1. Teeth Selection
The next step in the Fabrication of a complete denture after
articulation is teeth arrangement. Before arrangement, the teeth
should be selected, Artificial teeth are available in various forms
and shades. Teeth selection is very important as the selection of
the appropriate size, shape/occlusal form and colour/shade of the
artificial teeth determines the aesthetics and the function of the
denture. Aesthetics is a pleasurable feeling created within an
individual against the perception of an object.
Objectives in Teeth Selection
 The teeth should be in harmony with the surrounding
tissues.
 They should maintain the vertical dimension
 They should be efficient for mastication.
 Posterior teeth should be selected based on function
whereas the anterior teeth are selected predominantly
based on aesthetics.
General Considerations in Teeth Selection
The following principles should he considered prior to
teeth selection:
 The patient should be seated upright with his facial
muscles relaxed.
 The operator should sit in front of the patient and adequate
lighting should be used. Light source can be daylight, neon
light or fluore-scent light.
The selection of artificial teeth for a complete denture can
be divided into two sections:
 Anterior teeth selection
 Posterior teeth w4vcfion
ANTERMTEETH SELECTION
Anterior teeth play an important role in the aesthetics of a
patient. They am not subjected W heavy occlusal load like the
posteriors. Hence, aesthetics is given more importance during

2. anterior teeth selection. The following factors are also
considered during the selection of anterior teeth:
 Size of the teeth
 Form of the teeth
 Colour/shade of the teeth
Size of the Anterior Teeth
The tooth Size should be appropriate to the size of the face
and sex of the patient, The following methods are used as a
guide to select the 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.
Methods Using Pre-extraction Records
The pre-extraction records like diagnostic casts,
photographs radiographs teeth of close relatives and preserved
extracted teeth can be used to determine the size of the artificial
teeth.
Diagnostic casts They are prepared before the extraction
of the teeth. The operator can obtain an idea about the size and
shape of the teeth from these casts. The actual Size and shape
required can be determined brut the shade of the teeth cannot be
determined using this method.
Pro-extraction photographs Photographs showing the
lateral, anterior and anterolateral views of the patient should ken
before extraction. These photographs must show at least the
incisal edges of the anterior teeth, This method is useful to
determine the exact width and outline of the teeth.
Pro-extraction radiographs This is usually obtained from
the patient's previous dentist. Radiographic errors are a major
limitation to this method. The occluso-gingival height and the
outline of the teeth can be recorded. But the con-tour and size
cannot be accurately determined, bemuse the radiograph is a

3. two-dimensional image.
Teeth of close relatives This method is usually followed
only if the other records are not available, The size and contour
of the patient's son or daughter's tooth is taken as reference.
Preserved extracted teeth This is the best method to
determine the size of the anterior tooth. The exact details about
the size and contour can be recorded from this method.
Methods using Anthropological Measurements of the Patient
Anthropological measurements am mushy post-extraction
records, made directly from the Edentulous patient, These
methods measure certain anatomical dimensions and derive the
size of the teeth using certain formulae.
Anthropometric cephalic index The transverse
circumference of the head is measured using a measuring tape
at the level of the forehead. The width of the upper central
incisor can be derived from this measurement. Sears called this
formula as the anthropometric cephalic index.
𝒘𝒊𝒕𝒄𝒉 𝒐𝒇 𝒕𝒉𝒆 𝒖𝒑𝒑𝒆𝒓 𝒄𝒐𝒏𝒕𝒓𝒐𝒍 𝒊𝒏𝒄𝒊𝒔𝒐𝒓 =
𝑪𝒊𝒓𝒄𝒖𝒎𝒇𝒆𝒓𝒆𝒏𝒄𝒆 𝒐𝒇 𝒕𝒉𝒆 𝒉𝒆𝒂𝒅
𝟏𝟑
The bizygomatic width can be used to deter-mine the
width of the central incisor and also the combined width of the
anteriors. The bizygomatic width is the distance measured
between the malar prominences on either side. This
measurement is also used in Berry's Biometric index and H.
Pound's formulae.
‫معادلة‬
Berry's Biometric index Berry's bimetric index is used to
derive the width of the central incisor using the bizygornatic
width and/or the length of the face. the formula using the length
of the face cannot be used for edentulous patients. The length of
the face is the distance measured between the hairline and the
tip of the, chin.
‫معادلة‬

