2. TABLE OF CONTENTS
INTRODUCTION
OBJECTIVES
RESORPTION PATTERN IN MAXILLA AND MANDIBLE
BASICFACTORSINVOLVEDINPOSITIONINGOFANTERIORTEETH
INDIVIDUAL ARRANGEMENT OF ANTERIOR TEETH
TOOTH ARRANGEMENT IN DIFFERENT ARCH FORMS
ARRANGEMENTOFTEETHINFLUENCEDBYAGE,SEX,
PERSONALITY,COSMRTICFACTOR&CHARACTERIZATION
REFERENCES
3. Anterior teeth arrangement is an area of
Prosthodontics where Art dominates science, where
esthetics is the major concern, and where knowledge
must be applied to create a pleasing appearance
while simultaneously maintaining oral function.
INTRODUCTION
5. Studies conforming importance of
esthetics in complete dentures
Brewer, Reibel and Nassif JPD 1967
_ 12 patients received 7 sets of dentures each made by 7
dentists.
_ Each patient preferred the best looking dentures.
Straus et al. JPD 1977
– 64 patients were asked how their new complete dentures
improved their self image.
– Nearly all the patients responded that the new dentures
improved their appearance, increased self confidence,
and provided an overall sense of well being.
6. Technically, the anterior teeth are composed of
6 maxillary and 6 mandibular teeth.
Exceptions:
Sometimes maxillary first premolar is
considered more for esthetics than for
masticatory function.
Sometimes in Class 2 situations maxillary
cuspids assume a functional role by addition
of lingual centric stops.
7. Payne states “set the teeth in place where
they grow.”
Payne SH MEDCOM Inc , 1973
Ridge resorption have a major effect on the position of
anterior teeth
Mandibular ridge is used to determine arch form due
to resorption of maxillary ridge.
8. • In maxilla, resorption is centripetal. It occurs
on the labial and buccal areas
• Consequently, the residual ridge is usually
palatal to the original location of natural teeth.
• Hence teeth should be arranged labial to the
resorbed maxillary arch
9. 8 to 10mm
The facial surface of the central incisors should be 8-
10 mm anterior to the center of the incisive papilla.
Schiffman :Relation of maxillary canines to
the incisive papilla JPD 1964;14:469-472
The incisive papilla can also be used to help locate the
midline of dental arc ZARB - BOLENDER
Watt and Like man states “the distal surface canines should
be located in a coronal plane passing through the posterior
border of the papilla”
The tips of the canines are frequently +_1mm related to centre of
papilla.
10. The use of phonetics can also be used as a guide in the
placement of maxillary anteriors
11. • In mandible resorption is centrifugal. It occurs
anteriorly on the labial side and posteriorly on
the lingual side. In the premolar region it
occurs equally labially and lingually.
• Hence teeth should be arranged anteriorly
labial to the resorbed mandibular ridge
• Functional recording of neutral zone for the
arc form can be done in advanced cases of
resorption
12.
13. 5 factors are involved in positioning
anterior teeth.
Anterior slope - Labial inclination.
Mesiodistal inclination - Mesial or distal tilt.
Inferior-superior positioning - to a horizontal
plane - Above/below plane of occlusion.
Rotation on a long axis - Turning tooth on its
center axis.
Antero-posterior positioning - How far labially
or lingually (in or out) the anterior or posterior
teeth are located.
14. Maxillary central incisors
The maxillary central incisor is the most difficult
tooth to set because
1. Establishes the midline
2. Esthetic support of the patients lip
3. Proper arrangement of maxillary and
mandibular anterior and posterior teeth
relies on the setting of the maxillary
central incisor
ZARB-BOLENDER 12TH EDITION Pg311
15. 1.Mesiodistal inclination Its long axis
slopes towards the vertical axis
2.Inferior-superior positioning The
incisal edge should touch the
mandibular occlusion rim
3.Labial inclination Slopes labially
about 15 degrees when viewed from the
side. FENN
The contact point should coincide with
the midline of the face
16. Maxillary lateral incisors
1. The long axis should incline slightly
distally in the cervical area
2. The cervical portion of the tooth should
incline slightly lingually (neck is slightly
depressed)
3. The incisal edge of the lateral should be
raised approximately 0.5 to 1mm from the
mandibular occlusion rim.
4.Inclined labially about 20 degrees when
viewed from the side FENN
17. Maxillary canines
• In nature, the position of the canine teeth plays an
important part in the esthetic appearance of the
dentition.
