Tooth selection/ fellowships in orthodontics

ANTERIOR TOOTHANTERIOR TOOTH
SELECTION.SELECTION.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

Introduction.Introduction.
• Anterior teeth selection and arrangementAnterior teeth selection and arrangement
is an area of prosthodontics where artis an area of prosthodontics where art
dominates science,where esthetics is thedominates science,where esthetics is the
major concern,and where knowledge mustmajor concern,and where knowledge must
be applied to create a pleasingbe applied to create a pleasing
appearance while simultaneouslyappearance while simultaneously
maintaining oral function.maintaining oral function.

• The anterior teeth are primarily selectedThe anterior teeth are primarily selected
to satisfy esthetic requirements.to satisfy esthetic requirements.
• Posterior teeth's are selected to satisfyPosterior teeth's are selected to satisfy
masticatory functional requirements.masticatory functional requirements.
Technically, the anterior teeth areTechnically, the anterior teeth are
composed of 6 maxillary and 6composed of 6 maxillary and 6
mandibular teeth's.mandibular teeth's.
Introduction.

Introduction.Introduction.
Exceptions:Exceptions:
o Sometimes maxillary first premolar isSometimes maxillary first premolar is
considered more for esthetics than forconsidered more for esthetics than for
masticatory function.masticatory function.

• Patients expect 3 basic things form theirPatients expect 3 basic things form their
complete dentures.complete dentures.
– Favorable appearance.Favorable appearance.
– Comfort.Comfort.
– Chewing ability.Chewing ability.

• There are four main considerations inThere are four main considerations in
selecting the anterior teeth.selecting the anterior teeth.
1.1. Tooth sizeTooth size
2.2. Tooth moldTooth mold
3.3. ColorColor
4.4. Tooth materialTooth material

PRE-EXTRACTION GUIDES.PRE-EXTRACTION GUIDES.
• PHOTOGRAPHS.PHOTOGRAPHS.
• RAIDOGRAPHS.RAIDOGRAPHS.
• DIAGNOSTIC CASTS.DIAGNOSTIC CASTS.
• TEETHS OF RELATIVES.TEETHS OF RELATIVES.
• EXTRACTED TEETH.EXTRACTED TEETH.

PhotographsPhotographs
• More accurate than any other guide.More accurate than any other guide.
• Shows the natural teeth or at least the incisalShows the natural teeth or at least the incisal
edges.edges.
• Provides information about width and outlineProvides information about width and outline
form of the teeth.form of the teeth.
• Known factors:Known factors:
– Width/length on photo.Width/length on photo.
– interpupillary distance on photointerpupillary distance on photo
– Interpupillary distance on patientInterpupillary distance on patient
• Unknown factor: length or width of teeth to beUnknown factor: length or width of teeth to be
selected.selected.
• Recent photographs are of much value.Recent photographs are of much value.

NewNew
denturesdentures
made withmade with
the help ofthe help of
oldold
photographphotograph
•65 years:
Poor
esthetics
with 15
year old
dentures.
•Natural teeth at 20 years

• However, it is of value only when theHowever, it is of value only when the
photograph is a full-face portrait ofphotograph is a full-face portrait of
sufficient size.sufficient size.

DIAGNOSTIC CASTS.DIAGNOSTIC CASTS.
• Diagnostic casts of patients natural orDiagnostic casts of patients natural or
restored teeth.restored teeth.
• Size and form of the anterior teeth can beSize and form of the anterior teeth can be
determined.determined.

RADIOGRAPHS.RADIOGRAPHS.
• Can help in knowing size and form of theCan help in knowing size and form of the
lost teeth.lost teeth.
•DisadvantagesDisadvantages::
– Are always slightly enlarged.Are always slightly enlarged.
– Distortion may be there.Distortion may be there.

TEETH OF RELATIVESTEETH OF RELATIVES ..
• Sons or daughters tooth size , color, andSons or daughters tooth size , color, and
arrangement can be effectively used inarrangement can be effectively used in
selecting and arranging artificial teeth forselecting and arranging artificial teeth for
their parents.their parents.

EXTRACTED TEETH.EXTRACTED TEETH.
• Provides information as to the size andProvides information as to the size and
form.form.
• Not to be used for selecting color.Not to be used for selecting color.

