Teeth selection /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


TEETH SELECTION
AND TOOTH
ARRANGEMENT


Introduction
A knowledge and understanding of a number of physical and
biological factors directly related to the patient are required to
appropriately select artificial teeth to rehabilitate the occlusion.
The goals for this phase of therapy are to construct complete
dentures that (1) function well, (2) allow the patient to speak
normally, (3) are esthetically pleasing, and (4) will not abuse
the tissues over residual ridges. The prosthodontist is the best
person to accumulate, correlate, and evaluate the
biomechanical information so that the artificial teeth selected
will meet the individual needs of the patient. The selection and
arrangement of artificial teeth is a relatively simple non-time
consuming procedure, but it requires the development of
experience and confidence.

ANTERIOR TOOTH
SELECTION
•
•
•
•
•

Pre extraction guide
Post-extraction record
Size of anterior teeth
Form of anterior teeth
Color of teeth


ANTERIOR TEETH SELECTION
Clinical judgment and experience still remain the final
criteria in selection of the proper width and mold, The following are
among the most widely used and suggested methods for anterior tooth
selection.
A. Patient pre extraction records:
1. Diagnostic casts of the patient's natural or restored teeth prior to
extraction of the remaining teeth.
2. Request the most recent photographs of the patient before loss of his
teeth.
3. Measurements may also be made from radiographs of the teeth,
making allowances for lengthening or foreshortening .
4. The use of facial photographs is usually of far more help to the
dentist in determining the placement of anterior teeth, arch form, and
lip support than for the actual size of the mold of an artificial tooth.
5Teeth of close relative –www.indiandentalacademy.com
This method is usually followed only if other
records are not available.

B. Postextraction examination— if the patient is edentulous and
wearing complete dentures, examine the patient with the dentures he
presently wears, paying attention to the following:
1. Do the teeth appear lost in the face (too small or set too far
in)? .
2. Do the teeth appear too small, regular, and set like a picket
fence?
3. Are the teeth set too high, and are they almost lost from view
during speaking and smiling?
4. Are the teeth overbearing, too large, but of proportion in their
length and breadth to the size and dimensions of the face and head?
5. Do the maxillary teeth show in smiling, and the mandibular
teeth during speech?
All of these observations should be used in arriving at a
determination of which teeth should be selected for the trial denture. On
the basis of the teeth the patient is wearing, determine whether to
choose teeth that are larger or smaller, longer or shorter, wider or
narrower, flatter or having a more curved labial surface.

SIZE OF THE ANTERIOR TEETH
• Size of the face
• Size Of Maxillary Arch
• Incisive papilla and the canine eminence
• Maxillo-Mandibular Relation
• Contour of the residual ridge
• Vertical distance between the ridges
• Lips

SIZE OF THE ANTERIOR TEETH
Anatomic entities used as a guide for anterior teeth
size:
Size of the face:
Width of the central incisor = one sixteenth of the bizygomatic width of the face.
Combined width of the six anterior teeth = slightly less
than one third of the bizygomatic breadth of the face.


Size Of Maxillary Arch
The mold be used to make measurements of the maxillary cast.
Accurately contoured occlusal rims are required. Make the
measurements from the crest of incisal papilla to the hamular
notches and from one hamular notch to the opposite notch. The
combined length of the triangle in millimeters is used on the
selector. The circular slide rule indicates the tooth sizes, anterior
and posterior, for both arches.
LIMITATION
These criteria’s will not be usable in situations like spacing, rotating
and overlapping. The excessive or unusual loss of bone may also
influence the size of anterior teeth (length)
When the discrepancy between the size and related arch exist the
selection of anterior teeth is more governed by face size than the
arch size


• Incisive papilla and the canine eminence – the
combined width of the six anterior teeth is equal to
the length of a line drawn on the cast at the distal
termination of one canine eminence to the other.
•
Intra-orally, the patient is requested to relax
with the lips touching. A mark is made at the
corners of the lips. The distance between the two
marks on either side is equal to the combined
width of all the anterior teeth.


• . Maxillo-Mandibular Relation – Any
disproportion in the size between the maxillary
and mandibular arches influences the length,
width and position of the teeth. If mandible is
protruded; anterior teeth are larger, if mandible is
retruded; anterior teeth are smaller.
• . Contour of the residual ridge – teeth should be
placed in relation to follow the contour of the
residual ridges that existed when natual teeth were
present.


• Vertical distance between the ridges –
according to the available inter-arch space length
of the teeth can be selected. Minimal of the
denture base should be visible in the final
prosthesis.
• . Lips – During relaxed state the labial surface of
the maxillary anterior teeth support the upper lip.
When the teeth are together the incisal edge of the
maxillary incisors supports the superior border of
the lower lip


• FORM OF THE ANTERIOR
TEETH
•
•

Factors governing the form of the anterior teeth:
Form and contour of the face: from the frontal
aspect the shape of the face can be classified as –
–
–
–
–

Square
Square tapering
Tapering
Ovoid


Shapes of the artificial teeth chosen to be in harmony with
the size of the patient’s face


• From the lateral aspect the facial profile can be
classified as:
–
–
–
–

Straight
Concave
Convex
Form of the artificial anterior teeth should conform to
the form of the face.

• The labioincisal contour of the teeth usually
conforms to the profile of the individual

The geometric figures-square, tapering, ovoid,
and combinations there of serve as a
starting point in selecting the tooth form as
it is viewed from the frontal aspect .


Trubyte indicator
The indicator may be used in one of two ways to
establish the facial outline Place the tooth
indicator on the patient's face, allowing the nose to
come through the center triangle. Center the pupils
of the eye in the eye slots and hold the indicator
with its center line coinciding with the median line
of the face. The form of the face will be best
observed by noting the particular characteristic of
each form as it appears in comparison with the
vertical lines of the indicator


• In the square form the sides' of the face will
approximately follow the vertical lines of the
indicator. In the square tapering form, the upper
third of the lower two thirds will taper inward. In
tapering faces, the side of the face from the forehead
to the angle of the jaw will taper at an inward
diagonal.


• Ovoid faces will be best determined by examination
of the curved outline of the face against the straight
vertical of the face against the straight vertical of the
tooth indicator

• To determine the facial profile, observe the relative
straightness or curvature of the profile. Check three
points: the forehead, the base of the nose, and the
point of the chin. If these three points are in line, the
profile is straight. If the points of the forehead and of
the chin are recessive, the profile is curved

• 2. Sex: Curved features are associated with
feminity and square features are associated with
masculanity. Teeth selected for females are more
ovoid or tapering; whereas for males are more
squarish, and sharp edged.
• 3. Age: Aging process affects the entire
masticatory apparatus in general including the
teeth. Teeth wear at the incisal edges, labial
surface becomes more flatter and outline appears
more squarish.


COLOR OR SHADE OF ANTERIOR TEETH
Color is the sensation resulting from stimulation of the
retina of the eye by light waves of certain lengths. Shade is the
degree of darkness of a color with reference to its mixture with
black. When a tooth is viewed for the purpose of determining its
color, two principal colors yellow and gray are evident. The yellow
is more prominent in the gingival third, and the gray is more
prominent in the incisal third. The principal modifications are
termed hue. The degree of intensity of the hue, as measured by its
freedom from mixture with white, is saturation. Hue of the tooth is
actually the quality that the prosthodontist attempts to
duplicate. One other slight modification appears in teeth with thin
incisal edges. The yellow disappears, and the edge appears blue
gray. This is the only place that blue appears in a tooth.

