Teeth selection is very important as the selection of the appropriate size, shape/occlusal form and color/shade of the artificial teeth determines the aesthetics and the function of the denture. Aesthetics is a pleasurable feeling created within an individual against the perception of an object.

1. TEETH SELECTION IN
COMPLETE DENTURE
DR. ARATI
DEPT. OF PROSTHODONTICS,CROWN &
BRIDGE AND IMPLANTOLOGY
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2. CONTENTS
• Introduction
• Objectives of teeth selection
• Concepts of teeth selection
• Anterior teeth selection
size
form
shade or colour
composition
• Posterior teeth selection
size and number of teeth
form
material
• References
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3. Introduction
• Teeth selection is very important as the selection of the
appropriate size, shape/occlusal form and color/shade of the
artificial teeth determines the aesthetics and the function of the
denture.
• Aesthetics is a pleasurable feeling created within an individual
against the perception of an object.
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4. Objectives of teeth selection
• The teeth should be in harmony with the surrounding tissues.
• They should maintain the vertical dimension.
• They should be efficient for mastication.
• Posterior teeth should be selected based on function, whereas the
anterior teeth are selected predominantly based on aesthetics.
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5. • Teeth selection :-
1.Anterior teeth selection
2.Posterior teeth selection
• Anterior teeth – for aesthetic function
• Posterior teeth - for masticatory function.
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6. Anterior Teeth Selection
• Anterior teeth play an important role in the aesthetics of a patient.
• They are not subjected to heavy occlusal load like the posteriors.
Hence, aesthetics is given more importance during anterior teeth
selection.
• The following factors are also considered during the selection of
anterior teeth:
• Size of the teeth
• Form of the teeth
• Color/shade of the teeth
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7. 1. Size of the Anterior Teeth
• The tooth size should be appropriate to the size of the face and sex
of the patient.
• The following methods are used as a guide to select the size of the
teeth:
• Methods using pre-extraction records.
• Methods using anthropological measurements of the patient.
• Methods using anatomical landmarks.
• Methods using theoretical concepts.
• Other factors.
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8. a) Methods using pre-extraction
records
• The pre-extraction records, like diagnostic casts, photographs, radiographs,
teeth of close relatives and preserved extracted teeth can be used to determine
the size of the artificial teeth.
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9. • Diagnostic casts
They are prepared before the extraction of the teeth. The operator
can obtain an idea about the size and shape of the teeth from these
casts. The actual size and shape required can be determined but the
shade of the teeth cannot be determined using this method.
• Pre-extraction photographs
Photographs showing the lateral, anterior and anterolateral views of
the patient should be taken before extraction. These photographs
must show at least the incisal edges of the anterior teeth. This
method is useful to determine the exact width and outline of the
teeth.
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10. • Pre-extraction radiographs
This is usually obtained from the patient's previous dentist. Radiographic
errors are a major limitation to this method. The occlusogingival height and
the outline of the teeth can be recorded. But the contour and size cannot be
accurately determined because the radiograph is a two-dimensional image.
• Teeth of close relatives
This method is usually followed only if the other records are not available.
The size and contour of the patient's son's or daughter's tooth is taken as
reference.
• Preserved extracted teeth
This is the best method to determine the size of the anterior tooth. The exact
details about the size and contour can be recorded through this method.
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11. b) Methods using anthropological
measurements of the patient
• Anthropological measurements are usually post-extraction records
made directly from the edentulous patient.
• These methods measure certain anatomical dimensions and derive
the size of the teeth using certain formulae.
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12. - Anthropometric cephalic index
• The transverse circumference of the head is measured using a
measuring tape at the level of the forehead.
• The width of the upper central incisor can be derived from this
measurement.
• Sears called this formula the anthropometric cephalic index (Fig.
10.45)
Total width of the
upper anterior
Circumference of the head
13
:-
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13. • The bizygomatic width can be used to determine the width of the
central incisor and also the combined width of the anteriors.
• The bizygomatic width is the distance measured between the
malar prominences on either side.
• This measurement is also used in Berry's Biometric Index and H.
Pound's formulae.
• The width of the mandibular anterior teeth = 4/5th upper anteriors
Total width of the
upper anterior
:- Bizygomatic width
3.36
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14. Berry's Biometric Index
• Berry's Biometric Index is used to derive the width of the central
incisor using the bizygomatic width and/or the length of the face.
• The formula using the length of the face cannot be used for
edentulous patients. The length of the face is the distance
measured between the hairline and the tip of the chin (Fig. 10.46).