SELECTION OF SIZE.SELECTION OF SIZE.
• There are 2 dimensions to considerThere are 2 dimensions to consider
– The mesiodistal width.The mesiodistal width.
– The incisogingival length.The incisogingival length.

MEASUREMENTMEASUREMENT
EDENTULOUS CASTS.EDENTULOUS CASTS.
• Inaccurate due to resorption of ridges.Inaccurate due to resorption of ridges.
• Occlusal rims to be constructed forOcclusal rims to be constructed for
accurate measurements.accurate measurements.

• Gives the estimation of placement ofGives the estimation of placement of
apex of upper canines.apex of upper canines.
• Extension of parallel lines from theExtension of parallel lines from the
lateral surfaces of the alae of the noselateral surfaces of the alae of the nose
onto the labial surface of the upperonto the labial surface of the upper
occlusion rim.occlusion rim.

Relationship betweenRelationship between
intercanine distance and noseintercanine distance and nose
widthwidth
• It falls in the rangeIt falls in the range
28-45mm28-45mm
• Since anterior teethSince anterior teeth
are arranged in anare arranged in an
arc. the divider hasarc. the divider has
to be opened by 3-to be opened by 3-
4mm more than the4mm more than the
value of the nosevalue of the nose
width.width. www.indiandentalacademy.comwww.indiandentalacademy.com

• Distal surfaces of the natural canines isDistal surfaces of the natural canines is
usually located near the corner of theusually located near the corner of the
mouth.mouth.

GENERAL GUIDE .GENERAL GUIDE .
• Upper anterior teeth whose overall width isUpper anterior teeth whose overall width is
less than 48mm are relatively smallless than 48mm are relatively small
teeth. Those listed as over 52mm areteeth. Those listed as over 52mm are
relatively large teeth.relatively large teeth.

Anthropometric measurements.Anthropometric measurements.
Found from a study of 555 skulls.Found from a study of 555 skulls.
• Greatest bi zygomatic width / 16Greatest bi zygomatic width / 16
-gives approximation of-gives approximation of
the width of the upper centralthe width of the upper central
incisors.incisors.
- also known as- also known as HOUSEHOUSE
AND LOOP’S RULE.AND LOOP’S RULE.
• Greatest bi zygomatic width / 3.3Greatest bi zygomatic width / 3.3
-Overall width of the upper six-Overall width of the upper six
anterior teeth.anterior teeth.

• Lateral incisor are approximately 2 mmLateral incisor are approximately 2 mm
narrower and canine 1 mm narrowernarrower and canine 1 mm narrower
than the central incisors.than the central incisors.
• A facebow maybe used utilized toA facebow maybe used utilized to
obtain these measurement.obtain these measurement.

Length of central incisorLength of central incisor
• Facial measurement methodFacial measurement method
– Distance from the hair line to the gnathion inDistance from the hair line to the gnathion in
millimeters with the face at rest and divide thismillimeters with the face at rest and divide this
by 16.by 16.

• Amount of central incisor visible inAmount of central incisor visible in
young-3 mm.young-3 mm.
• In old – 11/2 mm.In old – 11/2 mm.

Using trubute tooth indicator.Using trubute tooth indicator.

UNIVERSAL DENTALUNIVERSAL DENTAL
COMPANY MOLD SELECTORCOMPANY MOLD SELECTOR

INCISAL PAPILLA – CUSPIDINCISAL PAPILLA – CUSPID
EMINENCE/BUCCALEMINENCE/BUCCAL
FRENUM.FRENUM.
• A line is placed on the cast at the distalA line is placed on the cast at the distal
termination of the cuspid eminence.termination of the cuspid eminence.
• When eminence are not discernible a lineWhen eminence are not discernible a line
is placed slightly anterior to theis placed slightly anterior to the
attachment of buccal frenum.attachment of buccal frenum.

MAXILLO-MANDIBULARMAXILLO-MANDIBULAR
RELATIONS.RELATIONS.
• In protruded mandible the anterior teeth'sIn protruded mandible the anterior teeth's
are frequently larger than normal.are frequently larger than normal.
• If mandibles are retruded, the mandibularIf mandibles are retruded, the mandibular
anterior teeth are frequently smaller.anterior teeth are frequently smaller.
• In protrusion the face is usually longer andIn protrusion the face is usually longer and
longer faces usually require longer teeth's.longer faces usually require longer teeth's.