The position of the patient and the source of light are very
important in color selection. The patient should be in an
upright position. The dentist should be in a position so that
the teeth are viewed in a plane perpendicular to the dentist's
plane of vision.
The teeth should be observed from different angles to
make certain that the shadows do not influence the color. The
patient's mouth should not be opened too wide but should
remain a dark cavity as in ordinary conditions.
White light is considered suitable. White light may be
secured from artificial sources if provided with the proper
filters. Eyes fatigue to color perception very rapidly and for
this reason they should not be focused on a tooth for more
than a few seconds www.indiandentalacademy.com

• If the proper shade is hard to establish the tooth and the
shade guide should be viewed from a distance of 6 or 8
feet.
• The color of the teeth, like the form, must be in harmony
with the surrounding environment if they are to appear
pleasing. Harmony should exist between the color of the
teeth and the color of the skin, hair, and eyes. The color
of the skin is a more reliable guide.
• A female patient’s cosmetics must be considered in
harmonizing with the complexion.

• Selecting The Color Of Artificial Teeth
• Observations of the shade guide teeth should be
made in three positions:

outside the mouth along the
side of the nose, will
establish the basic hue,
brilliance, and saturation


2) under the lips with only the
incisal edge exposed, will
reveal the effect of the
color of the teeth when the
patient's mouth is relaxed

3) under the lips with only the
cervical end covered and the
mouth open, will simulate
exposure of the teeth as in a smile.

Basic considerations are the harmony of tooth color with
the color of the patient's face and the inconspicuousness of
the teeth. The color selected should be so inconspicuous
that it will not attract attention to the teeth.
The color of the teeth should be observed on a bright day
when possible, with the patient located close to natural
light. The teeth should also be observed in artificial light,
since denture patients are often seen in this environment.


The "squint test" may be helpful in evaluating
colors of teeth with the complexion of the face.
With the eyelids partially closed to reduce light,
the dentist compares prospective colors of
artificial teeth held along the face of the patient.
The color that fades from view first is the one that
is least conspicuous in comparison to the color of
the face.

• Although some person’s natural teeth become darker
with age, there are many exceptions to this; it is therefore
incorrect to establish a rule that prescribes light teeth for
young patients and darker teeth for older ones.
• Tooth color must be in harmony with the facial coloring
at the time the dentures are made. Color of a tooth
changes immediately when it is removed from the mouth
and becomes non vital; it blanches further as the tooth
dries out.
• Thus, extracted teeth are valuable for size and form
selection but should not be used for color selection.

Posterior Teeth Selection
The selection of posterior teeth likewise involves
shade, size, number, and form
SHADE OF POSTERIOR TEETH
The shade of the posterior teeth should harmonize
with the shade of the anterior teeth. As noted
previously, the maxillary premolars are sometimes
used more for esthetic than for functional purposes.
Bulk influences the shade of teeth, and for this reason
it is advisable to select a slightly lighter shade for the
premolars if they are to be arranged for esthetics.

• Buccolingual Width of Posterior Teeth
The buccolingual widths of artificial teeth
should be less than the widths of the natural
teeth they replace. Artificial posterior teeth
that are narrow enhance the development of
the correct form of the polished surfaces of the
denture by allowing the buccal and lingual
denture flanges. to slope away from their
occlusal surfaces. These narrower forms,
especially in the lower denture, assist the
cheeks and tongue in maintaining the dentures
on the residual ridge.

Mesiodistal Length Of Posterior Teeth
The length of the mandibular residual ridge from the
distal of the canine to the beginning of the retromolar pad
is usually available for artificial posterior teeth. If the
residual ridge anterior to this point slopes upward, smaller
or fewer teeth must be used to avoid having a tooth over a
pronounced incline at the distal end of the ridge. This
shortened occlusal table will often prevent the lower
denture from sliding forward when pressure is applied on
the molars.

• The total mesiodistal width in millimeters of the four
posterior teeth is often used as a mold number. For
example, mold 32L signifies that the four posterior teeth
have a total mesiodistal dimension of 32 mm and a long
occluso-cervical length.
• The posterior teeth should not extend too close to the
posterior border of the maxillary denture because of the
danger of cheekbiting. However, if the posterior teeth do
not extend far enough posteriorly, the forces of
mastication will place a heavier load on the anterior part
of the residual ridges.

Posterior teeth are not arranged over the retromolar
pad, because:
• the pad is too soft and too easily displaced, has
glandular tissue which is hurt
• Putting teeth over it will allow the denture to tip
during mastication.
• Tendon of Tempolaris is inserted in the
retromolar region tends to displace the denture

Vertical Height of the Facial Surfaces of Posterior
Teeth
It is best to select posterior teeth corresponding to the interarch
space and to the height of the anterior teeth. Artificial posterior
teeth are manufactured in varying occlusal cervical heights.
The height of the maxillary first premolar should be
comparable with that of the maxillary canines to have the proper
esthetic effect. Without this relationship, the denture base material
will appear unnatural distal to the canines. Ridge lapping the
posterior teeth can be done without sacrificing leverage or
esthetics.
The form of the dental arch should copy, as nearly as
possible, the arch form of the natural teeth they replace.

Types of Posterior Teeth According to Materials
For many years, porcelain was the favorite tooth material because of the
rapid wear of acrylic resin. However, with the tendency for porcelain to
chip and fracture, acrylic resin teeth have gained in popularity. Improved
acrylic resin teeth and newer composite resin teeth are more wear
resistant, and they have supplanted porcelain during the past two decades
Acrylic resin or composite resin posterior teeth are specifically called for
when they oppose natural teeth or teeth whose occlusal surfaces have
been restored with gold. These resin teeth reduce the possibility that the
artificial teeth will cause unnecessary abrasion and destruction of the
natural or metallic occlusal surfaces of the opposing teeth

SELECTION OF MATERIAL FOR ARTIFICIAL
TEETH
Porcelain Teeth
Wear is clinically insignificant over a long period
of time.
No significant loss of vertical dimension.
Can be ground and polished and will hold shape
for years.
Allow for total rebasing procedures.
Maintain comminuting efficiency for years.
Difficult to grind and fit into close inter ridge
space without fracturing or loss of retention in the base.

Cause dangerous abrasion to opposing gold crowns and natural
teeth.
Have a sharp impact sound.
Ground surfaces must be highly polished to reduce friction and
prevent chipping.
Will not bond to the base material.
Potential for marginal staining due to capillary leakage .
Acrylic Resin Teeth
Wear is clinically significant.
Loss of occlusal vertical dimension due to wear.
Occlusal surface altered by wear is such that in five to seven years they
are inefficient and usually worn to a reverse curve.
Loss of comminuting efficiency.
Do not chip, and have softer impact sounds. Self adjusting and selfpolishing.
Easy to grind into close inter ridge space. Potential for bond to base
material.

Types of Posterior Teeth According to Cusp
Inclines
Posterior artificial teeth are manufactured with cusp inclines
that vary from steep to flat. Selecting the tooth to be used is
based on the concept of occlusion to be developed, the
philosophy of occlusion to be fulfilled, and the accomplishment
of both of these goals with the least complicated approach .
i- teeth to be balanced in centric and eccentric positions – cusp
teeth
ii- posterior teeth to disocclude in eccentric jaw movement –
cusp or monoplane teeth
iii – posterior teeth to be arranged in flat plane and balanced in
centric occlusion position only- monoplane teeth

ARRANGMENT OF TEETH
The four 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


HORIZONTAL POSITIONS
to provide stability to the denture bases.
to direct the masticatory forces along the long
axis.
to support lips and cheek for esthetics
to be compatible with functions of the
surrounding tissues for functions of masticaiton,
speech, swallowing and phonetics.


• Forces directed at right angles to the
supporting tissues are more stabilizing than
forces directed at an inclined plane.

