Achieving facial and functional harmony during arrangement of teeth

ACHIEVING FACIAL
AND FUNCTIONAL
HARMONY DURING
ARRANGEMENT OF
TEETH
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacdemy.com

CONTENTS
Introduction
Review of literature
Basic guides to develop harmony
 Preliminary selection of artificial teeth
 Horizontal orientation of teeth
 Vertical orientation of teeth
 Inclination of teeth
 Harmony in general composition of anterior teeth
 Refinement of individual tooth positions
 Concept of harmony with Sex, Personality and
Age of the patient
Summary and conclusion
References

INTRODUCTION
The anatomic structures . . . . . .
Homeostasis, Facial and functional harmony . . .
Normal physiological activity . . . .
“ Psychological factor in acceptance of denture ”

REVIEW OF LITERATURE
Pound E. (1951) conducted study on “Esthetic denture and
their phonetics value” and observed that phonetics is
controlled 100% by esthetics and the dentures should be
designed according to the principle of nature.
French A. (1951) conducted a study on the “selection and
arrangement of anterior teeth in dentures” and concluded
that the teeth should be arranged according to the face
form, arch form, width of mouth and ridge relation
Frush & Fisher in their series of articles (1955 – 59)
presented the concepts of creating the illusion of natural
teeth in artificial denture based on the elementary factor
suggested by the Sex, Personality and Age of the patient.

Martone A. L. (1964) conducted a study on the “Effect
of complete denture on facial Esthetics” and he
concluded that the loss of the teeth & their supporting
structures produces radical changes in facial appearances
and successful efforts should be made to restore the
appearances of face with complete dentures.
Curtis T. & Shaw E. (1987) studied on “The influence of
Removable Prosthodontics procedures and concept of the
esthetics of complete dentures” and concluded that the
esthetic results require more than the size, color, position
and arrangement of complete denture teeth. The
consultation appointment, impression making, location of
occlusal plain, polished surface, delivery and
maintenance all contribute to the esthetics of denture.

Preliminary selection of Artificial Teeth
 Anterior teeth – Esthetic requirement
 Posterior teeth – Masticatory functional requirement
 Compatibility with surrounding oral environment
 Preliminary selection is based on:
Size
Form
Color

SIZE
Selection of Anterior teethSelection of Anterior teeth
 Size of the face
 Size of Maxillary arch
 Incisal papilla and the cuspid eminence
 Maxillomandibular relations
 Vertical distance between ridges

Selection of Posterior teethSelection of Posterior teeth
 Functional harmony with musculature
 Less buccolingual dimension
 Anteroposterior dimension

FORM
 Conform to the general outline of face
 Facial forms
Square
Square tapering
Tapering
Ovoid
 Sex
 Ageing

Form of Posterior teethForm of Posterior teeth
 Occlusal surface – primary concern
 Balanced in centric and eccentric positions – cusp form
 Disocclusion in eccentric position – Cusp or monoplane
 Balanced in centric position only – Monoplane
Arrangement of artificial posterior teeth for functional
harmony depends on a thorough understanding of occlusion

SHADE
 Harmony with color of skin, eyes and hair
 Shade of posterior teeth should harmonize with shade
of anterior teeth
 Bulk influences the shade . . . .

Horizontal orientation of Anterior teeth
 Insufficient support of lipsInsufficient support of lips
 Drooping of corner of mouth
 Deepening of nasolabial groove
 Deepening of sulci
 Reduction in prominence in philtrum
 Reduction in visible part of vermilion border

 Excessive support of lipsExcessive support of lips
 Stretched appearance of lips
 Elimination of contour of lips
 Distortion of lip and sulci
 Tendency of lip to dislodge the denture

 Incisive papillaeIncisive papillae
Midline of upper denture

 Positioning of Canine
- If anterior to papilla . . .
- If posterior to papilla . . .
 Relationship of central incisors to reflection of soft tissuesRelationship of central incisors to reflection of soft tissues
 Anteroposterior position

 Buccolingual position of posterior teethBuccolingual position of posterior teeth
Mainly determined by Neutral zone

If teeth located lingually . . .
If teeth located buccally . . .

Vertical orientation
If the upper lip is relatively long . . .
Anterior teethAnterior teeth
If the upper lip is relatively short . .
Length and movement of upper lip

 Lower lip is a better guide
 Cusp tips of canine and I premolar are even with
lower lip
- If lower anterior - above this level- If lower anterior – below this level

 Maxillary anterior teeth are arranged according to phonetics

 Posterior teethPosterior teeth
 Two basic anatomic guide
- Orifice of Stenson’s Duct
- Retromolar pad
 If occlusal level is too low
 If occlusal level too high
 Character of residual ridge

