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SELECTION AND ARRANGEMENT OF ARTIFICIAL TEETH

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SELECTION AND ARRANGEMENT OF ARTIFICIAL TEETH FOR COMPLETE DENTURE PROSTHESIS,

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SELECTION AND ARRANGEMENT OF ARTIFICIAL TEETH

  1. 1. SELECTION AND ARRANGEMENT OF ARTIFICIAL TEETH FOR COMPLETE DENTURE PROSTHESIS Presented by– HEMAM SHANKAR SINGH 1
  2. 2. Contents 1. INTRODUCTION 2. ANTERIOR TOOTH SELECTION 3. MATERIALS OF ANTERIOR TOOTH 4. POSTERIOR TOOTH SELECTION 5. ARRANGEMENT OF THE TEETH 6. ARRANGEMENT OF ANTERIOR TEETH 7. ARRANGEMENT OF POSTERIOR TEETH 8. COMMON ERRORS IN ARRANGEMENT OF TEETH 9. CONCLUSION 10. REFERENCE 2 SELECTION
  3. 3. Introduction • This tends towards art and less to science and while the principles which follow will enable any clinician of average artistic ability to select teeth suitable for the average patient, the most pleasing results will always be obtained by those with an aesthetic sense. Anterior teeth are primarily selected to satisfy esthetic requirements. 3 SELECTION
  4. 4. Introduction • The selection of artificial teeth for edentulous patients requires a knowledge and understanding of a number of physical and biologic factors that are directly related to each patient. • The selection of artificial teeth is a relatively simple, non-time consuming procedure, but it requires development of experience and confidence. • Any choice of artificial teeth must be considered as a preliminary selection until the teeth are arranged on the trial denture bases and can be critically viewed in the patient’s mouth. 4 SELECTION
  5. 5. Anterior tooth selection • The selection of artificial teeth for edentulous patients when all records of form, color, and size have been lost is a clinical procedure. • Trial in the patient’s mouth is the best way • Much of the effectiveness of tooth selection depends on the ability of dentists to interpret what they see • Careful examination of the faces and teeth of people with natural teeth will develop a sense of dentofacial harmony that is the objective of tooth selection and esthetics • There must be harmony of color, form, size, and arrangement of teeth 5 SELECTION
  6. 6. Anterior tooth selection • Factors to be considered for selection of anterior teeth: A. Shade (color). B. Size. C. Form. 6 SELECTION
  7. 7. Anterior tooth selection SHADE: • A knowledge of the physics, physiology, and psychology of color is of value in the selection of the color • The color of most concern to dentist is the yellow color, because the colors of teeth and faces are primarily yellow • Colors have four qualities— 1. Hue 2. Saturation (chroma) 3. Brilliance (value) 4. Translucency • All these are involved in selection of teeth 7 SELECTION
  8. 8. Anterior tooth selection Hue • It refers to the dominant wavelengths present in a spectral distribution e.g. red, green, yellow, etc. • The hue of the teeth must be in harmony with the hue of the patient’s face. • Disharmony will make dentures look artificial Saturation • It is the amount of color per unit of area of an object 8 SELECTION
  9. 9. Anterior tooth selection Brilliance • It refers to the lightness or darkness of an object • Patient’s with fair complexion have lighter teeth than the patient with dark complexion Translucency • It is the property of an object that permits the passage of light through it but cannot give any distinguishable image • Presence of translucency makes the teeth looks alive 9 SELECTION
  10. 10. Anterior tooth selection • The factors of shade selection are:- 1. Age. 2. Sex. 3. Complexion. 4. Patient -preference 10 SELECTION
  11. 11. Anterior tooth selection 1. Age:-  The younger the patient, the lighter the color is preferred.  The color of natural teeth darken with age because of deposition of secondary dentin , wearing away of enamel and external staining from oral fluids, foods or tobacco. 2. Sex: -  The sex may effect color, it seems that females given brighter teeth than males. 11 SELECTION
  12. 12. Anterior tooth selection 3. Race:- SELECTION  The color of the face should harmonize the color of teeth. Lighter teeth are suitable for lighter skin, while darker teeth are suitable for darker skin, although darker people with dark skin seemed to have very light teeth. This is because of contrast in the skin and tooth color. 4. Patient preference (Method of pair comparison ):-  Show the patient a complete shade guide and select the two tabs that are lightest and darkest, hold them against the patient lip and ask them to point to the one that they prefer. More than two or three shades should be selected and comparison between them would help in final right selection. 12
