Prosthodontics

Complete Dentures :
Selection & Setting of
Artificial Teeth

 Esthetics is the primary consideration for
patients seeking prosthetic treatment.
 The size and form of the teeth are important
not only to dental esthetics but also to facial
esthetics. The goal is to restore the teeth in
harmony with the facial appearance.
 For the ease, we divided selection of artificial
teeth into :
1. Anterior teeth
2. Posterior teeth

 Selection criteria :
1. Selection of tooth Size.
2. Selection of tooth Shape ( Form ).
3. Selection of tooth color ( Shade ).
 Guides for selection of anterior teeth Size :
1. Pre-extraction guides.
2. Post-extraction guides.

Pre-extraction Guides for Size
1. Study Casts :
 Most reliable guide.
 Helps to duplicate patient
original teeth shape, size &
positional arrangement.
2. Photographs :
 Provide information on width &
form of teeth.
 Help in determining the
anterior teeth placement, arch
form & lip support.

3. Radiographs :
 They give a clue about
shape & size of teeth.
 Distortion of radiographic
images is an inherited
problem.
4. Extracted Teeth :
Excellent guide for size &
form of teeth. But not the
color !!
5. Previous dentures.

Post-extraction Guides for Size
1. Extra-oral Factors :
 Size of face.
 Lips
 Maxillo-mandibular relation.
 Nose width.
2. Intra-oral factors :
 Size of maxillary arch.
 Contour of residual ridge.
 Vertical distance between ridges.
 Incisive papilla & cuspid eminence.

Extra-oral Factors :
1. Size of face :
 Average width of maxillary central incisor =
1/16 of width of face measured between
zygoma.
 Combined width of six maxillary anteriors =
less than 1/3 of the bizygomatic breadth of
face.
 Trubyte Tooth Indicator, face bow
(bizygomatic width) & ruler can be used to
measure the size of maxillary anteriors .

2. Lips :
 During relaxed state labial surface of anteriors
support the upper lip.
 When teeth are together, incisal edge of
anteriors support the upper border of lower lip.
 About 2-3 mm of central incisors is visible
below lip.

3. Maxillo-Mandibular relation :
 Any disproportion in the size
between the maxillary &
mandibular arches influence
the length, width & position
of teeth.
 If mandible is protruded
(class 3), anterior teeth will be
larger.
 If mandible is retruded
(class 2), anterior teeth will be
smaller.

4. Nose Width :
 Hoffman conducted a study to
determine the relationship
between interalar width and
intercanine width.
 Boucher have suggested that the
width of the nose serve as a guide
for selection of mesiodistal
dimension of anterior teeth and
positioning the canine.
 The distance between tips of
canines is same as width of base
of nose.

Intra-oral Factors :
1. Size of maxillary arch :
 Mould selectors are used to make
measurements of maxillary cast.
 Make the measurements from crest of incisive
papilla to hamular notch & from hamular
notch to opposite notch. The combined lengths
are used on the selectors.

2. Contour of residual ridge :
 Artificial teeth should follow the contour of
residual ridges that existed when natural teeth
were present, but as absorption occurs 
alterations occur in contours of ridges.
 Maxillary arch resorption is vertically &
palataly  appears smaller.
Mandibular arch resorption is vertically 
appears larger.

3. Vertical distance between ridges :
 According to available inter-arch space, the
length of teeth is selected.
 Minimal denture base should be visible.

4. Incisive papilla & cuspid eminence :
 A flexible ruler is used to measure distance
between canines at their distal side through
incisive papilla .
OR :
 Ask the pt to relax with lips touching & point
marks are put at corners of the lips, The
distance between the marks is equal to width of
all anterior teeth.

Tooth Shape
Factors governing form of anterior teeth :
1. Form & contour of face :
 Shape of artificial teeth should
harmonies with shape of face frontally
( square, tapering, ovoid ) & laterally
(convex, concave, straight ).
 Trubyte indicator :
Place the tooth indicator on pt’s face,
allowing nose to come in center
triangle, center pupils in the eye slots
& hold the indicator with its center
line coinciding with median line of
face. Compare face form with vertical
lines of the indicator .

 In square form, sides of face will follow vertical
lines of the indicator.
 In tapering faces, side of face from forehead to
angle of jaw will taper at an inward diagonal.
 In Ovoid face, zygomatic width is the widest,
forehead & mandibular areas decrease in
dimensions.