Inclination of teeth
 Labial surface of bone
 Profile form of the patient

Anteroposterior curve
Mediolateral curve
Compensatory Curves

Harmony in general composition of anterior teeth
Harmony of dental arch form and form of residual ridge
Harmony of long axes of Central incisors and the face
Harmony of teeth with the smiling line of lower lip
Harmony of the opposing line of the labial and buccal surfaces
Harmony of the teeth and profile line
Harmony of incisal wear and age

 Harmony of dental arch form and form of residual ridgeHarmony of dental arch form and form of residual ridge
 Anterior arch
Square – Central incisor in line with canine
Tapering – Central incisor forward with canine
Ovoid – position between that of square and tapering

 Form of palatal vault
Broad and shallow – Square arch
High V-shape – Tapered arch
 Shape and position of dental arch – size of buccal corridor

 Harmony of long axes of Central incisors and the faceHarmony of long axes of Central incisors and the face
Midline of the dental arch

 Harmony of teeth with the smiling line of lower lipHarmony of teeth with the smiling line of lower lip
Lower lip forms a pleasant curvature on smiling - smiling line
Vertical position of upper canines . . . . . .

 Harmony of the opposing line of the labial and buccal surfacesHarmony of the opposing line of the labial and buccal surfaces
Setting teeth with long axis parallel to each other…….
Asymmetrical symmetry in the arrangement of teeth
Square and ovoid faces – lines nearly perpendicular
Tapering faces – more divergent from perpendicular

 Harmony of the teeth and profile lineHarmony of the teeth and profile line
 Three types – straight
convex
concave
 Labial surface of central incisor – parallel to
profile line of face
 In prognathic patients
 In retrognathic patients

 Harmony of incisal wear and ageHarmony of incisal wear and age
 Incisal edges and proximal surfaces – wear
concomitantly with age
 Young patient less incisal wear older patient more
wear
 Generally lingually placed upper anterior and
labially placed lower anterior …….
 If teeth selected have ball contact points – grinding
can be done

Refinement of individual tooth positions
Typical inclinations and rotations
Labiolingual inclination

 Mesiodistal inclination

 Rotational positions

 Superioinferior position

Harmony of spaces and individual tooth positions
Spaces between teeth - effective for emphasizing
individual tooth positions

Concept of harmony with Sex , Personality and AgeConcept of harmony with Sex , Personality and Age
of the patientof the patient
Frush and Fisher in their series of articles (1956 - 1959)
presented the concept of dentogenics which creates an
illusion of natural teeth in artificial dentures based on
the elementary factors suggested by sex , personality
and age of the patient.
 Sex interpretation
Central incisors – either one incisor is placed labially
bodily or at there incisal edges or both incisors
rotated with the distal surface forward with one
incisor depressed at cervical end.

 Lateral incisor – if rotated to show its mesial surface
gives softness and youthful appearance to the smile.
If rotated mesially the effect of smile is hardened.

Cuspids
- in general three rules are followed
- out at the cervical end
- rotated to show mesial surface
- almost vertical as seen from side
Depth grinding
- mesial surface of central
incisor
- flat, thin narrow teeth fits
delicate women
- thick bony or big sized tooth
is vigorous - men

 Personality
delicate
medium
vigorous
It is a practical and inspiring approach to primary mold
selection. It paves the path for further sex and age
refinements.

 Age
 If the cheeks sag . . . .
 Interincisal distance increases with age –
mandibular teeth becomes more visible
 Teeth abrade with age .. . . . . . . . .
 Smile line sharp . . . .
 Gingival tissues recede with age
 Natural teeth of older people support restorations . . .

Maintaining facial support and neuromuscular balance
 Orbicularis oris – Muscle of lip
 Buccinator – Muscle of cheek
 Factors affecting the repositioning of Orbicularis oris
- Thickness of labial flanges
- Anteroposterior positioning of teeth
- Separation of ridges

Conclusion
Complete denture fabrication can no longer be
considered solely as a function of tooth selection and
arrangement or the colors and contours of the denture
bases. It must also include the entire face in which the
expression of inner feelings, personality, comfort,
image, well being are all very evident. These hard and
soft components all contribute to the complete denture
esthetics and function are inseparable and should be
given every consideration when developing a successful
complete denture restoration.

References
Zarb - Bolender : Prosthodontic treatment for edentulous
patients. Twelfth edition, 2004.
Sharry J.J. : Complete denture prosthodontics, 1968.
Rahn and Heartwell : Textbook of complete denture, 4th
edition, 1993.
Boucher. C.O: Prosthodontic treatment for edentulous
patients. Ninth edition
Frush and Fisher : How Dentogenic restorations interpret the
sex factor, J. Prosthet. Dent. 1956;6 :160-172

Frush and Fisher : How Dentogenic restorations
interpret the Personality factor, J. Prosthet. Dent.
1956;6 :441-449
Frush and Fisher :The Age factor in Dentogenics, J.
Prosthet. Dent. 1957;7 :441-449
Dental Clinics of North America : Esthetic Dentistry,
April 1989

Achieving facial and functional harmony during arrangement of teeth

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