  13. 13. Anterior tooth selection SIZE • The size of the teeth should be in proportion to the size of the face and head • Women’s teeth are often smaller than men’s • A distinct difference between CI & LI is desirable in women • Following factors are used as a guide to select the size of the teeth 1. Methods using pre-extraction guides 2. Methods using anthropological measurements of the patient 3. Methods using theoretical concepts 4. Methods using anatomical landmarks 13 SELECTION
  14. 14. Anterior tooth selection METHODS USING PRE-EXTRACTION GUIDES It includes- • Diagnostic casts, • Photographs, • Radiographs, • Observation of the teeth of close relatives, and • Extracted teeth 14 SELECTION
  15. 15. Anterior tooth selection DIAGNOSTIC CASTS • Diagnostic cast of natural teeth are the most reliable guides in both selecting arranging anterior teeth. • The size and form of the anterior teeth can be determined on the diagnostic cast, and comparable artificial teeth are selected 15 SELECTION
  16. 16. Anterior tooth selection PHOTOGRAPHS • Provides information about the width of the teeth and possibly the outline form • An algebraic proportions may be established with some known and unknown factors such as interpupillary distance in patient and in the photograph, and the width or length of the CI in the photograph (unknown factor) 16 SELECTION
  17. 17. Anterior tooth selection INTRA-ORAL RADIOGRAPH • Radiographs made before the natural teeth were lost can supply information about the size and form of the teeth to be replaced. • However, radiographic image is slightly enlarged and may be distorted because of divergence of the x-ray 17 SELECTION
  18. 18. Anterior tooth selection EXTRACTED TEETH • Provides excellent information as to size and form for the artificial teeth • Cannot be used in selecting color 18 SELECTION
  19. 19. Anterior tooth selection METHODS USING ANTHROPOLOGICAL MEASUREMENTS • These methods measures certain anatomical dimensions and derive the size of teeth using certain formula 1. Anthropometric cephalic index 2. Berry’s biometric index 3. H. Pound’s formula 19 SELECTION
  20. 20. Anterior tooth selection • Anthropometric cephalic index (Sears) – Transverse circumference of the head is measured using a measuring tape at the level of the forehead Circumference of the head – Width of the upper CI=------------------------------------------- 13 bi-zygomatic width – Total Width of the upper anterior =------------------------------------------- 3.36 4 Total Width of the lower anterior =---- Width of the upper anteriors 5 20 SELECTION
  21. 21. Anterior tooth selection Berry’s biometric index bi-zygomatic width Width of the upper CI=----------------------------- 16 length of the face Width of the upper CI=----------------------------- 20 21 SELECTION
  22. 22. Anterior tooth selection H. Pound’s formula bi-zygomatic width Width of the upper CI=----------------------------- 16 length of the face length of the upper CI=----------------------------- 16 22 SELECTION
  23. 23. Anterior tooth selection METHODS USING THEORITICAL CONCEPT 1. Winklers concept 2. Typal form theory: Leon Williams (1917) 3. Temparamental theory: Dr. Sparzheim 4. Concept of harmony: J.W. White 23 SELECTION
  24. 24. Anterior tooth selection Winklers concept • According to winkler, the teeth should be selected based on three different view’s namely 1. Physiological 2. Psychological 3. Biomechanical • Physiolgical – Facial musculature contributes to the esthetics 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 24 SELECTION
  25. 25. Anterior tooth selection Winklers concept • Psychological • Camper’s line is the psychological plane of orientation • It is raised in happy people • It is tilted in depressed people • Biomechanical • According to this teeth should be set in the neutral zone 25 SELECTION
  26. 26. Anterior tooth selection Typal form theory: Leon Williams (1917) • According to this, the shape of the teeth should be inverse of the shape of the face Concept of harmony: J.W. White in 1872 • According to him, the size and color of the teeth should be in harmony with the size of the head and color of the eye 26 SELECTION