 To determine the facial profile, check 3 points :
Forehead, base of nose & point of chin.
 If these three were in line, the profile is straight.
If forehead & point of chin are recessive, the
profile is curved.

2. Sex :
 Curved features are associated with femininity
& square features are associated with
masculinity.
 Teeth selected for females are more ovoid or
tapered whereas teeth selected for males are
more squared with sharp edges.

Masculinity Femininity
prominent smaller
Square arch Curved arch
Square labial surface Curved labial surface
Square incisal edges Round incisal edges
Darker shade Delicate appearance
Flat smile line Curved smile line

3. Age :
 Aging process affect the entire masticatory
apparatus including teeth.
 Teeth wear at incisal edges, labial surface
becomes flatter & outline appears more
squared.

Young Old
Lighter shade darker
More incisal
translucency
less
Minimal wear of incisal
edges
Increased wear
Curved smile line flat
Pointed canines Loss of tip of canines

Color of Teeth
 A tooth has 2 colors :
1. The yellow which is more
prominent in the gingival third.
2. The gray which is more
prominent in the incisal third.
 Color  light waves of certain
lengths.
Shade  Degree of darkness of
a color.
 Color is described by : hue
(color appearance), value
(lightness) & chroma (color
purity).

 Pt should be in upright position & teeth
should be viewed in a plane perpendicular to
dentist’s plane of view.
 Teeth should be seen from different angles to
assure that they aren’t influenced by shadows.
 Pt mouth shouldn’t be opened too wide but
should remain a dark cavity as in ordinary
conditions.
 Eyes shouldn’t be focused on tooth for more
than few seconds to avoid their fatigue.
 Color of teeth should be in harmony with color
of skin, hair & eyes.

1. Shade .
2. Size & number.
3. Cuspal inclination.

Shade of Teeth
 Shade of posteriors should harmonize with
anteriors.
 Premolars play an esthetic role more than
functional, so they may be lighter than other
posteriors but not lighter than anteriors.

1. Buccolingual Width :
 Buccolingual width of artificial teeth should be
less than that of natural.
 These narrower forms assist the cheeks &
tongue in maintaining dentures on the
residual ridges.

2. Mesiodistal Width :
 It’s determined by length (from distal of canine
to beginning of retromolar pad) & slope of
residual ridge.
 The total mesiodistal width of posterior four in
millimeters is used as mold number, e.g. : mold
32L means that four posteriors have a total
mesiodistal dimension of 32 mm & a long
occluso-cervial length.
 Posterior teeth shouldn’t extend too close to
posterior border of maxillary denture because
of danger of cheek biting.

 Posterior mandibular teeth shouldn’t extend
over the retro molar pad, because :
1. The pad is too soft , too easily displaced & has a
glandular tissue that is hurt.
2. Putting teeth over pad will allow the denture to
tip during mastication.
3. Tendon of temporalis is inserted in the
retromolar region tends to displace the
denture.

3. Occlusogingival Dimension :
 Determined by interarch space & height of
anteriors.
 Height of maxillary first premolar should be
comparable to that of canine to provide esthetic
appearance.

 Selection of teeth is based on concept of
occlusion to be developed.
 Based on cuspal morphology, posterior teeth
can be classified into :
1. non-anatomical teeth.
2. Anatomical teeth.
3. Combination of anatomical & non-anatomical.

1. Non-anatomical Teeth :
 Known as monoplane or flat or
cuspless or zero degree teeth.
 They reduce lateral forces acting
on the denture.
 Indications :
 Flat ridge.
 Abnormal jaw relation.
 Where difficulty is faced in
recording centric relation.
 Where balanced occlusion isn’t
planed.

 Advantages :
 Freedom of occlusal movements from centric to
eccentric jaw positions.
 Elimination of lateral forces that can destabilize
the denture.
 Disadvantages :
 Not esthetically pleasing.
 Difficult to balance.
 Reduced masticatory efficiency.

2. Anatomical Teeth :
 Can be classed on bases of cuspal inclines.
 Cuspal inclines vary from 20-45 degrees.
 Indications :
 Good ridge form with sufficient retention &
support.
 Where balanced occlusion is planed.
 Where possible to record & transfer centric
relation with accuracy.

