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Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
Teeth arrangement for complete dentures/ orthodontics courses online
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Teeth arrangement for complete dentures/ orthodontics courses online

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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  • 1. Teeth arrangement for complete dentures INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Contents  Introduction  Principal factors governing positions of teeth  Anatomic landmarks – in maxilla in mandible  Facial profile  Anterior teeth arrangement  Arch form  Posterior teeth arrangement  Compensating curves  Ridge relations  Atypical arrangement of teeth -class 2 ridge relation -class 3 ridge relation  Teeth arrangement for balanced articulation  Teeth arrangement for monolpane occlusion  Teeth arrangement for lingualised occlusion  teeth arrangement for esthetics.  Review of literature  References www.indiandentalacademy.com
  • 3.  Esthetic tooth placement and physiological tooth arrangement are biologically compatible and desirable as end products of proper complete denture construction.  Proper placement of teeth should be functionally as well as esthetically pleasing. www.indiandentalacademy.com
  • 4. www.indiandentalacademy.com
  • 5.  The position of the maxillary anterior arch, and the arrangement of the individual teeth make the most crucial contribution to the appearance of the face.  The teeth are not only an important component of facial appeal, they give each face a unique identity, just as eyes, nose, and skeletal proportions make each face distinctive and easily recognised. www.indiandentalacademy.com
  • 6.  The artificial tooth replacements can, and should contribute to the distinction of each patient's face, just as the natural teeth did, and in the process go some way to restoring the lost body image.  The goal in setting artificial teeth is quite simply to put them where the natural teeth were (Bissasu, 1992). www.indiandentalacademy.com
  • 7.  The setting of teeth is a combination of science and art and one of the most abused sections of prosthetic dentistry.  It is very difficult to lay down exact rules for guidance in this phase of prosthetic dentistry.  Too often the emphasis is placed on occlusion as being the only important factor in arrangement of teeth. www.indiandentalacademy.com
  • 8. Some of the common errors in arrangement of teeth include:  Setting mandibular teeth too far forward to meet the maxillary teeth  Failure to make the cuspids the turning point of the arch  Setting the mandibular first premolar buccal to the canines  Setting maxillary posteriors over the ridge and then occluding the mandibular teeth , bringing them too far to the lingual in the molar region  Failure to set the posterior teeth in a line of compromise between the two ridges. www.indiandentalacademy.com
  • 9.  The artificial teeth are attached to a movable base resting on movable and displaceable living tissue, which are subject to damage.  They act as a unit , therefore, they must be arranged to function as a unit. www.indiandentalacademy.com
  • 10. Factors Governing the Positions of Teeth The positions of the artificial teeth are influenced by (1) the functions of the surrounding structures, (2) the cellular structure of the basal seat tissues, ( 3) the anatomic limits, and (4) the mechanical aspects. www.indiandentalacademy.com
  • 11.  The five principal factors regarding the arrangement of teeth are group 1 1.antero posterior position of the arch the arch as a unit 2.shape of the arch 3.orientation of the plane group 2 1.individual inclinations for balance individual positioning of the 2.individual positions for esthetics teeth in the arch www.indiandentalacademy.com
  • 12. The 4 principal factors that govern the positions of the teeth for complete dentures are (1) the horizontal relations to the residual ridges. (2) the vertical positions of the occlusal surfaces and incisal edges between the residual ridges. (3) the esthetic requirements, and (4) the inclinations for occlusion . www.indiandentalacademy.com
  • 13. HORIZONTAL POSITIONS  The antero posterior position of the arch should be governed chiefly by the orbicularis oris and its attaching muscles.  These muscles control the expression and reflect the personality and appearance of every person wearing complete dentures. www.indiandentalacademy.com
  • 14. The horizontal positions of teeth to residual ridges involve placing the teeth anteroposteriorly and mediolaterally (1) to provide stability (2) to direct forces of mastication to areas most favorable for support, (3) to support the lips and cheeks for esthetics, and (4) to be compatible with the functions of the surrounding structures www.indiandentalacademy.com
  • 15.  Forces directed at right angles to the supporting tissues are more stabilising than forces directed at an inclined plane.  Protrusive and lateral movements involving tooth contacts result in forces directed toward inclined planes and these forces are capable of dislodging the dentures. www.indiandentalacademy.com
  • 16.  The character of the mucosa and submucosa must be considered when the teeth are positioned.  The forces of mastication should not be directed to tissue incapable of withstanding force.  The differentiated submucosa in the distal two thirds of the palate and in the retromolar pad are not capable of bearing stress.  The loosely attached submucosa in the vestibular fornix provides a good denture seal area but should not be subjected to the stresses of occlusion. www.indiandentalacademy.com
  • 17. VERTICAL POSITIONS  The arrangement of artificial teeth in the correct vertical positions involves placing the anterior and posterior teeth in an acceptible position between the two residual ridges in a vertical direction. www.indiandentalacademy.com
  • 18. As in correct horizontal positioning, correct vertical positioning of teeth should provide 1. Denture stability 2. Favorable forces 3. Support for lips and cheeks 4. Compatibility www.indiandentalacademy.com
  • 19. Vertical positions of mandibular posterior teeth Two anatomic guides to establish the vertical position of the occlusal surfaces of the posterior teeth are (1) The orifice of the duct of the parotid gland (Stensen’s duct ) (2) the retromolar pad. www.indiandentalacademy.com
  • 20.  The occlusal surface of the maxillary first molar is approximately ¼ inch below the orifice of the duct of the parotid gland. www.indiandentalacademy.com
  • 21.  The occlusal surface of the last mandibular natural molars is on a plane approximately at the bottom of the upper third of the retromolar pad.  This vertical position is usually compatible with the activities of the tongue and cheeks. www.indiandentalacademy.com
  • 22. Vertical positions of maxillary anterior teeth  Esthetics and phonetics are used to establish the vertical position of the incisal edges of the maxillary anterior teeth.  The patient is instructed to say ‘ fifty five’ and the teeth are adjusted until the incisal edges of the maxillary incisors contact the vermilion border of the lower lip at the junction of the moist and dry mucosa. www.indiandentalacademy.com
  • 23.  The use of the ala tragus line is an expediency and not a reliable indication for the occlusal surfaces of the teeth.  The plane is not used unless it coincides with the other guiding factors. www.indiandentalacademy.com
  • 24.  The occlusal plane is established using the retromolar pad for the posterior and the incisal edge or lower lip line for the anterior points of reference. www.indiandentalacademy.com
  • 25. Facial profile  As a general rule, the labial faces of the maxillary central incisors are parallel to the profile line of the face.  In the prognathous type, where the mandibular incisors protrude, the incisal edges of the maxillary teeth are farther out than the necks of the teeth.  When the mandibular incisors are retruded, the incisal edges of the maxillary teeth are toward the lingual than the necks of the teeth. www.indiandentalacademy.com
  • 26. Labial face of central incisor parallel with the profile line of the face www.indiandentalacademy.com
  • 27.  When the maxillary central incisor is inclined to be parallel with the profile line of the face, the lateral incisor must be set at an opposite angle to avoid a predominance of parallelism. For example, in the retrusive case, when the maxillary central incisors are out at the neck, the lateral incisors must then be depressed at the neck in order to oppose the line that is made by the labial faces of the central incisors.  In the prognathous set up , the incisal edges of the maxillary central incisors are to the labial. The maxillary lateral incisors in this set up then are placed slightly out at the neck to oppose the central labial face line. www.indiandentalacademy.com
  • 28. Anatomic landmarks  Beauty in nature arises from variations being in harmony; without harmony, variations are abnormal and, consequently, not beautiful. By using anatomic reference, it is possible to place artificial teeth within the bounds, or “averages,” of nature, and individual esthetic and physiologic variations would be permitted during the trial denture phase. www.indiandentalacademy.com
  • 29. The anatomic landmarks most useful as guides for positioning artificial teeth are: in the maxilla 1) the maxillary labial vestibule, (2) the incisive papilla, (3) mid sagittal suture (4) canine lines (5) the maxillary tuberosity, in the mandible (1) the mandibular labial vestibule, (2)the retromolar pad. www.indiandentalacademy.com
  • 30.  The mid sagittal suture, incisive papilla and labial frenum are guides to the median line.  A line is drawn antero - posteriorly bisecting these points and the line extending to the margin of the cast. www.indiandentalacademy.com
  • 31.  Maxillary labial vestibule  The soft-tissue reflection of the maxillary vestibule from canine to canine forms the denture border in that region.  In most dentitions, the distance from the incisal edge of the central incisors to the labial vestibule at a point immediately lateral to the labial frenum is 22 mm.  This measurement seldom varies by more than 1 mm except in petite persons in whom it may be only 18 mm.  The position is perfected and verified at the trial denture appointment. www.indiandentalacademy.com
