,tissue tolerance etc

Cusp less teethCusp less teeth
Cuspless teeth are those which areCuspless teeth are those which are
designed without cuspal prominances ofdesigned without cuspal prominances of
masticatory surfacesmasticatory surfaces

Zero-degree teethZero-degree teeth
Zero-degree teeth are prosthetic teethZero-degree teeth are prosthetic teeth
having no cusp angles in relation to thehaving no cusp angles in relation to the
horizontal planehorizontal plane

CONCLUSIONCONCLUSION
The selection of teeth and theirThe selection of teeth and their
arrangement to meet estheticarrangement to meet esthetic
requirements demand artistic skill inrequirements demand artistic skill in
addition to scientific knowledge.addition to scientific knowledge.
There are no rules of thumb for thisThere are no rules of thumb for this
procedure; however, there are anatomicprocedure; however, there are anatomic
landmarks and manufactured aids thatlandmarks and manufactured aids that
can be used as guides.can be used as guides.

BIBLIOGRAPHYBIBLIOGRAPHY
 Essentials of complete dentureEssentials of complete denture
prosthodontics –prosthodontics – Sheldon winklerSheldon winkler
 Textbook of complete dentures –Textbook of complete dentures –
charles M. Heartwellcharles M. Heartwell
 Prosthodontic treatment for edentulousProsthodontic treatment for edentulous
patients –patients – BoucherBoucher
 Dental laboratory procedures (completeDental laboratory procedures (complete
dentures) –dentures) – Robert M.MorrowRobert M.Morrow

Selection of Teeth for Complete Dentures

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Selection of Teeth for Complete Dentures