 Advantages :
 Easier to balance.
 Better masticatory efficiency.
 Reduced chewing cycles.
 Better esthetics.
20°

3. Combination :
 This concept is called “Lingualized Occlusion“.
 Lingualized scheme use upper anatomical &
lower semi or non-anatomical teeth molds.
 Occlusion may be balanced by introducing
“compensating curves”.
 Advantages of lingualized occlusion :
 This concept provide maximum intercuspation.
 Adequate cuspal height for selective grinding.
 Natural & pleasing appearance.
 Occlusion can be balanced.

Material Selection
 Porcelain was favorite material because of
rapid wear of acrylic resin. However, with
tendency of porcelain to chip & fracture, acrylic
resin gained its popularity. Improved acrylic
resin teeth & newer composite resin teeth have
more wear resistance.
 Resin teeth reduce possibility that artificial
teeth will cause abrasion & destruction of
natural or metallic occlusal surfaces of
opposing teeth.

 Porcelain Teeth :
 Wear is clinically insignificant over long
period.
 No significant loss in vertical dimension.
 Can be ground & polished & hold shape for
years.

 Difficult to grind or fit into close inter ridge
space without fracturing or loss of retention in
base.
 Cause dangerous abrasion to opposing gold
crowns or natural teeth.
 Ground surfaces must be highly polished to
reduce friction & prevent chipping.
 Will not bond to base material.

 Acrylic Teeth :
 Wear is clinically significant.
 Loss of occlusal vertical dimension due to
wear.
 Don’t chip.
 Self polishing.
 Easy to grind into close inter ridge space .
 Potential for bond to base material.

 The 4 principal factors that govern the
positions of the teeth 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.
4. Inclination of teeth .

1. Horizontal Relation :
 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
mastication, 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.
 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.

 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.

Limits to place posteriors :
 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, along with
esthetics determine the lateral limits of
mandibular posterior teeth.

Limits to place anteriors :
 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.
 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.

 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.

2. Vertical Relation :
Correct vertical position of the teeth
should provide:
 Denture stability.
 Favorable forces.
 Support to lips and cheek.
 Compatibility.

 Vertical position 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 retromolar
pad.
 Esthetics and phonetics are used to
establish the vertical position of the incisal
edges of the maxillary anterior teeth.

 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 can be
used as a guide to position the
posterior artificial teeth in a vertical
direction.

3. Esthetic requirements :
Arrangement of teeth for esthetics
influenced by:
 Age.
 Sex.
 Personality.
 Cosmetic factor.

1. Influences of age :
 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.

2. 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 frontal.

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

4. Inclination of Teeth :
 Maxillary Anteriors.
 Mandibular Anteriors.
 Maxillary Posteriors.
 Mandibular Posteriors.

Guides for anterior teeth :
1. Residual alveolar ridge.
2. Incisive papilla.
3. Reflections of soft tissues
under the lip.

1. Residual Alveolar ridge :
As a general rule  the longer the natural teeth
have been out the farther the artificial teeth
should be from the ridge.
2. Incisive papilla :
 A line marking the centre of the incisive
papilla on the cast is extended forward onto
the labial surface of the cast and CI are set on
either side of this line.
 Labial surfaces of the central incisors are
usually 8-10 mm in front of the papilla.

3. Reflections of soft tissues under the lip :
 Labial surfaces and incisal edges of the
teeth are anterior to the tissues at the
reflection where the denture borders
would be placed.
 The accuracy of this guide decreases as
the resorption of the residual ridge
progresses.

Arrangement of Maxillary Anteriors :

Position of the maxillary central incisor:
 Mesiodistal inclination :
The maxillary central incisor is placed, so
that the long axis shows a slight distal
inclination, when viewed from front.
 Labiolingual inclination :
The neck of the tooth should be slightly
depressed when viewed from this side,
the tooth slopes (incisal edge ) towards
the labial side.
 The incisal edge :
Is in contact with the occlusal plane.

Position of the maxillary lateral incisor:
Mesio-distal inclination:
The maxillary lateral incisor is placed with
its long axis inclined noticeably distally
when viewed from the front.
Labio-lingual inclination:
The neck of the maxillary lateral incisor is
depressed (of the neck) more than the
central incisor, although the labial surface
will be nearly in line with the central
incisor.
The incisal edge:
Is ½ to 1mm above the level of the occlusal
plane.

