Selection of artificial teeth

King Faisal University
,College of Dentistry
Department of substitutive Dental
Sciences,
Clinical Removable Prosthodontics-I

Selection of Artificial
Teeth for Edentulous
patients

Lecture Outline
Introduction -

INTRODUCTION
Aesthetics is one of the objectives of the .complete denture prosthodontics
Harmony between the teeth, face, head and .skin
Artificial teeth selection is artistic skill and .scientific knowledge

.Cont
No rules of thumb for teeth selection, utilizing the anatomic land marks and
. manufactured aid will be helpful
For the ease, we divided selection of :artificial teeth into
Anterior teeth and
.Posterior teeth

-

Selection of the
.Anterior Teeth

Selection of the Anterior Teeth
: Pre-extraction guides. 1
.A. Study Casts
. B. Photographs
.C. Radiographs
.D. Extracted Teeth

Pre-extraction Guides
:A. Study Casts
Most reliable guide in selecting the size, shape, and position of the natural
.teeth

.Cont
:B. Photographs
Most recent photographs, close-up .with patient smiling
Facial photographs is usually helpful for determining the anterior teeth
placement, arch form, and lip support
than the actual size or the mould of
.artificial teeth

.Cont
:C. Intra-Oral Radiographs
Keeping in mind the radiographs distortion, radiographs will give clue
about width, length and shape of the
.teeth to be replaced

.Cont
:D. Extracted Teeth
Give clue about the size, shape and mould of the artificial teeth but not the
.color

Examination of Existing Dentures. 2
Asking patients in the initial interview :with the patient
What he/she likes or dislikes?about his/her appearance
?What changes would he/she wants-

Indirect Methods of teeth selection .3
(.(post-extraction guides
When all the records of form, color and size are lost, it is challenging
.procedure

A. Size of Anterior Teeth
B. Form of Anterior Teeth
C. Shade of Anterior Teeth

Size of Anterior Teeth
.Width of Anterior Teeth.1
. Length of Anterior Teeth. 2
Thickness of Anterior Teeth. 3

Size of Anterior Teeth
.A.Width of Anterior Teeth
Bizygomatic Width Using Trubyte Tooth Indicator, Face bow and ruler can be used to measure bizygomatic
. width
Width of the six Anterior Teeth =
Bizygomatic Width/3.3
Width of the Maxillary Central Incisor =
.Bizygomatic Width /16

.Cont
. The buccolingual centres of the hamular notches Width of the six anterior teeth = distance between the buccolingual centres of the hamular notches + 5
. mm
:The size and contour of the Residual Ridges :Maxillary Arch Resorption In anterior segment of the arch is in a Vertical and Palatal direction, posteriorly, the resorption is in a
.Vertical and Medial direction

.Cont
Mandubular Arch Resorption In anterior segment of the arch is in a Vertical and
Lingual direction, posteriorly, the resorption is in a
. vertical and slightly lingual direction
Maxillary arch appears smaller and mandibular arch .larger
:Corners of the Mouth
The distal surface of many natural upper canines ispositioned at the corner of the relaxed mouth, which
.represent inter canine distance

.Cont
:Canine Eminence 
If well-defined, the distance between lines drawn on the master cast of the upper jaw at the distal aspect
. of the eminence may give inter canine distance
:The width of the Nose
Vertical parallel lines extending from the lateral surfaces of the ala of the nose onto the labial
surface of properly contoured upper occlusal rim
will give indication of the position of the cusp tips of
. the maxillary canine teeth

.Cont
Width of Upper Anterior six teeth = width of
. the nose + 6 mm
: Lateral Surface of the Nose
Imaginary line along the lateral surface of - the nose, through the centre of the brow-line,
and contacting the lateral aspect of the ala.
The line on properly contoured occlusal rim
gives an indication of the distal aspect of the
canine at the point where the projected line
.passes through the occlusal plan