VERTICAL DISTANCEVERTICAL DISTANCE
BETWEEN THE RIDGES.BETWEEN THE RIDGES.
• The length of teeth is determined by theThe length of teeth is determined by the
space between the ridges.space between the ridges.
• When space is available it is advisable toWhen space is available it is advisable to
use long teeth.use long teeth.

Lips.Lips.
• Help in determined the length of the teeth.Help in determined the length of the teeth.
• The maxillary incisal edge extends inferior toThe maxillary incisal edge extends inferior to
or slightly below the lip margin.or slightly below the lip margin.
• ..

• When teeth are in occlusion and lips areWhen teeth are in occlusion and lips are
together, the labial incisal third of thetogether, the labial incisal third of the
maxillary anterior teeth supports themaxillary anterior teeth supports the
superior border of the lower lip.superior border of the lower lip.
• In speech the incisal edges of theIn speech the incisal edges of the
maxillary anterior teeth contact the lowermaxillary anterior teeth contact the lower
lip at the junction of the moist and drylip at the junction of the moist and dry
surfaces of the vermilion border. As insurfaces of the vermilion border. As in
pronouncing fifty fivepronouncing fifty five

Inner canthal distanceInner canthal distance
• Inner canthal distanceInner canthal distance
can be used to estimatecan be used to estimate
the mesiodistal width of athe mesiodistal width of a
maxillary central incisormaxillary central incisor
for an edentulous patient.for an edentulous patient.

• Size of the teeth should be inSize of the teeth should be in
proportion to the size of the face andproportion to the size of the face and
head.head.
• Larger persons have larger teethLarger persons have larger teeth
• But a large person may have smallBut a large person may have small
teeth with spaces between the teeth.teeth with spaces between the teeth.
• Or a small person may have largeOr a small person may have large
irregular aligned teeth.irregular aligned teeth.

• Woman have smaller teeth than men.Woman have smaller teeth than men.
• Lateral incisor should look more delicate inLateral incisor should look more delicate in
woman.woman.
• Size difference between central andSize difference between central and
lateral incisors should be more distinct inlateral incisors should be more distinct in
woman.woman.

Selection Of Form(shape orSelection Of Form(shape or
mold).mold).
• Form of artificial anterior teeth shouldForm of artificial anterior teeth should
harmonize with the shape of the patientsharmonize with the shape of the patients
face.face.
• Outline form is considered from a front viewOutline form is considered from a front view
of the patient.of the patient.
• The face from is identified by connecting theThe face from is identified by connecting the
following points on the lateral aspect of thefollowing points on the lateral aspect of the
face;face;
– the forehead,the forehead,
– the zygomatic archthe zygomatic arch
– Angle of the mandible.Angle of the mandible.

4 basic Outlines of faces4 basic Outlines of faces
• This was firs considered important by williamsThis was firs considered important by williams
and house and loopand house and loop (Leon Williams(Leon Williams
classification)classification)
– SquareSquare
• Square taperingSquare tapering
– TaperingTapering
– ovoidovoid

• The shape of theThe shape of the
maxillary centralmaxillary central
incisor shouldincisor should
resemble theresemble the
shape of the faceshape of the face
if it wereif it were
inverted.inverted.
• This methodThis method
selection is alsoselection is also
called ascalled as
GEOMETRICGEOMETRIC
THEORY.THEORY.

RELATION BETWEENRELATION BETWEEN
TOOTH SHAPE AND ARCHTOOTH SHAPE AND ARCH
SHAPESHAPE

• Check three points: the forehead,the baseCheck three points: the forehead,the base
of the nose,and the point of the chin.ifof the nose,and the point of the chin.if
these three points are in line ,the profile isthese three points are in line ,the profile is
straight.straight.
• 3 types of profiles are3 types of profiles are
• ConvexConvex
• straightstraight
• concaveconcave

SELECTION OF SHADE.SELECTION OF SHADE.
•COLOR HAS 4 QUALITIES.COLOR HAS 4 QUALITIES.

HUEHUE
• The hue of the teeth must be in harmonyThe hue of the teeth must be in harmony
with the color(Hue) of the the patientswith the color(Hue) of the the patients
face.face.
• In teeth guides yellow is the dominant hue.In teeth guides yellow is the dominant hue.