  • 32. Incisive papilla as a guide  The incisive papilla is a valuable guide to anterior tooth placement because it has a constant relationship to the natural central incisors .  The labial surfaces of the natural upper central incisors are 8-10 mm in front of the middle of the incisive papilla. www.indiandentalacademy.com
  • 33.  Another reference is the distance between the most anterior border of the incisive papilla and the labial surface of the central incisors, which varies from 5 mm for a square arch form, to 6 mm for an ovoid arch, to 7 mm, for one that tapers. www.indiandentalacademy.com
  • 34.  In addition, the incisive papilla is also related to the canines and is situated on the line passing through the tips of the canines in the dentate person. www.indiandentalacademy.com
  • 35. www.indiandentalacademy.com
  • 36.  If the artificial teeth are replaced in the natural tooth position by referring to the incisive papilla, the molar teeth will move forward and the tongue space will become wider. www.indiandentalacademy.com
  • 37.  If the anterior teeth are arranged on the incisive papilla, the lip cannot be adequately supported and their position will also affect the arrangement of the molar teeth.  The artificial teeth will be arranged altogether posteriorly and the tongue space will be greatly restricted.  If the anterior teeth are placed in the position previously occupied by the natural teeth by referring to the incisive papilla as a landmark, the molar teeth will have an anterior shift accordingly and approach the position of the natural teeth. Thus the tongue space will become wider. www.indiandentalacademy.com
  • 38.  The canine lines.  The six maxillary anterior teeth occupy the space between the distal of the right canine eminence and the distal of the left canine eminence.  When the canine eminences are visible on the cast, a line coinciding the posterior margin of the eminence coincides with the posterior surface of the canine.  This line is recorded on the margin of the cast.  When the eminences are not visible, the points recorded at the corners of the mouth using the mandibular occlusal rim are taken as reference. www.indiandentalacademy.com
  • 39.  Maxillary tuberosity  The maxillary tuberosity lies immediately posterior to the maxillary second molar. This relationship could be with the first or third molar instead of the second.  This landmark is less reliable as atrophy increases, but generally it is useful. www.indiandentalacademy.com
  • 40. www.indiandentalacademy.com
  • 41. Diagram of the upper arch showing average distances from the palatal gingival margins of the furthest horizontal extent of the denture flange in the incisal (A), canine (B), premolar ( C) and molar (D) regions (the biometric approach). The line X - X passing through the posterior border of the incisive papilla can be used as a guide to position the tips of the canines.www.indiandentalacademy.com
  • 42.  Mandibular labial vestibule  The relationship between the six mandibular anterior teeth and the mandibular labial vestibule is similar to the maxillary anterior tooth to vestibular relationship.  The principal difference is in the distance from the incisal edges to the labial vestibule which is approximately 18 mm.  When dentures are constructed, clinical verification is essential. www.indiandentalacademy.com
  • 43.  Retromolar pad   The retromolar pad is the anatomic landmark used most frequently as a reference for tooth placement for it applies in three dimensions—vertically, laterally, and anteroposteriorly.  It guides the height of the occlusal plane.  In a monoplane artificial-tooth arrangement, the occlusal plane lies in the middle of the pad. www.indiandentalacademy.com
  • 44.  Laterally, the retromolar pad guides the buccolingual position of the posterior teeth.  Pound states that the lingual cusps of the mandibular posterior teeth lie within a triangle formed by the buccal and lingual borders of the retromolar pad and the mesial surface of the mandibular canine.  Anteroposteriorly, no artificial teeth are placed posterior to the anterior boundary of the pad. www.indiandentalacademy.com
  • 45.  The mean measurements of preextraction buccolingual breadth of the alveolar process gives an approximate guide to the breadth of the flange of complete upper dentures and to pre-extraction lip and cheek positions. www.indiandentalacademy.com
  • 46. Anterior tooth arrangement  Payne states, “set the teeth where they grew.”  With this as a guide , it is possible to more closely place the artificial tooth in approximately the position that was in the patient’s natural dentition. www.indiandentalacademy.com
  • 47.  In the upper anterior region, bone resorption following extraction will occur upward and inward because of the direction and inclination of the roots of the teeth and alveolar process.  In addition, the buccal alveolar bone is thinner than that of the palatal side and thus bone resorption is faster and greater labially. Consequently, the alveolar crest will move posteriorly according to the resorption of the alveolar bone. www.indiandentalacademy.com
  • 48.  The alveolar crest of the upper anterior region will move posteriorly according to the pattern of bone resorption. If this pattern is ignored and the artificial teeth are placed on the crest of ridge, the lip support will be inadequate.  For the provision of adequate and appropriate support of the lip, the artificial teeth must be placed in the positions occupied by the natural teeth. www.indiandentalacademy.com
  • 49.  Placing anterior teeth in harmony with functional activity involves placing the teeth in an anteroposterior and mediolateral position in harmony with the action of the lips and the tongue. www.indiandentalacademy.com
  • 50. If the upper lip is not properly supported, its shape wilL be concave, thus the skin will lose its tension and wrinkles will occur, leading to the”denture-caused” elderly appearance. This is a characteristic feature of the denture wearing patient. With a new denture having adequate upper lip support, the elderly appearance is no longer obvious.www.indiandentalacademy.com
  • 51. Overlap of the anterior teeth The anteroposterior relationship of the upper and lower anterior teeth, that is the horizontal overlap, is automatically decided by the relation between the upper and lower residual ridges.  The upper and lower anterior teeth should not be in contact in the centric occlusal position in any case. www.indiandentalacademy.com
  • 52.  The incisal edges of the maxillary and mandibular anterior teeth should have a 0.5-mm vertical overlap.  A 1- to 2-mm horizontal overlap must exist between the lingual surface of the maxillary anterior teeth and the labial surface of the mandibular anterior teeth.  Such an arrangement will create a low incisal guidance, which is exactly what one should achieve for the patient. www.indiandentalacademy.com
  • 53. 0.5 mm of vertical overlap and 1 to 2 mm of horizontal overlap must exist between the maxillary anterior teeth and their mandibular antagonists to achieve a low incisal guidance, which is needed for the anterior teeth to function in harmony with most posterior tooth forms. www.indiandentalacademy.com
  • 54. The upper and lower anterior teeth should not be in contact in the centric occlusal position. www.indiandentalacademy.com
  • 55.  Settling of complete dentures occurs 1-2 weeks after insertion, mainly due to the compression of the mucosa under the denture base. So, if the anterior teeth are arranged in contact, following the settling of the dentures, an impact between the opposing anterior teeth and an upward thrust of the anterior region will occur during occlusion, leading to an earlier loss of denture retention.  Even though the teeth were in contact in the natural dentition, they should be arranged out of contact at least just enough to compensate for the amount of settling after insertion. www.indiandentalacademy.com
  • 56.  In addition, due to the excess pressure exerted, resorption of the alveolar ridge in the anterior region will be increased and soft tissue hyperplasia, that is so-called flabby gums, will occur in this region.  The teeth should be arranged out of contact just enough to compensate for the amount if settling which occurs soon after insertion. By providing such a horizontal overlap, the incisal guide inclination is reduced and there will also be an improvement in the stability of the complete denture. www.indiandentalacademy.com
  • 57.  When determining the vertical level of the incisal edges of the anterior teeth using the occlusion rim, it is generally adjusted so that the upper anterior teeth are exposed about 1-2 mm below the border of the upper lip with the mouth slightly opened.  However, depending on the individual, the amount of upper tooth showing varies. Therefore if this level is adhered to, the entire occlusal plane will be affected causing it to be either too high or low. www.indiandentalacademy.com
  • 58.  In the lower anterior region, the lower anterior teeth are covered by the lower lip and quite inferior to its border.  The incisal edges of the lower anterior teeth are located at the level of the lower lip when the mouth is slightly opened.  Therefore, the lower lip is said to be a better guide for the vertical orientation of the anterior teeth than the upper lip. www.indiandentalacademy.com
  • 59. a. b. The central incisors are slightly visible and they look esthetically pleasing. However, the lower anterior teeth are covered by the lower lip and quite inferior to its border (a). The occlusal plane is raised up so that the incisal edges of the lower anterior teeth and the cusps of the lower first premolars are located at the level of the lower lip when the mouth is slightly opened. Thus the balance between the upper and lower denture is improved (b). www.indiandentalacademy.com