• The artificial teeth must be placed in
suitable horizontal positions to allow the
muscle activity to occur naturally

• The positions of the teeth influence the phonetics
as exemplified by the J, ch, and sh sounds.
• When the maxillary anterior teeth are placed too
far posteriorly as related to the lower lip, the J
sound may be muffled.
• It may be necessary to arrange the mandibular
anterior teeth with more labial version to aid in the
correct enunciations of the ch and sh sounds
•

• In mastication, the tip of the tongue reaches into the
buccal and labial vestibules, gathers the food, and places
it on the occlusal surfaces.
• When the teeth are placed too far in a lateral or anterior
direction, the vestibular spaces are obstructed to the
tongue.
• When the teeth are placed too far in a medial or posterior
direction, the tongue will dislodge the mandibular
denture in an attempt to reach over the teeth

The crests of the residual ridges are aids in
positioning the artificial teeth if the natural teeth
were recently extracted and the cortical plates of
bone remain intact. Unfortunately, the crests of the
residual ridges do not remain in the same
anteroposterior or mediolateral positions.


As resorption of alveolar
ridge progresses, the
maxillary arch becomes
narrower and the
mandibular arch becomes
broader.


LIMITS TO PLACING POSTERIOR TEETH
• The mandibular arch determines the posterior limit
for placing posterior teeth
• Mucosa considered capable of bearing stress
terminates at the retromolar papilla
• Medial extension of the mylohyoid ridge
determines the medial limit in placing mandibular
posterior teeth- if placed more lingually than it,
elevating the tongue may dislodge the denture
• Actions of tongue and cheek, alongwith esthetics
determine the lateral limits of mandibular
posterior teeth

•
• LIMITS TO PLACING ANTERIOR TEETH.

• Involves placing the teeth in an anteroposterior and
mediolateral position in harmony with the action of
the lips and the tongue.
• Establish horizontal overlap sufficient to prevent
the anterior teeth from contacting when the
posterior teeth are in centric occlusion .

•
•

POSITIONING OF THE TEETH ACCORDING TO THE HORIZONTAL
RELATION OF THE JAWS .

•

Maxillary arch is broader
than the mandibular arch

Using larger teeth buccolingually may
be required.

•
•

Maxillary arch is smaller
than the mandibular arch

The buccolingual relations of the teeth
are reversed

•

Place the buccal cusps of the
mandibular teeth lateral to the buccal
cusps of the maxillary teeth

•


• The mediolateral and anteroposterior positions of
the anterior teeth influence sounds in speech.
• f – incisal edges of maxillary centrals should
barely contact the vermillion border of the lower
lip.
• s- mandibular anterior teeth affect the s sound .
•
• th – the tip of the tongue should make contact with
the palatal surface of maxillary anterior teeth

• The artificial maxillary central incisors should be
placed anterior to the incisal papilla regardless of
the relation of the papilla to the existing residual
ridge
• When natural teeth are present, the inclinations of
the anterior teeth, as related to the crest of the
alveolar ridge, are downward and forward.
Usually this relationship is accentuated as
resorption takes place.

• The upper lip is supported in the area of the
philtrum by labial surfaces of the maxillary
anterior teeth and at the corners of the mouth by
the canines.
• In normally related jaws, the border of the lower
lip is supported by the labial incisal third of the
maxillary anterior teeth.

• Reteromolar fossae- triangle formed by external
oblique line and mylohyoid line. This triangle is
slightly posterior and lateral to the position of the
molar teeth.
• Reteromolar papilla – small pear-shaped area of
gingival tissue situated at the base of reteromolar
pad limits the position of artificial teeth.
• Reteromolar pad- pear shaped pad of tissue
located at the distal end of the mandibular ridge.
• Mandibular canine – turning point of the
mandibular arch, distal part is rotated posteriorly.

•

•
•
•
•

Definite anatomic landmarks
to be used as guides in
arranging the anterior teeth
are
the incisal papilla
the midsagittal suture, and
the canine lines.
By locating these
landmarks and recording
their positions on the cast,
one establishes points of
reference indispensable to
the correct arrangingof the
teeth

• In the absence of other more definite information, the
arch form is used as a guide for the initial arrangement
of the teeth
• The anterior teeth for the tapered arch places the central
incisors farther forward than the canines .
• The anterior teeth for the square arch places the central
incisors nearly horizontal with the canines.
• The anterior teeth for the ovoid arch places the six anterior
teeth in gentle curve.

A-SQUARE , B- TAPERING, C- OVOID

• The size and shape of the head are reliable factors
in determining arch form.
• Round heads are associated with square arches
and a broad flat arrangement of the anterior teeth.
The labial surfaces of the central incisors are in
full view, and the canines are prominent.
• Long narrow heads are associated with long
narrow, palates, tapered arches, and a tapered
anterior tooth arrangement.

VERTICAL POSITIONS
Correct vertical position of the teeth should
provideDenture stability
Favorable forces
Support to lips and cheek
Compatibility


Vertical postion of the mandibular teeth –
The occlusal surface of the last
mandibular molar is on a place approximately
at the bottom of the upper third of the
retermolar pad.
Vertical position of the maxillary teeth is usually determined by the esthetics,
phonetics.

• The occlusal groove, on the inner surface of the
cheek, is located opposite the occlusal plane of
the natural mandibular posterior teeth.
• When this groove is present, it is a reliable guide
to the position occupied by the occlusal surfaces
of the natural mandibular posterior teeth and can
be used as a guide to positioning the posterior
artificial teeth in a vertical direction .


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 following are aids to establishing the vertical positions of the
artificial teeth by using occlusion rims:

1. Attach hard wax occlusion rims to accurate, stable record
bases.

2. Properly contour the occlusion rims in an anteroposterior
and mediolateral direction.

• 3. Instruct the patient to say "fifty-five" and establish the vertical
length of the occlusion rims in the anterior section
of the
maxillary arch.
• 4. Reduce the posterior occlusal surfaces until the surface is
parallel to a line drawn from the ala of the nose to the tragus of
the ear .
• 5. Make a face-bow transfer and a centric relation record and
attach the casts to the articulator.
• 6. Record the top of the retromolar pad on the cast.
• 7. Alter the occlusion rims so the posterior vertical positions of
the mandibular rim are on a plane at the same level as the top of
the retromolar pads and the anterior vertical position is in contact
with the maxillary occlusion rims.

• Remember that the use of the
ala – tragus line is an
expediency and is not a
reliable indication for the
occlusal surfaces of the teeth.
• The plane is not used unless it
coincides with the other
guiding factors.
• Establish the plane , using the
retromolar pad for the
posterior and the incisal edge
or low lip line for the anterior
points of reference.

Arrangement of teeth for esthetics
Influenced by:
Age
Sex
Personality
Cosmetic factor


Influences of age:
Muscle tonus decreases with age, cheek saghorizontal overlap of posterior teeth increased to
prevent cheek biting.
Interincisal distance increases with age:
therefore more of the incisal portion of the
mandibular teeth is visible.
Teeth abrade with age. Central and lateral
incisor lie at same horizontal levels.
Smile of older individuals is more curved than
sharp as in for young individuals.

Influences of sex:
Square features are associated with males, and
rounded or oval with females.
Incisal edge of maxillary anterior teeth follows the
curve of the lower lip for females.
Distal surface of the maxillary central incisor is
rotated posteriorly for females. The mesial portion of
the lateral incisor usually overlaps the central incisor in
case of females.
In males the central incisor’s distal half overlaps the
lateral incisor.
Distal surface of female canines are rotated distally
making only mesial half visible. In males even the
distal surface is visible when viewed from fronatal

Personality of the patient:
Habitual patterns and qualities of behaviour.
Profession and public appearance of the patient.
Cosmetic Factor
Patients personal interest in grooming. Teeth for an
otherwise neat, well groomed patient can expected
to be similar.


