Artificial Teeth Arrangement

Artificial teeth arrangementArtificial teeth arrangement
11

 After the registration of theAfter the registration of the
maxillo-mandibular jawmaxillo-mandibular jaw
relationship , therelationship , the
artificial teeth must be set inartificial teeth must be set in
centric occlusal position.centric occlusal position.
22

 Selecting the artificial teethSelecting the artificial teeth
The facial form of the patient should beThe facial form of the patient should be
classified into square, ovoid or tapering.classified into square, ovoid or tapering.
The form of the teeth should be inThe form of the teeth should be in
harmony with the form of the face, squareharmony with the form of the face, square
teeth are used for those with a square faceteeth are used for those with a square face
and so on. In addition, the patient’s age,and so on. In addition, the patient’s age,
gender and personality should be taken intogender and personality should be taken into
consideration when trying to improve theconsideration when trying to improve the
appearance.appearance.
33

Anterior tooth selectionAnterior tooth selection
 Size determined by:Size determined by:
 Evaluation of existing dentureEvaluation of existing denture
 Old photographsOld photographs
 Width of the six anterior teethWidth of the six anterior teeth
with a flexible rulerwith a flexible ruler
 Trubyte tooth selectorTrubyte tooth selector
99

Selection of anterior teethSelection of anterior teeth
 Mold selection is base onMold selection is base on
the outline of the facethe outline of the face
Three classifications of facial
form:
a) Square
b) Tapering
c) Ovoid
1010

The color is also important, dark and opaqueThe color is also important, dark and opaque
teeth should be selected for elderly patient,teeth should be selected for elderly patient,
light and translucent teeth for the younglight and translucent teeth for the young
patient. The size of the teeth must also be inpatient. The size of the teeth must also be in
harmony according to the size of the face andharmony according to the size of the face and
the gender of the patient.the gender of the patient.
1111

Arranging the artificial teethArranging the artificial teeth
The process of arranging the artificial teeth isThe process of arranging the artificial teeth is
termed setting-up.termed setting-up.
Objectives of the setting up of teeth areObjectives of the setting up of teeth are
 to provide a comfortable and atraumatic occlusionto provide a comfortable and atraumatic occlusion
 to assist in preparing food for deglutitionto assist in preparing food for deglutition
 to impart a pleasing and natural appearanceto impart a pleasing and natural appearance
 to assist in speechto assist in speech
1212

Setting up of the teeth consists of three major componentsSetting up of the teeth consists of three major components
 Position and inclination of the teethPosition and inclination of the teeth
 Occlusal form and occlusal arrangementOcclusal form and occlusal arrangement
 Orientation of the occlusal planeOrientation of the occlusal plane
1313

A.A. Position and inclination of the teethPosition and inclination of the teeth
Successful denture requires that artificial teeth beSuccessful denture requires that artificial teeth be
placed in the position occupied by the natural teeth.placed in the position occupied by the natural teeth.
The artificial teeth should be set in neutral zone (or)The artificial teeth should be set in neutral zone (or)
zone of muscular equilibrium where the forces ofzone of muscular equilibrium where the forces of
the lips and cheek from outside are neutralized orthe lips and cheek from outside are neutralized or
equalized by the force of the tongue inside.equalized by the force of the tongue inside.
1414

Fig.Fig. The pressure of theThe pressure of the
tongue and cheeks in holdingtongue and cheeks in holding
the food in place stabilizes thethe food in place stabilizes the
dentures by pressing them ontodentures by pressing them onto
the ridge. The resultant force ofthe ridge. The resultant force of
these muscles on the denturethese muscles on the denture
tend to seat it on the ridge thantend to seat it on the ridge than
cause it to become unstable.cause it to become unstable.
(From Fish, W.E. Principles of(From Fish, W.E. Principles of
Full Denture Prosthesis,Full Denture Prosthesis,
London, 1937, John Bale &London, 1937, John Bale &
Sons and Currow, Ltd)Sons and Currow, Ltd)
1717

Direction of the bone resorption is fromDirection of the bone resorption is from
labial side to palatal sidelabial side to palatal side in thein the
maxillary anterior regionmaxillary anterior region andand buccal side tobuccal side to
palatal sidepalatal side in the maxillaryin the maxillary posterior regionposterior region..
Therefore, the upper teeth should be placedTherefore, the upper teeth should be placed
a little outside the residual ridge.a little outside the residual ridge.
2626

