This document discusses factors to consider when selecting anterior teeth for dental prosthetics. It describes evaluating the size, form, and color of the new teeth based on the patient's existing anatomy when possible, as well as anthropometric measurements. Size can be estimated using pre-extraction records, the patient's facial features, or theoretical concepts linking tooth dimensions to head or facial proportions. Form follows the patient's facial profile or type. Color selection considers the patient's age, skin tone, and other characteristics to achieve natural harmony with the face. Multiple techniques ensure the new teeth appear appropriately sized, shaped, and colored for a comfortable and aesthetic result.

1. Selection of
anterior teeth
By: Arbiya Anjum.s S

2. Good afternoon

3. Introduction
•Anterior teeth play an important role
in aesthetics of a patient.
•They are not subjected to heavy
occlusal loads like posteriors.

4. Factors considered during
selection of anterior teeth
•Size of the teeth
•Form of the teeth
•Colour or shade of the teeth

5. Size of the anterior teeth
•Tooth size should be
appropriate to the size of the
face and sex of the patient

6. Methods to select size of
the teeth
•Methods using pre extraction records
•Methods using anthropological
measurements of the patient
•Methods using anatomical landmarks
•Methods using theoretical concepts
•Other factors

7. Methods using pre extraction records
•Diagnostic casts
•Radiographs
•Pre extraction photographs
•Teeth of close relatives and
•Preserved extracted teeth

8. Diagnostic casts
•These are prepared before extraction
of the teeth
•Operator can obtain an idea about size
and shape of the teeth from the
casts
•Shade cannot be determined

9. Radiographs
•Obtained from previous dentist
•Errors are a major limitation
•Occluso gingival height and the outline
of the teeth can be recorded
•Contour and size cannot be accurately
determined, because the radiograph is
2d image

10. Pre extraction photographs
•Photographs showing lateral, anterior and
anterolateral view of the patient should be
taken before extraction
•Photographs should show atleast the incisal
edges of anterior teeth
•It is useful to determine the exact width
and outline of the teeth

11. Teeth of close relatives
•Used when other records are
not available
•Size and contour of the
patient’s son or daughter’s
tooth is taken as the
reference

12. Preserved extracted teeth
•Best method to determine the size of
the anterior teeth
•Exact details about the size and
contour can be recorded from this
method

13. Methods using anthropological
measurements of the patient
•These are the post extraction records
made directly from the edentulous
patient
•It measures certain anatomical
dimensions and derive the size of the
teeth using certain formula

14. Anthropometric cephalic index• Transverse circumference of the head is measured
using a measuring tape at the level of the
forehead
• The width of the upper incisor can be derived by
this method
• Bizygomatic width can be used to determine the
width of the central incisor and combined width of
the anteriors
• It is the distance between the malar prominences
on either side

16. Total width of the upper anteriors = bizygomatic width
3.36
Total width of the lower incisors=4th the width of the upper anteriors
5

17. Berry’s biometric index
• It is used to derive the width of the central incisor
using the bizygomatic width and/or the length of the
face
• Length measured between the hairline and the tip of
the chin
Width of the maxillary central incisor= bi zygomatic width
16
Width of the maxillary central incisor = length of the face
20

18. H pound’s formula
•Pound derived 2 formulae to determine
the width and length of the central incisor
using the bi-zygomatic width and the
length of the face

19. Methods using anatomical landmarks
•Size of the maxillary arch
•Location of the canine eminences
•Buccal frenal attachments
•Corners of the mouth and
•Ala of the nose

20. Size of the maxillary arch
•The distance between incisive papilla and
hamular notch on one side is added with the
distance between 2 hamular notches
•This gives the combined width of all the
anterior and the posterior teeth of the
maxillary arch

21. Location of the canine
eminences
•A canine eminence is formed in the region between
the canine and the first premolar after extraction
of teeth
•The distance between the canine eminences is
measured along the residual ridge
•The measured value gives the combined width of
anterior teeth

22. Location of buccal frenal
attachment
•The attachments of the buccal
frenum are marked on the residual
ridge gives the combined width of
the maxillary anteriors

23. Location of Corners of the
mouth
•The corner of the mouth marks the distal
end of the canine
•The corners of the mouth are recorded on
the occlusal rim and the distance is
measured between these markings
•The anteriors are set within these
markings