• The width of the maxillary central incisor= Bizygomatic width /16
• The width of the maxillary central incisor= Length of the face /20
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15. -Based on the size of the face
• This is a tentative measurement in which the size of the teeth is
determined by the size of the face. For example, large teeth are
selected for patients with a large face.
• Pound's formula :-
Pound derived two formulae to determine the width and length of the
central incisor using the bizygomatic width and the length of the face
respectively.
• The width of the maxillary central incisor = Bizygomatic width /16
• The length of the maxillary central incisor= Length of the face /16
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16. - Based on the width of the nose
• The width of the nose is measured with a vernier calliper. This
measurement is transferred to the occlusal rim. The width of the
nose is equal to the combined width of the anterior teeth.
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17. c) Methods using anatomical
landmarks
• Various anatomical landmarks like the size of the maxillary arch
and location of the canine eminences, buccal frenal attachments,
corners of the mouth and ala of the nose can be used to determine
the size of the artificial teeth.
Size of the maxillary
arch
Location of canine
eminences
Location of the buccal
frenal attachments
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18. Location of the corners
of the mouth
Location of the ala of the
nose
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19. d) Methods using theoretical concepts
• The following theoretical concepts proposed by various authors
can be used to determine the size of the anterior teeth:
1. Winkler's concept
2. Typal form theory by Leon Williams (1917)
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20. Winkler's concept
• According to Winkler, the teeth should be selected based on three
different views, namely, physiological, psychological and
biomechanical.
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21. Typal form theory by Leon Williams
(1917)
• This theory helps to determine the size and form of the anterior
teeth. According to him, the shape of the teeth should be inverse
of the shape of the face. That is, if the face tapers downwards, the
teeth should taper upwards.
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22. 2. Form of the Anterior Teeth
• The form or outline of the anterior teeth can be determined using
the following factors:
• Shape of the patient's face or facial form.
• Patient's profile.
• Dentogenic concept and dynesthetics.
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23. - Shape of the patient's face or facial
form
• This is based on typal form theory by Leon Williams.
• According to him, the facial form can be described as one among the
following four types:
• Ovoid
• Tapering
• Square
• Combination of the above.
• The teeth selected should be in harmony with the facial form. Ovoid
teeth are preferred for patients with an oval face, etc. (Figs. 10.55A to
C).
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24. -Patient's profile
• The patient may have a convex, straight or a concave profile. The
labial form of the anterior teeth should be similar to the facial
profile of the patient.
• For example, the labial form should be straight for patients with a
straight profile, and convex for a patient with a convex profile
(Figs. 10.56A and B).
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25. Dentogenic concept and dynesthetics
(sex, personality, age or SPA factor)
• It was first described by Frush and Fisher. According to them, the
sex, personality and age of the patient determine the form of the
anterior teeth.
• Sex:-
The form or shape of the teeth differs in males and females. The
differences in the shape of the anterior teeth in males and females
are:
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26. • In females, the incisal angles are more rounded and the teeth have a
lesser angulation. In males, the incisal angles are rounded to a lesser
degree and the teeth are more angular (Figs. 10.57A and B).
• The incisal edge of the central incisors is parallel to the lips and the
laterals are above the occlusal plane in males. But the incisal edges of the
central and lateral incisors follow the curve of the lower lip in females
(Figs. 10.58A and B).
• The distal surfaces of the centrals are rotated posteriorly for females. The
mesial surfaces of the lateral incisors are rotated anteriorly in relation to
the centrals in females (Fig. 10.59).
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28. • In males, the mesial ends of the laterals are hidden by the centrals.
This makes the canine very prominent in males (Fig. 10.60).
• Only the mesial thirds of the canines are visible in females
because they are rotated anteriorly, whereas even the middle two-
thirds of the canines are visible in males (Figs. 10.61A and B).
• The cervical regions are prominent in males than in females.
• Females on smiling expose more anterior teeth. Hence, the
premolars should be arranged based on aesthetics for females.
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29. Age
• The age of the patient is important in teeth selection because of the
physiological and functional changes that occur in the oral tissues. The
patient can be either young, middle-aged or old-aged.
• The following changes are observed with an advance in the age of the
patient:
• Due to decrease in muscle tone, sagging of the cheeks and the lower
lips occurs. To prevent cheek biting (due to sagging),the horizontal
overlap of the posterior teeth can be increased.
• Interocclusal distance reduces with age. Hence, mandibular teeth are
more visible than the maxillary teeth.
• Old people usually have abraded teeth with worn-out contacts. Hence,
placement of contoured teeth may look artificial.
