This document describes 15 different techniques that have been used over time for selecting the size, form, and shade of anterior teeth for complete denture patients. The key techniques discussed include Winkler's biological-physiological concept from the 1950s, Pounds concept from measuring facial features like bizygomatic width, and using anatomic landmarks like the incisive papilla as guides. More recent techniques involve using mold selectors and other instruments to correlate the tooth form with classifications like ovoid, square, and tapering facial forms based on geometric patterns. Selection considers factors like facial size, maxillary arch size, and achieving functional efficiency and aesthetically pleasing results.

1. 1

2. ANTERIOR TEETH SELECTION
FOR COMPLETE DENTURE
PATIENTS
2

3. CONTENTS
3
Introduction
Objectives of teeth selection
Anterior teeth selection
• Size
• Form
•Shade and color
Size of face
• Winklers concept
•Pounds concept
Form
• Dentogenic concept

4. • Patient preferences
• Selection of material
• Discussion
• Summary
• References
4

5. INTRODUCTION
5

6. OBJECTIVES OF TEETH SELECTION
Functional efficiency
Normal speech
Aesthetically pleasing
No tissue abuse
Maintenance of the vertical dimension
6

7. Evolution of techniques
7
Young in 1954 described the evolution of various techniques
used in the selection of anterior tooth mold.
Technique 1
During the ivory age and early porcelain period ,teeth were selected or created
mostly by dimensional measurements of the denture space and arch size with
little regards to aesthetics.
(Heartwell C.M,Rahn A.O(1986).Syllabus of complete dentures,4th Ed.Lea
and Febiger,Philadelphia)

8. Technique 2
8
The "temperamental technique" was the first technique of selecting tooth
form from the point of view of influence and universal acceptance.It
required several years to associate and establish dental characteristics of the
temperaments and to incorporate them in manufactured tooth forms.This
occurred by 1885.
(Wright W.H (1936).Selection and arrangement of artificial teeth for
complete dentures.Journal of American Dental Association,23,2291)

9. Technique 3
9
The "typal form" concept projected by W.R Hall in 1887.This was the
initiation of the geometric theory later presented by Williams.The basis
of this classification was mainly on the labial surface curvatures,outline
form and neck width.Hall gave the classification of overall tapering and
square.
(Hayward D.E (1968).Use of natural upper teeth in complete
dentures.J.Prosthet Dent 19,359)

10. Technique 4
10
Berry's biometric ratio method-1906.Berry investigated the correlation
between face form and tooth form and resulted in the discovery that the
maxillary central incisor was 1/16 the width of the face and 1/20 its
length.Difficulty in practical applications discouraged the use this
technique.
(Mavroskoufis F et al (1981).Nasal width and incisive papilla as guides for
the selection and arrangement of maxillary anterior teeth.J.Prosthet Dent
45,592)

11. Mavroskoufis et al in 1981 concluded that the interalar nasal width is a
reliable guide for selecting the mold of anterior teeth.The authors advocate
that the tips of the canine be set on a line which passes through the posterior
border of the incisive papilla which proved to be a stable anatomic
landmark.The incisive papilla can also be used as a guide for arranging the
labial surface of the central incisors at 10 mm anterior to the posterior
border of the papilla.
11

12. Technique 5
12
"Clapps tabular dimension table method"-1910.Teeth were selected based
on the overall dimension of six anterior teeth arranged on the Bonwill
circle and the vertical tooth space available in the patient.
(Clapp G.W (1995).How the science of aesthetic tooth form selections
made easy .J.Prosthet .Dent.5,596)

13. Technique 6
13
Valderrama's "Molar tooth Basis" was projected in 1913.This method of
only historical value used varying measurements between combinations of
cusp points to indicate the size of the individual and overall tooth
measurements.The basic problem with this technique is that edentulous
patients have no molars.

14. Technique 7
14
Cigrande in 1917 advocated the use of the outline form of the fingernail
to select the outline form of the upper central incisor.The size was
modified to meet the requirements of tooth space and other
relationships.
(Fenn,Lidelow,Gimson (1989).Clinical Dental Prosthetics,3rd
Ed,Wright.)

15. Technique 8
15
The geometric method or Law of Harmony.Williams "Typal form method"
projected by J.Leon Williams in 1914 is based on the geometric pattern
created by the outline form of the bony face frame-the ovoid,square and
tapering forms.William arrived at this classification after extensive
anthropological study.This method is probably still the way in which most
dentists select anterior artificial teeth.