  • 60. ARCH FORM  In the absence of other more definite information, the arch form is used as a guide for the initial arrangement of the teeth.  The edentulous arch form bears a direct relation to the contour of the face provided there has been no loss of bone due to disease, no loss of bone due to the length of time the teeth have been missing, and that the teeth were all removed at one time.  The opposing arches do not always follow the same contour. www.indiandentalacademy.com
  • 61.  Anterior and posterior teeth must vary in size and form, therefore teeth must be selected from anterior and posterior molds separately rather than from teeth all on one card. www.indiandentalacademy.com
  • 62. The arches are classified in a general way as  Square  Tapering  Ovoid www.indiandentalacademy.com
  • 63. A-SQUARE , B- TAPERING, C- OVOID www.indiandentalacademy.com
  • 64.  The central incisors in a square arch form assume a position more nearly back to the canines than in any other setup.  The four incisors have very little rotation as they have sufficient room in the arch.  This gives a broader effect to the teeth and should harmonise with a broad square face. www.indiandentalacademy.com
  • 65.  In the tapering arch, the central incisors are a greater distance forward than the canines.  There usually is considerable rotation and lapping of these teeth because there is less space in the arch.  The narrowed effect is in harmony with the narrower, tapering face. www.indiandentalacademy.com
  • 66.  In the ovoid arch, the central incisors are forward to the canines, in a position between that of the square and tapering arches.  The teeth are seldom rotated and have a broad effect that should be in harmony with a round , ovoid face. www.indiandentalacademy.com
  • 67.  When it is decided to set anterior teeth irregularly, it is essential that both canine cusps lie in the same coronal plane and are equidistant from the median sagittal plane. If this is not done the irregularities produced in the anterior teeth will result in an asvmmetry of the posterior parts of the arch.  To ensure that the canines are symmetrically placed , the following rules should be observed regarding the setting of the incisors, so that any irregularities will compensate one another. www.indiandentalacademy.com
  • 68.  If the angle between the incisal edge of the right central incisor and the median sagittal plane (A’) is less than the angle between the incisal edge of the left central incisor and the median sagittal plane (A”), then the angle subtended by the right lateral incisor to the median sagittal plane (B’) should be greater than the angle subtended by the left lateral incisor to the median sagittal plane (B”).  If A’ is less than A” then B’ should be greater than B”. www.indiandentalacademy.com
  • 69. Method of setting the upper incisors so that rotational irregularities compensate each other and enable the symmetrical placement of the canines. www.indiandentalacademy.com
  • 70.  In the average individual the sagittal angle between the columella and the lip is about a right angle, but several factors influence the actual angle in any individual. a. If the teeth are proclined the nasolabial angle tends to be approximately 90 , but if the teeth are retroclined the angle tends to be more than a right angle. b. if the columella is prominent and at a lower level than the ala, a nasolabial angle of more than a right angle is indicated, but if the columella and ala are at the same level this indicates a right angle. www.indiandentalacademy.com
  • 71. The effect of tooth inclination and nose form on the nasolabial angle. A. When the teeth are proclined, the nasolabial angle is about 90 or less. B. When the teeth are retroclined, the nasolabial angle must be more than 90 . C. When the columella is prominent and the ala is high, the nasolabial angle is more than 90 ‘. D. When the columella and ala are at the same level, the nasolabial angle is about 90 www.indiandentalacademy.com
  • 72. Maxillary Central Incisors  Long axis of tooth should be parallel to the midline when viewed labially.  Incisal edge is in contact with the occlusal plane.  Maxillary central incisors should have a labial inclination of 15 degrees.  Tip of incisal pin should be touching the mesioincisal angle of central incisors.  Incisal edges are in a straight line with the distoincisal edge slightly curved. www.indiandentalacademy.com
  • 73. Maxillary Lateral Incisors  Long axis of the tooth should be distally inclined.  Cervically it is not as prominent as central incisors.  Incisal edge is 1 mm above the occlusal plane.  Lateral incisors should have a labial inclination of 20 degrees.  Incisal edges follows the curvature of the arch www.indiandentalacademy.com
  • 74. Maxillary Canine  Long axis of tooth should be straight.  When viewed from front, only mesial half of tooth is visible.  Neck of cuspid should be prominent.  Incisal edge is tucked in to harmonize with the adjacent incisal edge.Cusp is in contact with the occlusal plane.  Long axis of tooth should be parallel to the vertical axis.  When viewed incisally the canines are rotated upto 90 degrees following the curvature of arch. www.indiandentalacademy.com
  • 75. Mandibular Central Incisors  Long axis should be straight and parallel to the midline.  Incisal edge should be 2 mm above occlusal plane.  Long axis should be labially inclined when viewed from side.  Maxillary midline should coincide with mandibular midline.  Incisal edges should be in straight line with the distoincisal edge slightly curved. www.indiandentalacademy.com
  • 76.  Mandibular Lateral Incisors  Long axis should be parallel to the midline.  Incisal edge should be 2 mm above occlusal plane.  Long axis should be labially inclined but not as steeply as central incisors.  Incisal edges follows the curvature of arch. www.indiandentalacademy.com
  • 77. Mandibular Canine  Long axis of tooth should be mesially inclined i.e sloping towards the midline  Cusp tip is slightly more than 2 mm above occlusal plane.  Placed in a sloping manner thus known as sleeping canine.  Long axis should have a slight lingual inclination when viewed from the side.  Canines are rotated upto 90 degrees. www.indiandentalacademy.com
  • 78. Arrangement of posterior teeth  The preliminary arrangement of posterior teeth involves the application of principles similar to those applied in the arrangement of anterior teeth.  The artificial posterior teeth should be placed near to where the natural teeth were positioned.  This placement will make it easier for the patient to adapt to the dentures, permits tongue and cheeks to function effectively during speech, mastication, and deglutition, and is esthetically more acceptable than a purely mechanical position. www.indiandentalacademy.com
  • 79.  The posterior plane of occlusion is an extension of this anterior plane level with the junction between the middle and upper third of the retromolar pads bilaterally.  These posterior references (retromolar pads) will place the overall plane at a level that is familiar to the tongue. www.indiandentalacademy.com
  • 80.  The use of these anteroposterior landmarks also creates an occlusal plane essentially parallel to the ala-tragus line. www.indiandentalacademy.com
  • 81.  Research by Foley and Latta showed that the parotid papilla was on the average 3.3 mm above the occlusal plane and should be considered and used as a guide for establishing the height of the occlusal plane. www.indiandentalacademy.com
  • 82.  If it is too high, the upper and lower posterior teeth can bite the papilla during function.  If the plane is too low, the tongue can overlap the lower teeth and cause tongue biting.  Interference with normal tongue action due to a high or low occlusal plane will adversely influence denture base stability . www.indiandentalacademy.com
  • 83.  The curvature of the arch of anterior teeth should flow pleasingly toward the posterior teeth.  The posterior teeth are positioned in such a way that they are properly related to the bone that supports them and to the soft tissues that contact their facial and lingual surfaces. www.indiandentalacademy.com
  • 84. Regarding the anatomic landmarks used for locating the the lower molar teeth, Pound reported that the positions of the lower molars are situated between two lines projected from the buccal and lingual aspects of the retromolar pad to the mesial aspect of the cuspid.  Also, as stated by Ortman, the lingual cusps of the natural molars are approximately in vertical alignment with the mylohoid ridge , and thus the mylohyoid ridge is a reliable guide for determining the lingual limit of the artificial lower teeth.  The lower posterior teeth must never be arranged lingually to this ridge. Both are generally used as guides to guess the position occupied by the natural teeth. www.indiandentalacademy.com
  • 85. The lingual surfaces of the lower molars are situated between two lines projected from the buccal and lingual aspects of the retromolar pad to the mesial aspect of the cuspid (Pound, E). www.indiandentalacademy.com
  • 86.  In the final tooth arrangement, the posterior form of the arch will be determined largely by the “neutral zone” between the cheeks and tongue.  This is the space resulting from the removal of the posterior teeth and the loss of bone from the residual ridges. www.indiandentalacademy.com
  • 87.  Therefore the final arrangement of the arch must be developed with respect for the tongue and cheek .  The solution to the problem is to position the teeth along a line extending from the tip of the canine to the middle of the retromolar pad.  This arbitrary line should pass through the central fossa of the mandibular premolars and molars. www.indiandentalacademy.com
  • 88.  The basic principle for the buccolingual positioning of posterior teeth is that they should be positioned over the residual ridge.  The canine and retromolar pad should provide guides for this arrangement.  The distance between the distal of the mandibular canine and the mesial of the retromolar pad is measured to determine the total anterposterior space to be covered. www.indiandentalacademy.com
  • 89.  The maxilla does not afford a landmark to which to measure, while the mandible rises with an upward curvature and prevents a setting of the teeth too far to the posterior. www.indiandentalacademy.com