  27. 27. Anterior tooth selection METHODS USING ANATOMIC LANDMARKS Seven anatomic entities are used as guides to selection of anterior teeth for size: 1. Size of the face 2. Size of the maxillary arch 3. Incisal papilla and the cuspid eminence or the Buccal Frenum 4. Maxillomandibular relations 5. The contour of the residual ridges 6. The vertical distance between the ridges 7. The lips 27 SELECTION
  28. 28. Anterior tooth selection SIZE OF THE FACE: • The average width of the maxillary CI is estimated to be one sixteenth of the width of the face measured between the zygoma. • The combined width of the six maxillary anteriors is slightly less than one third of the Bizygomatic breadth of the face • The face-bow can be used as a caliper to record the Bizygomatic breadth of the face. 28 SELECTION
  29. 29. Anterior tooth selection SIZE OF THE MAXILLARY ARCH: • Make measurements from the crest of the incisal papilla to the hamular notches and from one hamular notch to the opposite hamular notch • The combined length of the three legs of the triangle in millimeters is used on the selector • Mold selector can be used for the measurement • The circular slide rule indicates the tooth sizes, anterior and posterior, both arches 29 SELECTION
  30. 30. Anterior tooth selection INCISAL PAPILLA AND THE CUSPID EMINENCE OR THE BUCCAL FRENUM: • if the cuspid eminence are discernible, a line can be placed on the cast at the distal termination of the eminence. • if the cuspid eminence are not discernible, the attachments of the Buccal Frenum can be used. A lined placed slightly anterior to the Frenum attachment will be distal to the eminence • the measured distance between this two cuspid eminence gives the combined width of the six maxillary teeth 30 SELECTION
  31. 31. Anterior tooth selection INCISAL PAPILLA AND THE CUSPID EMINENCE OR THE BUCCAL FRENUM: • occlusal rim can be used to to locate the distal of cuspid eminence. • A pointed instrument is passed to the occlusal rim at each corner of the lips and a mark is recorded • The distance between the marks following the contour of the arch is the combined width of the six maxillary anterior teeth 31 SELECTION
  32. 32. Anterior tooth selection MAXILLOMANDIBULAR RELATIONS: • The sizes and the positions of the teeth will have to vary from the accepted normal if the teeth in the one arch are to complement the teeth in the other arch. • In instances of protruded mandibles the mandibular teeth are frequently larger than normal. • If the mandibles are retruded, the mandibular teeth are frequently smaller. 32 SELECTION
  33. 33. Anterior tooth selection • THE CONTOUR OF THE RESIDUAL RIDGES: SELECTION – The artificial teeth should be placed to follow the contour of the residual ridges that existed when the natural teeth were present. – A knowledge of direction of resorption of the two arches will allow a fairly accurate visualization of the original contour. – Resorption of maxillae in anterior segment is in a vertical and palatal direction, Posteriorly in vertical and medial direction – In mandible in in anterior segment is in vertical and lingual direction, Posteriorly in vertical and lingual direction 33
  34. 34. Anterior tooth selection • THE VERTICAL DISTANCE BETWEEN THE RIDGES: – The length of the teeth is determined by the available space between the existing ridges. • THE LIPS – When the teeth are in occlusion and the lips are together, the labial incisal third of the maxillary anterior teeth supports the superior border of the lower lip – In speech the incisal edges of the maxillary anterior teeth contact the lower lip at the junction of the moist and dry surfaces of the vermilion border. – It is best demonstrated when the letter F, as in fifty five is pronounced 34 SELECTION
  35. 35. Anterior tooth selection FORM OF ANTERIOR TEETH:- • The form and outline of the anterior teeth can be determined using the following factors: 1. Shape of the patient’s face or facial form 2. Patient’s profile 3. Dentogenic concept and dynesthetics 35 SELECTION
  36. 36. Anterior tooth selection Shape of the patient’s face or facial form – This is based on the Typal form theory by Leon Williams – According to him, facial form can be described • square, • ovoid and • tapering. 36 SELECTION