16. Technique 9
16
"Maxillary arch outline form " projected by Nelson in 1920.This
technique assumed that the arch outline form was a valid method
since it was related to an individuals anatomy.This was invalidated by
changes in arch form due to resorption.

17. Technique 10
17
"Wrights Photometric method"proposed in 1936 was based on
using a photograph of the patient with natural teeth and establishing
a ratio by comparative computation of measurements of like areas
of the face and photograph.

18. Technique 11
18
"The multiple choice method" introduced by Myerson in 1937 was based on
a need for a selective range in labial surface characteristic of transparent
labial and mesial surfaces ,varying surface colour tone,and characterization
of teeth by time and wear.
( K e r n B . E ( 1 9 6 7 ) . A n t h ro p o m e t r i c p a r a m e t e r s o f t o o t h
selection.J.Prosthet.Dent.17,431)

19. Technique 12
19
"Anthropometric-Cephalic index method" projected by Sears in 1941 was
based on the fact that the width of the upper central incisor could be
determined by dividing either the transverse circumference of the head /
13.

20. Technique 13
20
"Bioform technique" proposed by the Dentists Supply company in 1950 is
based on the geometric outline forms of face and teeth -the "House"
classification for 4 Basic and 3 combination Typal forms,and 3-dimensional
harmony of tooth form and face form.It is associated with the tabular and
mold guide systems and is currently in use.
(Hickey J.C,Zarb G.A,Bolender C.L (1985).Bouchers prosthodontics
treatment for edentulous patients,9th edition,Mosby,S.Louis)

21. Technique 14
21
The "Trubyte tooth indicator" or "Selection indicator instrument"
method advocated by the Dentists supply Company which is correlated
with Williams and House's Typal form theory and the Tabular
technique.

22. Technique 15
22
House instrumental method of projecting Typal outline and profile
silhouettes onto the face by means of a telescopic projector instrument and
silhouette form planes.This was correlated with designated mould numbers
and size variation.This was proposed by House in 1939 and by the Dentists
Supply Company in 1950.

23. Technique 16
23
"Automatic instant selector guide" of the Austenal company in 1951
correlated form,size and appearance in such a manner that only a single
reading was required to select the appropriate tooth mould based on
dimensions of denture space and harmony of face and tooth form.

24. The Golden proportion
24
If we study the beauty of nature,teeth or art,we will discover a
common principle running throughout.This common principle is the
universal recognition of pleasant proportion of 1.618:1.A constant
ratio between the larger and smaller length.
In terms of proportion,the smaller tooth is about 62% the size of the
larger one.This had been offered as a corner stone of smile design
theory.

25. CONCEPTS IN SELECTING
25
THE SIZE OF THE ANTERIORTEETH

26. WINKLERS CONCEPT
Biological -
physiological
Biomechanical Psychological
26

27. Biological Physiological
27

28. Proper understanding of the facial musculature,normal facial
appearance,physiological parameters.
A proper impression procedure -with final cast that has accurate
representation of the vestibule and other remaining structures.
In older patients there is a loss elasticity of the facial musculature.There
is a tendency to plump out the face with additional thickness of denture
base material.
Another approach to reduce wrinkles-increase the vertical dimension.
Adverse effects???
28

29. Biomechanical
29

30. "On the ridge" or "How far off the ridge?"
30
In general-place the anterior teeth as closely in relation to the
residual ridges as were the original natural teeth….
Fish states that"there is no exception to the rule of replacing the
natural teeth by setting the artificial ones in exactly the same
relation to the body of the maxilla unless the patients
appearance will be improved by some slight modification".

31. "The proper position for the tooth is not necessarily on the
ridge,inside the ridge,or outside the ridge,but at a point
where the tongue and cheek pressures balance"
31

32. 32

33. The Psychological view-point
33

34. Broad smile-positive self evaluation
Tight lipped small smile-negative self evaluation.
34
•
•
•
•
Unsure
hesitant
questioning
introverted
Campers plane-psychological plane of orientation
This,to a certain extent has an effect in determining the
appearance of a patients psychological state.