• In a denture they play an equally important role.
• They have esthetic and functional influence on both
the anterior and posterior tooth arrangements
18. 1. The incisal edge of the canine should touch the
mandibular occlusion rim.
2. The long axis should be perpendicular to the
occlusal plane.
3.Canines are arranged on the line drawn
perpendicular to the midline of the palate,
through the centre of incisive papilla
Sheldon Winkler 2nd edition pg 203
19. • Viewed from the anterior, the mesiolabial
surface of the canine is prominent, and the
gingival one-third is positioned more facially
than the incisal one-third.
Prominent neck
20. • Profile or side view emphasizes the almost
vertical long axis and position of the canine.
21.
22. • 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.
ZARB-BOLENDER 12TH EDITION
Pg311
23. Mandibular central incisors
• 1. The long axis of the mandibular
central incisor should be set
perpendicular to the occlusal plane.
• 2.It slopes slightly labially when
viewed from the side
3. The contact point of mandibular
incisors should coincide with the
midline of the maxillary teeth.
24. Set the mandibular central incisors so that the
maxillary incisors cover them, 0.5mm vertically
and there is 1-2mm horizontal overlap. This will
create a low incisal guidance ideal for the patient
ZARB-BOLENDER 12TH EDITION Pg312
25. Mandibular lateral incisors
• 1. The long axis of the mandibular incisor
should be slightly inclined distally at the
cervical portion of the tooth.
• 2. The occlusal height should be the same at
the central incisors.
• 3. there is no labial inclination when
viewed from the side
26. Mandibular canines
1. The long axis of the mandibular canine is
nearly perpendicular with a slight lingual and
distal inclination to the occlusal plane
2. The tip of the canine should be at the same
occlusal height as the mandibular central and
lateral incisor
29. Tooth Arrangement in the Square Arch
• The two centrals are usually set to an almost straight line
across the front of the arch.
• The laterals are also positioned with a nearly full labial aspect
and exhibit very little rotation. This give prominence to the
canines.
• The teeth also tend to be straight up and down, rather than
sloping
30. Tooth Arrangement in the Tapering Arch
• Rotation of the centrals on their long axis
inward at the distal, which sets the two teeth at
an angle.
• Rotation and lapping of teeth is often
observed , and crowding is a result.
• This often reduces the amount of labial surface
visible.
31. Tooth Arrangement in the Square Tapering Arch
• The Square Tapering arrangement combines
characteristics of the Square and Tapering
forms, modifying both.
32. Tooth Arrangement in the Ovoid Arch
• The Ovoid arrangement exhibits definite
curvature; rotation is seldom observed.
• The central incisors in the Ovoid anterior arch
are often set well forward of the canines.
• A typical Ovoid alignment shows a fullness of
labial surface from canine to canine.
33. Arrangement of teeth is influenced
by
• Age
• Sex
• Personality
• Cosmetic factor
• Artistic reflection
Heartwell 5th edition Pg 339
35. 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
• Middle age – incisal wear, mild staining slight spacing due to
drifting, which can be incorporated in the dentures.
• Old age – long axis is not in alignment, gum recession,
erosion natural staining, occlusal and incisal wear caused by
habit.
36. • The displayed amount of anterior teeth is determined
by muscle position that varies from one person to
another, and with age
Tjan AH, Miller GD, Some esthetic
factors in a smile J PD 1984
Jan;51(1):24-8
• The lips and cheeks are supported by teeth, not by
denture borders
37. Display of maxillary central incisors decreases
with age and is concurrently accompanied by a
gradual increase in the display of mandibular
central incisors
The Journal of Contemporary Dental Practice,
Volume 5, No. 1, February 15, 2004
Reason :With age muscle tone decreases as a
result lower lip sags and upper lip drops
38. • Teeth abrade with age
• The centrals and laterals abrade in a straight line
• Canines abrade in a curve
• The abrasion of the incisal edges of anterior teeth
flattens the arch
39. Gingival tissues recede with age,
recession can be reproduced by:
Long tooth
Contouring the wax,
and then staining it a bit
40. • For complete denture patients, a guideline was suggested to
adjust the vertical length of the maxillary occlusion rim in
the anterior region by extending it approximately 2 mm
below the relaxed lip
• Conversely, reduction in the amount of maxillary anterior
teeth visibility contributes to the early perception of aging
of individuals in their 40s
44. “Smile Line” (maxillary incisal edges) should
follow the line of the lower lip in smiling in
females
Sheldon Winkler 2nd edition pg
203
45. • In males central incisors are on a horizontal
plane parallel with the lip, laterals are above
the plane and canines are on the plane.