ARRANGING TEETH FOR COMPLETE
DENTURE OCCLUSION
Maxillary Central Incisor:
The long axis of the tooth is perpendicular to
the horizontal
(labiolingual inclination)
Its long axis slopes towards the vertical axis
( mesiodistal inclination)
Slopes labially about 15 degrees when
viewed from the side.
Incisal edge is in contact with the occlusal
plane.

Maxillary Lateral
Incisor:
Long axis slopes rather more
towards the midline
Inclined labially about 20
degrees when viewed from
the side
The neck is slightly depressed
The incisal edge is about
1mm short of the occlusal
plane.

Maxillary Canine :
Its long axis is parallel to the
vertical axis when
viewed from both the front
and side or it may be
slightly to the distal.
The bulbous cervical half of
the tooth provides its
prominence.
Its cusp is in contact with the
horizontal plane.
.
The neck of the tooth must
be prominent

Remaining maxillary teeth are arranged on the other side of the
arch to complete the anterior set up.
To maintain the set teeth in position, the wax supporting the teeth
must be heated and sealed both to the teeth and to the record base.


First premolar:
• Long axis is parallel to the
vertical axis when viewed from
the front or the side.

• Its palatal cusp is about 1mm
short of, and its buccal cusp in
contact with, the occlusal plane.


Second premolar:
• Its long axis is parallel with
the vertical axis when viewed
from the front or the side.
• Both buccal and palatal cusps
are in contact with the
occlusal plane.


First molar:
• Long axis slopes buccally
when
viewed from the front, and
distally when viewed from
the side.

• Only mesiopalatal cusp is in
contact
with the occlusal www.indiandentalacademy.com
plane.

Second molar:
• Long axis slopes buccally more
steeply
than the first molar when viewed
from
the front, and distally more steeply
when viewed from the side.

• All four cusps are clear of the
occlusal
plane, but the mesiopalatal cusp is
nearest to it.

Arranging the
Mandibular Teeth
Mandibular central incisor:
• Long axis slopes slightly towards the
vertical
axis when viewed from the
front.
• Slopes labially when viewed from the side.
• Incisal edge is about www.indiandentalacademy.com
2mm above occlusal
plane

Mandibular lateral incisor:
• Long axis inclines to vertical
axis when viewed from the
front
• Slopes labially when viewed
from side but not so steeply
as the central incisor.
• Incisal edge is about 2mm
above occlusal plane

Mandibular canine:
• Long axis leans very slightly towards
the midline when viewed from the
front.
• Leans very slightly lingually when
viewed from the side
• Neck is slightly prominent and the
tooth is tilted to the distal
• Tip at same level as incisors.

First premolar:
• Long axis is parallel to the vertical plane when
viewed from the front and the side.
• Its lingual cusp is below the horizontal plane
• Its buccal cusp about 2mm above it as it contacts
the mesial marginal ridge of the upper first
premolar.

Second premolar:
• Long axis is parallel to the vertical plane when
viewed from both the front and the side.
• Both cusps are about 2mm above the occlusal
plane.
• The buccal cusp contacts the fossa between the
two upper premolars.

First molar:
• Long axis leans lingually when viewed from the front
and mesially when viewed from the side.
• All cusps are at a higher level above the occlusal plane
than those of the second premolar.
• The buccal and distal cusps are higher than the mesial
and lingual.
• The mesiobuccal cusp occludes in the fossa between
upper second premolar and first molar.

Second molar:
• Lingual and mesial inclination of the long axis is more
pronounced than in the case of the first molar.
• All the cusps are at a higher level above the occlusal
plane than those of the first molar, the distal and buccal
cusps more so than the mesial and lingual.
• The mesiobuccal cusp contacts the fossa between the
two upper molars.

Arranging the Posterior Teeth
.
The anatomical guides most often used in developing the anterior
plane of occlusion are the corners 0f the mouth.
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.
The height of the occlusal plane is not simply a matter of
dividing the maxillomandibular denture space equally. This space is
governed by the relative amount of bone lost from the two ridges.
More bone may have been lost from the maxilla than from the
mandible and the occlusal plane should not be placed an equal
distance between the two ridges. It also should not be at a level that
would favor the weaker of the two ridges (basal seats). The most
reliable guides are esthetics or anterior tooth placement and the
retromolar pads

.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 arbitary line should pass through the central
fossa of the mandibular premolars and molars
The basic principle for the buccolingual
positioning of posterior teeth is that they should positioned over
the residual ridge. The canine retromolar pad should provide
guides for arrangement.


Anterior teeth arrangement according to

Dentogenic concept of dental esthetic: SPA
factor
It is the interpretation of three main factor which every patient
posses, sex, personality and age.
To construct a dentogenic restoration effectively is a matter of
interpreting the sex, personality and age of the patient properly in
the denture. This is done through detailed consideration of the three
equally important parts of the denture – the tooth, its position and
the matrix. The quality of femininity, masculinity, personality and
the various physiologic ages will be revealed in the smile as a
result of way we do our interpretation.
A dentogenic dentures gives the denture wearer an inner sense of
well being, the veneer perceives fulfillment of the denture wearer’s
personality in his smile and the dentist who fabricated the denture
feels deeply rewarded.

Interpretation of sex factor in Dentogenic
restoration, sex identity in dentures is a symbol of progress
in prosthetic dentistry, on artistic challenge to all of us, which
is met with the application of dentogenics
The expression of feminine characteristics
Femininity is expressed by roundness, smoothness and
softness that is typical of women.
Therefore the selection of basic shape which has the soft lines
expression of the feminine form, together with effective
personality characteristics is particularly helpful.
The expression of Masculine characteristic
A typical masculine form is described as (cuboidal) hard
muscular, vigorous appearance beyond the evaluation of
physical appearance. A basic tooth form, which expresses
masculine characteristic show big or, boldness and hardness.
Thus sex identity becomes an automatic part of our esthetic
procedures .

SEX
INTERPRETATION
OF
TOOTH
POSITIONING
Positioning of the teeth is necessary in further conveying
sex characteristics to a denture. However, definite
positions cannot be assigned to one sex or the other, as
other factors other than sex must be taken into
consideration.
The anterior teeth should be arranged in a lively
position.
Central incisor can be arranged in four different
harmonious lively positions.
The incisal edge of one upper central incisor can be
brought anteriorly to create on effect of hardness.
If one of the central incisor is moved out at the base but
leaving the incisal edge together – softness is important
to the anterior teeth.

A more vigorous look can be given by one of the
central incisor bodily anterior to the other, yet
another position for incisors is a combined
rotation of the two centrol incisor with their
distal surface forward having one incisor
depressed at the cervical and the other depressed
incisally.
These 4 positions can be treated either
softly or more vigorously as it is for men or
women
Their placement controls I) midline ii) speaking
line iii) smile line iv) lip support v) labioverison

Lateral Incisors: (Right/left lateral incisor should have
asymmetric long axis)
This tooth is referred to as the sex tooth or it imparts effect of
hardness or softness to anterior tooth by its position.
Lateral incisor rotated to shape its mesial surface, slightly over
lapping the central incisor imparts softness and youth fullness to
smile .
If lateral incisor is rotated mesially. The effect of the smile is
hardened which is best for vigorous man.


The soft position (S) of the lateral incisor is produced by
rotating it’s mesial surface outward and inward rotation
produces hard position (H)

• Canines: (Rotated to show mesial surface,
controls, the buccal corridor).
• A prominence in the canine tooth imparts
great importance and thereby gives the
smile a vigorous look, which is more
suitable to the male sex.