  37. 37. Anterior tooth selection Profile of the face: • Can be divided into: – Straight, – convex and – concave. • The labial surface of Upper central incisor viewed from the mesial aspect should be in harmony with profile of the face. 37 SELECTION
  38. 38. Anterior tooth selection Dentogenic concept and dynesthetics: Dentogenics is the art, practice and technique of creating the illusion of natural teeth in artificial dentures and is based on the elementary factor influenced by sex, personality and age of the patient. It was first described by Frush and Fisher. The term “Dynesthetics” is derived from Greek word “dynamics” meaning power. It supports in working factor of dentogenic concept. 38 SELECTION
  39. 39. Anterior tooth selection Dentogenic concept: Sex: – In female, the incisal angles are more rounded and the teeth have lesser angulation while in males, the incisal angles are rounded to a lesser degree and teeth are more rounded. – The incisal edge of the CI is parallel to the lips and the laterals are above the occlusal plane in males. But in females it follows curve of the lower lip (CI & LI) – The distal surface of CI are rotated posteriorly for females. 39 SELECTION
  40. 40. Anterior tooth selection Dentogenic concept: Sex: – Lateral incisors • Mesial surface are rotated anteriorly in relation to CI in females • The mesial ends are hidden by the CI. This makes the canine very prominent in males – Canines • Only the mesial thirds are visible in females because they are rotated anteriorly in relation to the CI whereas even the middle two-thirds of the canine are visible in males 40 SELECTION
  41. 41. Anterior tooth selection Dentogenic concept: Age: – Age can be easily separated into young, middle or elderly. – Due to decrese in muscle tone, sagging of the cheeks and the lower lips occur. To prevent cheek biting, horizontal overlap of the posterior teeth can be increase. – Inter occlusal distance reduces with age. Hence, mandibular teeth are more visible than the maxillary teeth. – In old patients the teeth tend to have square form due to attrition, more round features disappears and line angle quite seen in those patients. 41 SELECTION
  42. 42. Anterior tooth selection Dentogenic concept: Age: – Old patient have gingival recession, & can be reproduced in the dentures – The color of the teeth also changes with age. Personality: – It seems reasonable that a large vigorous type of persons have teeth of a size and form with prominent markings, different from those of a delicate appearing patient. 42 SELECTION
  43. 43. Anterior tooth selection Dynesthetics: – The term “Dynesthetics” is derived from Greek word “dynamics” meaning power. – It supports in working factor of dentogenic concept. – The technique of Dynesthetics is an auxiliary stimulus in the creation of a dentogenic restoration. – It is secondary to sex, personality and age factors. – These are rules, which concern the three important division of denture fabrication 1. The tooth 2. Its position 3. Its matrix 43 SELECTION
  44. 44. MATERIALS OF ANTERIOR TEETH MATERIALS OF ANTERIOR TEETH:- There are two main types: 1. Porcelain, 2. Acrylic Porcelain teeth: We have vacuum fired and air fired. The vacuum is better because they are harder and have luster. Generally porcelain teeth are preferred particularly for young person because they look more vital, very smooth and difficult to abrade. 44 SELECTION
  45. 45. MATERIALS OF ANTERIOR TEETH MATERIALS OF ANTERIOR TEETH:- Acrylic teeth: They are made from acrylic resin, indicated when there is insufficient inter-occlusal distance, and grinding becomes necessary, also in situation where there are opposing natural teeth, partial denture and gold bridge. They are inferior when they are compared with porcelain because they can not maintain luster for long time and abraded easily. 45 SELECTION
  46. 46. MATERIALS OF ANTERIOR TEETH ACRYLIC TEETH : 1- Not brittle, but poor abrasion resistance. 2- Esthetic very good. 3- Chemical bonding with denture base. 4- Easily ground and polish. 5- Transmit fewer forces to the mucosa. 6- No clicking on contact. 7- Thermal expansion same as acrylic denture base. PORCELAIN TEETH : 1- Brittle, more resistance to abrasion 2- Excellent (does not stain). 3- Mechanical bonding by pins or undercuts holes. 4- Difficult to grind and polish. 5- More forces to the mucosa. 6- Clicking on contact. 7- Much lower than acrylic causes stresses in acrylic denture base. 46 SELECTION
