Dr shabeel pnDr shabeel pn

ANTERIOR TEETH SELECTION

THE ANTERIOR TEETH ARE PRIMARILY SELECTED TO SATISFY THE ESTHETIC REQUIREMENT,WHERE AS THE POSTERIOR TEETH ARE PRIMARILY SELECTED TO SATISFY THE FUNCTIONAL REQUIREMENTS THE ANTERIOR TEETH ARE COMPOSED OF SIX MAXILLARY AND SIX MANDIBULAR TEETH.

INTRODUCTION

OBJECTIVES FOR TOOTH OBJECTIVES FOR TOOTH SELECTIONSELECTION

TO CONSTRUCT THE COMPLETE DENTURE THAT…………TO CONSTRUCT THE COMPLETE DENTURE THAT…………

1. FUNCTION WELL EFFICIENT 1. FUNCTION WELL EFFICIENT

FOR MASTICATION.FOR MASTICATION.

2. ALLOW PATIENT TO SPEAK 2. ALLOW PATIENT TO SPEAK NORMALLY.NORMALLY.

3. ESTHETICALLY PLEASING.3. ESTHETICALLY PLEASING.

4. WILL NOT ABUSE TISSUE OVER 4. WILL NOT ABUSE TISSUE OVER RESIDUAL RIDGE. RESIDUAL RIDGE.

5. SHOULD MAINTAIN THE VERTICAL 5. SHOULD MAINTAIN THE VERTICAL DIMENSION DIMENSION

FACTORS FOR SELECTION OF ANTERIOR TEETH

1. SIZE OF THE TEETH

2. FORM OF THE TEETH

3. COLOR / SHADE OF THE TEETH

4. COMPOSITION OF MATERIAL OF TEETH

SIZE OF THE TEETHSIZE OF THE TEETH

There are seven anatomic entities are used as anatomic guides for the selection of anterior teeth for size

1. SIZE OF THE FACE

2. SIZE OF THE MAXILLARY ARCH

3. INCISAL PAPILLA AND CUSPID EMINENCES 4. MAXILLO MANDIBULAR RELATIONS

5. THE CONTOUR OF THE RESIDUAL RIDGE

6. VERTICAL DISTANCE B\W THE RIDGES

7. THE LIPS

1. SIZE OF THE 1. SIZE OF THE FACEFACE

The average width of the maxillary The average width of the maxillary central incisor is estimated to be one central incisor is estimated to be one sixteenth of the face measured between sixteenth of the face measured between the zygoma.the zygoma.

The size of the maxillary central incisor The size of the maxillary central incisor is important for they are the most is important for they are the most prominent teeth in arch as individual is prominent teeth in arch as individual is viewed from frontal position.viewed from frontal position.

““the tribute tooth indicator” is useful in the tribute tooth indicator” is useful in determining the maxillary central determining the maxillary central incisor.incisor.

2. SIZE OF THE MAXILLARY 2. SIZE OF THE MAXILLARY ARCHARCH

The mold selector can be used to make The mold selector can be used to make measurement of the maxillary cast.measurement of the maxillary cast.

Accurately contoured occlusion rims Accurately contoured occlusion rims are requiredare required

The measurements are made from the The measurements are made from the midline on the maxillary occlusion rim midline on the maxillary occlusion rim to the distal of the cuspid eminenceto the distal of the cuspid eminence

Measure the distance from the distal of Measure the distance from the distal of one cuspid eminence to the distal of one cuspid eminence to the distal of the other with a flexible.the other with a flexible.

THE SIZE OF THE THE SIZE OF THE MAXILLARY ARCHMAXILLARY ARCH

3. INCISAL PAPPILAE & THE CUSPID 3. INCISAL PAPPILAE & THE CUSPID EMINENCE OR THE BUCCAL FRENUMEMINENCE OR THE BUCCAL FRENUM

If the cuspid eminence are visible, a line can If the cuspid eminence are visible, a line can be placed on the cast at the distal termination be placed on the cast at the distal termination of the eminence.of the eminence.

If the cuspid eminence are not visible the If the cuspid eminence are not visible the attachment of the buccal frenum can be used. attachment of the buccal frenum can be used. A line placed slightly anterior to the frenum A line placed slightly anterior to the frenum attachment will be distal of the eminence.attachment will be distal of the eminence.

Measure the distance from the distal of one Measure the distance from the distal of one cuspid eminence to the distal of the other with cuspid eminence to the distal of the other with a flexible ruler. The ruler should follow the a flexible ruler. The ruler should follow the contour of the ridge and as it reaches midline, contour of the ridge and as it reaches midline, it should be placed on the anterior border of it should be placed on the anterior border of the incisal papilla. the incisal papilla. The combined width of The combined width of the six max anterior teeth is determined in the six max anterior teeth is determined in mms. mms.