Sheldon Winkler 2nd edition pg
343
46. • With the lips at rest, females display more
maxillary central incisors than males.
Vig RG, Brundo GC. The kinetics of
anterior tooth display. J P D 1978
May;39(5):502-4.
47. • The males displayed more of the maxillary lateral,
canine, and mandibular anterior teeth than the
females
Frush JP, Fisher RD. How dentogenic
restorations interpret the sex factor. J
P D 1956; 6: 160-72
51. Vigor
• A characteristic of the bold, vigorous face is the
dominant size and alignment of the teeth.
• larger size of the lateral incisors and canines, and
their straight bold arrangement
• Vigor and boldness are not necessarily solely
masculine characteristics, since strong, bold faces
may be found in many female patients.
52. Softness
• Softness in a tooth arrangement is a reduction
of the labial surface in terms of its visual
appearance.
• A rounded form with an ovoid outline is far
softer to the eye than a straight line or a flat
plane
53. Individuals with shorter upper lips display more
maxillary central incisor surface than people with
longer upper lips, and those with longer upper lip
show more mandibular central incisors
56. • Cosmetic factor involves personal grooming.
• For a person who dresses neatly, is well groomed, the artificial
teeth should complement these efforts.
• For a person who dresses unpleasantly , has bushy unkempt
eyebrows and hair, if too much strived for refinement in the
arrangement ,the teeth would not be in harmony with their
settings and would therefore appear more artificial.
Heartwell 5th edition Pg 345
58. • Artistic reflection is the arrangement of teeth
to reflect the dentists concept of what appears
natural for the patient.
• It should be acceptable to the patient
• Synonym: characterization
59. Characterization
It is the modification of the form and color of
the denture base and teeth to produce a more
lifelike/natural appearance
Glossary of prosthodontic terms
It enhance the natural appearance of the
individual.
60. • Hardy stated that, “To meet the esthetic needs
of the denture patient, we should make the
(denture) teeth look like (the patient’s) natural
teeth”
Hardy IR. Problem solving in
denture esthetics.
DCNA 1960:305-20
61. • Varying the direction of the long axis of teeth.
• Create asymmetry
Martone stated that, “The key to esthetics lies in
asymmetry.”
Martone AL. Effects of complete dentures
on facial esthetics. JPD 1964;14(2):231-
55.
• Use of eccentric midline
62. Asymmetry and its influence on tooth
arrangement
Smilecreatedusingonlytherightsideofthenaturalsmile
Natural smile showing asymmetry
63. • Placement of one tooth parallel to midline and slight
rotation of contra lateral tooth posteriorly
• Slight anterior placement of one central incisor to
other central incisor
• Place the neck of one maxillary central incisor in a
posterior direction and the neck of other central
incisor in an anterior direction.
• Spacing and diastemas often exist in natural
dentition
64. References
1. Brewer, Nassif and Reibel JPD 1967
2. Clinical dental prosthetics by FENN 3rd Edition Pg
110-112
3. Frush JP, Fisher RD. How dentogenic restorations
interpret the sex factor. J Prosthetic Dent 1956
4. Glossary of Prosthodontic Terms
5. Heartwell CM , Rahn AO. Textbook of complete
denture
6. Hardy IR. Problem solving in denture esthetics.
DCNA 1960:305-20
7. Martone AL. Effects of complete dentures on facial
esthetics. JPD 1964;14(2):231-55.
8. Payne SH MEDCOM Inc , 1973
65. 9. Rudd and Marrow
10.Schiff man :Relation of maxillary canines to the
incisive papilla JPD 1964;14:469-472
11.Sheldon Winkler 2nd edition
12.Straus et al. JPD 1977
13.The Journal of Contemporary Dental Practice,
Volume 5, No. 1, February 15, 2004
14.Tjan AH, Miller GD, The JG. Some esthetic factors
in a smile. J Prosthetic Dent. 1984 Jan;51(1):24-8
15.Vig RG, Brundo GC. The kinetics of anterior tooth
display. J P D 1978 May;39(5):502-4.
16.Zarb GA, Bolender CL, Carlsson GE. Boucher’s
prosthodontic treatment for edentulous patients.