  47. 47. Posterior tooth selection SELECTION Posterior teeth are selected for color, buccolingual width, mesiodistal length, vertical height (occluso-gingival length) and occlusal form. 1- Shade (color): Shade of posterior teeth should be harmonized to the shade of anterior teeth, maxillary first premolars are sometimes used for esthetic more than function, so it's advisable to select premolar teeth with lighter color than the other posterior teeth, but not lighter than anterior teeth. Generally the shades of posterior teeth are slightly darker than anterior teeth (post. Contain dentin more than ant.). 47
  48. 48. Posterior tooth selection 2- Bucco-lingual width:- SELECTION The bucco-lingual width of posterior teeth should be slightly narrower than natural teeth to decrease occlusal surfaces which direct less stress during function to supporting tissue, and also enhance the development of the correct form of polished surfaces of the denture. 3- Mesio-distal width: The mesio-distal width of posterior teeth should be equal to the distance between canine line and anterior border of maxillary tuberosity for upper teeth. For lower teeth should be equal to distance between canine line and anterior border of retro molar pad area.(the width with in design limit) 48
  49. 49. Posterior tooth selection 4- The occluso-gingival height The occluso-gingival height or length is controlled by the available inter-arch distance. The length of the maxillary first premolar should be comparable to that of maxillary canine to have the proper esthetic effect. The height of posterior teeth usually divided into long, short, medium. Long posterior teeth are generally more esthetic in appearance than are shorter teeth. 49 SELECTION
  50. 50. Posterior tooth selection 5- Occlusal form: Selecting the tooth to be used is based on the concept of occlusion to be developed, the philosophy of occlusion to be fulfilled, and the accomplishment approached. It is given in the table below. 50 SELECTION
  51. 51. 51 COMPARISION OF DENTURE TOOTH MOLDS AND OCCLUSAL CONCEPTS TOOTH MOLD OCCLUSAL CONCEPT ADVANTAGE DISADVANTAGE SELECTION 20 or 30- degree cusp teeth • Centric jaw record, face bow, protrusive records to semi-adjustable. • Set upper anterior and posterior teeth, then lowers to cross-arch contact or “balanced-occlusion” • Reported slightly more efficient in chewing tests • Posteriors appears more natural • Most time and complexity of records • Limitations of anterior tooth positions • Restriction of posterior tooth positions to that allowed by Cuspal anatomy Monoplane 0- degree • Centric jaw record only • Simple articulator • Set 12 anterior teeth with Overjet but no overbite • Set lower teeth in flat plane to middle of retromolar pad • Set upper to match; no attempt on contact on excursions • Simplest of all recordings • Simplest articulators • Quick arrangement of teeth • Wide range of posterior tooth positions possible • No lateral stresses on mucosa with parafunction • Easier for patients with uncoordinated closures • Flat premolars may appears less esthetic • Reported as less aesthetics • Anterior esthetics need more Overjet and no overbite
  52. 52. 52 SELECTION COMPARISION OF DENTURE TOOTH MOLDS AND OCCLUSAL CONCEPTS TOOTH MOLD OCCLUSAL CONCEPT ADVANTAGE DISADVANTAGE Flat teeth with compensating curve or second molar ramp  Centric jaw record  Semi-adjustable articulator  Anterior teeth with Overjet and slight overbite  Posterior set to contact on at least 1 point on non-working or balancing side  Simple to set up; allows for more esthetic overlap of anterior teeth  The posterior point contact maintain denture base stability on excursion or parafunction  Slightly more laboratory set up  Premolars appear flat if visible Combination or “lingualized” occlusion  Centric jaw record  Monoplane lower posterior teeth set to retromolar pad  Anatomic upper posterior teeth set with only lingual, not buccal cusp touching  Upper premolars appear natural  Some range of posterior tooth position allowed  Reported slightly better chewing than monoplane  Some grinding needed to create upper cusp tip/lower fossa contacts
  53. 53. Posterior tooth selection 53 SELECTION 10° 20° 33°
  54. 54. ARRANGEMENT OF THE TEETH 54 ARRANGEMENT
  55. 55. Arrangement Of The Teeth Arrangement Of The Anterior Teeth It is important that the artificial anterior teeth are placed in the same antero-posterior position and at the same length as the original natural esthetics and phonetics 55 ARRANGEMENT