4. Based on the size of Me lace This is a tentative
measurement in which the size, of the teeth is determined by the
size of the face. For example, large teeth are selected for patients
with a large face.
H. Pound's formula Pound derived two formulae to
determine the width and length of the central incisor using the
bi-zygomalic width and the length of the face respectively.
‫معادلة‬
Based on the width of the nose The width of the nose is
measured with a venire caliper. This measurement is transferred
to the occlusal rim. The width of the nose, is equal to the
combined width of the anterior teeth.
Methods using Arrafomcal Landmarks
Various anatomical landmarks like the size of the
maxillary arch and location of the canine eminences, buccal
frenal attachment, corners of the mouth and sin of the nose can
be used to determine the size of the artificial teeth.
Size of the maxillary arch The distance between the
incisive papilla and the ha molar notch on one side is added with
the distance between two hamular notches. This gives the
combined width of all the anterior and paserior teeth of the
maxil-lary arch.
Location of canine eminences Acanine eminence is
formed in the region between the canine and the first premolar
after extraction of teeth.
The distance between the two canine eminences is measured
along the residual ridge. This measured value gives the
combined width of the anterior teeth .
Location of the buccal franal attachments The
attachments of tire buccal frenum are marked on the residual
ridge. The distance between the two markings recorded along
the residual ridge gives the combined width of the maxillary
anteriors.

5. Location of the corners of the mouth The comer of the
mouth marks the distal end of the canine. The comers of the
mouth are recorded on the occlusal rim and the distance is
measured between these markings. The anterior teeth are set
within these markings.
Location of the alt of the nose The patient is asked to sit
upright and look straight. A line pas- sing through the midpoint
between the eyebrows and the lateral end of the alt of the nose
extended onto the occlusal rim gives the combined width of the
anterior teeth .
Methods Using Theoretical Concepts
The following theoretical concepts proposed by various
authors can be used Codetermine the size of the anterior teeth.
Winkler's concept According to Winkler, the teeth should
be selected based on three different views, namely,
physiological, psychological and bio-mechanical.
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 when the vertical dimension is
increased. But this should not be carried out to avoid other
complications listed in the previous chapter. The dentist should
evaluate the perioral tissues and arrange the teeth accordingly.
Refer clinical examination in Chapter 2.
Physiological, A patient with a positive self-evaluation
shows a broad smileand 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 is tilted downward in depressed people.
Biomechanical The teeth should be placed such that they
fulfil the biomechanics of the denture. It is not-necessary to set
the teeth on, outside, or inside the ridge. Instead they should
beset in the neutral zone (the zone of balance between the buccal
and lingual musculature) .
Typal form theory: Leon Williams (1917) This theory
helps to determine the size and form of the anterior teeth.

6. 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
shale of the will nay warp for each individual, because, it was
not possible for two fingerprints to be alike. According tit him,
the outline of the teeth are not important. because, it is subjected
tit change throughout life. Ile proposed that tile size, colour,
form and contour are the most important factors it, be
considered during will sedation.
Temperamental theory: Dr. Sparzheim This theory is
based on the concept of Hippocrates. It is one of the oldest
theories proposed around 2400 Years ago. Hippos rates stated
that the body comprised of four mires of ???? namely blood,
phlegm, yellow and black Files. Imbalance of these juices is the
basis for the various ailments and differen-ces in man.
Man can classified based oil the dominance of humour as
follows:
 Sanguineness type Blood dominance.
 Phlegmatic type: Phlegm dominance (phlegm
is a oaten' fluid elaborated from brain).
 Choleric type: Yellow bile dominance (from liver).
 Melancholic type. Black bile dominance (from spleen).
Association of certain mental, functional and physical
characteristics created the tempera-mental theory. People of
each group exhibit a certain I vile of teeth.
Concept of Harmony: J. W While in 1872 Accor-ding to
him, the size and colour of tile teeth Should be in harmony with
the size of the head and colour of the eye, respectively.
Other factors Other factors that influence the size of teeth
are:
 Size of file face.
 Inter-arch spacing.
 Distance between file distal ends of the maxillary
cuspids.
 Length of the lips.
 Size n and relation of the arches.