35. 35

36. Selection of AnteriorTeeth
Factors affecting are:
Size of the teeth
Form of the teeth
Colour/shade of the teeth
Additional clinical and technical considerations
36

37. 37
Size of the anterior teeth
Size of the face.
Size of the maxillary arch.
Incisal papilla and the cuspid eminences or the buccal
frenum
Maxillomandibular relations.
The contour of the residual ridges.
The vertical distance between the ridges.
The lips.

38. Size of the face
Average width of maxillary central incisor=1/16th of the width of the
face measured between the zygoma.
Combined width of the 6 maxillary anterior teeth =slightly less than
1/3rd of the bizygomatic breadth of the face.
Width of maxillary central incisor=length of the face/20
The Trubyte tooth indicator can be used to measure the size of the
maxillary central incisors.
38

39. 39

40. 40

41. POUNDS CONCEPT
41
Tooth width by measuring the distance from zygoma to zygoma.
Width of central incisor =bizygomatic width /16
Total width of anteriors=bizygomatic width /3.36
Total width of lower anteriors=4/5 th width of upper anteriors
Length of the central incisor =length of the face/16
Width of upper central incisors=circumference of the head/13
(Sears concept)

42. Size of the maxillary arch
The mold selectors are used to make measurements of the maxillary cast.
Make measurements from crest of the incisive papilla to the hamular
notches and between the two hamular notches.The combined length of
the 3 legs of the triangle in millimetres is used.
42

43. 43

44. Shivrayan A et al (2013) had done a study on the relationship between
pterygomaxillary notches, maxillary anterior teeth and the Dental arch. The study
was conducted on 70 individuals. All the measurements were taken directly on the
casts with a precise digital caliper. Interhamular width and distal maxillary arch
width were found to be almost equal to sum total mesio distal dimension of
maxillary anterior teeth. Interhamular width remains the same dimension during
lifetime; as it does not undergo alveolar bone resorption.
Relationship between pterygomaxillary Notches, Maxillary Anterior teeth
and Dental arch: An Invivo study. National Research Denticon 2013;
4:294- 302.
44

45. Incisal papilla and the cuspid eminences or the buccal frenum
A flexible ruler is used and the distance between the 2 canine eminences at
their distal side is measured in millimeters.This measurement gives the
combined width of the 6 anterior teeth.
Another method is with the occlusal rim.The vertical line drawn from this
mark coincides with the pupil of the eye.The distance between the marks
following the contour is the total width of the anteriors.
45

46. Harper was the first to describe the incisive papilla as a guide in denture
prosthetics in determining the labial extent of the central incisors.
46
Schiffman studied 507 maxillary casts of dentate patients. An imaginary line
passing through the tips of the cuspids was found to be within 1mm of passing
through the center of the incisive papilla in 92.1% of all the casts.
Harper RN: The incisive papilla.J Dent Res 1948;27:661-668 3I.
Schiffman P: Relation of the maxillary canine to the incisive papilla.J Prosthet
Dent 1964;14:469-472

47. Maxillomandibular relations
Any disproportion in size between the maxillary and the mandibular
arches influences the length ,width and position of the teeth.This is of
importance in class II and class III maxillomandibular relations.
47

48. The contour of the residual ridges
The artificial teeth should follow the contour of the residual ridges that
existed when natural tooth were present.With resorption ,there is
alteration in the contours of the ridge.As resorption occurs,because of
morphology,maxillary arch appears smaller and the mandibular arch
appears larger.
48

49. Vertical distance between the ridges
The length of the teeth is determined by the available space between the
existing ridges.It is advisable to use a tooth long enough to eliminate
the display of the denture base.
49

50. The lips
This guides the selection of the length of the maxillary anterior teeth
.At rest,the labial surface of the maxillary anterior teeth should
support the upper lip.In speech,the incisal edges of maxillary anterior
teeth should contact the lower lip at the junction of the moist and dry
surfaces of the vermillion border ,when the patient pronounces 'f'.
50

51. Inner canthal distance, interpupillary distance, intercommissural distance, distance
between the tips of the maxillary canines and distance between the distal surfaces of
the canines were measured. On the cast, the distance between tips of maxillary
canines and distance between distal surfaces of maxillary canines were noted.
Extra oral anthropometric measurements of the interpupillary distances and the
intercommissural distances with the help of standardised photographs can help us
determine the combined widths of the anterior teeth accurately, thus aiding their
selection in the absence of pre-extraction records.
Kini AY,Angadi GS.Gerodontology. 2013 Jun;30(2):105-11
51