In theIn the mandibular anterior regionmandibular anterior region, the bone, the bone
resorption isresorption is from labial side to lingual side.from labial side to lingual side.
So lower anterior teeth should be set upSo lower anterior teeth should be set up a littlea little
outside the ridge.outside the ridge.
2727

In theIn the mandibularmandibular premolar regionpremolar region, the bone resorption is, the bone resorption is
directly downwardsdirectly downwards. Thus, lower premolar teeth should. Thus, lower premolar teeth should
be placed on the ridge.be placed on the ridge.
The bone resorption in theThe bone resorption in the mandibular posterior regionmandibular posterior region isis
from lingual side to buccal sidefrom lingual side to buccal side suggesting that lowersuggesting that lower
posterior teeth should be set up slightly inside the ridge.posterior teeth should be set up slightly inside the ridge.
If they overhang the tongue can grind down the lingualIf they overhang the tongue can grind down the lingual
cusps of these teeth.cusps of these teeth.
2828

 The following anthropometry can estimate theThe following anthropometry can estimate the
position of neutral zone.position of neutral zone.
a. Distance between vertical line of the incisal edgea. Distance between vertical line of the incisal edge
and the incisive papilla is about 8 – 10mm.and the incisive papilla is about 8 – 10mm.
b. Distance from the incisal edge to the vestibule isb. Distance from the incisal edge to the vestibule is
about 22 mm.about 22 mm.
c. Canine papilla canine line which is a straight linec. Canine papilla canine line which is a straight line
passing through the incisive papilla and parallelpassing through the incisive papilla and parallel
with the maxillary tuberosity indicates the positionwith the maxillary tuberosity indicates the position
of the maxillary canines.of the maxillary canines.
3030

d. A line joining the angle of the mouth and thed. A line joining the angle of the mouth and the
upper third of retromolar coincides with theupper third of retromolar coincides with the
posterior occlusal plane in rest position.posterior occlusal plane in rest position.
e. Camper’s line which joining the base of the ala ofe. Camper’s line which joining the base of the ala of
the nose to the tragus of the ear is parallel withthe nose to the tragus of the ear is parallel with
posterior occlusal plane ( ala-tragus line)posterior occlusal plane ( ala-tragus line)
f. Pound’s triangle – lingual cusps of the lowerf. Pound’s triangle – lingual cusps of the lower
posterior teeth lie between the two lines down fromposterior teeth lie between the two lines down from
the mesial line angle of the canine to the extremethe mesial line angle of the canine to the extreme
side of the retromolar pad.side of the retromolar pad.
3131

g. Buccolingual Breadth(g. Buccolingual Breadth( BLB )BLB )
Buccolingual breadth is the rough average measurementBuccolingual breadth is the rough average measurement
from the remnant of the maxillary palatal gingivalfrom the remnant of the maxillary palatal gingival
margin to the oral surface of lip and cheek in incisor,margin to the oral surface of lip and cheek in incisor,
canine, premolar and molar regions.canine, premolar and molar regions.
In edentulous stage, there is resorption of the alveolarIn edentulous stage, there is resorption of the alveolar
ridge and also the pressure from the muscles [lips andridge and also the pressure from the muscles [lips and
cheek] cause the change in position [neutral zone]cheek] cause the change in position [neutral zone]
compare width dentulous statecompare width dentulous state
3232

Buccolingual breadth (continued)Buccolingual breadth (continued)
Thus in denture construction, artificial teeth must be setThus in denture construction, artificial teeth must be set
a little outside the ridge {in the neutral zone}. Thea little outside the ridge {in the neutral zone}. The
exact measurements are 6mm in incisor, 8mm inexact measurements are 6mm in incisor, 8mm in
canine, 10mm in premolar, 12mm in molar.canine, 10mm in premolar, 12mm in molar.
Thus the mean measurements of preextraction buccoThus the mean measurements of preextraction bucco
lingual breadth of the alverolar process give anlingual breadth of the alverolar process give an
approximate guide to the breadth of the flange ofapproximate guide to the breadth of the flange of
complete upper dentures and to pre extraction lip andcomplete upper dentures and to pre extraction lip and
cheek positions.cheek positions. 3333