  56. 56. Arrangement Of The Anterior Teeth Guides for arrangement of anterior teeth 1. Residual alveolar ridge 2. Incisive papilla 3. Reflections of soft tissues under the lip • The carved occlusal rims should provide reliable guides for placement of the anterior teeth in wax occlusion rims • They indicate the likely antero-posterior and vertical positions of the incisor teeth 56 ARRANGEMENT
  57. 57. Arrangement Of The Anterior Teeth RESIDUAL ALVEOLAR RIDGE • In patient with long edentulous period, much bone could have been lost from the residual alveolar ridge. In this situation, artificial teeth should not be placed against the ridge • As a general rule: the longer the natural teeth have been out the farther the artificial teeth should be from the ridge • The teeth should be placed closer to the residual ridge when there is less shrinkage and farther from ridge when there has been more resorption 57 ARRANGEMENT
  58. 58. Arrangement Of The Anterior Teeth RELATIONSHIP TO INCISIVE PAPILLA • Incisive papilla is a guide to anterior tooth position because it has a constant relationship to the natural CI • A line marking the centre of the incisive papilla on the cast is extended forward onto the labial surface of the cast and CI are set on either side of this line • Incisive papilla is also a guide to the antero-posterior position of the teeth • Labial surfaces of the Ci are usually 8-10 mm in front of the papilla 58 ARRANGEMENT
  59. 59. Arrangement Of The Anterior Teeth RELATIONSHIP TO REFLECTION OF SOFT TISSUE • Labial surfaces and incisal edges of the teeth are anterior to the tissues at the reflection where the denture borders would be placed • The accuracy of this guide decreases as the resorption of the residual ridge progresses 59 ARRANGEMENT
  60. 60. Arrangement Of The Anterior Teeth Arrangement of the maxillary anterior teeth: • In placing and positioning the maxillary anterior teeth the objective is to provide balance between maximum esthetics and proper phonetics. The maxillary anterior teeth should support the upper lip in a natural position. • After the loss of the natural anterior teeth, bone resorption usually occurs more on the labial aspect than on the palatal aspect of the maxillary ridge. To compensate for this loss of bone structure the maxillary anterior teeth should be placed labial to the residual ridge. 60 ARRANGEMENT
  61. 61. Arrangement Of The Anterior Teeth • The incisive papilla in the edentulous maxillary arch acts as a guide to proper placement of the maxillary central incisors. The maxillary central incisors fall approximately 8 to 10 mm anterior to the point of intersection of a line that bisects the midline of the palate perpendicularly through the incisive papilla. (mid line is between the labial frenum and the incisive papilla) • The labial contour of the teeth should follow the labial contour of the occlusal rim. • The right and left maxillary anterior teeth should be positioned symmetrically on either side of the arch. 61 ARRANGEMENT
  62. 62. Arrangement Of The Anterior Teeth Position of the maxillary central incisor: – Mesio-distal inclination: • The maxillary central incisor is placed, so that the long axis shows a slight distal inclination, when viewed from front. 62 ARRANGEMENT – Labio-lingual inclination: • The neck of the tooth should be slightly depressed when viewed from this side, the tooth slopes (incisal edge ) towards the labial side. – The incisal edge: • Is in contact with the occlusal plane.
  63. 63. Arrangement Of The Anterior Teeth Position of the maxillary lateral incisor: Mesio-distal inclination: The maxillary lateral incisor is placed with its long axis inclined notesable distally when viewed from the front. 63 ARRANGEMENT Labio-lingual inclination: The neck of the maxillary lateral incisor is depressed (of the neck) more than the central incisor, although the labial surface will be nearly in line with the central incisor. The incisal edge: is ½ to 1mm above the level of the occlusal plane.
  64. 64. Arrangement Of The Anterior Teeth Position of maxillary canine: Mesio-distal inclination: The maxillary canine is placed so that the long axis has slight distal inclination from the front view. 64 ARRANGEMENT Labio-lingual inclination: The neck of the maxillary canine is prominent. The tooth axis is vertical (straight ) when viewed from the side.