7. Form of the Anterior Teeth
The form or outline the anterior teeth can be determined
using the following factors:
 Shape of thy patient's face or facial form.
 Patient's profile.
 Dentogenic concept and dynesthetics.
Shape of the Patient's Face or Facial Form
This is based on Typal form theory by Leon Williams.
According to him, the facial dorm can be described as one
among the following four types:
 Ovoid
 Tapering
 Square
 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.
Patient's 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 .
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.
Sex The form or shape of the teeth differs in males and
females. The differences in the shape of the anterior teeth in
males and females are:
 In females, the incisal angles are more rounded and the
teeth have a lesser angulation. In males, the incisal angles

8. are rounded to a lesser degree and the teeth are more
angular.
 The incisal edge of the central incisors is parallel to the
lips and the laterals are above the occlusal plane in males.
But the incisal edges of the central and lateral incisors
follow the curve of the lower lip in females.
 The distal surface of the centrals am, rotated posteriorly
for females.
 The mesial surface of the lateral incisors am totaled
anteriorly in relation to the centrals in females.
 In males the mesial end of the laterals am hidden by the
centrals. This makes the canine very prominent in males.
 Only the mesial thirds of the canines am visible in females
because they am rotated anteriorly, whereas even the
middle two-thirds of the canines am visible in males.
 The cervical regions am prominent in males than in
females.
 Females on smiling expose mum anterior teeth hence, the
premolars should be arranged based on aesthetics for
females.
Age The age of the patient IS important in teeth selection
because of the physiological and functional changes that occur
in the oral tissues. The patient can be either young, middle-aged
or old-aged. The following changes are observed with an
advance in age of the patient:
 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.
 Inter-occlusal distance reduces with age. Hence,
mandibular teeth are mom visible than the maxillary teeth.
 Old people usually have abraded teeth with worn out
contacts. Hence, placement of con-toured teeth may look
artificial.
 Old patients have gingival recession. It can be reproduced
in the dentures to provide a natural appearance.

9.  Old people show a blunt smile line and pathologic
migration of teeth.
 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 (Refer colour
selection).
Personality The dentist should and arrange the teeth so that
it improves the patient's personality. The patient can be either
vigorous or delicate.
 More squarish, large teeth are, selected for vigorous
people.
 The anteriors should be in a flat plane for executives.
 For executives, the teeth should be relatively smaller and
more symmetrically arranged.
Colour for Anterior Teeth
Before selecting the colour for anterior teeth, some basic
concepts about colour should be understood. A single colour can
be described under four parameters.
 Hue.
 Saturation or chroma.
 Brilliance or value.
 Translucency
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 Chrome
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

10. produce darker or y lighter shades respectively. In people with
light skin colour, teeth with lighter shades should be chows and
vice versa.
Translucency
It is the property of the object to partially allow passage of
light through it. Enamel has high brilliance and translucency;
hence, artificial teeth should also show the same properties for a
natural appearance.
The hue and brilliance of a tooth is influenced or
determined by the following factors:
 Age.
 Habits.
 Complexion.
 Colour of the eyes.
 Colour of the patient's hair.
Age
 Young people have lighter teeth whole the colour of the
pulp is shown through the translucent enamel.
 Old people show dark and opaque teeth due to the
deposition of secondary dentin and constituent reduction in
size of the pulp chamber.
 Teeth are, more shier in old people as they get
polished due to regular wear of the teeth.
 Teeth of older people obtain brownish tinge because
exposed dentin tends to stain.
 Preserved extracted teeth are not used to select the colour
of the teeth because thee become discoloured (as they are
non-vital).
Habits
Smokers, alcoholics and pan chewers have discoloured
teeth due to stains. In such people, porcelain teeth am preferred
because they am not porous and do not allow percolation.