.Cont
:The Incisive Papillae
The line parallel to the coronal plane contacts the natural canine teeth near the tips of the
.cusps
:Maxillomandibular Relations
Any disproportion in size between the maxillary and mandibular arches influences
the length, the width, and position of the
.teeth

.Cont
: Cranial Circumference
Direct relation between the width of the six maxillary anterior teeth and cranial
circumference (as horizontal circumference
of the cranium about a plane passing
through the glabella and maximum occipital
. point
Width of Maxillary anterior teeth = Crinial
circumference/10

Length of Anterior Teeth
The Vertical Distance between the
:Ridges
The length of the teeth is determined by the. available space between alveolar ridges
It is more aesthetically acceptable to use along tooth to eliminate the display of the
.denture base

.Cont
The Lips

The labial surface of the maxillary anterior teeth support the upper lip
and the amount of the central incisors
visible below the lipis about 2-3 mm in
young people and less than half that
. amount in elderly people
That extension will vary in relation to .the fullness of the lips

.Cont
When the teeth are in occlusion and the lipsare together, the labial incisal third of the
maxillary anterior teeth support the superior
.border of the lower lip
The amount of tooth which an individual:shows varies depending on the following
.Length of the upper lip
.Mobility of the upper lip
.Vertical dimension of occlusion
(.Vertical overlap (over bite

.Cont
Thickness of the Anterior Teeth
.It has important role on phonetics In general thicker teeth have preference in .selection
Ease with setting (spacing, rotation,…( and.better aesthetics
The manufacturers of denture teeth usuallyrelate the size of the mandibular anterior
.teeth to the maxillary anterior teeth

HELPFUL GUIDES IN THE
SELECTION OF TOOTH SIZE
Generally, larger people have larger teeth; in addition, men usually have larger teeth than
women, particularly when comparing the maxillary
.lateral incisors
Approximate location of the distal surface of the maxillary canines can be indicated by marks made
on the maxillary occlusion rim at the corners of the
mouth. Then the distance between the marks is
measured around the labial surface of the
occlusion rim (overall width of the maxillary six
(artificial teeth in curve

.Cont
The width of most natural maxillary central incisors is over 8.5 mm and any tooth less than 8 mm is
rare. The combined width of the maxillary six
anterior teeth is normally 46 mm or more and
.anything less than 45 mm is very unusual
Natural anterior teeth vary greatly in size, but as a rule they are much larger than is generally realized
and one of the commonest prosthetic errors is to
use teeth which are too small, thus making them
.appear obviously false

Form (shape( of Anterior Teeth
The outline form of the anterior teeth should
harmonize with the shape of the patient’s
. face
The shape of the maxillary central incisor bears a definite relationship to the shape of
.the face
They classified the human face into three basic types: square, tapering, and ovoid, may
have combination of two or more of these
.basic forms

.Cont
:THE SQUARE TYPE
the sides of the face are almost parallel

:THE SQUARE TAPERING
is similar to the square type except that the
parallelism exist only on a point just below
the zygomatic arches and then the face
.develops a tapering effect

.Cont
:THE TAPERING TYPE
in these faces the dimensions decrease downward,
the forehead being the widest, the zygomatic
width somewhat less and the mandibular width
.the least

:THE OVOID TYPE
this type is always characterized by the zygomatic
width being the widest, the forehead and the
.mandibular areas being of decreased dimensions
the method of tooth selection become known as the
.geometric theory

HELPFUL GUIDES IN THE
SELECTION OF TOOTH FORM
The Form and Contour of the Face
The form of artificial anterior teeth should harmonize with the shape of the patients
.face
The geometric outline of the face when viewed from the frontal, mesial, distal
.and incisal aspects

.Cont
The geometric figures, square, tapering, ovoid and combinations therefore serve as a starting
point in selecting the tooth form as it is viewed
.from the frontal aspect
The Trubyte Tooth Indicator* may be used in one :of the two ways to establish the facial outline
.The general outline of the face from the frontal aspect
To determine the facial profile

Shape of the Edentulous Maxillary Arch
It was recognized that there was some relationships between the shape of the
edentulous maxillary arch and the
.maxillary teeth