52. The following 6 measurements were recorded for each set of casts: left mid-
maxillary to right mid-maxillary, representing the distance between the respective
residual ridge crest points adjacent to each canine eminence; left retromolar pad to
right retromolar pad; incisive papilla to left hamular notch; incisive papilla to right
hamular notch; left hamular notch to right hamular notch; and incisive papilla to
vibrating line. These measurements were statistically compared with the control, the
canine-to-canine distance as marked on the contoured maxillary occlusion rim to
indicate the relaxed commissures.
Based on the results of this study, use of the right hamular notch to left hamular
notch measurement plus 10 mm provides a useful method for determining the
width of the 6 maxillary anterior teeth for complete denture patients.
J Prosthet Dent 2010;105: 44-50
52

53. Form of anterior teeth
Form and
contour
of the face
Dentogenic
concept
53
Pre-extraction
records

54. The shape of the artificial tooth should harmonise with the
patients facial form.
Leon Williams-shape of upper incisors is the shape of the face-
most useful guide.
Leon classified shape of face into 3-
• square
• tapering
• ovoid
54

55. 55

56. Facial Profile
Forehead Base of the nose Prominent point
of the chin
56

57. Dentogenic concept
Frush and Fisher(1957)
Teeth are selected and arranged
Sex
57
Personality Age

58. Sex of the patient
58
Curved facial feature-More feminity
Square features-Masculinity
Teeth of females are more ovoid or tapering than square.
However,the form of the teeth will vary as the features vary.

59. 59

60. In females,
60
• Incisal angles are more rounded
• The incisor edges of the central and lateral incisors follow the curve
of the lower lip
• The distal surfaces are rotated posteriorly in females
• Only the mesial thirds of the canine are visible in females since they
are rotated anteriorly.

61. 61

62. In males,
• The incisor edge is parallel to the plane and the
• laterals are above the occlusal plane.
• The labial surfaces of central incisors are not usually
rotated
• In males,the mesial ends of the laterals are hidden by the
central .This makes the canine very prominent.
• The middle two thirds of the canines are visible in males.
62

63. Age
The following changes are seen as age advances
Due to decrease in muscle tone,sagging of cheeks and lower lip 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.
Teeth abrade with age.The cuspids abrade in a curve.
The abrasion of incisal edges flattens with the arch,fullnessof the lower
lip diminishes.
63

64. Gingival tissues recede with age.It can be reproduced in dentures to
provide a natural appearance.
The smiling line is sharp in young people and lesser sharp in older
people with pathologic migration of teeth.
The color of teeth also changes with age.The enamel is abraded and
the dentine which carries a yellow color is more visible.
64

65. Personality
Delicate
65
Medium pleasing Vigorous

66. 66

67. 67
Role of individual teeth in personality interpretation
Central incisors-contribute to desired strength and action of the
smile.
Lateral incisors-being subordinated in position to the central i n c i s
o r s - h a r d n e s s a n d s o f t n e s s , a g g r e s s i v e n e s s o r
submissiveness,vigorous tendency or delicate tendency of the patient.
The cuspids must dominate the lateral incisors in color,form and
position.

68. A study on the aesthetic considerations in the selection of teeth for
68
complete denture patients. Pre extraction records which included
diagnostics casts, recent photographs and radiograph of the teeth were
taken. Post extraction examination included; size and form of edentulous
arch, if patient wore dentures; then should be examined in the mouth giving
importance to physiological and aesthetic aspects. The factors influencing
the size and former the anterior teeth are; size of the anterior teeth; form of
the anterior teeth; color of the interior teeth. Dentogenic factors included
sex factor, personality factor, and Age factor.
They concluded that selection of teeth mainly depends on the type of
patient and the condition of supporting tissues.
Ahmad I. Anterior dental aesthetics: Facial prospective.Br.Dent.J 2005;
199:15- 21.

69. Pre extraction records
69
• Facial photographs-width and outline forms
• Diagnostic casts
• Radiographs
• Teeth of close relatives
• Extracted teeth-size and form

70. Colour or shade of anterior teeth
70
• The age of the patient
• The individual complexion pattern
• The patients desires
• The colour of hair and eyes
• Habits of the patient

71. Colour
Hue
71
Value Chroma
Hue-specific color produced by a specific wavelength.It should be
in harmony with the patients skin color else it will look artificial.
Value-lightness or darkness of the object.It is the dilution of a color
with either black or white to produce darker or lighter shades
respectively.
Chroma-The amount of color per unit area of an object.It denotes the
intensity of the color.