11. Complexion
 The colour of the firth chosen should be in harmony with
the complexion of the patient, The colour of the face is
more important because the teeth fall into the framework
of the face.
Colour of the Eyes
 Only the colour of the iris is considered.
 This measure is more unreliable because the eyes are too
small and faraway from the teeth to significant influence
the choice of colour.
Colour of the Patient's Hair
It is very unreliable because of factors like cosmetics, etc.
Also, hair colour changes, with age.
Steps in the selection of colour for 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.
The following reference points on the face can be used to
select the colour of the troth:
 Side of the nose: This point helps to determine the basic
title. brilliance and saturation.
 Under the lips with only the incisal exposed: This
reference point gives an idea of how the teeth will look
when the patient is relaxed.
 Under the lips with mouth aide open and only the cervical
third cervical thinl couered: The third reference point
gives an idea of how the teeth will look when the patient is
smiling.
Squint lost 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 [lie colour of the face. The colour of the
teeth that fades first from view is least conspicuous (contrasting)
to the colour of the face.

12. Posterior teeth Selection
It is classified under two divisions, namely:
 Size of the teeth
 Form of the teeth.
Size of the Posterior Teeth
The following factors are considered while selecting the
size of the teeth:
 Buccolingual width.
 Mesiodistal length.
 Ciedusogingival height.
Buccolingual Width
The buccolingual width of the artificial teeth should be
decreased so that the buccal and lingual Surfaces slope out from
the occlusal surface to provide a proper path of escapement of
food during mastication.
It should be such that the forces from the tongue neutralize
the forces of the check. If the buccolingual width increases, the
forces acting on the denture will also increase, leading to
increase in the rate of ridge resumption. Broader teeth encroach
into the tongue space leading to instability of tire denture. Also,
the teeth should not encroach into the buccal corridor space to
avoid check biting.
Mesiodistat Length
The mesiodistal length of each tooth should be selected
such that the combined length of all the posterior teeth on that
side of the arch does not exceed the distance between the canine
and the retromolar pad.
Posterior teeth should not be placed over steep
antemposterior ridge slope as this would lead to forward
displacement of the denture. Similarly the teeth should not be
placed over displaceable tissues like the retromolar pad as it will
cause tipping of the denture during function.
In cases with inadequate mesiodistal length, the premolar
can be omitted.

13. Occluso-gingival Height
It is determined by the available inter-arch distance. The
occlusal plane should be located at the midpoint of the
interocclusal distance (Fig. 10.62). Large teeth selected for cases
with inadequate interocclusal distance appear artificial and
require modification before arrangement. Measures like altering
the thickness of the denture base can also be done to
accommodate large teeth.
Form of the Posterior Teeth
Posterior teeth are available in different forms. Before we
go into the details about each tooth form, we shall discuss the
factors that control the w1oction of the form of a tooth.
Factors that control the selection of the form of a tooth:
 Condular incintion Teeth with a high cuspal height are
requires for patients with steep condylar guidance. This is
because the jaw separation will increase for patients with
acute condylar guidance during protrusion.
 Height of Me residual rid e: Shallow cusped teeth go better
with shallow ridges.
 Palient's age: Teeth with shallow cusps am, preferred in
older people.
 Ridge reotionshipr: 0 ͦ or monoplane teeth tire preferred
for cases with posterior cross bite or severe class II
relationship.
 Hanau's quint (discussed later).
Morphologically teeth can be classified as.,
 Cusp teeth
- Anatomic teeth
- Semi-anatomic or modified cusp or low cusp teeth
 Cuspless teeth
 Special forms

