Selection of anterior teeths. /certified fixed orthodontic courses by Indian dental academy


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Selection of anterior teeths. /certified fixed orthodontic courses by Indian dental academy

  1. 1. Anterior Tooth Selection. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Introduction.  Anterior teeth selection and arrangement is an area of prosthodontics where art dominates science,where esthetics is the major concern,and where knowledge must be applied to create a pleasing appearance while simultaneously maintaining oral function.
  3. 3. Introduction. The anterior teeth are primarily selected to satisfy esthetic requirements.  Posterior teeth's are selected to satisfy masticatory functional requirements. Technically, the anterior teeth are composed of 6 maxillary and 6 mandibular teeth's. 
  4. 4. Introduction. Exceptions: o Sometimes maxillary first premolar is considered more for esthetics than for masticatory function. o Sometimes in class 2 situations maxillary cuspids assume a functional role by addition of lingual centric stops.
  5. 5.  Patients expect 3 basic things form their complete dentures. • Favorable appearance. • Comfort. • Chewing ability.
  6. 6. Studies conforming importance of esthetics in complete dentures 1. Brewer, Reibel and Nassif 1967: JPD • 12 patients received 7 sets of dentures each made by 7 dentists. • Each patient preferred the best looking dentures.
  7. 7. 2. Straus et al. JPD 1977 • 64 patients were asked how their new complete dentures improved their self image. • Nearly all the patients responded that the new dentures improved their appearance,increased self confidence,and provided an overall sense of well being.
  8. 8.  1. 2. 3. 4. There are four main considerations in selecting the anterior teeth. Tooth size Tooth mold Color Tooth material
  9. 9. Pre-Extraction Guides.
  10. 10. Photographs     More accurate than any other guide. Shows the natural teeth or at least the incisal edges. Provides information about width and outline form of the teeth. Known factors: • Width/length on photo. • interpupillary distance on photo • Interpupillary distance on patient   Unknown factor: length or width of teeth to be selected. Recent photographs are of much value.
  11. 11. •Natural teeth at 20 years •65 years: Poor esthetics with 15 year old dentures. New denture s made with the help of phtogra ph
  12. 12. Bindra et al JPD 2001   The technique described by wehner et al is of proven value in calculating the width of a central incisor when the only available evidence is a preextraction photograph. However, it is of value only when the photograph is a full-face portrait of sufficient size.
  13. 13. Diagnostic Casts.   Diagnostic casts of patients natural or restored teeth. Size and form of the anterior teeth can be determined.
  14. 14. Radiographs.   Can help in knowing size and form of the lost teeth. Disadv • Are always slightly enlarged. • Distortion may be there.
  15. 15. Teeth of Relatives.  Sons or daughters tooth size , color, and arrangement can be effectively used in selecting and arranging artificial teeth for their parents.
  16. 16. Extracted teeth.   Provides information as to the size and form. Not to be used for selecting color.
  17. 17. Selection of Size.  There are 2 dimensions to consider • The • The mesiodistal width. inciso-gingival length.
  18. 18. Measurement edentulous casts.   Inaccurate due to resorption of ridges. Occlusal rims to be constructed for accurate measurements.
  19. 19.   Gives the estimation of placement of apex of upper canines. Extension of parallel lines from the lateral surfaces of the alae of the nose onto the labial surface of the upper occlusion rim.
  20. 20. Relationship between intercanine distance and nose width   It falls in the range 28-45mm Since anterior teeth are arranged in an arc. the divider has to be opened by 3-4mm more than the value of the nose width.
  21. 21.  Distal surfaces of the natural canines is usually located neat the corner of the mouth.
  22. 22. Sketching on occlusion rims By Kitzis. occlusion rim reduced till 1-2 mm visible. Proper contour is given . Some wax trimmed from labial aspect and replaced with warmed aluwax. 
  23. 23.   Wax to be molded by patient with functional movements of patients and manual movement by dentist The incisal portion of the rim is adjusted to follow the contour of the line of the lower lip.
  24. 24.    Mark the midline of the face. Sketch in desirable shape ,size ,and contour of the teeth. This gives more accurate indication of the actual portion(incisal) of the anterior teeth that will show during speech and smiling.
  25. 25. General guide .  Upper anterior teeth whose overall width is less than 48mm are relatively small teeth. Those listed as over 52mm are relatively large teeth.
  26. 26. Anthropometric measurements. Found from a study of 555 skulls.  Greatest bi zygomatic width / 16 -gives approximation of the width of the upper central incisors. - also known as house and loop’s rule.  Greatest bi zygomatic width / 3.3 -Overall width of the upper six anterior teeth.
  27. 27.   Lateral incisor are approximately 2 mm narrower and canine 1 mm narrower than the central incisors. A facebow maybe used utilized to obtain these measurement.