General, we will adopt for the cuspid conjointly the
three following positions:
(1) out at the cervical end, as seen from the
front
(2) rotated to show the mesial face
(3) almost vertical as seen from the side

THE THIRD DIMENSION-DEPTH GRINDING
The "denture look" is due mostly to the flat appearance of the
artificial upper anterior teeth, their lack of depth, or of "body." The
depth grinding is done on the mesial surface of the central incisor
only. Central incisors are the widest, almost always the longest,
and therefore, the most noticeable of the six anterior teeth.
It is necessary to develop the desired effect in the depth grinding
by consideration of these main factors:


• a flat thin narrow tooth is delicate looking and fits
delicate women ( little depth grinding)
• a thick bony big sized tooth heavily carved on it’s labial
surface is vigorous and to be used exclusively for men
( severe depth grinding)
• For the average patient the depth grinding will be an
average between delicate and vigorous
• Depth grinding reduces the width of the central incisor
according to the severity of grinding to be accomplished.

Grinding of teeth for age abrasion effect
Of early youth: Teeth prominent, bulbous gums, no abrasion
short stuffy tooth, spacing between lateral, cuspid developmental
groove
early middle age – incisal wear, mild staining slight spacing due
to drifting, which can be incorporated in the dentures.
Middle age – More incisal wear on C, L, canine, mild staining
recession of gum
Old age – long axis is not in alignment, gum recession, erosion
natural staining, occlusal and incisal wear caused by habit.


Interpretation of personality
dentogenic restoration

factor

in

For a dentogenic restoration the human personalities can
be grouped into three categories.
The vigorous- Hard, aggressive, muscular type
The medium type- Normal, robust, healthy
The delicate type fragile, frail appearance.
Personality of denture depends on the selection of tooth molds,
tooth colors tooth position, and the matrix of the teeth (denture
base)
When we incorporate the personality factor in
esthetics we do so keeping in mind the influence of the sex and
age factors as we proceed.

Interpretation of age factor in dentogenic restoration
As age progress in human individual there will be visible
changes in the appearance of his teeth as in other living
tissues.
It is an artistic challenge to the prosthodontist to maintain a
favorable relationship between his chronologic life and his
physiologic mouth condition.
Age in artificial tooth
Is established by mold refinement by grinding of the teeth
and its matrix (gum).
Gives the denture a individual look and eliminates an
artificial look diastema is a common condition seen in the
mouth of the adult because of the drifting of teeth resulting
from premature loss of teeth. Again matrix interdental
papilla loses its stippled appearance, receding gum line will
suggest recession. www.indiandentalacademy.com

DENTOGENIC CONCEPT
Dynesthetic theory
Term Dynesthetic is derived from the Greek word ‘dynamis’
meaning power. It supports in working factors of the
dentogentic concept. The technique of dynesthetic is an
auxiliary stimulus in the creation ot a dentogenic restoration.
It is secondary to sex personality and age factors. These are
rules, which concern the three important division of denture
fabrication.
1) The tooth 2) its position and 3) its matrix and should not be
confused with dentogenic procedure. The skilled technicians
ability allows the dentist to further refine the dynesthetic rules
according to own perception at the try in appointment.


Consideration in dynesthetics
The following are the dynesthetic consideration, which are
necessary for the production of dentogenic restoration.
Mold- The selection of an acceptable personality mold, involves
its subsequent treatment for abrasion, erosion, dept grinding,
masculinity or femininity, shaping and polishing.
Lip support- This is the bodily anterior, posterior positioning of
the teeth, which adequately support the upper lip in natural
and pleasing manner. The pleasing lip support is achieved by
the anterior teeth and matrix. The border of the lip support is
carried chiefly by the central incisor.


Mid line- The features of face usually start one way or another
and its is rather difficult to see a true midline in a dentition.
It is usually more eccentric than is noticed. Therefore an
eccentric midline in a denture if not to exaggerated, is
acceptable and may lead to the elusion ot the natural
dentition. The mid axis is important to general composition
and should be vertical to the incisal and occlusal plane.
Labioversion- The most pleasing effect is obtained when the
long axis of the central incisors are either vertical or with a
slight labial inclination.
Speaking line- It is the incisal length or the vertical
composition of the anterior teeth. It is spoken of, as the
speaking line because the final evolution of the incisal
length is made when the patient is speaking seriously, the lip
of the lateral incisors should be seen.

Smiling line- The smiling line is a curve whose path
follows the incisal edges of the central incisors up
and backs to the incisal edges of the lateral incisors
and then to the lips of the cuspids. It is determined
by the age of the patient and decreases, as the
patient gets older.
Central incisor position: The central incisors are the
corner stones of tooth position, if their positions are
correct, then the position of all of the other teeth
will be more nearly correct and their placement
controls.
a) The midline
b) Speaking line
c) the lip
support d) Labiovesion
e) Smiling line
compositions. www.indiandentalacademy.com

The canine position: It supports the anterior arch forms in its
widest part and controls the size of the buccal corridor. It
should be carefully positioned so as to dominate the lateral
incisor and to complete the desired upward curve of the
smiling line. It should be abraded to copy the physiologic
age of the patient.
The three basic requirement of the canine position are
a) Tooth should be rotated to show its mesial surface
b) The cervical end should be out and
c) When observed from the right, the long axis of the
cuspid should be vertical
Space: Spacing in the anterior or posterior teeth are extremely
effective but their size and positions must be artistically
and hygienically formed.

The rules which must be observed are
a) All spaces must be shaped to shed food.
b) A diastema below the central incisor is unsightly and
should be avoided.
c) Diastema should be asymmetrically placed on either side
of the dental arch.
d) The width of the diastemas should be controlled so as not
to appear unsightly.
Embrasures- Represent a divergence of the proximal surface of
the anterior teeth from the contact point.
Buccal corridor- is created between the buccal surface of the
posterior teeth and the corner of the lips when the patient
smiles- the buccal corridor begins at the cuspid and its size
and shape are controlled by the position and stand of the
cuspid.
The use of the buccal corridor prevents the sixty-tooth smile, or
the molar-to-molarwww.indiandentalacademy.com characteristic of a
smile, which is often
denture.

Long axis- upon close examination of the position of the
natural teeth, it will be noticed that their long axis very
even though these variance is sometimes in minute
degrees. It is there and should be exaggerated in a
dentogenic restoration as an artistic device.
Gumline- at the cervical ends of the teeth should vary in
height. The generally accepted rule for this are that the
gumline should be formed.
a) Slightly below the high lip line at the central incisor.
b) Lower than the CI gum line of the later incisors.
c) Higher than the CT or LI gumline at the cuspid end.
d) Slightly lower than at the cuspid, at the bicuspid.


Inter dental papilla- in a dentogenic restoration the esthetic
consideration ot the denture base lies in the matrix of the
tooth. The general rule for papilla
a) The papilla must extent to the point of tooth contact.
b) The papilla must be of various lengths
c) Interdental papilla must be convex in all direction
d) Papilla must be shaped to the age
e) The papilla must, end near the labial face of the tooth
Labial and buccal denture base contour
The denture base contours beyond the matrix should provide
self cleaning surfaces and therefore should not be over
accentuated with depressions grooves, folds of any shape
which would defect the smooth cleaning act on of the
cheeks and lip.