.Cont
Sex
Curved facial features are associated with femininity and square features are
.associated with masculinity
Ovoid tooth is more feminine and square tooth is more masculine
A curve labial surface is more feminine and the flat labial surface is more
.masculine

.Cont
Age
As the features change with the aging process so does the form of the teeth.
The lips lose their curves and cuspid's
bow, and the teeth wear at the incisal
.edges and inetrproximal surfaces
The labial surface seem flatter, and the outline from appears more square

.Cont
The male become more square in form to complement the added weight and
squareness of the body, as the body of the
female loses its curves, the teeth loses
.their curves
Age and sex should be reflected in the .tooth mould selection

.Cont
The mould guide groups the various denture tooth moulds available into facial
outline from such a square, ovoid,
tapering, tapering ovoid, and square
.tapering
The dentist should select the anterior denture teeth from the group that
coordinates with the arch form and the
.patients typal face form



- Mould chart provides illustration of
each of the six anterior teeth and gives
the measurements of the denture teeth
to the right of each mould. These
measurements include the length and
width of the maxillary central incisor as
well as the width of the six anterior
teeth on curve.

.Cont
Once you have selected the maxillary anterior denture teeth, use the mould guide chart to find
the corresponding mandibular anterior denture
teeth. When selecting denture teeth for Class II
anterior tooth relationship, you must use a
mandibular mould smaller than that
recommended by the mould guide. Because of the
.retruded and narrow mandibular arch from
Likewise when selecting anterior denture for a Class III relationships you must use a mandibular
mould larger than that recommended by the
mould guide, because of the protruded and wider
.mandibular arch form

SHADE OF ANTERIOR TEETH
The selection of a suitable shade for an edentulous person is a matter of individual
.judgment
Color is not critical for the edentulous patient provided that it is compatible with
the general coloring of the skin and to
lesser extent the hair and the iris of the
eyes but most importantly with the age of
.the patient
The hue and saturation of color in the .teeth must harmonize with that of the skin

SUGGESTED GENERAL GUIDELINES
FOR SHADE SELECTION
People with fair complexions generally have teeth with less color, and the colours are
less saturated, thus the teeth are lighter
and are in harmony with the color of the
.face
Younger patients will be exhibit a great vitality and brilliance and require lighter
shade. The teeth of younger patient also
often have pink tint due to underlying
pulpal tissues, besides, they exhibit incisal
.translucency

Older patients tend towards less brilliance and darker shades, brown and yellow
.shades are more prevalent
Maxillary central incisor are the lightest teeth in the mouth; maxillary laterals and
mandibular incisors are slightly darker;
.canines are darker still
Breaking up the color of the anterior teeth can be accomplished by selecting teeth of
different shades from different sets of six
.anterior teeth

The apparent shade of the tooth is affected by its position of the arch. More prominent
teeth appear lighter while those in a
.recessed position appear darker
Generally when selecting the mandibular anterior tooth shade, the same shade
selected for the maxillary anterior teeth
.may be used
Posterior teeth are usually uniform in color .and very slightly lighter than canines

HELPFUL CLINICAL GUIDES IN THE
PROCESS OF SHADE SELECTION
Patient should be in an upright position. The dentist should be in a position so that the
teeth are viewed in a plane perpendicular to
the plane vision. Distance and angulation
are factors of major significance. The shade
selection should be evaluated from the
distance as well as at close range. The
teeth should also be viewed from both
sides as well as from the straight frontal
.position
The patients mouth should not be opened too wide, but should remain a dark cavity as in
.ordinary conditions

It is best if the dentist eliminates all but two or three shades before conferring with the
patient. He should never approach the
.patient with entire shade guide
Hold the shade guide outside the mouth against the skin of the face, and also near
the eyes of the hair of the patient. Harmony
should exist between the color of the teeth
.and the color of the skin, hair and eyes
Always moisten the shade guide with saliva or water