  28. 28. The ratio of cranial circumference to the width of the upper anterior teeth 10: 1 In 90% of 509 subjects in a study be kern,1967 
  29. 29. Length of central incisor  Facial measurement method • Distance from the hair line to the gnathion in millimeters with the face at rest and divide this by 16.  Wax rim method. • Instruct the patient to smile • Place a line on the rim at that point to which the lip elevates. • General guideline: the maxillary lip comes close to the gingival neck of the tooth when a patient smiles broadly
  30. 30.    Amount of central incisor visible in young-3 mm. In old – 11/2 mm. The amount of tooth seen depends on following factors. • • • • Length of upper lip Mobility of upper lip Vertical height of occlusion. Overbite.
  31. 31. Using trubute tooth indicator.
  32. 32. Size of the maxillary arch.  Mold selector method. • Accurate contoured occlusal rims are required. • Make the measurements from the crest of the incisal papilla to the hamular notches and from one hamular notch to the opposite hamular notch. • the combined length of the 3 legs of the triangle in millimeters is used on the selector. • When discrepancies between face size and related arch size exist,the selection of anterior teeth should be governed more by face size than by arch size.
  33. 33. Universal dental company mold selector     Superimpose median line and move scanner to touch the cuspid line Mold width is indicated in lower scale. Read the mold length in the transparent area.
  34. 34. Incisal papilla – cuspid eminence/buccal frenum.    A line is placed on the cast at the distal termination of the eminence. When eminence are not discrenible a line is placed slightly anterior to the attachment of buccal frenum. Ruler should follow contour of the ridges and in midline should be placed on the anterior border of the incisive papilla.
  35. 35. Maxillo-mandibular relations.    In protruded mandible the anterior teeth's are frequently larger than normal. If mandibles are retruded, the mandibular anterior teeth are frequently smaller. In protrusion the face is usually longer and longer faces usually require longer teeth's.
  36. 36. Vertical distance between the ridges.   The length of teeth is determined by the space between the ridges. When space is available it is advisable to use long teeth.
  37. 37. Lips.     Help in determined the length of the teeth. The maxillary incisal edge extends inferior to or slightly below the lip margin. When teeth are in occlusion and lips are together,the labial incisal third of the maxillary anterior teeth supports the superior border of the lower lip. In speech the incisal edges of the maxillary anterior teeth contact the lower lip at the junction of the moist and dry surfaces of the vermilion border. As in pronouncing fifty five.
  38. 38. Inner canthal distance   Inner canthal distance can be used to estimate the mesiodistal width of a maxillary central incisor for an edentulous patient. Aleem abdullah JPD 2002
  39. 39.     Size of the teeth should be in proportion to the size of the face and head. Larger persons have larger teeth But a large person may have small teeth with spaces between the teeth. Or a small person may have large irregular aligned teeth.
  40. 40.
  41. 41.    Woman have smaller teeth than men. Lateral incisor should look more delicate in woman. Size difference between central and lateral incisors should be more distinct in woman.
  42. 42. Selection Of Form(shape or mold).    Form of artificial anterior teeth should harmonize with the shape of the patients face. Outline form is considered from a front view of the patient. The face from is identified by connecting the following points on the lateral aspect of the face; • • • the forehead, the zygomatic arch Angle of the mandible.
  43. 43. 4 basic Outlines of faces  This was firs considered important by williams and house and loop (Leon williams classification) • Square  Square tapering • Tapering • ovoid
  44. 44.   The shape of the maxillary central incisor should resemble the shape of the face if it were inverted. This method selection is also called as Geometric
  45. 45.    Most dental manufacturers base their entire systems of tooth selection on these typal forms. As ovoid teeth are not usually seen in an ovoid shaped face ,Scientifically this method of selecting teeth form is flawed. Wright found that 60.7% of his subjects had natural maxillary central incisor that were not the inverted facial forms.
  46. 46.    Bell examined the maxillary central incisors of 31 subjects whose natural teeth were considered esthetically acceptable. There was no correlation between the form of face and the form of the maxillary central incisors. Conclusion: though flawed this approach may be reasonable from an artistic point of view.
  47. 47. Lee 1962     Compares the width of face and teeth at At level of foreheadgingival third At level of zygomata.maximum width At level of incisal tip.
  48. 48. Relation between tooth shape and arch shape
  49. 49. Tooth curvature  The form of the tooth should conform to the contour of the face as considered from the labial,mesial,distal and incisal aspects. Tooth manufacturers labels its tooth molds F(flat ) or C (curved) according to the labial surface.
  50. 50.    The shape of labial surface is more important than outline form. Labial surface when viewed from the mesial should show a contour similar to that when viewed in profile. “This approach to the problem,although scientifically unsound,was used by many tooth manufacturers and is ,perhaps,the basis of tooth selection most often used today.” -sharry
  51. 51.      Check three points: the forehead,the base of the nose,and the point of the chin.if these three points are in line ,the profile is straight. 3 types of profiles are Convex straight concave
  52. 52.  Labial surface of the tooth when viewed from the incisal should show a convexity or flatness similar to that seen when the face is viewed from under the chin or from the top of the head.
  53. 53.
  54. 54. Selection of Shade.  Color has 4 qualities.
  55. 55. hue    Hue it is the specific color produced by a specific wavelength of light acting on the retina. The hue of the teeth must be in harmony with the color(Hue) of the the patients face. In teeth guides yellow is the dominant hue.