OCCLUSAL SCHEMES FOR COMPLETE DENTURE
OCCLUSION
The occlusal scheme or the tooth molds selected occlusal
rehabilitation will depend on the concept of occlusion that has been
selected to satisfy the needs of the patient. The posterior teeth,
arrangement according to the occlusal concept selected, should
fulfill the dentist's philosophy of occlusion as which appear
esthetically pleasing.
Prosthetic tooth anatomy seems to be more important to
dentists than to the patients who use the teeth. In the absence of
clear evidence of the benefits of one tooth anatomy compared with
others, dentists should use the least complicated procedures and
tooth forms that will satisfy their concepts of occlusion and
articulation of a mucosal supported dentition

.
There are several schools of thought on the choice of occlusal
forms of posterior teeth for the three concepts of occlusion most
often selected, namely, (1) bilateral balance,
(2) monoplane or nonanatomical, and
(3) lingualized articulations.
Anatomical molds usually are selected for bilateral
balanced articulation; however, nonanatomical teeth can be used in
a balanced concept with the use of compensating curves.
Nonanatomical or cusp less teeth are generally the choice for
monoplane although teeth with cusps also can be used. For the
lingualized occlusal concept, a combination of upper anatomical
and lower non-anatomical molds has been introduced by several
tooth manufacturers .


Arranging Anatomical Teeth to a
Balanced Articulation
The anterior teeth are set with a minimal vertical
overlap of 0.5 to 1 mm and 1 to 2 mm of horizontal overlap to
establish a low incisal guidance .
In the arrangement of the 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


Setting the Mandibular Teeth First
The primary consideration in positioning the premolars is that
they follow the form of the residual ridge. 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


.
The second premolar is set in a similar manner.
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.
. In the positioning of the mandibular first molar, the
central groove is placed on the canine to retromolar pad
reference line. The vertical height of the tooth is adjusted by
positioning the cusp tips on the occlusal plane. 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 The index finger is used to
hold the cervical neck of the maxillary tooth in place while the
articulator is closed www.indiandentalacademy.com

.
Setting the Maxillary Teeth First
In arranging the maxillary posterior teeth first, start with
the maxillary first premolar and continue the arrangement of the
teeth through to the second molar. During the positioning of these
teeth, the maxillary lingual cusps are aligned with the reference
line that has been scribed on the mandibular wax occlusal rim
from the mandibular canine tip to the middle of the retromolar
pad.
Positioning the maxillary teeth with a slight opening of
the contact points between these teeth allows the mandibular
teeth to better assume their correct mesiodistal position as they
are interdigitated with the maxillary posterior teeth.

2 Arranging nonanatomical mandibular
Posterior Teeth to Balanced Articulation
anteroposterior and mediolateral compensating curves
permits the establishment of a balanced articulation.
In such arrangements, the mandibular teeth
usually are arranged first followed by the maxillary
teeth.
the use of the several reference lines and guides
developed for the anatomical arrangement also are
used with the nonanatomical teeth. The major difference
is in the positioning of the mandibular posterior teeth to
develop the compensating curves.

Anteroposterior Compensating Curve
The anteroposterior compensating curve begins at the
distal marginal ridge of the first posterior replacement tooth
(which is usually the second premolar) and continues through the
second molar .most often the number of poseriot teeth used in
balanced articulation with nonanatomical teeth will be limited to
three.eliminating the first premolar is a logical choice because
this tooth has less occlusal surface for the mastication.
Mediolateral Compensating Curve
A mediolateral compensating curve also is needed to
provide the needed tooth structure to achieve balanced
articulation during lateral movements. This curve also is initiated
with the first replacement tooth and continues through the second
molar , the degree to which the facial cusps are elevated in
relation to the lingual cusps to establish this curve will vary with
the condylar and incisal guidance

.
FIRST PREMOLAR
The central fossa of the mandibular premolar tooth is aligned
with the reference line from the tip of the canine to the middle
of the retromolar pad. The long axis of the tooth is
perpendicular to the occlusal plane, and the facial cusp is
slightly elevated above the lingual cusp.


First Molar
Position the mandibular first molar next to the premolar with
the mesial marginal ridge at the same level as the distal marginal ridge
of the premolar and its distal marginal ridge slightly ele-vated.
. The distal of the first molar should be elevated approximately
I mm above the occlusal plane that was established by the anterior and
posterior reference points. When viewed in the frontal plane, the
mediolateral compensating curve, initiated with the setting of the
premolar, should be maintained by a slight elevation of the facial cusp
above the lingual cusp..


Second Molar
The anteroposterior compensating curve is continued
posteriorly by elevating the distal of this second molar tooth
approximately 2 mm above the occlusal plane established by the
reference points.
Posterior Teeth
The mandibular posterior teeth are arranged for the other
side of the arch with the same criteria an procedures as just
outlined.


Arranging Nonanatomical Maxillary Posterior
Teeth to Balanced Articulation
After some of the wax occlusal rim distal to
the canine is removed, the first premolar is set. Place a
small portion of soft, pink wax on the neck of the maxillary
premolar and attach the tooth to the record base. Carefully
close the articulator and establish contact between the
occlusal surface of the maxillary tooth and the central
fossa or marginal ridges of the mandibular antagonist.
There should be approximately I to 2 mm of horizontal
overlap of the maxillary facial cusp in relation to the
mandibular facial cusp.

First Molar
Aligning their marginal ridges and facial surfaces.
Establish contact between the maxillary occlusal surface and the
central fossa or marginal ridges of the mandibular antagonist..
Second Molar Position the maxillary second molar tooth. Again,
carefully close the articulator and establish the tooth contacts as
you did with the first molar.
Remaining Maxillary Posterior Teeth The maxillary posterior
teeth are arranged for the other side of the arch with the same
criteria and procedures as previously outlined for maxillary
posterior teeth.


3

Arranging Nonanatomical Teeth to
Monoplane Articulation
With this concept of occlusion, there is no attempt to
eliminate deflective occlusal contacts in lateral or
protrusive excursions.
The dentist's desire to achieve an optimal esthetic
result will require some vertical overlap of the anterior
teeth. However, this can generally be accommodated for
with sufficient horizontal overlap to permit a range of
anterior and lateral movements without anterior tooth
contacts. Basically, the patient can clench and grind in and
around maximum intercuspation during both functional and
nonfunctional activities. However, some deflective occlusal
contacts of the posterior teeth will be experienced

The condylar inclinations on the articulator are
set at 0 degrees. The articulator is reduced to a simple
hinge articulator.
With the mandibular wax occlusion rim
positioned on its cast on the articulator small segment
of the rim is removed from the posterior tooth area.
The maxillary posterior teeth positioned one at
a time with the mandibular occlusal rim and its
references and guides for the placement.
The maxillary teeth are positioned occlude with
the flat surface of the mandibular occlusion rim
.


There should be approximate l to 2 mm of
horizontal overlap of the maxilla facial cusp in
relation to the mandibular occlusal rim
When completed, the occlusal surfaces of the
maxillary posterior teeth should be flat against the
mandibular wax occlusal rim.
The mandibular teeth are arranged so they
maximally contact the upper teeth.
The anteroposterior relation of the upper and lower
teeth is not critical because of the absence cusps.

Arranging Mandibular Posterior Teeth to Lingualized
Articulation

Lingualized articulation has been advocated
many practitioners over the past 70 years, and most
instances these clinicians have done so with a variety
of tooth molds. However, what has been lacking for
the practitioner are tooth molds design specifically for
this concept.
Myerson Lingualized, Integration (MLI) molds
represent an occlusion scheme designed for this
concept. It has been suggested that these molds will
provide maximum intercuspation, an absence of
deflective occlusion contacts, adequate cusp height for
selective occlusal reshaping, and a natural and pleasing
appearance
.

The MLI teeth are available in two posterior tooth molds: (1)
controlled contact (CC) and (2) maximum contact MC molds .
The primary difference in the two molds is the maxillary posterior
teeth
The mandibular teeth are the same for both molds. The
mandibular teeth were designed with lower cusp heights and
multiple occlusal spillways to assist in mastication.
The selection of one or the other mold (CC or MC) is dependent
on the patient's ability to consistently reproduce their centric jaw
relation position.
For those patients in whom uncertainty exists in the
registration and reproducibility of the centric jaw relation
position, the CC mold is suggested because it provides for greater
freedom of movement around maximum intercuspation.