The inclination of the teeth are influenced byThe inclination of the teeth are influenced by
a.a. muscles such as – modiolus, tongue ,muscles such as – modiolus, tongue ,
buccinator and orbicularis oris musclebuccinator and orbicularis oris muscle
b.b. appearance that is profile view of the faceappearance that is profile view of the face
(angle between the nose and philtrum)(angle between the nose and philtrum)
c.c. phonetic such as labial sound, labio-dentalphonetic such as labial sound, labio-dental
sound, linguo-dental sound,linguo-palatalsound, linguo-dental sound,linguo-palatal
sound etc: andsound etc: and
d.d. functionfunction 3737

B.B. Occlusal form and occlusal arrangementOcclusal form and occlusal arrangement
Occlusal form of the teeth include the high cuspOcclusal form of the teeth include the high cusp
anatomical form , inverted cusp form andanatomical form , inverted cusp form and
shallow cusp form.shallow cusp form.
If the high cusp anatomical form is used, need toIf the high cusp anatomical form is used, need to
be precision, i.e. point centric.be precision, i.e. point centric.
Because it creates the inclined plane effect,Because it creates the inclined plane effect,
cuspal interference and tilting of the denturecuspal interference and tilting of the denture
whenever there is a little deviation from thewhenever there is a little deviation from the
point centric.point centric. 3838

Point centric is obtained by setting the teeth inPoint centric is obtained by setting the teeth in
balanced occlusion. i.e with as many teeth asbalanced occlusion. i.e with as many teeth as
possible in occlusion in any lateral or protrusivepossible in occlusion in any lateral or protrusive
jaw positionjaw position
the anatomical articulator (adjustable articulator)the anatomical articulator (adjustable articulator)
must be used.must be used.
3939

Inverted cusp form and shallow cusp teeth areInverted cusp form and shallow cusp teeth are
commonly used when setting up dentures oncommonly used when setting up dentures on
simple hinge articulators andsimple hinge articulators and
provided the cusps are not too highprovided the cusps are not too high
they produce tolerable results and prevent thethey produce tolerable results and prevent the
cuspal interference causing damage tocuspal interference causing damage to
the underlying tissues.the underlying tissues.
4040

 Good Residual RidgesGood Residual Ridges
 Well Coordinated PatientWell Coordinated Patient
 Previously successful withPreviously successful with
anatomic denturesanatomic dentures
 Denture opposes naturalDenture opposes natural
dentitiondentition
 When “Lingualized”When “Lingualized”
occlusion is desiredocclusion is desired
 Poor Residual RidgesPoor Residual Ridges
 Poor Neuromuscular controlPoor Neuromuscular control
(Bruxers, CP etc.)(Bruxers, CP etc.)
 Previously successful withPreviously successful with
Monoplane Dentures orMonoplane Dentures or
Severely worn occlusion onSeverely worn occlusion on
previous dentureprevious denture
 Arch discrepanciesArch discrepancies
 Class II or III or Cross-biteClass II or III or Cross-bite
 Immediate DenturesImmediate Dentures
 except when opposing naturalexcept when opposing natural
dentitiondentition
 Potential poor follow-upPotential poor follow-up
Monoplane OcclusionMonoplane Occlusion Anatomic Denture TeethAnatomic Denture Teeth
Indications for ApplicationIndications for Application
4141

 No vertical componentNo vertical component
to aid in shearing duringto aid in shearing during
masticationmastication
 OcclusalOcclusal adjustmentadjustment
impairs efficiency unlessimpairs efficiency unless
spillways and cuttingspillways and cutting
edges restorededges restored
 Patients may complainPatients may complain
of lack of positiveof lack of positive
intercuspation positionintercuspation position
 Somewhat estheticallySomewhat esthetically
limited (don’t look likelimited (don’t look like
natural teeth)natural teeth)
Reduction of horizontalReduction of horizontal
forcesforces
CR can be developed as anCR can be developed as an
area instead of a pointarea instead of a point
Freedom of movementFreedom of movement
Can develop solid occlusionCan develop solid occlusion
despite arch alignmentdespite arch alignment
discrepanciesdiscrepancies
Easily adapted to situationsEasily adapted to situations
prone to denture baseprone to denture base
shiftingshifting
Easy to set and adjust teethEasy to set and adjust teeth
AdvantagesAdvantages DisadvantDisadvantagesages
Monoplane OcclusionMonoplane Occlusion
4242