Always place the teeth under consideration in the shade of the upper lip in the position
they are too occupy; they will appear darker
.in this position than in the hand
Attempt to look at the face as a whole rather than focus entirely on the teeth, and
whenever possible select the teeth shade
under natural or color – corrected artificial
.light

Eyes fatigue to color perception very rapidly. Looking steadily at a soft blue, gray green
card before looking at the shade guide of
the tooth as beings placed in the
appropriate area of the patient mouth.
Another method is to place different shade
guide in rapid succession in and out of the
mouth and go by the first impression of
which is best match. The squint test may be
helpful. Many practitioners prefers the flash
.perception technique

When in doubt about a particular shade select a tooth which is obviously too
dark, and view it in position then try
one which is obviously too light,
gradually merging these two extremes
.until pleasing shade selection
Remember that the lighter the shade .the more artificial the tooth looks

Patient participation in shade selection .can be very delicate matter
Remember that the apparent shade of a tooth is affected by its position in the
arch; more prominent teeth appear
lighter while those in a recessed
.position appear darker

TOOTH ARRANGEMENTS
It remains the dentists responsibility to select the mould, shade and material and
.ultimately to refine the arrangement
Arrangement of the anterior teeth should be individualized to the patients cosmetic
needs the bottom line is that the teeth
must look like they belong in the patients
.mouth
The time devoted to arranging the anterior teeth is often greater than for any other
.steps in denture fabrication

Arranging the anterior teeth while the patient is present can be worthwhile for
.both the patient and dentist

DENTOGENIC CONCEPT IN
SELECTING ARTIFICIAL TEETH
Frush and Fisher introduced the dentogenic concept for establishing the
.esthetics of a patient’s complete denture
Also tended to use darker shades in men or patient with bold and vigorous
.personalities
They used lighter shades in women and .patients with delicate personalities
They also advise the dentist to select arrange and alter teeth an carve the
gingiva to suit the patient age and sex and
.personality

Age
Natural teeth wear with age in most patients and this wear can be simulated by grinding the
.incisal edges, of the denture teeth
Chips or notches can also be placed on the incisal .edges
The labial surfaces of the anterior teeth can be .roughened to remove surface gloss
With increasing age, the amount lips are gently parted decreased from 2-3 mm at age 29 to no
.teeth showing at 60 years of age

Incisor with approximately 05 mm showing at age 29 and 2-3 mm showing the age of
.60
In youth the interdental papillae are pointed closely, adapted to the tooth. And
stippled. With age, they become shortened
blunted, edentulous and smooth, with
signs of gingival recession around the
.necks of some teeth

Sex
For anterior tooth arrangement appear feminine, the incisal edges must follow a
.curve which suggests softness
An anterior mesial rotation of the lateral incisor combined with a slightly cervical
inclination of one of the central incisors
and a canine with its cervical portion facing
outward compared to the incisal edge,
.provides a feminine arrangement

A more masculine appearance is achieved by a more square tooth form. The incisal edges
are flat with less of a curve to the edges of
.the six anterior teeth
The central incisor can be arranged so that the incisal edges are in line with each other,
or even and level at the mesial edges to
.create an even more masculine arrangement

Personality
Attempting to position and shape the teeth to complement the patients personality
. involves getting to know the patient
Although the guidelines of dentogenics are not absolute they do offer helpful
suggestions for enhancing the cosmetic
.appearance of many patients teeth

:considered in relation to
Shade. 1
Size and number. 2
Form. 3
Material. 4

SHADE OF POSTERIOR TEETH
The shade of the posterior teeth should harmonize with the shade of the anterior
teeth. The maxillary premolars are
sometimes used more for esthetics than
. for functional purposes
They may be slightly lighter than the other posterior teeth but not lighter than the
.anterior teeth

SIZE AND NUMBER OF POSTERIOR
TEETH
Space available for posterior teeth may be :defined in three dimensions
Buccolingual dimension Mesiodistal dimension Occluso-gingival dimension

-

:BUCCOLINGUAL DIMENSION
it is considered to have the buccolingual width of the artificial teeth less than that of
.natural teeth
Should not be accomplished at the .expense of losing support for the checks