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30. • Old patients have gingival recession. It can be reproduced in the
dentures to provide a natural appearance.
• Old people show a blunt smile line and pathologic migration of teeth.
• The color of the teeth also changes with age. In old people, the enamel is
abraded and the dentine which carries a yellow tinge, is more visible.
Personality :-
The dentist should select and arrange the teeth so that it improves the
patient's personality. The patient can be either vigorous or delicate.
• More squarish, large teeth are selected for vigorous people.
• The anteriors should be in a flat plane for executives.
• For executives, the teeth should be relatively smaller and more
symmetrically arranged (Fig. 10.62).
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31. 3. Color for Anterior Teeth
• Before selecting the color for anterior teeth, some basic
concepts about color should be understood. A single color
can be described under four parameters:
• Hue
• Saturation or Chroma
• Brilliance or value
• Translucency
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32. Posterior Teeth Selection
• It is classified under two divisions, namely:
• Size of the teeth
• Form of the teeth.
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33. 1. Size of the Posterior Teeth
• The following factors are considered while selecting the size of
the teeth:
• Buccolingual width
• Mesiodistal length
• Occlusogingival height.
• Buccolingual width:-
• The buccolingual width of the artificial teeth should be decreased
so that the buccal and lingual surfaces slope out from the occlusal
surface to provide a proper path of escapement of food during
mastication.
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34. • It should be such that the forces from the tongue neutralize the
forces of the cheek.
• If the buccolingual width increases, the forces acting on the
denture will also increase, leading to increase in the rate of ridge
resorption.
• Broader teeth encroach into the tongue space leading to instability
of the denture. Also, the teeth should not encroach into the buccal
corridor space to avoid cheek biting (Figs. 10.65A to C).
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35. Mesiodistal length
• The mesiodistal length of each tooth should be selected such that the
combined length of all the posterior teeth on that side of the arch does not
exceed the distance between the canine and the retromolar pad (Fig. 10.66).
• Posterior teeth should not be placed over steep anteroposterior ridge slope
as this would lead to forward displacement of the denture.
• Similarly, the teeth should not be placed over displaceable tissues like the
retromolar pad as it will cause tipping of the denture during function.
• In cases with inadequate mesiodistal length, the premolar can be omitted.
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36. • Occlusogingival height It is determined by the available interarch
distance.
• The occlusal plane should be located at the midpoint of the
interocclusal distance (Figs. 10.67A and B). Large teeth selected for
cases with inadequate interocclusal distance appear artificial and
require modification before arrangement. Measures like altering the
thickness of the denture base can also be done to accommodate large
teeth.
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37. 2. Form of the Posterior Teeth
• Posterior teeth are available in different forms (Table 10.1).
• Factors that control the selection of the form of a tooth :-
• Condylar inclination: Teeth with a high cuspal height are required for patients
with steep condylar guidance (Figs. 10.68A and B). This is because the jaw
separation will increase for patients with acute condylar guidance during protrusion.
• Height of the residual ridge: Shallow cusped teeth go better with shallow ridges
(Figs. 10.69A and B).
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38. • Patient's age: Teeth with shallow cusps are preferred in older
people.
• Ridge relationship: 0° or monoplane teeth are preferred for cases
with posterior crossbite or severe class II relationship (Fig. 10.70).
• Hanau's quint.
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39. 3. Morphologically Teeth can be
Classified as:-
• Cusp teeth - Anatomic teeth
- Semianatomic or modified cusp or low-cusp teeth
• Cuspless teeth
• Special forms
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40. REFERENCES
• Heartwell cm, rohn ao (2002) tooth selection. In: textbook of complete dentures, 5th ed. Bc
decker, pp 305–319
• Frush jp, fisher rd (1958) the dynesthetic interpretation of dentogenic concept. J prosthet den
8:558–581
• Young ha (1954) selecting the anterior tooth mould. J prosthet dent 4:748–760
• The science of anterior teeth selection for a completely edentulous patient: a literature review
j indian prosthodont soc (jan-mar 2011) 11(1):7–13
• Hoffman w jr, bomberg tj, hatch ra (1986) interalar width as guide in denture tooth selection.
J prosthet dent 55:219–221
• Zarb ga, bolender cl, hickey jc, carlsson ge (1998) selecting artificial teeth for the edentulous
patient. Textbook on bouchers prosthodontic treatment for the elderly, 10th edn. Bi
publications pvt ltd, new delhi, pp 330–351
• Single maxillary complete denture carl f. Driscoll, dmd*, radi m. Masri, bds, ms dent clin n
am 48 (2004) 567–583
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41. S
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