INCISAL PAPILLA AND THE INCISAL PAPILLA AND THE CUSPID EMINENCES OR THE CUSPID EMINENCES OR THE

BUCCAL FRENUMBUCCAL FRENUM

4.MAXILLO MANDIBULAR 4.MAXILLO MANDIBULAR RELATIONSRELATIONS

Any disproportion in size between the Any disproportion in size between the maxillary and mandibular arches maxillary and mandibular arches influence the length, width, and the influence the length, width, and the position of the teeth.position of the teeth.

In instances of protruded mandible, In instances of protruded mandible, the mandibular anterior teeth are the mandibular anterior teeth are frequently larger than normal. If the frequently larger than normal. If the mandible are retruded the mandible are retruded the mandibular anterior teeth are mandibular anterior teeth are frequently smaller. frequently smaller.

5. CONTOUR OF THE RESIDUAL 5. CONTOUR OF THE RESIDUAL RIDGERIDGE

The artificial teeth should be placed The artificial teeth should be placed to follow the contour of the residual to follow the contour of the residual ridges that existed when the natural ridges that existed when the natural teeth were present.teeth were present.

The loss of contour as a result of The loss of contour as a result of resorption, accident or surgery resorption, accident or surgery makes this a difficult task. makes this a difficult task.

As resorption occurs, the maxillary As resorption occurs, the maxillary arch appears smaller and the arch appears smaller and the mandibular arch larger.mandibular arch larger.

6. THE VERTICAL DISTANCE BETWEEN 6. THE VERTICAL DISTANCE BETWEEN THE RIDGESTHE RIDGES

The length of the teeth is determined The length of the teeth is determined by the available space between the by the available space between the existing ridges.existing ridges.

When the space is available, it is When the space is available, it is more esthetically acceptable to use a more esthetically acceptable to use a tooth long enough to eliminate the tooth long enough to eliminate the display of the denture base. Teeth display of the denture base. Teeth are more attractive in appearance are more attractive in appearance than denture base material.than denture base material.

THE VERTICAL DISTANCE THE VERTICAL DISTANCE BETWEEN THE RIDGES.BETWEEN THE RIDGES.

7.THE LIP7.THE LIPWhen the lips are relaxed and apart When the lips are relaxed and apart

the labial surface of the maxillary the labial surface of the maxillary anterior teeth support the upper lip. anterior teeth support the upper lip. The incisal edge extends inferior to The incisal edge extends inferior to or slightly below the lip margin.or slightly below the lip margin.

When the teeth are in occlusion and When the teeth are in occlusion and the lips are together, the labial the lips are together, the labial incisal 3incisal 3rdrd of the max anterior teeth of the max anterior teeth supports the superior border of the supports the superior border of the lower liplower lip

In speech the incisal edges of the In speech the incisal edges of the max anterior teeth contact the lower max anterior teeth contact the lower lip at the junction of the moist and lip at the junction of the moist and dry surfaces of the vermillion border. dry surfaces of the vermillion border.

THE LIPTHE LIP

VISIBLE PORTION OF ANTR TEETH AT VISIBLE PORTION OF ANTR TEETH AT REST REST 2mm BELOW THE RELAXED 2mm BELOW THE RELAXED LIPLIP

TheThe length length and theand the width width are the only are the only two dimensions which need to determining the size two dimensions which need to determining the size

of the teethof the teethLengthLength

The length of the upper six anterior teeth The length of the upper six anterior teeth is normally such that the neck of the teeth is normally such that the neck of the teeth will overlap the anterior ridge by 2-3mmwill overlap the anterior ridge by 2-3mm

Cervically up the incisive edges of the Cervically up the incisive edges of the centrals will show below the relaxed lip.centrals will show below the relaxed lip.

Length of the teeth depends on the Length of the teeth depends on the following factorsfollowing factors

- length of the upper lip - length of the upper lip - mobility of the upper lip- mobility of the upper lip- vertical height of occlusion- vertical height of occlusion- overbite- overbite

LENGTHLENGTH

WidthWidth Most satisfactory way of selecting teeth width Most satisfactory way of selecting teeth width

is to choose a set which are wide enough to is to choose a set which are wide enough to allow the canines to be mounted on the allow the canines to be mounted on the canine eminence when set up.canine eminence when set up.

HARMONYHARMONY

The face length is taken from supra The face length is taken from supra orbital ridge line to inferior border of orbital ridge line to inferior border of the chin.the chin.