 Difficult to setDifficult to set
 Less adaptable to archLess adaptable to arch
relation discrepanciesrelation discrepancies
 Horizontal forceHorizontal force
development due to cuspdevelopment due to cusp
inclinationsinclinations
 Harmonious balancedHarmonious balanced
occlusion is lost withocclusion is lost with
denture base settlingdenture base settling
 Requires frequent follow-upRequires frequent follow-up
and may require moreand may require more
frequent relines to maintainfrequent relines to maintain
proper occlusionproper occlusion
 Definite point of positiveDefinite point of positive
intercuspation may beintercuspation may be
developeddeveloped
 Esthetically similar to naturalEsthetically similar to natural
dentitiondentition
 Tooth-to-tooth and cusp-to-Tooth-to-tooth and cusp-to-
cusp balanced occlusion cancusp balanced occlusion can
be achievedbe achieved
 Maintains some shearingMaintains some shearing
ability after moderate wearability after moderate wear
AdvantagesAdvantages DisadvantagesDisadvantages
Anatomic OcclusionAnatomic Occlusion
4343

In occlusal arrangement of the teeth, there mustIn occlusal arrangement of the teeth, there must
bebe anterior and posterior clearances.anterior and posterior clearances.
Antero-posterior centre is only theAntero-posterior centre is only the premolars andpremolars and
first molar region.first molar region.
TheThe centralization of the forcescentralization of the forces is used becauseis used because
97%97% of chewing is only in this area.of chewing is only in this area.
4444

C.C. Orientation of the occlusal planeOrientation of the occlusal plane
The occlusal plane of the artificial of theThe occlusal plane of the artificial of the
teeth should be placed in the position whereteeth should be placed in the position where
the occlusal plane of the natural teeth wasthe occlusal plane of the natural teeth was
situated, that is the functional level in whichsituated, that is the functional level in which
the cheek and tongue can cooperate tothe cheek and tongue can cooperate to
perform mastication smoothly.perform mastication smoothly.
4545

The occlusal plane of the dentures is almostThe occlusal plane of the dentures is almost
parallel with both the upper lower alveolarparallel with both the upper lower alveolar
ridges.ridges.
The anterior occlusal plane is determined byThe anterior occlusal plane is determined by
upper anterior teeth. If it is correct, theupper anterior teeth. If it is correct, the
anterior occlusal plane is parallel with theanterior occlusal plane is parallel with the
interpupillary line.interpupillary line.
4646

The upper anterior teeth are exposed about 1-2The upper anterior teeth are exposed about 1-2
mm below the lower border of the upper lipmm below the lower border of the upper lip
with the mouth slightly opened.with the mouth slightly opened.
The lower anterior teeth are covered by theThe lower anterior teeth are covered by the
lower lip and are quite inferior to its border.lower lip and are quite inferior to its border.
The incisal edges of the lower anterior teeth areThe incisal edges of the lower anterior teeth are
located at the level of the lower lip when thelocated at the level of the lower lip when the
mouth is slightly opened in most patients.mouth is slightly opened in most patients. 4747

The posterior occlusal plane which is parallelThe posterior occlusal plane which is parallel
with the Camper’s line should be just belowwith the Camper’s line should be just below
the equator of the tongue and posteriorly thethe equator of the tongue and posteriorly the
occlusal plane is the level with the upper thirdocclusal plane is the level with the upper third
of the retromolar pad.of the retromolar pad.
4848

An anteroposterior and a lateral curves.An anteroposterior and a lateral curves.
The anteroposterior curve (curve of Spee)The anteroposterior curve (curve of Spee)
follows an imaginary line touching the buccalfollows an imaginary line touching the buccal
cusps of all the lower teeth from the lowercusps of all the lower teeth from the lower
canine backwards , and approximates to thecanine backwards , and approximates to the
arc of the circle.arc of the circle.
A continuation of this curve backwards in theA continuation of this curve backwards in the
natural dentition will nearly always passnatural dentition will nearly always pass
through the head of the condyle.through the head of the condyle. 4949