  • 90.  A point ito 2 mm below the top of the retromolar pad and the tip of the positioned mandibular cuspid are guides used in the placement of the mandibular posterior teeth.  The central grooves of the posterior teeth are positioned on a line between the cuspid tip and the middle of the retromolar pad. When only three posterior teeth are arranged, it is essential that the central grooves of the molars be positioned slightly to the buccal to avoid crowding the tongue. www.indiandentalacademy.com
  • 91.  The key to an ideal, anatomically related setup of the upper and lower posterior teeth is the proper relationship between upper and lower canines.  When correctly related , the mesial incline of the upper canine opposes the distal incline of the lower canine. www.indiandentalacademy.com
  • 92. Maxillary 1st Premolar  Long axis should be straight  Palatal cusp should coincide with the crest of the lower residual ridge  Buccal cusp should touch the occlusal plane.  Palatal cusp should be 1mm above the occlusal plane www.indiandentalacademy.com
  • 93.  Maxillary 2nd Premolar  Long axis should be straight  The palatal cusp should coincide with the crest of the residual ridge  Both Buccal and Palatal cusps should contact the occlusal plane www.indiandentalacademy.com
  • 94.  Maxillary 1st Molar  The long axis should be inclined mesially when viewed from the buccal aspect .  The mesiopalatal cusp should coincide with the crest of the lower residual ridge.  The long axis should be inclined palatally when viewed from the proximal aspect .  The mesio-palatal cusp should contact the occlusal plane.  Distobuccal cusp should be 0.5mm above the occlusal plane  Distolingual cusp 0.5 – 0.75mm  above the occlusal plane www.indiandentalacademy.com
  • 95. Maxillary 2nd Molar  Long axis should be inclined mesially when viewed from the buccal aspect.  The mesial tilt should be more than that of the 1st molar .  Mesiopalatal cusp should coincide with the crest of the lower residual ridge; but be 0.75mm above it.  Long axis should be inclined palatally when viewed from the proximal aspect.  All cusps should be above the occlusal plane. The mesiopalatal cusp is the closest to the occlusal plane (0.75mm) www.indiandentalacademy.com
  • 96.  Mandibular 1st molar  Long axis should be inclined mesially when viewed from the buccal aspect  Long axis should incline lingually when viewed from proximal aspect.  All cusps should be at a higher level  than the occlusal plane  Mesiobuccal cusp should occlude with the distal marginal ridge of the maxillary 2nd premolar and the mesial marginal ridge of the maxillary 1st molar.  The mesiobuccal cusp of the maxillary 1st molar should occlude in the buccal groove of the mandibular 1st molar. www.indiandentalacademy.com
  • 97.  Mandibular 2nd molar  Long axis should be inclined mesially when viewed from the buccal aspect.  Long axis should incline lingually when viewed from the proximal aspect.  All cusps should be above the occlusal plane .  Mesiobuccal cusp occludes with the distal marginal ridge of maxillary 1st molar & mesial marginal ridge of the maxillary 2nd molar www.indiandentalacademy.com
  • 98. Mandibular 2nd premolar  Long axis should be straight when viewed from the buccal aspect .  Both cusps should be 2mm above the occlusal plane.  The buccal cusp occludes with the mesial marginal ridge maxillary 2nd premolar and the distal marginal ridge of the maxillary 1st premolar www.indiandentalacademy.com
  • 99. Mandibular 1st premolar  Long axis should be straight when viewed from the buccal aspect .  Buccal cusp should be 2mm above the occlusal plane.  Lingual cusp tip should lie below the occlusal plane .  Tip of the buccal cusp should contact with the mesial marginal ridge of the maxillary 1st premolar and mesial marginal ridge of the maxillary 1st premolar www.indiandentalacademy.com
  • 100. Arranging the premolars and the modiolus  At the corner of the mouth situated almost in the position of the lower first premolar, many muscle fibers of the muscles of mastication and expression such as the buccinator and orbicularis oris converge to form a muscle knot called the modiolus.  When the buccinator, the orbicularis oris, etc. contract during functional movements such as mastication or speech, the modiolus strongly pushes the buccal side of the premolar region. www.indiandentalacademy.com
  • 101.  The buccinator, which contracts during mastication, can produce an effective muscle contraction only if its anterior and posterior ends are fixed.  Its anterior end is at the modiolus which is supported by the first premolar.  Therefore, if the first premolar is placed more lingually to the position of the natural teeth, the buccinator will lose its support during function and can not function effectively during mastication as in the dentate state.  To perform its functions smoothly, the first premolar should be arranged in the position of the natural teeth, namely buccally to the alveolar crest. www.indiandentalacademy.com
  • 102. When the lower posterior teeth are placed where the natural teeth were situated, one has to also consider the size of the artificial teeth.  An undercut tends to occur increasingly under the lower molars of the natural dental arch as it is followed posteriorly. So, also in the denture, if the artificial teeth are arranged in the position occupied by the natural teeth, an undercut will be produced on the lingual polished surface under the posterior teeth.  The tongue will bulge into the undercut and raise the denture, causing it to be dislodged. www.indiandentalacademy.com
  • 103.  The occlusal surface area of the artificial posterior teeth is smaller than that of the natural teeth in order to reduce the load on the supporting tissues during mastication. This will also work effectively in this situation.  The use of posterior teeth which are narrow buccolingually will produce no undercut under the teeth. More favorably, these teeth are also smaller mesiodistally, so that the position of the posterior teeth shifts mesially where there is less undercut in the natural dentition. www.indiandentalacademy.com
  • 104.  If the posterior teeth are arranged in the position where the natural teeth were, the undercut will also occur on the lingual polished surface under the teeth. The tongue will bulge into the undercut and raise the denture. www.indiandentalacademy.com
  • 105. If posterior teeth which are narrow buccolingually are used, no undercut will occur lingually under the teeth. www.indiandentalacademy.com
  • 106. As the artificial posterior teeth are smaller mesiodistally, the position of the posterior teeth shifts mesially where there is less undercut in the natural dentition. www.indiandentalacademy.com
  • 107.  By using artificial teeth which are much smaller than the natural teeth, a large tongue space can be obtained.  In addition, the forces from the cheeks and tongue will be balanced. So, this situation can resolve problems arising in edentulous patients, who typically have a large, strong tongue. www.indiandentalacademy.com
  • 108.  Compensating curves  From the foregoing descriptions of the orientation of the teeth it will be seen that they are arranged so that the posterior teeth, when considered as a whole unit, form two curves  antero posterior and  lateral curve. www.indiandentalacademy.com
  • 109. Anteroposterior curve  Compensating curves are the artificial curves introduced into dentures in order to facilitate the production of balanced articulation: they are the artificial counterparts of the curves of Spee and Monson which are found in the natural dentition.  The anteroposterior curve follows an imaginary line touching the buccal cups of all lower teeth from the lower canine backwards,and approximates to the arc of a circle.  A continuation of this curve in the natural dentition (curve of Spee) , will nearly always pass through the head of the condyle . www.indiandentalacademy.com
  • 110. The curve of Spee of the natural dentitionwww.indiandentalacademy.com
  • 111.  If the path followed by the condyles is horizontal, then the teeth could be set to conform to a horizontal plane. When the mandible moves forwards the teeth will remain in contact. www.indiandentalacademy.com
  • 112.  If the path travelled by the condyles is at an angle from the horizontal plane (as it always is to some extent), then as soon as the mandible moves forwards the condyles commence to descend, and the posterior teeth will lose contact if they have been set to conform to a horizontal plane. www.indiandentalacademy.com
  • 113.  If the posterior teeth, instead of being set on a horizontal plane, are set to an anteroposterior curve then as the mandible moves forwards and the condyles travel downwards all the teeth can remain in contact. www.indiandentalacademy.com
  • 114. (a) Retruded contact position with an occlusal surface which is an arc of the circle of which the condylar path is also an arc. (b) In protrusion, contact is maintained www.indiandentalacademy.com
  • 115.  The lateral curves  In the natural dentitjon there are two lateral curves, one involving the molar teeth (the curve of Monson), and the other involving the teeth anterior to the second premolars.  The second premolars are not involved in any curve as they lie on a horizontal plane.  The posterior curve has its concavity facing upwards and increases in steepness from before backwards, the occlusal surfaces of the upper molars facing outwards and downwards. The anterior curve is a reverse of the posterior curve just described. www.indiandentalacademy.com
  • 116. Lateral compensating curves (a) Molar curve; (b) second premolar; (c) first premolar curve www.indiandentalacademy.com
  • 117.  When the mandible is moved laterally the rotating condyle on the working side (i.e. the side towards which the mandible is moved) remains in the glenoid fossa and moves very slightly outwards and backwards (Bennett movement).  The orbiting condyle on the other side (balancing or non-working side) travels downwards and forwards. www.indiandentalacademy.com