Position of maxillary canine:
 Mesio-distal inclination:
The maxillary canine is placed so that
the long axis has slight distal
inclination from.
 Labio-lingual inclination:
The neck of the maxillary canine is
prominent. The tooth axis is vertical
when viewed from the side.
The cusp tip:
Is in contact with the occlusal plane.

The maxillary canine has two planes
on the labial surface; mesial plane
should follow the contour of the
anterior teeth, while the distal plane
will be in line with the posterior teeth.

Arrangement of Mandibular Anteriors :

 The midline of the maxillary central
incisor should be followed while placing
the mandibular central incisor.
 The mandibular anterior teeth should not
be in contact horizontally with the
maxillary teeth (over jet).
 The mandibular anterior teeth should not
be in contact vertically with the maxillary
anterior teeth (over bite).

Position of the mandibular central incisor:
 Mesio-distal inclination:
The long axis is perpendicular to the
occlusal plane (vertically upright).
The central incisor is placed with its
neck depressed and the tooth will
show that it’s labially inclined
when viewed from one side.
 The incisal edge:
Are 1-2 mm above the occlusal
plane.

Position of the mandibular lateral
incisor:
The mandibular lateral incisor
is placed with its long axis
showing a slight distal
inclination.
The labial surface is
perpendicular to the occlusal
plane.
 The incisal edge:
Are 1-2 mm above the occlusal
plane.

Position of the mandibular canine:
The mandibular canines are placed
with a more distal inclination (neck
distally placed) than the mandibular
lateral incisors.
The neck of the tooth is placed
prominently. The tooth shows a
slight lingual inclination (at the
incisal edge) when viewed from the
side
 The incisal tip:
Lies 1-2 mm above the occlusal plane.

Arrangement of Posterior Teeth :
The objective here is to have the
intercuspation of the posterior
teeth so precise that any
deviation of this occlusion in
the mouth will be easily
detected.

The guide lines used in arrangement of
posterior teeth:
1. The line of the crest of lower residual
ridge. Which extend between the middle
of retromolar pad, and tip of lower
canine, the central grooves of the lower
posterior teeth should coincide with this
line.
2. The line extending between the tip of
lower canine and upper 2/3 of retromolar
pad will determine the height of lower
posterior teeth.

Arrangement of maxillary posterior teeth:-
Maxillary premolars:
1. Premolars are set vertically to occlusal plane.
2. Facial cusp of maxillary 1st premolar touch
the occlusal plane while the lingual cusp is
raised from occlusal plane approximately 12
mm
3. The facial cusp of maxillary 1st premolar
should be seat into the embrasure between
the mandibular 1st and 2nd premolars.
4. Lingual cusp should be over the crest of the
ridge
5. Facial and lingual cusp of maxillary 2nd
premolar touch the occlusal plane.

Maxillary molars:
1. The inclination of maxillary molars are mesially
and slightly lingually to create a 6 degree
upward curve.
2. Mesio-lingual cusp of maxillary 1st molar should
touch the occlusal plane and the lingual cusps
are over the crest of the mandibular ridge
3. The mesiobuccal cusp of upper 1st molar should
rest in the buccal groove of the lower 1st molar,
and the mesio-lingual cusp should seat into the
central fossa of lower 1st molar.
4. Maxillary 2nd molar are set with no cusp
touches the occlusal plane. All the lingual cusps
are over the crest of the mandibular ridge

Arrangement of mandibular posterior teeth :
1. The Mandibular 1st molar is first set into centric
occlusion.
2. Mesiobuccal cusp of maxillary 1st molar fit in
to the buccal groove of mandibular first molar.
3. The mesioligual cusp of Mandibular 1st molar
fit into the central fossa of the maxillary first
molar.
4. Set the mandibular 2nd molar, the mesiobuccal
cusp of maxillary 2nd molar fit in to the buccal
groove of mandibular 2nd molar.

5. Then set mandibular 2nd premolar, its cusp tip
should be positioned in the embrasure between
maxillary 1st and 2nd premolars.
6. The last tooth are mandibular 1st premolar
which should be position in the embrasure
between maxillary canine and maxillary 1st
premolar.
7. Mandibular premolars follow the curvature of
the canine.
8. Mandibular posterior teeth are set on or
slightly lingual to the crest of the ridge.

Done By : Ola Qatu
Submit to : Dr. Mudar Kamal
.. AQU ..

Prosthodontics

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