  65. 65. Arrangement Of The Anterior Teeth The cusp tip: Is in contact with the occlusal plane. The maxillary canine has two planes on the labial surface; mesial plane should follow the contour of the anterior teeth while the distal plane will be in line with the posterior teeth. 65 ARRANGEMENT
  66. 66. Arrangement Of The Anterior Teeth Arrangement of the mandibular anterior teeth: 1. The midline of the maxillary central incisor should be followed while placing the mandibular central incisor. 2. The imaginary roots of the mandibular anterior teeth should be directed towards the residual ridge. this will often place the mandibular teeth labial to the residual ridge. 3. The mandibular anterior teeth should not be in contact horizontally with the maxillary teeth (over jet). 4. The mandibular anterior teeth should not be in contact vertically with the maxillary anterior teeth (over bite). 66 ARRANGEMENT
  67. 67. Arrangement Of The Anterior Teeth 67 ARRANGEMENT
  68. 68. Arrangement Of The Anterior Teeth Position of the mandibular central incisor: Mesio-distal inclination: The long axis is perpendicular to the occlusal plane (vertically upright). 68 ARRANGEMENT Labio-lingual inclination: The central incisor is placed with its neck depressed and the tooth will show that it’s labially inclined when viewed from one side. The incisal edge: Are 1-2 mm above the occlusal plane.
  69. 69. Arrangement Of The Anterior Teeth Position of the mandibular lateral incisor: Mesio-distal inclination: The mandibular lateral incisor is placed with its long axis showing a slight distal inclination. 69 ARRANGEMENT Labio-lingual inclination: The labial surface is perpendicular to the occlusal plane. The incisal edge: Are 1-2 mm above the occlusal plane.
  70. 70. Arrangement Of The Anterior Teeth Position of the mandibular canine: Mesio-distal inclination: The mandibular canines are placed with a more distal inclination (neck distally placed) than the mandibular lateral incisors. 70 ARRANGEMENT Labio-lingual inclination: The neck of the tooth is placed prominently. The tooth shows a slight lingual inclination (at the incisal edge) when viewed from the side The incisal tip: Lies 1-2 mm above the occlusal plane.
  71. 71. Arrangement Of The Anterior Teeth Horizontal overlap (over jet): This the horizontal distance between the incisal edge of the maxillary central incisor and the labial surface of the mandibular central incisor. 71 ARRANGEMENT Vertical overlap (over bite): The maxillary anterior teeth overlap the mandibular anterior teeth and this overlapon the vertical axis is called the vertical overlap.
  72. 72. Arrangement Of The Anterior Teeth Incisal guide angle: The incisal guide angle is the angle formed with the horizontal plane by drawing a line in the sagittal plane between the incisal edges of the maxillary and mandibular central incisors when the teeth are in centric occlusion. 72 ARRANGEMENT The amount of vertical and horizontal overlap determines the sagittal incisal guidance. Incisal guidance is the path traveled by the mandibular central incisor from centric occlusion position to the protrusive occlusal position.