  • 118.  If the teeth are set on a horizontal plane, those on the non-working side will lose contact, due to the downward movement of the condyle on that side. If, however, the teeth are set to conform to a curve, the steepness of which relates to the steepness of the condylar path, then the teeth will remain in contact during the lateral and downward movements . www.indiandentalacademy.com
  • 119. Ridge relations The anatomic structure of the maxilla and mandible is such that they tend to resorb from each other, i.e., the mandible becomes wider and the maxilla narrower because the inclination of the alveolar process is upward and inward in the maxilla and outward and downward in the mandible. www.indiandentalacademy.com
  • 120. Natural teeth in normal (80 degree) inclination. Lines a,b,c,d show successive stages of resorption and increasing disparity between the widths of the arches. www.indiandentalacademy.com
  • 121. Resorption does not take place in parallel levels. The solid outlines show successive forms of ridges ; at stage d, the intra alveolar crestal angle is only 73 degrees www.indiandentalacademy.com
  • 122. The ridge relations may be classified as  Prognathous – anterior and posterior teeth of the maxilla are set to the lingual instead to the buccal of the mandibular teeth. Cross-bite A is a ridge relation that is normal in the anterior portion of the mouth and prognathic in the posterior ridge relation. Cross-bite B is a combination of ridge relations that may be classified as normal in the posterior areas and prognathic in the anterior part of the mouth. Crossbite A is a ridge relation that is very common, while crossbite B is rarely found. These combinations of ridge relation are caused by intermittent premature loss of teeth with no replacements.  orthognathous - retrusion of the mandibular anterior teeth with the posterior teeth in normal relation to each other. www.indiandentalacademy.com
  • 123. Crossbite A relation Anterior relation Posterior relation www.indiandentalacademy.com
  • 124. Crossbite B Anterior relation Posterior relation www.indiandentalacademy.com
  • 125. Orthognathous relationship Anterior relation Posterior relation www.indiandentalacademy.com
  • 126. Atypical arrangement of teeth Tooth overlap of patients with maxillary protrusion  In patients who had an Angle’s Class II. division 1 malocclusion in their natural dentition, in order to provide a good appearance, it is not uncommon for the upper anterior teeth to be arranged more lingually than their normal position and sometimes even some of the alveolar process is removed to arrange the teeth further back. In this way, the prominent appearance is removed and the appearance of the patient is apparently improved.  However, if one sticks to arranging the teeth posteriorly, the tension of the upper lip will be lost and a youthful appearance may disappear. www.indiandentalacademy.com
  • 127. Patients having maxillary protrusion are characterized by a deep vertical overlap of the anterior teeth and a marked forward movement of the mandible. www.indiandentalacademy.com
  • 128.  Also, a deep vertical overlap of the anterior teeth and a marked forward translation of the mandible during function are characteristic of these cases.  If this is neglected and the anterior teeth are arranged posteriorly, the horizontal overlap will reduce and the large mandibular movement during function will be hindered.  The dentures may be displaced by the anterior teeth impacting during function. www.indiandentalacademy.com
  • 129.  Therefore, in order to improve the appearance of those patients with maxillary protrusion without loss of denture retention, a method is used in which the upper anterior teeth are arranged at a higher level than the natural teeth without altering their anteroposterior position. Thus, the deep vertical overlap is reduced, leading to improvement in the facial appearance and a smoothing of the mandibular movements.  It is important to give a shallow incisal guide inclination for good denture stability. www.indiandentalacademy.com
  • 130. POSTERIOR ARRANGEMENT FOR CLASS II RELATIONSHIP  The lower ridge is small and markedly inside the upper ridge. The anterior teeth exhibit a pronounced horizontal overlap when they are arranged properly for esthetics.  The upper posterior teeth may need to be set more palatally than usual in order that they may occlude with the lower teeth.  The lower teeth should never be set outside the ridge . www.indiandentalacademy.com
  • 131.  Either anatomic, modified anatomic, or non- anatomic teeth can be used for these retrusive cases.  The selection of the occlusal form is based on the same factors of ridge strength, form, and interridge space as for the normal ridge relation.  Because the lower ridge in these patients is usually small and weak in relation to the upper, the buccolingual inclines are modified to a shallow angulation, or nonantomic teeth are selected. www.indiandentalacademy.com
  • 132. Tooth overlap of patients with mandibular protrusion  Many patients with mandibular protrusion have a marked translation of the mandible during function, similar to those patients with maxillary protrusion. Therefore, even though the appearance of the patient can be improved as much as they expect, the upper anterior teeth should not be arranged to cover the lower anterior teeth regardless of a marked mandibular movement and the relationship of the upper and lower residual ridges.  In patients with mandibular protrusion, arranging the teeth in an edge- to-edge-like incisal relationship (the upper and lower anterior teeth are not in contact) is the limit. www.indiandentalacademy.com
  • 133. In the case of mandibular protrusion, the anterior teeth should be arranged in an edge-to- edge- like relationship. If possible, the upper anterior teeth should be arranged more labially than their natural position. www.indiandentalacademy.com
  • 134.  The anterior teeth are best set edge to edge or, in extreme cases, with a negative overjet .  An edge-to-edge relationship, although it may appear difficult to accomplish, is almost always possible by retro-inclining the lower incisors and setting the upper incisors more labially, especially at the incisal edge. www.indiandentalacademy.com
  • 135.  When setting the posterior teeth it is often difficult to occlude them in a normal relationship because of the discrepancy between the ridges, particularly in the molar region.  In extreme cases it may be necessary to reverse the tooth relationship .  This means that instead of the buccal cusps of the lower molars fitting into the fossae of the upper molars, the reverse occurs. www.indiandentalacademy.com
  • 136.  Sometimes the crossing of the occlusion has to be applied to all the posterior teeth, but more commonly it is only the molars which are affected.  In cases presenting marked inferior protrusion it is frequently necessary to set the upper teeth far outside the ridge and it is then important that the buccal flange is sufficiently wide that the polished surface has the correct shape . www.indiandentalacademy.com
  • 137.  If the retention of the denture is satisfactory the only trouble likely to result from setting teeth over the buccal sulcus is a midline fracture of the denture due to its continual flexion, particularly if the occlusion is not balanced, and a metal palate may be incorporated. www.indiandentalacademy.com
  • 138. Arranging teeth to a balanced articulation  The objective of balancing a denture occlusion is to create simultaneous bilateral contacts from the centric relation position to all eccentric occlusal positions that are free of interferences.  These multiple contacts should be smooth, uniform, and in harmony with the temporomandibular joints and neuromuscular activity.  Once achieved, first by the proper positioning of the teeth during the setup and then refined by selective grinding, a lingual contact balanced occlusion also provides lever stability for the denture bases. www.indiandentalacademy.com
  • 139. Prerequisites for Balancing the Occlusion  There are four specific conditions that must be met by the mandibular posterior teeth in order to achieve a balanced occlusion: (1) the mandibular posterior teeth must be set so that the occlusal surfaces are horizontal; (2) the plane of occlusion must have a proper orientation; (3) a compensating curve must be set; and (4) the teeth must be modified so that there are no interlocking transverse ridges. www.indiandentalacademy.com
  • 140. The maxillary teeth must be (1) modified to eliminate buccal cusp contact, (2) set so that the upper lingual cusps have a positive but static centric occlusal contact, and (3) have no buccal cusp contacts in lateral excursions www.indiandentalacademy.com
  • 141.  The anterior teeth are set with a minimal vertical overlap of 0.5 to 1mm and 1 to 2 mm of horizontal overlap to establish a low incisal guidance. www.indiandentalacademy.com
  • 142.  In the arrangement of posterior teeth, most clinicians set the mandibular teeth before the maxillary because this provides better control of the orientation of the plane of occlusion both mediolaterally and superoinferiorly . www.indiandentalacademy.com
  • 143. Setting the mandibular teeth Premolars  The primary consideration in positioning the premolars is that they follow the form of the residual ridge.  The central fossa should be in line with the antero posterior reference line. www.indiandentalacademy.com
  • 144.  The facial surface of the premolars should be perpendicular to the occlusal rim, and yet slightly facial to the canine, but never farther facially than the buccal flange.  In the ideal situation, the mandibular first and second premolars, with their central grooves, are positioned on a line from the canine tip to 1 to 2 mm below the top of the retromolar pad. www.indiandentalacademy.com
  • 145.  The long axis of the tooth is positioned so that the cusp tips are level with the remaining mandibular wax occlusal rim.  The second premolar is set in a similar manner. www.indiandentalacademy.com
  • 146.  When these lower teeth have been arranged, a segment of the maxillary occlusal rim is removed to accommodate the first maxillary premolar, which is set into maximum intercuspation with the two lower premolars. www.indiandentalacademy.com