Breadth is the distance between the Breadth is the distance between the zygomatic processes.zygomatic processes.

The length is greater than width The length is greater than width would indicate teeth of those would indicate teeth of those proportions, irrespective of their proportions, irrespective of their shape.shape.

BERRY’S BIOMETRIC INDEXBERRY’S BIOMETRIC INDEX

Used to derive the length of central incisor Used to derive the length of central incisor using zygomatic width or the length of the using zygomatic width or the length of the face.face.

Length of the face is the distance measured Length of the face is the distance measured B\W the hairline and the tip of the chin. B\W the hairline and the tip of the chin.

Width of the maxillary central incisor Width of the maxillary central incisor =zygomatic width/ 16 =zygomatic width/ 16

=length of the =length of the face/20face/20

POUND’S FORMULAPOUND’S FORMULA

To determine the length and width of To determine the length and width of central incisor using the zygomatic central incisor using the zygomatic width and length of face respectively.width and length of face respectively.

Width of the max CI =Width of the max CI =ZYGOMATIC WIDTHZYGOMATIC WIDTH//1616

Length of the CI = Length of the CI = LENGTH OF THE FACELENGTH OF THE FACE//1616

ANTHROPOMETRIC CEPHALIC ANTHROPOMETRIC CEPHALIC INDEXINDEX

The transverse circumference of the head is measured The transverse circumference of the head is measured using a measured tape at the level of the forehead.using a measured tape at the level of the forehead.

Width of the upper CI= circumference of the head/13Width of the upper CI= circumference of the head/13

Total width of the upper antrs=bizygomatic width/3.36Total width of the upper antrs=bizygomatic width/3.36

Total width of the lower antrs= 4/5Total width of the lower antrs= 4/5thth width of upper width of upper anteriorsanteriors

Based on the width of the noseBased on the width of the nosewidth of the nose= combined width of the anterior width of the nose= combined width of the anterior

teethteeth

•

METHODS USINGMETHODS USING PRE-EXTRACTION PRE-EXTRACTION

RECORDSRECORDS

DIAGNOSTIC CASTSPRE-EXTRACTION PHOTOGRAPHSPRE-EXTRACTION RADIO GRAPHSTEETH OF CLOSE RELATIVESPRESERVED EXTRACTED TEETH

Methods using theoretical Methods using theoretical conceptconcept

Winkler's concept

According to Winkler, THE TEETH SHOULD BE SELECTED BASED ON THREE DIFFERENT VIEWS

A – PHYSIOLOGICAL

B – PSYCHOLOGICAL

C - BIOMECHANICAL

PHYSIOLOGICALPHYSIOLOGICAL

The facial musculature contributes to The facial musculature contributes to esthetics of the patientesthetics of the patient

Increasing the thickness of the Increasing the thickness of the denture base in the labial and the denture base in the labial and the buccal sulci can produce a puffy buccal sulci can produce a puffy appearance.appearance.

Facial wrinkles fade when when the Facial wrinkles fade when when the vertical dimension is increased.vertical dimension is increased.

PSYCHOLOGICALPSYCHOLOGICAL

A patient with a +ve self evaluation shows A patient with a +ve self evaluation shows a broad smile up the one width a negative a broad smile up the one width a negative self evaluation shows a tight lipped small self evaluation shows a tight lipped small smile smile

The campers line the psychological plane The campers line the psychological plane of orientation (superior border of the of orientation (superior border of the tragas of ear to inferior border of the ala of tragas of ear to inferior border of the ala of the nose). the nose).

It is raised in happy people and is tilted It is raised in happy people and is tilted down ward in depressed people. down ward in depressed people.

BIOMECHANICALBIOMECHANICAL

The teeth should be placed such that The teeth should be placed such that they fulfill the biomechanics of the they fulfill the biomechanics of the denture.denture.

The teeth should be set in the The teeth should be set in the neutral zone.neutral zone.

BIOMECHANICALBIOMECHANICAL

COLOR/SHADE OF THE COLOR/SHADE OF THE TEETHTEETH

Color is described by means ofColor is described by means of- hue - hue

- value- value

- chroma- chroma

• Tooth shade must be compatible with the patient’s Tooth shade must be compatible with the patient’s facial expression and eye colorfacial expression and eye color

• The color must be in harmony with surrounding The color must be in harmony with surrounding environment like hair, skin and eyes.environment like hair, skin and eyes.

• The neck of the teeth has a more pronounced color The neck of the teeth has a more pronounced color than incisive edge.than incisive edge.