Laterl curves -two curvesLaterl curves -two curves
Molar curve (curve of Monson)Molar curve (curve of Monson)
The other curve involving the teeth anterior toThe other curve involving the teeth anterior to
the second premolars.the second premolars.
Curve of MonsonCurve of Monson
- Lateral curvature of occlusal plane- Lateral curvature of occlusal plane
- Start from 1Start from 1stst
molar regionmolar region
- Occlusal surface of upper molar downwards,Occlusal surface of upper molar downwards,
outwards, and posteriorly.outwards, and posteriorly.
- Radious about 4½ inches.Radious about 4½ inches.
- Axis ---GlabellaAxis ---Glabella
5050

1. Only 3 % of mastication in anterior region & 97 %1. Only 3 % of mastication in anterior region & 97 %
is at 4,5,6 areais at 4,5,6 area
2. In 4,5,6 area – good bony foundation2. In 4,5,6 area – good bony foundation
whereas spongy bone is abundant inwhereas spongy bone is abundant in
the anterior regionthe anterior region
Centralised occlusion
5353

3. Teeth are arranged opposite the ridge in3. Teeth are arranged opposite the ridge in
4,5,6 area according to the direction of4,5,6 area according to the direction of
bone resorption (mechanical advantage)bone resorption (mechanical advantage)
4. Occlusal forces & muscle pull are directed4. Occlusal forces & muscle pull are directed
at right angle to the supporting ridge --at right angle to the supporting ridge --
directed at an incline in the anterior regiondirected at an incline in the anterior region
5454

5. TMJ & mandible __ third type of lever so that occlusal5. TMJ & mandible __ third type of lever so that occlusal
load in the 4,5,6 area is nearer to the jointload in the 4,5,6 area is nearer to the joint
6. Mandibular first molar is set a little inside the ridge, thus,6. Mandibular first molar is set a little inside the ridge, thus,
during mastication the denture will be wedged betweenduring mastication the denture will be wedged between
the tongue & the alveolar ridgethe tongue & the alveolar ridge
7.Width of the alveolar ridge is broader in 4,5,6 area7.Width of the alveolar ridge is broader in 4,5,6 area
compared to the anterior region (provided thatcompared to the anterior region (provided that
edentulousness period is not so different)edentulousness period is not so different)
8. Occlusion in 4,5,6 area provides centralization of forces8. Occlusion in 4,5,6 area provides centralization of forces
for the retention & stability of lower denture.for the retention & stability of lower denture.
5555

Anterior ClearanceAnterior Clearance
(at centric occlusion, protrusion & lateral movements of(at centric occlusion, protrusion & lateral movements of
the mandible)the mandible)
1.1. only 3 % of mastication take placeonly 3 % of mastication take place
2.2. only for aesthetics & speechonly for aesthetics & speech
3.3. more distant from the TMJmore distant from the TMJ
4.4. thin cortical bone & spongy bone onlythin cortical bone & spongy bone only
5.5. angulated forces may be appliedangulated forces may be applied
5656

Posterior ClearancePosterior Clearance
1.1. eccentric balance is not requiredeccentric balance is not required
2.2. mastication in 2mastication in 2ndnd
molar region is only formolar region is only for
high power strokeshigh power strokes
3.3. with dentures, patients are recommended towith dentures, patients are recommended to
avoid hard foodavoid hard food
5757

 1. Point centric with high cusps (lock each other in one1. Point centric with high cusps (lock each other in one
fixed contact position)fixed contact position)
If notIf not  intercuspal deviation / cuspalintercuspal deviation / cuspal
interference (incline plane effect)interference (incline plane effect)
especially return stroke of lateral swingespecially return stroke of lateral swing
↓↓
horizontal denture movementhorizontal denture movement
↓↓
denture will slide into centric occlusiondenture will slide into centric occlusion
( at the expense of bone resorption)( at the expense of bone resorption)
↓↓
rapid alveolar bone resorptionrapid alveolar bone resorption
High cusp formHigh cusp form
5858