For those patients in whom muscle control is not a problem and
jaw relation records are easily repeated, the MC mold may be the
tooth selection of choice.
In the MC mold, the maxillary teeth are more anatomical
in appearance with greater cusp heights. This form demands
some minor reshaping and refinement of the occlusal fossae and
marginal ridges of the mandibular teeth during the arrangement
of the teeth to accept the lingual cusps of the maxillary teeth.
With the MC mold, a more exacting occlusion can be
attained in maximum intercuspation, and bilateral balanced
articulation can be developed over a greater range of movement
both anteroposteriorly and mediolaterally.
Lingualized integration is based on the maxillary lingual
cusp functioning as the main supporting cusp in harmony with
the occlusal surfaces of the lower teeth..

The maxillary cusp heights in the CC mold are lower and permit
greater flexibility around maximum intercuspation.
The tooth contacts in eccentric positions remain as
bilateral balanced articulation, even though the range of contact
is less because of the reduced height to the maxillary lingual
cusps. However, a greater range of contact is probably not
necessary for most edentulous patients, and the bilateral
balanced articulation achieved with the CC mold is very
acceptable.
In the arrangement of the teeth for lingualized articulation,
the mandibular teeth are set first to establish the occlusal
plane.


The MLI tooth scheme calls for anteroposterior and
mediolateral compensating curves arranged in the
mandibular arch, thereby permitting balanced
articulation between the maxillary lingual cusps and the
mandibular teeth during various jaw movements.
1 Anterior and Posterior Reference Points
2 Buccolingual Positioning of the Teeth
3 Anteroposterior Compensating curve
4 Mediolateral Compensating Curve


Premolar The first premolar tooth is positioned in contact
with the canine and with its long axis perpendicular to the
occlusal plane. The occlusal surface is positioned on the
occlusal plane; however, the facial cusp is elevated slightly
above the lingual cusp to establish the mediolateral com
pensating curve. The second premolar is eliminated from the
arrangement.
First Molar.
The distal marginal ridge of this tooth is elevated
slightly above the mesial marginal ridge to create the
anteroposterior compensating curve. The mediolateral
compensating curve is maintained by elevating the facial cusp
of the molar slightly above the lingual cusp. The central fossa
of the first molar is positioned slightly to the facial of the
reference line connecting the canine with the middle of the
retromolar pad

Second Molar
The anteroposterior compensating curve is continued
by elevating the distal marginal ridge of this tooth. the
retromolar pad.. The mediolateral compensating curve is
continued by elevating the facial cusps above the lingual
cusps.
Remaining Mandibular Posterior Teeth The mandibular
posterior teeth are arranged for the other side of the arch with
the same criteria and procedures, as previously outlined.


Arranging Maxillary Posterior Teeth to
Lingualized Articulation
Premolar
The first tooth arranged in the maxillary arch is the first
premolar. This tooth is selected because of its cusp tip to cervical
margin height.. The lingual cusp is positioned to contact the
marginal ridge or occlusal fossa of its mandibular antagonist.
No attempt is made at this time to balance the facial or
lingual cusps in lateral or protrusive movements. Maximum
interdigitation of the lingual cusp against the occlusal surface of the
mandibular tooth is the primary consideration


First Molar
Often, a Class I molar relationship will not be present. Such a
relationship is not necessary, and positioning of the teeth to establish
such a relationship is discouraged.
Integration of the lingual cusps with the marginal ridge or
fossa of the mandibular antagonist is the primary consideration.
Second Molar
The anteroposterior compensating curve is continued when
the tooth is closed into contact with the mandibular tooth. Again,
maximum intercuspation is essential, as is the maintenance of the
mediolateral compensating curve.

Arranging the Maximum Contact Mold
In the arrangement ofthe MC mold, the maxillary teeth are
positioned with the incisal pin slightly open when the lingual cusps
are in contact with their mandibular antagonists.
The prominence of the maxillary lingual cusps will require
some occlusal reshaping of the central fossae and marginal ridges
of the lower teeth to establish maximum intercuspation.
After each maxillary tooth is positioned, a thin sheet of
articulating paper is interposed between the tooth and its
mandibular antagonist. The articulator is closed, marking the first
contact point. The contact point on the occlusal surface of the
mandibular tooth is enlarged by grinding with a round bur to
permit the lingual cusp to obtain positive seating with the lower
tooth. This process is continued until maximum interdigitation is
achieved and the incisal pin is in contact with the incisal table.

POSTERIOR TEETH ARRANGEMENT FOR
CLASS II RELATION SHIP
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 vertical overlap should be kept as small as
esthetics and phonetics will allow in order to establish
an incisal guidance as shallow as possible . In most of
these cases, the horizontal overlap is great enough to
accommodate for mastication without the anterior teeth
interfering during the function of mastication on the
posterior teeth.

The small arch of the lower ridge retruded to a
position inside the upper makes it impossible to
obtain the correct upper and lower canine
relationship.
The lower canine is inside the upper arch
of teeth and is more distal in its relationship to
the upper canine than in class I .This gives a
toothontooth vertical relationship to the
posterior teeth that can be articulated to establish
a stable centric and eccentric occlusion after
special grinding procedures

Setting the Mandibular Posterior Teeth
•
The same criteria described for setting lower
teeth are applied to this case. The lower anteriors
were set for lip support and the first premolar
follows the arch contour established by them so
that the modiolus is supported. Any attempt to
set the lower anterior or posterior teeth to an
exaggerated labial or buccal position in relation
to the lower ridge is contraindicated because it
will create an unfavorable lever action on the
lower denture base during function.

Either anatomic, modified anatomic, or nonanatomic
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 nonanatomic teeth are
selected.
After the lower premolars are initially set, the
upper first premolar is temporarily set to evaluate its
position. It will have a marked buccal overlap with the
upper lingual cusp usually opposing the lower buccal
cusp.

The initial grinding follows the same basic concepts that
modified the buccolingual inclines and eliminated the
mesiodistal interlocking cusp heights and transverse
ridges .
A special grinding procedure is then necessary to
establish a stable centric occlusal contact for the
premolars. The buccal tips of the lower premolars are
flattened to a horizontal table . Usually, the molar teeth
do not need this additional grinding procedure on their
buccal cusps because the lower ridge crest in the molars
region is under the upper ridge. This permits the upper
molar lingual cusps to be set in the modified central
fossa of the lower molars .

Grinding Modifications for Upper Posterior Teeth
The upper anatomic or modified anatomic teeth are
initially ground to eliminate all mesiodistal interlocking
transverse ridges and cusp heights. The buccal cusps are
shortened progressively from the premolars to the molars
The maxillary premolars need additional special
grinding on the lingual cusp to create a flat stable platform for
centric occlusal contact with the lower premolars
Setting the Upper Posterior Teeth
Before the upper posterior teeth are set the incisal guide
pin must be checked for the proper occluding vertical
dimension. The condylar locks are opened so that eccentric
excursions can be made into right lateral, left lateral, and
protrusive positions. The incisal guidance should be set for most
patients so that the anterior teeth just clear during these
excursions.

Anterior interference, evident by extensive excursions
on the articulator, cannot be eliminated when patients have a
deep vertical overlap. This interference will not be traumatic to
the foundation tissues if it occurs outside of the normal
masticatory cycle. Fortunately, this holds true for most
orthognathic patients because there is ample compensating
horizontal overlap .
1. The upper first premolar is set so that its flattened lingual
cusp occludes with the flattened buccal cusp of the lower first
premolar . The amount of buccal overlap of this tooth will vary
in each case because of the difference in ridge relationships in
orthognatic patients. In severe retrusions, the first premolars
may be out of contact in centric occlusion.
2. The upper second premolar is set with its flattened lingual
cusp occluding with the flattened buccal cusp of the lower
second premolar. There is less buccal overlap and a larger area
of contact is possible between these teeth .