• Incisive edge is more translucent than body of Incisive edge is more translucent than body of toothtooth

Older people have dark and opaque teeth Older people have dark and opaque teeth and are more shiny also, than young and are more shiny also, than young peoplepeople

in people who are smokers, alcoholics and in people who are smokers, alcoholics and chewers have discolored teeth due to chewers have discolored teeth due to stains porcelain teeth are preferred since stains porcelain teeth are preferred since they don’t allow percolation.they don’t allow percolation.

The color of the teeth chosen should be in The color of the teeth chosen should be in harmony with the complexion of the harmony with the complexion of the patient.patient.

COLOR OR SHADECOLOR OR SHADE

SHADE TABSSHADE TABS

FORM OF THE ANTERIOR FORM OF THE ANTERIOR TEETHTEETH

The form of the teeth should be conformed The form of the teeth should be conformed to contour of the face as considered from to contour of the face as considered from the labial, mesial, distal and incisal aspectthe labial, mesial, distal and incisal aspect

The general outline of the tooth should The general outline of the tooth should conform to the general outline of the face conform to the general outline of the face when viewed from frontal aspect.when viewed from frontal aspect.

Three factors are used as guides in the Three factors are used as guides in the selection of anterior teeth for form.selection of anterior teeth for form. 1.1. The form and contour of the face The form and contour of the face 2.2. SEXSEX3.3. AGE AGE

THE FORM AND CONTOUR OF THE FORM AND CONTOUR OF THE FACETHE FACE

According to According to Leon Williams Leon Williams classification faceclassification face

Three types Three types 1.1.SquareSquare

2.2.TaperingTapering

3.3.Ovoid Ovoid

TRIBYTE INDICATORTRIBYTE INDICATOR

to determine the facial form and outline

SQUARESQUARE

Facial formFacial form- the width of the forehead, - the width of the forehead,

zygomatic arch and mandibular zygomatic arch and mandibular angle is equal.angle is equal.

• ProfileProfile- straight and flat ala area- straight and flat ala area

• Incisal formIncisal form- mesial and distal lines are - mesial and distal lines are

almost parallel till the length of 2/3almost parallel till the length of 2/3rdrd from incisal edge.from incisal edge.

ovoidovoid

Facial formFacial form

- width of zygomatic arch is - width of zygomatic arch is wider than the distance of forehead.wider than the distance of forehead.

• Profile Profile

- ovoid ala area- ovoid ala area• Incisal formIncisal form

- mesial and distal lines are - mesial and distal lines are curved.curved.

TaperingTapering

Facial form Facial form - the width becomes narrow - the width becomes narrow

from forehead towards to zygomatic from forehead towards to zygomatic arch and mandibular angle.arch and mandibular angle.

• ProfileProfile- curved or flat- curved or flat

• Incisal formIncisal form- mesial and distal lines become - mesial and distal lines become

narrow from incisal edge to cervical narrow from incisal edge to cervical end.end.

SQUARE , OVOID , SQUARE , OVOID , TAPERING FORMSTAPERING FORMS

TOOTH FORM IN RELATION TO ARCH TOOTH FORM IN RELATION TO ARCH FORMFORM

V shaped arch - incisors with narrow neck (tapering) Square arch – parallel sided incisor (square)Round arch – ovoid teeth

Dentogenic concept (SPA)Dentogenic concept (SPA)

Sex, personality, age are the factors Sex, personality, age are the factors which will determine the form of the which will determine the form of the antr teethantr teeth

SEXSEX

curved facial features are associated with feminity and square features are associated with musculinity

MUSCULINEMUSCULINE• Prominent teethProminent teeth• Large sized teeth Large sized teeth • Square arch formSquare arch form

• Square labial surfaceSquare labial surface• Square incisal edges Square incisal edges

and cornersand corners• Darker shadeDarker shade• Flat smiling lineFlat smiling line• Canine – cervical area Canine – cervical area

is more visible and is more visible and prominent prominent

FeminineFeminine • Smaller teethSmaller teeth• Round corners Round corners • Curved contours & arch Curved contours & arch

formform• Curved labial surfaceCurved labial surface• Round incisal edges and Round incisal edges and

cornerscorners• Delicate appearanceDelicate appearance• Curved smiling lineCurved smiling line• Canine – mesial 3Canine – mesial 3rdrd only only

seenseen

PersonalityPersonality The dentist should select and arrange teeth so that it improves the patient’s personality. The patient can be vigorous or delicate.

More squarish and large teeth are selected for vigorous people For executives, the anteriors should be in a flat plane and the teeth should be relatively smaller and more symmetrically arranged.