24. Location of the Ala of the
nose
•The patient is asked to sit upright
and look straight
•A line passing through the midpoint
between the eyebrows and the lateral
end of ala of the nose extended onto
the occlusal rim gives the combined
width of the anterior teeth

25. Methods using theoretical concepts
•Wrinkler concept :
• According to wrinkle the teeth should be selected based on 3 different
views namely ,physiological, psychological and biomechanical
•Physiological-biological:
• The facial musculature contributes to the aesthetics of a patient.
Increasing the thickness of the denture base in the labial and buccal
sulci can produce a puffy appearance
• Facial wrinkles fade away when the vertical dimension is increased
• The dentist should evaluate the perioral tissues and arrange the teeth
accordingly

26. •Psychological
• A patient with a positive self evaluation shows a broad
smile and the one with a negative self evaluation shows a
tight lipped small smile
• The camper’s line is the psychological plane of orientation
• It is raised in happy people and it is tilted downward in
depressed people
•Biomechanical
• The teeth should be placed such that they fulfill the
biomechanics of the denture
• It is not necessary to set the teeth on ,outside or inside
the ridge
• Instead they should be set in the neutral zone

27. TYPAL FORM THEORY: LEON
WILLIAMS(1917)
• This theory helps to determine the size and form of the anterior
teeth.
• According to him, the shape of the teeth should be inverse of the
shape of the face.
• That is, if the face tapers downwards, the teeth should taper
upwards.
• Steins, in 1936, opposed this concept and said that the shape of
the teeth may vary for each individual, because it was not possible
for two fingerprints to be alike.
• According to him, the outline of the teeth are not important,
because, it is subjected to change throughout life. He proposed that
the size, colour, form and contour are the most important factors
to be considered during teeth selection.

28. TEMPERAMENTAL THEORY: DR.
SPARZHEIM.
•This theory is based on the
concept of Hippocrates.
•Hippocrates stated that the
body compromised of four Juices
of harmony namely blood,
phlegm, yellow and black biles.
•Imbalance of these juices is the
basis for the various ailments and

29. • Man can be classified based on the dominance of
humour as follows:
1.Sanguinous type: Blood dominance.
2.Phlegmatic type: Phlegm dominance (phlegm is a
watery fluid elaborated from brain).
3.Chloeric type: Yellow bile dominance (from liver).
4.Melancholic type: Black bile dominance (from spleen).
• Association of certain mental, functional and physical
characteristics created the temperamental theory.
• People of each group exhibit a certain type of teeth.

30. CONCEPT OF HARMONY:
J.W.WHITE(1872)
•According to him, the size and colour of
the teeth should be in harmony with the
size of the head and colour of the eye,
respectively.

31. OTHER FACTORS
• Other factors that influence the size of teeth
are:
1.Size of the face.
2.Inter-arch spacing.
3.Distance between the distal ends of the
maxillary cuspids.
4.Length of the lips.
5.Size and relation of arches.

32. FORM OF THE ANTERIOR
TEETH.
•The form or outline of the anterior teeth can
be determined using the following factors:
1.Shape of the patents face or facial form.
2.Patients profile.
3.Dentogenic concept and dynesthetics.

33. SHAPE OF THE PATIENT’S
FACE OR FACIAL FORM.
• This is based on typal form theory by Leon Williams. According to
him, the facial form can be described as one among the following
four types:
1.Ovoid
2.Tapering
3.Square
4.Combination of the above.
• The teeth selected should be in harmony with the facial
form.Ovoid teeth are preferred for patients with an oval face,
etc.

35. PATIENTS PROFILE
• The patient may have a convex, straight or a concave
profile.
• The labial form of the anterior teeth should be
similar to the facial profile of the patient.
• For example, the labial form should be straight for
patients with a straight profile, convex for a patient
with a convex profile.

36. DENTOGENIC CONCEPT AND
DYNESTHETICS: (SEX, PERSONALITY ,
AGE OR SPA FACTOR)
•It was first described by Frush and
Fisher.
•According to them, the sex,
personality and age of the patient
determine the form of the anterior
teeth.

37. SEX
• The differences in the shape of the anterior teeth in males and
females are;
1.In females, the incisal angles are more rounded and the teeth have
a lesser angulation.
2.In males, the incisal angles are rounded to a lesser degree and the
teeth are more angular.
3.The incisal edge of the central incisors is parallel to the lips and
the laterals are above the occulusal plane in males.
4.But the incisal edges of the central and lateral incisors follow the
curve of the lower lip in females.
5.The distal surface of the centrals are rotated posteriorly for
females.