  • 147.  The first three premolars set (two mandibular and one maxillary) are the key to the relative anteroposterior intercuspation of all the remaining posterior teeth.  Once the premolars are set and properly related to each other, positioning of the remaining mandibular posterior teeth is easily accomplished. www.indiandentalacademy.com
  • 148. Molars  The mesial cusps are on the plane established by the anterior teeth and bicuspids.  The distal cusps of the first molars are raised about 0.5 mm above this plane.  The buccal and lingual cusps are set at the same height to make the transverse plane horizontal.  The central fossa is aligned with the canine – retromolar pad reference line. www.indiandentalacademy.com
  • 149.  The second molar continues the cuspal elevation of the compensating curve.  This imaginary extension should run parallel to the condylar inclination.  The buccal and lingual cusps are horizontal and the central fossa is aligned with the canine – retromolar pad reference points. www.indiandentalacademy.com
  • 150. Setting maxillary posterior teeth Premolar  The first premolar is placed next to the canine and the articulator is closed to its proper vertical and central position. www.indiandentalacademy.com
  • 151.  The tooth is guided so that the lingual cusp fits into the lower common central fossa at the midpoint of the distal marginal ridge of the first mandibular premolar and the mesial marginal ridge of the second molar.  The buccal cusp is raised slightly out of contact. www.indiandentalacademy.com
  • 152.  The second premolar is placed with the lingual cusp in contact with the central fossa at the midpoint of the distal marginal ridge of the mandibular second molar and mesial marginal ridge of the mandibular first molar. www.indiandentalacademy.com
  • 153. Molars  After these adjustments are completed, the maxillary first molar is articulated with the mandibular first molar.  After the maxillary first molar is positioned, the articulator is closed so that the mandibular tooth will assist in seating the maxillary tooth into maximum intercuspation.  This will develop the desired lingual cusp contact of the maxillary molar in the central fossa of the mandibular antagonist. www.indiandentalacademy.com
  • 154.  The maxillary first molar is set with a slightly more buccal tilt than the maxillary second premolar.  The tooth will have a mesial inclination dictated by the amount of compensating curve established by the mandibular molars.  The mesiolingual cusp sets into the central fossa of the mandibular first molar and the distolingual cusp contacts the centers of the distal marginal ridge of the mandibular first molar and the mesial marginal ridge of the second molar in centric occlusion . www.indiandentalacademy.com
  • 155.  The maxillary second molar should be set with slightly more buccal tilt and its mesiolingual cusp contacts the central fossa of the lower second molar.  Once the teeth are set and securely luted in place and the wax has cooled, the placement of the lingual cusps is inspected from the distal aspect of the articulator .  All of the upper lingual cusps should occlude in the common central fossa of the modified lower teeth. www.indiandentalacademy.com
  • 156.  Without this as a starting point, a stable static centric occlusion is not possible. excursions.  The right and left lateral excursions for the completed unilateral setup are then checked. There should be working and balancing contacts that are in harmony with the guidance of the condylar inclination and incisal guidance.  Ideally, in this occlusal scheme there should be five working cusp contacts, five balancing cusp contacts, and no upper buccal cusp contacts. www.indiandentalacademy.com
  • 157.  This ideal is seldom achieved at this stage of the setup. There are usually some prematurities on lower buccal or lingual inclines; however, the teeth should have potential for contact by slight selective grinding.  When functioning as balancing contacts, upper lingual cusps ride over the lower buccal (lingual-facing inclines) cusp inclines diagonally.  When acting as working cusps, upper lingual cusps pass between modified triangular ridges of the lower lingual cusps that run either to the marginal ridge or to the groove between the cusps of the lower molars. www.indiandentalacademy.com
  • 158.  When viewed from the back of the articulator all of the upper lingual cusps should occlude in the lower central fossa as described.  These are the centric occlusion holding contacts. Since the lower teeth were set to fixed criteria and securely waxed into position, all adjustments to the occlusion at this time are made by altering the position of the upper teeth.  Until these contacts are precise and secured with wax, the upper posterior setup is incomplete. www.indiandentalacademy.com
  • 159.  There should be simultaneous working and balancing contacts bilaterally.  In protrusive excursion the lingual cusps of the upper right and left second molars should glide up the distal inclines of the lower second molars. There should be no cuspal collisions of other posterior teeth to mar a smooth excursion.  As the protrusive excursion brings the upper and lower anterior teeth in apposition, they should just glide by each other under the guiding factors of the compensating curve and the condylar inclination. www.indiandentalacademy.com
  • 160.  This initial balance achieved during the setup of the upper posteriors must be further refined by selective grinding.  The occlusion is examined again to check for any tooth movement.  The dentures are now ready for the try-in. After verification of the trial dentures in the mouth, the dentures are returned to the articulator for final waxing and refining of the occlusion.  Small dicrepancies in the initial setting as well as errors due to small tooth movements during the final waxing are corrected by judicious selective grinding. www.indiandentalacademy.com
  • 161. The black diamonds indicate the maxillary lingual cusp contact area. The arrows indicate the paths of the maxillary lingual cusps in balancing, working, and protrusive excursions. www.indiandentalacademy.com
  • 162. Selective Grinding for Static Centric Contacts  Once the initial balance is achieved during the setup of the maxillary posteriors, the complete occlusion must be refined by selective grinding.  A length of thin articulating paper is placed on the posterior teeth, and the articulator is gently tapped several times in centric occlusion.  There should be marks on each of the areas shown .  If marks show on lower cusp inclines, the inclines are ground to eliminate deflective contacts. www.indiandentalacademy.com
  • 163.  If there are any upper lingual cusps out of contact, the nonoccluding maxillary teeth are repositioned by moving the lingual cusps down into contact.  Only the lower central fossae or marginal ridges should be ground, not the upper lingual cusps.  If any significant grinding is done on the lower teeth, the occlusal vertical dimension will be reduced and anterior interference will occur. www.indiandentalacademy.com
  • 164.  If any upper buccal cusps or inclines are in contact, they should be ground out of contact.  Only the upper lingual cusp, that is, the pestle of the mortar- and-pestle-type lingual contact occlusion, should articulate with the lower posteriors .  The final result after several tappings and spot grindings should be stable contacts with all upper lingual cusps in the common lower central fossae. The occlusion is now ready to be refined for working and balancing contacts. www.indiandentalacademy.com
  • 165. Selective Grinding for Working and Balancing Contacts  When the mandible moves to the left, this becomes the working side.  The upper left lingual cusps should contact the lower left lingual cusps.  The right side is then the balancing side, and the upper lingual cusps should contact the lower buccal cusps.  Only one lateral excursion (either the left or right) should be checked at a time. www.indiandentalacademy.com
  • 166.  A strip of thin articulating paper is placed between the posterior teeth bilaterally.  While keeping gentle pressure on the maxillary member of the articulator, move it to the right (this is equivalent to moving the mandible to the left). This duplicates a left lateral excursion.  Ideally, in this occlusal scheme there should be five working cusp contacts, five balancing cusp contacts, and no upper buccal cusp contacts. www.indiandentalacademy.com
  • 167.  When functioning as balancing contacts, upper lingual cusps ride lower buccal (lingual-facing inclines) cusp inclines diagonally.  When acting as working cusps, upper lingual cusps pass between modified triangular ridges of the lower lingual cusps that run either to the marginal ridge or to the groove between the cusps of the lower molars .  There usually is some prematurity on the working or balancing side that prevents total working or balancing cusp contact. Grind the marked premature balancing contacts, heavily marked working side contacts, or both, on the lower teeth. www.indiandentalacademy.com
  • 168.  By selectively spot grinding the premature inclines and cusps, a smooth harmonious multiple contact of the desired contacts will occur.  Do not grind the upper lingual cusps. Do not grind the lower buccal cusps. There should be no upper buccal cusp contact in any excursion.  As the premature inclines and high cusps are selectively ground until there is simultaneous contact of working and balancing cusps, the cusp rise is gradually reduced.  This may create anterior inerference on the working side, which must be eliminated.  Usually, there is sufficient compensating horizontal overlap for any vertical overlap to allow for a simple solution by grinding. www.indiandentalacademy.com
  • 169.  The lingual of the upper anterior incisal edges and the labial of the lower anteriors are ground to eliminate any interference that develops while selectively grinding to balance the occlusion.  Grinding on the anterior teeth should always be conservative so that the esthetic value of the anterior teeth is not disturbed.  The finished result should be a smooth gliding left lateral excursion with ten simultaneous working and balancing contacts (five working and five balancing contacts). www.indiandentalacademy.com