• Saturation (chroma)Saturation (chroma)
– It is the amount of color per unit area.It is the amount of color per unit area.
– Some teeth appear more yellowSome teeth appear more yellow
• Brilliance (value) it is the lightness orBrilliance (value) it is the lightness or
darkness of an object.darkness of an object.
– The relative amount of white or black in theThe relative amount of white or black in the
teeth determines their lightness orteeth determines their lightness or
darkness.darkness.

THE COLOR OF HAIRTHE COLOR OF HAIR

Color of eyes.Color of eyes.
• Color of eyes has been suggested asColor of eyes has been suggested as
guide to select the color of teeth.guide to select the color of teeth.
• Not a sound method since color of Iris isNot a sound method since color of Iris is
so small compared to total face and theso small compared to total face and the
eyes are not close to the teeth.eyes are not close to the teeth.

Color of face.Color of face.
• It should be the basic guide to select toothIt should be the basic guide to select tooth
color.color.

Age and colorAge and color
• Color of natural teeth progressively darkens withColor of natural teeth progressively darkens with
age.age.
• Pulp chamber becomes smaller with age due toPulp chamber becomes smaller with age due to
deposition of secondary dentindeposition of secondary dentin
• This makes the tooth more opaque and reducesThis makes the tooth more opaque and reduces
the effect of pulp color.the effect of pulp color.
• As wear occurs due to abrasive forces the toothAs wear occurs due to abrasive forces the tooth
becomes smoother and more reflective.becomes smoother and more reflective.

Jaw relation and color.Jaw relation and color.
• Class 1 same selected for both theClass 1 same selected for both the
arches.arches.
• Class 3 : prognathic patient slightly darkerClass 3 : prognathic patient slightly darker
teeth for the lower arch than the upper asteeth for the lower arch than the upper as
lighter teeth will stand out.lighter teeth will stand out.
• Class 2 : lighter teeth than the upper toClass 2 : lighter teeth than the upper to
give the illusion that the teeth are moregive the illusion that the teeth are more
anterior than they really are.anterior than they really are.

Selecting the color.Selecting the color.
• It should be done in 3 positionsIt should be done in 3 positions
• Outside the mouth along the side of theOutside the mouth along the side of the
nose.nose.
• It will establish the basicIt will establish the basic
hue,brilliance,and saturation.hue,brilliance,and saturation.

Selection of tooth material.Selection of tooth material.
• Conventional acrylic resinConventional acrylic resin
• Interpenetrating polymner network(IPN)Interpenetrating polymner network(IPN)
acrylic resinacrylic resin
• Composite resin teethComposite resin teeth
• Porcelain.Porcelain.

Indications for resin teeth.Indications for resin teeth.
• Recent extractionsRecent extractions
• Immediate denturesImmediate dentures
• Limited interocclusal distance.Limited interocclusal distance.
• If current denture producing clickingIf current denture producing clicking
sound.sound.

Composite resin teethComposite resin teeth
• It consists of an organic filler andIt consists of an organic filler and
liquid matrix based on a modifiedliquid matrix based on a modified
Bowen resin.Bowen resin.
• Liquid matrix and the organic fillerLiquid matrix and the organic filler
contain approximately 20% Pyrolyticcontain approximately 20% Pyrolytic
silicium dioxide,which is used as asilicium dioxide,which is used as a
thickening and strengthening agent.thickening and strengthening agent.

Porcelain teeth.Porcelain teeth.
• Highest wear resistance.Highest wear resistance.
• Good stain resistance.Good stain resistance.
• Disadv: clicking sound inDisadv: clicking sound in
nervous patients and withnervous patients and with
those havingthose having
neuromuscular coordinationneuromuscular coordination
problems.problems.
• More prone for chipping andMore prone for chipping and
fracture.fracture.
• Cannot be given whenCannot be given when
interarch space is less.interarch space is less.www.indiandentalacademy.comwww.indiandentalacademy.com

Dentogenic conceptDentogenic concept
• By frush and fisher on 1957By frush and fisher on 1957
• Also called SPA theoryAlso called SPA theory
• SexSex
– malemale
– FemaleFemale
• PersonlityPersonlity
– Vigrous delicateVigrous delicate
• AgeAge
– YoungYoung
– Middle ageMiddle age
– Old.Old. www.indiandentalacademy.comwww.indiandentalacademy.com

Tooth selection/ fellowships in orthodontics

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