72. When a tooth is viewed from determining its color-2
principal colors
Yellow-more prominent in the gingival third
Grey-More prominent in the incisal third
72
Hue of the tooth is actually the quality the dentist tries to
duplicate.

73. Colour of hair,eyes and skin
73
• Blue,green or light coloured eyes with fair skin-lighter shade
teeth
• Black or dark eyes-darker teeth

74. Age
With increasing age -progressively darker
Attrition at incisal edge-decreased translucency with age
More shiny as age advances-regular wear of teeth
Brownish tinge-exposed dentin tends to stain
74

75. Selecting color
75
Place the shade tab in the following areas
• Along the side of the nose-establishes basic hue,value and chroma
• Under the lips with only the incisor edge exposed-reveals the effect of
color of teeth when the patients mouth is relaxed.
• Under the lip with only the cervical end covered and mouth open-
simulates the exposure of teeth as in smile.

76. Squint test
Evaluates colour of the teeth with complexion of the face.
Eyes are partially closed to reduce light ,dentist compares the selected
shade tabs by holding them along the face of the patient.The color that
fades from the view first is the one that is least conspicuous and is in
harmony with the color of the face.
Whenever possible-record the size,form and colour of the natural teeth
before extracting them.
76

77. Additional clinical and technical considerations
Patient preference
Highly visible gingiva
Limited interocclusal space
Opposing natural teeth
77

78. The personal touch-Characterization of selected teeth
Teeth can be modified to create a personal smile in a number of
ways and combinations such as
Changes in color and position
Individual grinding and placement
Placement of restorations and worn appearance
78

79. 79

80. 80

81. SUMMARY
81

82. 82
TEXTBOOK REFERENCES
• Heartwell.C.Syllabus for complete dentures.4th edition.
• Zara Bolender,Eckert,Jacob.Prosthodontic treatment for edentulous
patients.12 th edition.
• Winkler S.Essentials of complete denture prosthodontics.2nd edition.
• Rahn Arthur.textbook of complete denture.BC Decker.6th edition
• RM Basker,JC Davenport.Prosthetic treatment of edentulous patient.
• Sharry J.J.Complete denture prosthodontics.Mc Graw Hill.3rd edition.

83. 83
JOURNAL REFERENCES
• Wright W.H (1936).Selection and arrangement of artificial teeth for complete
dentures.Journal of American DentalAssociation,23,2291.
• M. Vasantha Kumar Science of Anterior Teeth Selection for a Completely
Edentulous Patient: A Literature Review .J Indian Prosthodont Soc (Jan-Mar 2011)
11(1):7–13
• Harvard D.E (1968).Use of natural upper teeth in complete dentures.J.Prosthet Dent
19,359
• Mavroskoufis F et al (1981).Nasal width and incisive papilla as guides for the
selection and arrangement of maxillary anterior teeth.J.Prosthet Dent 45,592
• Clapp G.W (1995).How the science of aesthetic tooth form selections made
easy .J.Prosthet .Dent.5,596
• Kern B.E (1967).Anthropometric parameters of tooth selection.J.Prosthet.Dent.
17,431
• Hickey J.C,Zarb G.A,Bolender C.L (1985).Bouchers prosthodontics treatment for
edentulous patients,9th edition,Mosby,S.Louis

84. 84
• Shivrayan A.Relationship between pterygomaxillary Notches, Maxillary Anterior
teeth and Dental arch: An Invivo study. National Research Denticon 2013; 4:294-
302.
• Kini AY, Incisal papilla as a guide in teeth selection.Gerodontology. 2013 Jun;30(2):
105-11
• Ahmad I. Anterior dental aesthetics: Facial prospective.Br.Dent.J 2005; 199:15- 21.
• Baker .Denture cast measurements in anterior teeth selection.J Prosthet Dent
2010;105: 44-50
• Harper RN: The incisive papilla.J Dent Res 1948;27:661-668 3I.
• Schiffman P: Relation of the maxillary canine to the incisive papilla.J Prosthet Dent
1964;14:469-472

85. 85