COMPARISON OF SIZE OF THE TEETH OF COMPARISON OF SIZE OF THE TEETH OF DIFFERENT PERSONS ACCORDING TO DIFFERENT PERSONS ACCORDING TO

HEIGHTHEIGHT

AGEAGE

Age Age

Younger peopleYounger people Lighter shadeLighter shade More incisal More incisal

translucencytranslucency Minimal wear of incisal Minimal wear of incisal

edgeedge Curved smiling lineCurved smiling line Pointed caninesPointed canines

Older peopleOlder people Darker shadeDarker shade Less incisal Less incisal

translucencytranslucency

increased wear of increased wear of incisal edgesincisal edges

Flat smiling lineFlat smiling line Loss of tips of canineLoss of tips of canine

COMPOSITION OF THE COMPOSITION OF THE MATERIALMATERIAL

Porcelain teethPorcelain teeth Hard to abradeHard to abrade Retain their finishRetain their finish It must have It must have

mechanical support to mechanical support to the denture basethe denture base

Easier to breakEasier to break

acrylic teethacrylic teeth Not so hard and abrade Not so hard and abrade

easilyeasily It does not need any It does not need any

mechanical supportmechanical support Resin teeth are also Resin teeth are also

indicated if patient is indicated if patient is wearing denture that wearing denture that click during speechclick during speech

Their combinations can also be used

Steps in antr teeth selectionSteps in antr teeth selection

STEP 1STEP 1 THE 1THE 1STST STEP IS TO LISTEN TO THE PATIENT STEP IS TO LISTEN TO THE PATIENT ASK THE PATIENT WHAT HE WANTS AND ASK THE PATIENT WHAT HE WANTS AND

PRIOR IMPORTANCE IS GIVEN TO HIMPRIOR IMPORTANCE IS GIVEN TO HIM PT’S BY- STANDER’S OPINION IS ALSO VALIDPT’S BY- STANDER’S OPINION IS ALSO VALID

• STEP 2STEP 2 GET RECORDS OF EXISTING AND PREVIOUS GET RECORDS OF EXISTING AND PREVIOUS

TEETHTEETH ASK THE PATIENT TO BRING ANY MODELS, ASK THE PATIENT TO BRING ANY MODELS,

OLD DENTURES AND PHOTOS.OLD DENTURES AND PHOTOS.

STEP 3STEP 3• VIEW THE PATIENT’S FACE IN GOOD LIGHTVIEW THE PATIENT’S FACE IN GOOD LIGHT• GIVE A MIRROR TO THE PATIENT TO HOW THEY LOOK.GIVE A MIRROR TO THE PATIENT TO HOW THEY LOOK.

STEP 4STEP 4 ALLOW THE PATIENT TO SELECT THE COLOR OF THE ALLOW THE PATIENT TO SELECT THE COLOR OF THE

TEETHTEETH

STEP 5STEP 5 CHOOSE THE SIZE OF THE TOOTH THAT IS APPROPRIATE CHOOSE THE SIZE OF THE TOOTH THAT IS APPROPRIATE

TO EXISTING DENTURE, MODELS OF PREVIOUS TEETH.TO EXISTING DENTURE, MODELS OF PREVIOUS TEETH.

STEP 6STEP 6 SELECT THE MODEL OF THE TEETHSELECT THE MODEL OF THE TEETH

ATS SHOULD BE COMPLETED ATS SHOULD BE COMPLETED EARLY IN TREATMENT PREFERABLY EARLY IN TREATMENT PREFERABLY BEFORE FINAL IMPRESSIONS ARE MADE. BEFORE FINAL IMPRESSIONS ARE MADE. THIS ALLOW TIME FOR JUDGMENT OF THIS ALLOW TIME FOR JUDGMENT OF RESULT BEFORE TEETH ARE NEEDED. RESULT BEFORE TEETH ARE NEEDED.

CONCLUSIONCONCLUSION

ATS IS THE AREA OF ATS IS THE AREA OF PROSTHODONTIC CARE IN WHICH THE PROSTHODONTIC CARE IN WHICH THE PATIENT SHOULD BE GIVEN A PATIENT SHOULD BE GIVEN A PRIMARY RESPONSIBILITY TO PRIMARY RESPONSIBILITY TO DETERMINE THE ESTHETIC OUT COME. DETERMINE THE ESTHETIC OUT COME. SO, A DENTIST SHOULD ASSIST THE SO, A DENTIST SHOULD ASSIST THE PATIENT IN MAKING THE BEST PATIENT IN MAKING THE BEST DECISION.DECISION.

THANK THANK YOU…YOU…