.Cont
MESIODISTAL DIMENSION
Overall mesiodistal width of the posterior teeth is determined by the length and
.slope of the mandibular residual ridge
The mesiodistal width of the posterior teeth is measured from the approximate
position of the distal surface of the
mandibular canine to the mesial end of the
.retromolar pad
The total mesiodistal width in millimeters of the posterior teeth is often used as a
.mould number

.Cont
OCCLUOGINGIVAL DIMENSION
Length of the posterior teeth is determined by the amount of interarch distance. The
greater the distance the longer tooth which
can be used in the vertical space available
more aesthetically pleasing than short
.tooth
Most manufacturers supply posterior teeth in L (long) M (medium) and S (short) lengths

.Cont
A few artificial tooth manufacturers produce short bite teeth for patients
with minimal interarch space short bite
teeth have long facial surface but short
.oclusal portions

FORM OF POSTERIOR TEETH
The three basic tooth moulds anatomic, :semianatomic and nonanatomic
:Anatomic Teeth
An anatomic tooth is one that is designed to stimulate the natural tooth form. The
standard anatomic tooth has inclines of
approximately 33 or more and somewhat
.resembles natural teeth
Anatomic teeth allow balance occlusion to be more readily obtained because of the cusp
.length

.Cont
If opposing ridge relations are fairly normal and the ridge size considered good,
.anatomic teeth are usually indicated
:Advantages
Maximize estheticsProvide balanced occlusion with greater easeProvide better initial penetration of the bolus-

.Cont
:Semi-anatomic Teeth
When the cusp incline is less steep than the conventional anatomic teeth of 33 it
can be classified as a modified or semianatomic teeth. These teeth still look
somewhat like natural teeth but have
modified features to eliminate the
. problems of the purely anatomic teeth
Teeth which look like well-worn natural teeth, but provide the function of
.mechanical of flat plane posteriors

.Cont
:Non-anatomic Teeth 
These teeth are essentially flat (0-ddegree or cuspless) i.e. has no cusp height to
interdigitate (intercuspate) with opposing
.teeth
:Indications
Patients with crossbite tooth relationshipsPatients with poor neuromuscular control orcoordination
Patients with severly resorbed ridgesPatients who have a large discrepancybetween centric jaw and centric occlusion

SELECTION OF THE POSTERIOR
TOOTH MOULD
There is no simple method of posterior teethmould selection, nor are there scientific data
available to support the selection of one
mould over another. Masticatory efficiency,
comfort, and preservation of the supporting
structures are primary concerns of both the
patient and the dentist. The occlusal scheme
chosen, the specific posterior tooth mould
selected, and the arrangement of the teeth
.are also influenced by patient factors

.Cont
It should be understood that the concept of balanced occlusion is
desired when using cusp or modified
cusp form teeth and that non-balanced
occlusion in the eccentric position is
.desired for non-anatomic teeth

.Cont
Factors for consideration when choosing
:prosthetic teeth
Ridge morphologyInterarch distanceArch relationshipNeuromuscular controlEstheticsCombination of foodPrevious denture-wearing experience-



.Cont
The dentist select the posterior tooth mould
:after
, Establishing the plane of occlusionRegistering and transferring the centric jawrelation at the proper occlusal vertical
. dimension
.Mounting the master casts on the articulatorSetting the horizontal condylar guidance from,the protrusive record
Arranging the maxillary anterior teeth for lipsupport, aesthetic, phonetics, and
Arranging the mandibular anterior teeth to.control the condylar guidance

.Cont
:Materials of the posterior teeth
Artificial posterior teeth are supplied in acrylic resin, in a combination of
acrylic and metal and porcelain (airfired or vacuum-fired porcelain). Most
modern porcelain teeth are vacuum.fired

.Cont
Consideration in choosing acrylic or porcelain
:include
Esthetics Color stability Wear Transmission of stress Modification Polishing Bonding Fracture Repair -

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