38. 6.The mesial surface of the lateral incisors are rotated
anteriorly in relation to the centrals in females.
7.In males the mesial end of the laterals are hidden by the
centrals. This makes the canine very prominent in males.
8.Only the mesial thirds of the canines are visible in
females because they are rotated anteriorly, whereas even
the middle two-thirds of the canines are visible in males.
9.The cervical regions are prominent in males than in
females.
10.Females on smiling expose more anterior teeth hence,
the premolars should be arranged based on aesthetics for
females.

39. AGE
• The following changes are observed with an advance in age of the patient.
1.Due to decrease in muscle tone, sagging of the cheeks and the lower lips
occur. To prevent cheek biting (due to sagging), the horizontal overlap of
the posterior teeth can be increased.
2.Inter-occusal distance reduces with age. Hence, mandibular teeth are more
visible than the maxillary teeth.
3.Old people usually have abraded teeth with worn out contacts. Hence,
placement of contoured teeth may look artificial.
4.Old people have gingival recession. It can be reproduced in the dentures to
provide a natural appearance.
5.Old people show a blunt smile line and pathologic migration of teeth.
6.The colour of the teeth also changes with age. In old people, the enamel
is abraded and the dentine which carries a yellow tinge, is more visible.

40. PERSONALITY
• The patient can be either vigorous or delicate.
1.More squarish, large teeth are selected for vigorous
people.
2.The anterior should be in a flat plane for executives.
3.For executives, the teeth should be relatively smaller
and more symmetrically arranged.

41. COLOUR OF ANTERIOR TEETH
• Hue: It denotes a specific colour produced by a specific
wavelength of light. It should be in harmony with the
patient’s skin colour or else it will produce an artificial look
for the denture.
• Saturation or Chroma: It is the amount of colour per
unit area of an object. In other words, it denotes the
intensity of the colour. Objects with highly saturated colours
lack depth.
• Brilliance or Value: It denotes the lightness or darkness of
an object. It is actually the dilution of the colour with
either black or white to produce darker or lighter shades
respectively. In people with skin colour, teeth with lighter
shades should be chosen and vice versa.

42. •The hue and brilliance of a tooth
is influenced or determined by the
following factors:
1.Age
2.Habits
3.Complexion
4.Colour of the eyes
5.Colour of the patient’s hair.

44. Age:
1. Young people have lighter teeth where the colour of the pulp is shown through the
translucent enamel.
2. Old people show dark and opaque teeth due to the deposition of secondary dentin
and consequent reduction I size of the pulp chamber.
3. Teeth are more shiny in old people as they get polished due to regular wear of the
teeth.
4. Teeth of older people obtain a brownish tinge because exposed dentin tends to stain.
5. Preserved extracted teeth are not used to select the colour of the teeth because
they become discoloured (as they are non-vital).
Habits:
1. Smokers, alcoholics and pan chewers have discoloured teeth due to stains. In such
people, porcelain teeth are preferred because they are not porous and do not allow
percolation.
Complexion:
1. The colours of the teeth chosen should be in harmony with the complexion of the
patient.
2. The colour of the face is more important because the teeth fall into the framework
of the face.

45. Colour of the Eyes:
1.Only the colour of the iris is considered.
2.This measure is more unreliable because the eyes
are too small and far away from the teeth to
significantly influence the choice of colour.
Colour of the Patient’s Hair:
1.It is very unreliable because of factors like
cosmetics, etc. Also, hair colour changes with
age.

46. STEPS IN SELECTION OF COLOUR
OF ANTERIOR TEETH
• For the replacement of a single tooth , the adjacent teeth can be taken as a
guide.
• For an edentulous patient , factors like skin colour , hair colour and eye
colour are considered.
• Reference points on the face can be used to select the colour of the teeth
• Side of the nose
• This point helps to determine the basic hue, brilliance and saturation
• Under the lips with the mouth wide open and only the cervical third covered
• The reference point gives an idea of how the teeth will teeth will look when
the patient is smiling

47. SQUINT TEST
•It is used to check and compare the colour of the
teeth with the colour of the face . the dentist
should partially close his eyes to reduce light and
compare artificial teeth of different shades with
the colour of the the face.
•The colour of the teeth that fades first from view
is least conspicuous to the colour of the face.

48. THANK YOU!