  • 170.  Selective Grinding for Protrusive Balance  The upper right and left second molar cusps should ride up the distal inclines of the lower right and left second molars with enough rise to clear the anteriors.  There should be no interference between the buccal cusps of the upper teeth and any of the lower buccal cusps.  If anterior interference occurs, either move or grind the lower offending anterior tooth slightly or increase the distal incline on the lower second molar by increasing the compensating curve. www.indiandentalacademy.com
  • 171.  Polishing the Teeth  The surfaces of any ground teeth should be polished to eliminate friction between occluding surfaces.  Friction is greater between porcelain surfaces than between acrylic surfaces. This increases the incidence of chipping in porcelain teeth.  Porcelain teeth should be smoothed and polished with a rubber porcelain polishing wheel until each lateral excursion is free of grating or frictional drag. Final polishing can be achieved with a felt wheel and aluminum oxide.  Acrylic teeth can be smoothed with pumice and polished with acrylic polish. www.indiandentalacademy.com
  • 172. NONANATOMIC (ZERODEGREE) POSTERIOR SETUP  Prosthodontics has always been concerned with the maintenance of the remaining supporting structure.  It is now widely accepted that cusped teeth, such as the modified anatomic setup, if properly coordinated with one another and with mandibular movements, provide an efficient and esthetically pleasing posterior setup for many patients. The presence of cusps, however, does introduce horizontal thrusts. www.indiandentalacademy.com
  • 173.  Many severely resorbed or generally debilitated ridges may not stand these potentially destructive forces.  Nonanatomic posterior teeth were designed to favor these types of ridges by minimizing the horizontal component of force during mastication and during parafunctional movements. www.indiandentalacademy.com
  • 174.  The indications for the use of flat teeth are as follows: (1) flat ridges, (2) knife-edge ridges (3) large interridge space, (4) milling type of chewing pattern with broad excursions, and (5) where debilitation has reduced the patient’s coordination needed to handle a cusped type of occlusion. www.indiandentalacademy.com
  • 175.  The flat teeth occlude in two dimensions (length and width), but the mandible, because of the incline of the condylar path, moves in a three-dimensional accurate path.  The loss of the vertical component (cuspal rise) in flat teeth alters the protrusive and bilateral balance that is possible with cusped teeth.  The traditional amount of anterior vertical overlap must also be eliminated or modified in order to avoid anterior interference in lateral and protrusive excursions. www.indiandentalacademy.com
  • 176. The arrows indicate the direction and magnitude of forces that are brought to bear on the denture foundation during mastication. www.indiandentalacademy.com
  • 177. Mandibular Setup Anteroposteriorly  The position and height of the lower first premolar is governed by the height of the lower canine.  The marginal ridges should be confluent and rise with a slight curve of Spee starting at the first molar.  The distal of the second molar should be at the height of the center of the retromolar pad. www.indiandentalacademy.com
  • 178. Buccolingually  The center of the teeth should be a straight line from the tip of the canine to the apex of the retromolar pad. The lower occlusal table should not be buccal to the residual ridge or lingual to the mylohyoid ridge. Laterally horizontal  The lower teeth should be horizontal. No lingual tilt (Monson curve) should be set. www.indiandentalacademy.com
  • 179. Maxillary Setup  Anteroposteriorly  There is no mesiodistal exactness needed as with cusped teeth, since there is no interdigitation of cusps.  Buccolingually  The upper teeth should be set on the lower teeth ‘flat-on-flat” rather than with a buccal cusp rise as in the cusp setup .  Buccal overjet of approximately one half the width of the tooth should be set to prevent cheek biting. Be sure that the lingual portion of the upper teeth is in contact with the center area of the lower teeth. www.indiandentalacademy.com
  • 180. Monoplane teeth are set on a horizontal plane and horizontally to each other. www.indiandentalacademy.com
  • 181. Lingualised occlusion  Lingualized occlusion is an attempt to maintain the esthetic and food-penetration advantages of the anatomic form while maintaining the mechanical freedom of the nonanatomic form.  The lingualized concept utilizes anatomic teeth for the maxillary denture and modified nonanatomic or semianatomic teeth for the mandibular denture. www.indiandentalacademy.com
  • 182. Indications  It is particularly helpful when the patient places high priority on esthetics but a nonanatomic occlusal scheme is indicated by oral conditions such as severe alveolar resorption, a Class II jaw relationship, or displaceable supporting tissue. If the nonanatomic occlusal scheme is used, esthetics in the premolar region are compromised. With lingualized occlusion, the esthetic result is greatly improved while still maintaining the advantages of a nonanatomic system . www.indiandentalacademy.com
  • 183.  The goal for bilateral balanced occlusion with lingualized occlusion should be to achieve smooth bilateral contact with excursive movements of 2 to 3 mm away from centric relation. www.indiandentalacademy.com
  • 184. PRINCIPLES OF LINGUALIZED OCCLUSION (1) Anatomic posterior 30 or 33 degree teeth are used for the maxillary denture. Tooth forms with prominent lingual cusps are helpful. (2) Nonanatomic or semianatomic teeth are used for the mandibular denture. Either a shallow or flat cusp form is used. A narrow occlusal table is preferred when severe resorption of the residual ridges has occurred. (3) Modification of the mandibular posterior teeth is accomplished by selective grinding which is always necessary regardless of specific tooth or material. www.indiandentalacademy.com
  • 185. (4) Maxillary lingual cusps should contact mandibular teeth in centric occlusion. The mandibular buccal cusps should not contact the upper teeth in centric occlusion, as is customary with usual anatomic tooth placement .  It is helpful to slightly rotate the maxillary posterior teeth buccally to allow for slight clearance of the buccal cusps in the working position and to reduce the need for extensive grinding. www.indiandentalacademy.com
  • 186. (5) Balancing and working contacts should occur only on the maxillary lingual cusps. The posterior teeth are arranged and adjusted to establish bilateral balanced occlusion in lateral mandibular excursions for a range of 2 to 3 mm around centric relation .  Selective grinding of the maxillary buccal cusps may be needed to create a small clearance between the maxillary and mandibular buccal cusps on the working side when excursive movements are initiated.  The maxillary lingual cusps remain in contact on the working side. This helps to reduce lateral movement of the lower denture by placing occlusal forces more lingual to and toward the center of the mandibular teeth.  On the balancing side the maxillary lingual cusps contact the mandibular buccal cusps as is customary with anatomic occlusal arrangements. www.indiandentalacademy.com
  • 187. (6) Protrusive balancing contacts should occur only between the maxillary lingual cups and the lower teeth. Reduction of anteroposterior interferences on the mandibular teeth may be necessary in order to provide a range of balanced occlusion in the protrusive position.  Selective grinding for protrusive movements should be done only on the mandibular teeth so that lateral balancing contacts and the vertical dimension of occlusion are not changed.  After processing, the dentures are remounted on the articulator and the occlusion is refined to create smooth, simultaneous contacts between the teeth during excursive movements. www.indiandentalacademy.com
  • 188.  In the arrangement of the teeth for lingualized articulation, the mandibular teeth are set first to establish the occlusal plane. www.indiandentalacademy.com
  • 189. Teeth arrangement for esthetics  The arrangement of the teeth should be individualized to the patient’s cosmetic needs.The teeth must look like they belong in the patient’s mouth.  Frush and Fisher suggested guidelines for selection and arrangement of anterior teeth based upon the patient’s age, sex, and personality. www.indiandentalacademy.com
  • 190.  Arrangements to meet esthetic requirements are usually associated with the composition, size, shape and color of the six anterior teeth. However, the horìzontal and vertical positions of posterior teeth are intimately involved in facial expression .  The general features and asymmetries should be observed and recorded during the first appointment with the patient. www.indiandentalacademy.com
  • 191. Age  Age is often revealed by the amount of maxillary and/or mandibular teeth that show during rest or function.  With increasing age, the amount of maxillary central incisors exposed when the lips are gently parted decreases from 3 + mm at age 29 to no tooth showing at 60 years of age. The opposite occurs for the mandibular incisors, with approximately 0.5 mm showing at age 29 and 3 mm showing at age 60. www.indiandentalacademy.com
  • 192.  Frush and Fisher state that the dignity of advancing age can be successfully portrayed in the denture by careful tooth color selection and mold refinement.  By varying the long axis of the teeth, using diastemata, and grinding the incisal edges, the appearance of the anterior teeth can be transformed from youthful to advanced in age. www.indiandentalacademy.com
  • 193.  As muscle tonus decreases,the position of the teeth for support to the lips and cheeks are more critical.  Teeth abrade with age.the central and lateral incisors abrade in a straight line,and canines in a curve.  The wearing away of teeth creates spaces between teeth.  The smile line is sharp in younger people than in the older people. www.indiandentalacademy.com