  56. 56.  Saturation (chroma) • It is the amount of color per unit area. • Some teeth appear more yellow than other .I.e hue is same but there is more of it.  Brilliance (value) it is the lightness or darkness of an object. • The relative amount of white or black in the teeth determines their lightness or darkness.
  57. 57.  People with fair complexions generally have teeth with less color and colors are less saturated. 
  58. 58. Translucency     It is the property of the object that permits the passage of light through it but does not give any distinguishable image.. The apparent color of teeth is different when the lightening of the interior oral cavity is changed. When the mouth is nearly closed,the teeth will appear darker than when it is open wide and the interior well lighted. When light is reflected through the teeth from the oral cavity,the teeth will appear lighter and more pink than in other light situations.
  59. 59.    The basic caucasian color is yellow. Complementary color of yellow is blue. Staring at blue card or cloth for 30 seconds make a more accurate observation of the yellow color.
  60. 60. The color of hair   is unreliable and can be inaccurate because hair color changes more rapidly than tooth color. People can change the color of hair from week to week.
  61. 61. Color of eyes.   Color of eyes has been suggested as guide to select the color of teeth. Not a sound method since color of Iris is so small compared to total face and the eyes are not close to the teeth.
  62. 62. Color of face.  It should be the basic guide to select tooth color.
  63. 63. Age and color     Color of natural teeth progressively darkens with age. Pulp chamber becomes smaller with age due to deposition of secondary dentin This makes the tooth more opaque and reduces the effect of pulp color. As wear occurs due to abrasive forces the tooth becomes smoother and more reflective.
  64. 64.   Wearing of incisal edges, losing of enamel and translucency and dentin picks up stain. Teeth’s take a brownish tinge particularly the incisal edges of lower anterior.
  65. 65. Jaw relation and color.    Class 1 same selected for both the arches. Class 3 : prognathic patient slightly darker teeth for the lower arch than the upper as lighter teeth will stand out. Class 2 : lighter teeth than the upper to give the illusion that the teeth are more anterior than they really are.
  66. 66. Selecting the color.    It should be done in 3 positions Outside the mouth along the side of the nose. It will establish the basic hue,brilliance,and saturation.
  67. 67.     Under the lips with only the incisal edge exposed. Will reveal the effect of the color of the teeth when the patient’s mouth is relaxed. Under the lips with only the cervical end covered and the mouth open. Will simulate the exposure of the teeth as in a smile.
  68. 68. Squint test    Helpful in evaluating colors of teeth with the complexion of the face. With the eyelids partially closed to reduce light,the dentist compares prospective colors of artificial teeth held along the face of the patient. The color that fades from the view first is the one that is least conspicuous in comparison to the color of the face.
  69. 69. Hallarman, 1971  There is no correlation between tooth color and • Natural hair color • eye color. • Skin color of forehead or cheek.    Canines are darker than central incisors Color darkens with age. Females have lighter natural teeth.
  70. 70. Selection of tooth material.     Conventional acrylic resin Interpenetrating polymner network(IPN) acrylic resin Composite resin teeth Porcelain.
  71. 71. Indications for resin teeth.     Recent extractions Immediate dentures Limited interocclusal distance. If current denture producing clicking sound.
  72. 72. Interpenetrating polymner network(IPN) acrylic resin    By dentsply international. This tooth material is non filled ,highly cross linked copolymer with an interpenetrating polymer network. It is harder more abrasion resistant,more stain resistant and more heat resistant than conventional resins.
  73. 73. Composite resin teeth    Vivosit (orthosit- posterior teeth) by Ivoclar. It consists of an organic filler and liquid matrix based on a modified Bowen resin. Liquid matrix and the organic filler contain approximately 20% Pyrolytic silicium dioxide,which is used as a thickening and strengthening agent.
  74. 74.    Pyrolytic silicium dioxide has particle size of 10 to 400 A which is less than wavelength of visible light- it makes for a highly esthetic appearance. It chemically bonds with the denture base material. It has better wear resistance than the conventional acrylic resin.
  75. 75. Porcelain teeth.      Highest wear resistance. Good stain resistance. Disadv: clicking sound in nervous patients and with those having neuromuscular coordination problems. More prone for chipping and fracture. Cannot be given when interarch space is less.
  76. 76. Resin anteriors and porcelain posteriors.  Maxillary anterior • Opposing mandibular natural teeth with distal extension partial denture. • It allows for wear of acrylic anterior if ridge resorption and settling takes place over a period of time and patients do not return for proper denture Rebasing services.  Mandibular anteriors • Accn to payne “ longer lingual slopes, are less apt to chip and will wear as settling occurs.they can be ground and reshaped to look more natural and their incisal edges can be easily stained with darker cold cured resin where desirable.
  77. 77. Dentogenic concept    By frush and fisher on 1957 Also called SPA theory Sex • male • Female  Personlity • Vigrous delicate  Age • • • Young Middle age Old.
  78. 78. Thank you For more details please visit