2. Edentulous patient ---- loss of proprioceptive impulses2. Edentulous patient ---- loss of proprioceptive impulses
from periodontal ligamentsfrom periodontal ligaments  wandering jawwandering jaw  notnot
consistent with point centric.consistent with point centric.
3. During mastication ---- between position I & II3. During mastication ---- between position I & II
4. Long period of edentulous may have produced4. Long period of edentulous may have produced anterioranterior
bite of accommodationbite of accommodation
bite of conveniencebite of convenience (position III)(position III)
5. Wright (1960s) – when there is 1 mm jaw closure5. Wright (1960s) – when there is 1 mm jaw closure
(physiologic bone resorption),mandible moves ½ - 1 mm(physiologic bone resorption),mandible moves ½ - 1 mm
forwardforward
6. Minor errors in registration of jaw relationship can be6. Minor errors in registration of jaw relationship can be
easily rearranged with area centric rather than with pointeasily rearranged with area centric rather than with point
centriccentric 5959

Centric balance & eccentric balanceCentric balance & eccentric balance
1.1. Centric occlusion – the only significant toothCentric occlusion – the only significant tooth
contact during function eccentric contact ----contact during function eccentric contact ----
parafunctionalparafunctional
2.2. Eccentric contact – bruxismEccentric contact – bruxism
3.3. Mastication is strictly unilateralMastication is strictly unilateral
contact is mostly during return stroke of tear-contact is mostly during return stroke of tear-
drop fashion (0.1 sec) during this briefdrop fashion (0.1 sec) during this brief
contact on one side, the other side does notcontact on one side, the other side does not
dislodge as there is not enough time for thedislodge as there is not enough time for the
salivary meniscus to receedsalivary meniscus to receed
6060

4. Apart from the meniscus (peripheral seal),4. Apart from the meniscus (peripheral seal),
physiological forces may have developedphysiological forces may have developed
along with adaptation of the denture.along with adaptation of the denture.
5. Longer contact5. Longer contact  during bruxism (sleep)during bruxism (sleep)
when the dentures are not wornwhen the dentures are not worn
6. Enter bolus6. Enter bolus  exit balanceexit balance
7. Not in natural dentition (patient may get7. Not in natural dentition (patient may get
confused)confused) 6161

Advantages of using buccolingually narrowAdvantages of using buccolingually narrow
posteriorsposteriors
I.Consistent with biological requirement (easilyI.Consistent with biological requirement (easily
to arrange in the neutral zone / not encroachto arrange in the neutral zone / not encroach
the tongue space)the tongue space)
II.Good for mechanical resistance (can arrangeII.Good for mechanical resistance (can arrange
opposite the alverloar ridge)opposite the alverloar ridge)
III.Consistent with the narrow oral cavityIII.Consistent with the narrow oral cavity
(narrow potential space or neutral zone(narrow potential space or neutral zone
especially when edentulousness period isespecially when edentulousness period is
long)long) 6262

IV. Better polished surface design can be madeIV. Better polished surface design can be made
V. Increased mastication efficiency can beV. Increased mastication efficiency can be
expected ( better penetration into the bolus)expected ( better penetration into the bolus)
VIVI.. LLesseresser pressure onto the supportingpressure onto the supporting
underlying structures (P =F/A)underlying structures (P =F/A)
6363

Selection of anterior teethSelection of anterior teeth
 ShadeShade
 SizeSize
 MoldMold
6666

Shade selection and conversionShade selection and conversion
tabletable
6767

Indications for nonanatomic posterior dentureIndications for nonanatomic posterior denture
teethteethRidge relationRidge relation
Poor bearing surfacePoor bearing surface
Bruxism and poorBruxism and poor
coordinationcoordination
Previous success withPrevious success with
nonanatomic denture teethnonanatomic denture teeth
6868

Indications for anatomic posteriorIndications for anatomic posterior
teethteeth
Ideal ridge relationshipsIdeal ridge relationships
Favorable alveolar ridge contoursFavorable alveolar ridge contours
Previously successful withPreviously successful with
anatomic posterior teethanatomic posterior teeth
6969

Artificial Teeth Arrangement

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