  • 194. Sex  Square features are associated with males and curved features with females.  Roundness ot the arch form denotes femininity, and squareness denotes masculinity.  The incisal edges of the maxillary anterior teeth of females follow the curve of the lower lip. www.indiandentalacademy.com
  • 195. characteristics  Flat labial surface,mesiodistally and incisogingivally.  sharper mesioincisal and distoincisal angles  Broad arch form; central incisors slightly turned in on the mesial side.  For the male, the mesial surface of the lateral incisor is often hidden behind the distal surface of the central incisor. The distal surface of the lateral incisor is rotated very slightly in a posterior direction . Feminine characteristics  Curved labial surface— mesiodistally and incisogingivally  Rounded mesioincisal and distoincisal angles  Tapered or curved arch form; central incisors turned in at the distoincisal edge.  the mesial surface of the lateral incisor is often seen in an anterior relation to the distolabial surface of the central incisor. The distal surface of the lateral incisor is rotated in posterior direction. The smile is softened as a result of this arrangement Masculine www.indiandentalacademy.com
  • 196.  incisal edge of lateral incisor often at same level as central incisor  Broad lateral incisors  canines more prominent and turned out at the incisal edge  The canines for males are rotated less in a posterior direction. The mesial two thirds of the labial surtace is exposed when viewed from the front .  Incisal edge of lateral incisor raised compared to central incisor and canine  Narrow lateral incisors.  Canines arranged to appear turned in at the incisal edge (inclined palatally)  The distal surfaces of the canines for females are rotated in a posterior direction; the mesial third of the labial surface is exposed when viewed from the front. www.indiandentalacademy.com
  • 197. Feminine type of smile line Masculine type of smile line www.indiandentalacademy.com
  • 198. Incisal edges of maxillary anterior teeth. Acceptable curvature of up (1 and 2) as guide for arranging artificial teeth for esthetics and function; unacceptable reverse curve (3). www.indiandentalacademy.com
  • 199. Personality  The personality of a person is expressed in their behavioural patterns and qualities of behaviour. Their personality can be influenced by the appearance of their teeth.  It is the obligation of the dentist to arrange artificial teeth in a manner to encourage the development of an attractive personality. www.indiandentalacademy.com
  • 200.  Attempting to position and shape the teeth to complement the patient’s personality involves getting to know the patient.  Frush and Fisher have used a “personality spectrum” ranging from delicate to medium pleasing to vigorous.  The delicate personality is fragile and frail, while the vigorous is hard and aggressive. These personalities have ranges and blend with the medium personality, which is more moderate and somewhat robust. A small segment of the population has a delicate personality, while a slightly larger group is vigorous. The vast majority is in the medium range but tends toward the delicate or vigorous. www.indiandentalacademy.com
  • 201. Most men are found to be toward the vigorous end of the spectrum and most women are found to he toward the delicate end of the spectrum. However, both may still be within the broad medium personality band.www.indiandentalacademy.com
  • 202.  1. Delicate—meaning fragile, frail, the opposite of robust.  2. Medium pleasing—meaning normal, moderately robust, healthy and of intelligent appearance.  3. Vigorous—meaning the opposite of delicate; hard and aggressive in appearance, the extreme male animal, muscular type, almost primitive, ugly. www.indiandentalacademy.com
  • 203.  The central incisors play the dominant role in establishing the personality, followed by the canines and finally the lateral incisors.  A variation in their shade as well as in the long axis of their alignment contributes to the overall success of the final dentures. www.indiandentalacademy.com
  • 204. Prosthodontic care is not the direct responsibility of the dental laboratory technicians. The dentist – the professional oral physiologist – must perfect the trial denture to make it harmonise with the stomatognathic system of the patient, frequently a most challenging experience. www.indiandentalacademy.com
  • 205. Review of literature  Ortman H.R. and Tsao in 1979 conducted a study on the relationship of the incisive papilla to the maxillary central incisors and stated that the average distance between the most anterior point of the maxillary central incisors and the most posterior point of the papilla was 12.454 mm with a standard deviation of 3.897 mm. www.indiandentalacademy.com
  • 206. Okane H. et al in 1979 conducted a study on the effect of anteroposterior inclination of the occlusal plane on biting force and concluded that 1.Biting force during maximum clenching was the greatest when the occlusal plane was made parallel to the ala tragus line.it decreased when the occlusal plane was inclined about 5 degrees anteriorly or 5 degrees posteriorly . 2. The efficiency of biting force exertion during maximum clenching showed the best value when the occlusal plane was made parallel to the ala tragus line. www.indiandentalacademy.com
  • 207.  Foley P.F. and Latta in 1985 conducted a study on the position of the parotid papilla relative to the occlusal plane and concluded that a fairly constant relationship exists between the parotid papilla and the occlusal plane. An additional finding was that this relationship may not be the same on each side of the mouth. www.indiandentalacademy.com
  • 208.  saunders,1925 , Schlosser RO et al reported a high percentage of edentulous cases having consistency between the face form and arch form . A continous line drawn along the alveolar crest as far as the tuberosities and just posterior to the junction of the hard and soft palate when inverted and superimposed onto the face was to correspond with the chin margin,jaw lines,cheek lines and eyebrows. Artificial tooth selected to arch form and therefore face form produced esthetically pleasing effect. www.indiandentalacademy.com
  • 209.  Goyal B.K.and Bhargava in 1974 did a study on Arrangement of artificial teeth in abnormal jaw relations: Maxillary protrusion and wider upper arch, and Mandibular protrusion and wider lower arch,and concluded that the upper-lower ridge relationship is an individual problem for each complete denture patient.One has to deviate from the usual procedures to achieve successful results. www.indiandentalacademy.com
  • 210.  Mavroskoufis F. in 1981 conducted a study on the Nasal width and incisive papilla as guides for the selection and arrangement of maxillary anterior teeth, and concluded that the interalar nasal width is a reliable guide for selecting the mold of anterior teeth, and that the incisive papilla provides a stable anatomic landmark for arranging the labial surfaces of the central incisors at 10 mm anterior to the posterior border of the papilla.  The mesiodistal width of the set of anterior teeth (four incisors and the mesial halves of the canines) should be determined by adding 7 mm to the patient’s nasal width .  The tips of the canines on the horizontal plane, should be set on a line which passes through the posterior border of the incisive papilla .  The distance between them should equal the patient’s nasal width, so that from the frontal view they would each seem to lie on a perpendicular line drawn from each of ala of the nose. www.indiandentalacademy.com
  • 211.  Bissasu M. in 1999 conducted a study on the Use of lingual frenum in determining the original vertical position of mandibular anterior teeth and concluded that 1. The measurement of the distance between the AALF (anterior attachment of the lingual frenum) and the incisal edges of mandibular incisors is reliable when the frenum is recorded during function. 2. The position of the AALF can be considered a relatively stable anatomic landmark when the frenum is recorded during function. 3. The distance between the AALF and the incisal edges of the mandibular central incisors can be used on preextraction diagnostic casts, made from irreversible hvdrocolloid impression material in stock trays, as a preextraction record for determining the original vertical position of the mandibular anterior teeth. www.indiandentalacademy.com
  • 212. REFERENCES  Sheldon Winkler.: Essentials of complete denture Prosthodontics, ed. 2, 2004.  zarb-bolender : Prosthodontic treatment for edentulous patients - ed 12. 2004.  Heartwell :Textbook of complete dentures – ed 5.  David M. Watt and A. Roy Macgreggor : Designing complete dentures – ed 2 . 1986.  D.J. Neill and R. I. Nairn : Complete denture prosthetics-, ed 3. 1990  Iwao Hayakawa : Principles and practices of complete dentures- creating the mental image of a denture.  Alexander R. Halperin :Mastering the art of complete dentures . www.indiandentalacademy.com
  • 213. 4. J P Frush, R Fisher. How dentogenic restorations interpret the sex factor. J.Prosthet Dent 1956;6:160-172 5. J P Frush, R Fisher. How dentogenics interprets the personality factor. J.Prosthet Dent 1956;6:441-449 6. J P Frush, R Fisher. Age factor in dentogenics. J.Prosthet Dent 1957;7:05-13 7. Harold R. Ortman and Ding H. Tsao. Relationship of the incisive papilla to the maxillary central incisors. J Prosthet Dent. 1979; 42; 492-496 8. B.K. Goyal and K.Bhargava, Arrangement of artificial teeth in abnormal jaw relations: maxillary protrusion and wider upper arch. J Prosthet Dent. 1974; 32; 107-111 9. B.K. Goyal and K.Bhargava Arrangement of artificial teeth in abnormal jaw relations: mandibular protrusion and wider lower arch. J Prosthet Dent. 1974; 32; 458- 461. www.indiandentalacademy.com
  • 214. 10. Curtis M. Becker,Charles C. Swoope, Lingualised occlusion for removable prosthodontics. J Prosthet Dent. 1977; 38; 601- 608. 11. Arthur R. Roraff, arranging artificial teeth to anatomic landmarks. J Prosthet Dent. 1977; 38; 120 - 130. www.indiandentalacademy.com
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