The mesiodistal relationship of the upper and lower
premolars is not critical because the flattened cusp contacts
and the elimination of mesiodistal inclines do not demand a
critical tooth position for a stable occlusion.
3. After setting the upper premolars, mark the centric occlusal
contacts with articulating paper to analyze for stability and the
area of contact. The contacts must not be on deflective
and enlarge the area of contact. Readjust the upper premolars
to centric occlusion and recheck the contacts.
4. The upper molars can be set with their lingual cusps in the
modified central fossa of the lower teeth. Again the contacts
must be checked for deflective inclines and corrected by the
same grinding procedures described for the premolars.
5. The posteriors now should have a centric occlusion with
stable non deflective stops. Only the lingual cusp are the
occluding elements on the upper teeth . They contact the
buccal cusp of the lower premolars and the central fossa of the
lower molars .

POSTERIOR
ARRANGEMENT
RELATIONSHIP

FOR

CLASS

III

The usual approach to the arrangement of the anterior
teeth for the class III is to set the upper anteriors as far forward as
esthetics requires for the support of the upper lip and to set the
lower anteriors as far lingual on the ridge as possible without
interfering with the tongue .
The patient treated with this basic approach looks less
prognathic and the anterior teeth, except for the very pronounced
class III relationship, can be set edgetoedge .
This procedure creates no particular problem in
establishing the proper relationship between the upper and lower
canines. It permits an anatomically normal . vertical interdigitated
relationship for the posterior teeth.

The problem is the horizontal relationship of the teeth in
the posterior region, where the lower ridge is in an abnormal
buccal relation to the upper.
This requires an atypical arrangement of the posterior
teeth to control the biomechanical forces of the occlusion. The
atypical arrangement is commonly called a crossbite occlusion.
In this type of occlusion the upper posterior teeth are
crossed over the lower posterior teeth so that the buccal cusp of
the upper is in the lower central fossa instead of the lingual cusp.
This may occur either unilaterally or bilaterally,
depending on the posterior upper and lower ridge relationship .


The crossing point of this occlusion depends on the
buccolingual vertical relationship of each case. The crossing

over of the upper posterior tooth occurs when a
conventional occlusal relationship would position the
upper tooth too far to the buccal
In this errant position, the tooth would create
unfavorable displacing leverage on the upper base during
function. It would also impinge on the buccal mucosa,
which would result in additional displacing forces acting
on the teeth and denture base. Cheek biting is also
common with teeth positioned too far to the buccal


Selection of Posterior Teeth
The same indications for the selection of the
size and the modification of the occlusal form for
the conventional case hold for this type of ridge
relationship. However, it is the upper ridge that is
primarily considered since it is always the smaller
and usually the weaker ridge.
When the lower ridge is markedly resorbed a
nonanatomic teeth is indicated . The buccolingual
and mesiodistal relation of the upper and lower
posteriors is not as critical with this type of
occlusion .

Usual guidelines are followed as it was followed in
normal relationship .An attempt to set the lower posterior
teeth under the upper ridge so that the upper and lower
posterior will have a conventional occlusal relationship
will position the lower teeth too far lingual .This will
restrict the tongue movements and cause displacement of
the lower denture .
Grinding Modifications for Lower Posterior Teeth
No variations in the grinding procedures are made
in the initial modification, which unlocks the mesiodistal
interdigitation and reduces the buccolingual inclination.
Additional spot grinding is necessary to establish a static
centric occlusion when the upper posteriors are set.

Grinding Modifications for Upper Posterior
Teeth
Each upper posterior tooth is modified before it is
set. The transverse ridges are flattened to eliminate the
mesiodistal interlocking potential of the anatomic tooth.
Special additional individual tooth grinding is necessary as
the teeth are set. It depends on the tooth that initiates the
crossing over of the occlusion.
When this occurs, the upper tooth is flattened both
on buccal and lingual cusps to establish a static centric
occlusal contact with the lower tooth .
The teeth in crossbite relation need additional
modification by grinding on the upper buccal cusps. They
must be rounded to occlude in the modified central fossa of
the lower.

Setting the Upper Posterior Teeth
The upper first premolar can usually be set in
conventional relationship to the lower premolars. The upper
lingual cusp is set in the common central fossa of the modified
lower premolars . It should be in a complimentary esthetic
position in relation to the upper canine and should establish a
normal arch form.
The second premolar usually requires special
consideration because it starts the crossover to the crossbite
occlusal relation. The upper buccal and lingual cusps are
flattened. When it is properly set in relation to the upper ridge,
the articulator is closed to evaluate its occluding position with
the lower teeth.
The lower teeth must now be flattened on the buccal
and lingual cusp inclines so that a stable occlusal contact is
established when the articulator is closed to the occluding
vertical dimension . www.indiandentalacademy.com

The upper first and second molars are set in a crossbite
relation, which puts the rounded upper buccal cusps in the lower
central fossa. This position of the upper molar teeth provides for a
compatible arch form of teeth in relation to the maxilla and
provides a favorable leverage system during function.
The crossing point can vary from case to case, depending
on the degree of prognathism and the residual ridge relationship.
It may not be bilaterally symmetric. When the basic concepts of
acceptable arch form, biomechanical principles, and tooth
modification are applied intelligently, any degree of prognathism
and aberrant ridge relation can be successfully managed either
with modified anatomic or nonanatomic teeth.

REVIEW OF
LITERATURE

• Temperament in relation to the teeth..Dent cosmos
1884:26::113120 . White JW
proposed the temperament theory in dentistry to
aid tooth selection and improve esthetics . Sex and
age were also considered factors that influence
dental composition and enhancing the esthetic
effect .formulations of tese features determine the
suitable tooth forms ,size ,colours,textures and
denture base contours for each temperament .


• Dental and facial types . Am syst dent1887,2:10301052 .
Ivy RS
gave description of specefic arch forms,together with
complementry palatal conours for each tempearament .for
example a flat anterior arch that turned posteriorly to form
diverging lines was consistent with bilious temperament
.in cross section palatal vault was almost square .The
sanguine arch resemble a horesshoe in outline while
palatal contour was semicircular . The nervous
temperament had an arch that gently curved on either side
to form a rounded point anteriorly .likewise the palate had
a high vault reminiscent of a gothic arch . An almost
semicircular arch typified the lymphatic temperament with
a rounded ,shallow palate.


• Is the theory of temperament the foundation to the study of
prosthetic art? Dent mag 1905;1:405413. Berry FA.
Found a analogy between face form and tooth form .in
his study facial outline was determined by drawing a line
midway between the hairline and eyebrows to the zygomas
on each side and down to the chin. The inversion of this
outline form was purported to represent almost without
exception the natural mould of the central incisor . It also
sugested that original arch form could be assessed by using
the inverted form of the cheeks and chin as an accurate
guide .when viewed obliquely the cheek outline revealed
the labila countour of the canine.


• Complete denture prosthesis,ed
3.london.saunders,1925:47:915923. 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 palte when inverted and superimposed on the 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.

CONCLUSION
• Selecting anterior teeth for a complete denture can
be difficult if no preextraction records are
available. A review of dental literature shows that
several factors has been proposed as an aids for
artificial teeth selection,and numerous method has
been devised for their evaluation as reliable
esthetic factors in determining artificial tooth form
To date ,however , no universally reliable
method has been found for determining tooth
form.

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