14. Cusp Teeth
They have cusps and fossae-like natural teeth. They are of
two types, namely anatomic and semi-anatomic. Cusp teeth can
be used in the following occlusal schemes:
 Bilateral balanced occlusion in centric and eccentric
relations.
 Balance in centric only.
 Non-intercepting cusp (modified occlusion).
Anatomic teeth These- teeth resemble normal newly-
erupted teeth. They provide the best aesthetics and are the most
commonly used type of artificial teeth. The cusps resemble
normal dentition with an angle of 33 ͦ . Anatomic teeth with 30 ͦ
cuspal angulations are also available and am, commonly known
as Pilkington-Turner teeth.
Advantages of anatomic teeth
 Closely resembles natural teeth-highly aesthetic.
 Proper contours for crushing and triturating.
 Presence of adequate sluiceways.
 Greater chewing efficiency. excessive chewing pressure is
minimized.
 Mom vertical chewing stroke.
 Cuspal inclines provide a depth to obtain eccentric
balance.
 Provides a greater resistance to rotation of dentures.
 Provides a comfortable position to return to when cusps
are making contact in fossae.
Disadvantages of anatomic teeth
 More difficult and time consuming to obtain balanced
occlusion.
 Settling (stabilization of occlusion) results in more
damaging interferences.
 possibilities of more lateral stress in function.
 Settling also causes the vertical dimension at occlusion to
decrease and the mandible to move forward,

15.  Settling will lead to residual ridge resorption.
Semi-anatomic Teeth
They are also known as modified-cusp or low-cusp teeth.
They may have 20 ͦ or 10 ͦ cuspal angulation. l0 ͦ semi-anatomic
teeth am commonly known as functional or anatoline teeth.
They are used in cases with mild discrepancies in jaw relation.
They are more flexible to arrange than anatomic teeth but then
am not as flexible as non -anatomic teeth.
Advantages of semi-anatomic teeth
 Easier it, arrange and obtain balanced occlusion.
 Can provide freedom if settling occurs.
 Reduction of lateral stresses.
 Provides all the advantages of cusp teeth.
Disadvantages of semi-anatomic teeth
 Less aesthetic (buccal cusps are shorter)
 Leis chewing efficiency (controversial: some claim
greater)
Cuspless Teeth
They are also known as 0 ͦ, flat, or monoplane teeth. They
have no cuspal angulation hence are very flexible to vet. It is
easy to vet non-anatomic teeth in balanced occlusion. Cuspless
teeth can be used for the following occlusal schemes:
 Bilateral balance with a compensating curve.
 Three-paint balance with a balancing ramp.
 Hat plane-balance in centric only.
 Reverse-pitch (Anti-Monson) curve.
Advantages of cuspless occlusal schemes
 More stable lower denture during mastication
 More vertical chewing stroke.
 More shear in the chewing stroke.
 More tongue room.

16. ??????????????? schemes
 Less stability to the upper denture.
 No balance in excursive glides (unless plea-sure curve
added). Refer arrangement of teeth.
Advantages of 0i teeth
 Easy to set up.
 Least lateral stress.
 Least anterior-posterior interferences after settling.
 Best cur patients with poor muscular control.
 Best for patients with poor ridge relationships.
 Reduced buccolingual width, and sharp grooves and
sluiceways compensate for cusps in obtaining equal
chewing efficiency.
Disadvantages of 0 ͦ teeth
 Very difficult to obtain balanced occlusion in excursive
movements.
 Less chewing efficiency especially for fibrous or tough
food.
 Poor aesthetics.
 When set on a flat plane, a space develops pos-tericirly
when excursions occur ("Christenson's phenomenon"),
causing excessive pressure and resorption in the anterior
region.
Special Tooth Forms
They include French's posteriors, coffee bars masticator,
VO posteriors, Sosin-bladed teeth and many others. Cutter bars
and masticators are no longer available. These teeth am,
discussed in detail in the first chapter under the parts of a
complete denture.
Advantages
 Some can provide moderate to excellent function.
 To date, meet efficient design is Sosin bladed teeth.

17. Disadvantages
 Often aesthetics is poor.
 Best forms require meticulous execution and skill.
 More expensive
 Many commercially available forms are poorly designed
and have only "gimmick" value.
Selection of Teeth Based on the Type of Material Used
Acrylic, porcelain or new hard acrylics are the most
commonly used. Composite teeth are also available. Acrylic and
porcelain teeth have been discussed in parts of a complete
denture. Hard acrylic teeth show more resistant to wear and
stains. Acrylic and porcelain teeth are discussed detail in parts of
a complete denture in Chapter 1.
Teeth arrangement is the next step in the fabrication of a
complete denture. Before we go into the principles of
arrangement of teeth, we shall discuss the concepts of occlusion.