  73. 73. Arrangement Of The Posterior Teeth Arrangement Of The posterior Teeth Posterior teeth are set up in tight centric occlusion. The mandibular teeth are set in the wax occlusion rim over the residual ridge in their ideal bucco-lingual position and the maxillary teeth are set in tight centric occlusion with them regardless of their bucco-lingual position. The objective here is to have the intercuspation of the posterior teeth so precise that any deviation of this occlusion in the mouth will be easily detected. 73 ARRANGEMENT
  74. 74. Arrangement Of The Posterior Teeth Standardized parameters 1. Curve of Wilson' as transversal compensating curve. 2. Curve of Spee' as sagittal compensating curve. 3.Optimum intercuspation of the antagonists. 74 ARRANGEMENT
  75. 75. Arrangement Of The Posterior Teeth Curve of Wilson Transversal compensating curve. It runs frontally (transversally), touching the cusp tips of the posterior teeth. In the lower arch, it is produced by an even inclination of the right and left molars towards the lingual, corresponding to an inclination towards the buccal in the maxilla. When setting-up complete dentures, the teeth should be positioned along this curve 75 ARRANGEMENT
  76. 76. Arrangement Of The Posterior Teeth Curve of Spee Sagittal compensating curve. Its bow-shaped line of occlusion in dentition. Spee described it as the "shifting path" of the mandible. The segment of the circle drawn has its center in the orbital cavity. 76 ARRANGEMENT
  77. 77. Arrangement Of The Posterior Teeth The guide lines used in arrangement of posterior teeth: 1. The line of the crest of lower residual ridge. Which extend between the middle of retromolar pad, and tip of lower canine, the central grooves of the lower posterior teeth should coincide with this line. 2. The line extending between the tip of lower canine and upper 2/3 of retromolar pad will determine the height of lower posterior teeth. 77 ARRANGEMENT
  78. 78. Arrangement Of The Posterior Teeth Arrangement of maxillary posterior teeth:- a. Maxillary premolars: 1. Premolars are set vertically to occlusal plane. 2. Facial cusp of maxillary 1st premolar touch the occlusal plane while the lingual cusp is raised from occlusal plane approximately 12 mm 3. The facial cusp of maxillary 1st premolar should be seat into the embrasure between the mandibular 1st and 2nd premolars. 4. Lingual cusp should be over the crest of the ridge 5. Facial and lingual cusp of maxillary 2nd premolar touch the occlusal plane. 78 ARRANGEMENT
  79. 79. Arrangement Of The Posterior Teeth 79 ARRANGEMENT
  80. 80. Arrangement Of The Posterior Teeth b. Maxillary molars: 1. The inclination of maxillary molars are mesially and slightly lingually to create a 6 degree upward curve. 2. Mesio-lingual cusp of maxillary 1st molar should touch the occlusal plane and the lingual cusps are over the crest of the mandibular ridge 3. The mesiobuccal cusp of upper 1st molar should rest in the buccal groove of the lower 1st molar, and the mesio-lingual cusp should seat into the central fossa of lower 1st molar. 4. Maxillary 2nd molar are set with no cusp touches the occlusal plane. All the lingual cusps are over the crest of the mandibular ridge 80 ARRANGEMENT
  81. 81. Arrangement Of The Posterior Teeth 5. Facial cusps of maxillary teeth form a gentle curve, while the lingual cusps form a similar curve about 12 mm below the facial cusps . 6. Use a template to cheak the buccal alignment of, canine, premolars and mesial buccal cusp of maxillary 1st molar should touch the template, while the distobuccal cusp not touch. 7. To check the buccal alignment of maxillary posterior teeth, all four cusps of maxillary molars touch the template while the premolar do not touch the template. 81 ARRANGEMENT
  82. 82. Arrangement Of The Posterior Teeth 82 ARRANGEMENT
  83. 83. Arrangement Of The Posterior Teeth Arrangement of mandibular posterior teeth 1. The Mandibular 1st molar is first set into centric occlusion. 2. Mesio-buccal cusp of maxillary 1st molar fit in to the buccal groove of mandibular first molar. 3. The mesioligual cusp of Mandibular 1st molar fit into the central fossa of the maxillary first molar. 4. Set the mandibular 2nd molar,the mesio-buccal cusp of maxillary 2nd molar fit in to the buccal groove of mandibular 2nd molar. 5. Then set mandibular 2nd premolar,its cusp tip should be positioned in the embrasur between maxillary 1st and 2nd premolars. 83 ARRANGEMENT
  84. 84. Arrangement Of The Posterior Teeth 5. The last tooth are mandibular 1st premolar which should be position in the embrasure between maxillary canine and maxillary 1st premolar. 6. Mandibular premolars follow the curvature of the canine. 7. Mandibular posterior teeth are set on or slightly lingual to the crest of the ridge. 84 ARRANGEMENT
  85. 85. Arrangement Of The Posterior Teeth 85 ARRANGEMENT
  86. 86. Arrangement Of The Posterior Teeth 86 ARRANGEMENT
  87. 87. Common errors in arrangement of teeth. 1. Lack of rotation of anterior teeth to give a narrower effect. 2. Setting mandibular anterior teeth too forward in order to meet maxillary teeth. 3. Failure to make the canine the turning point of the arch. 4. Setting mandibular 1st premolar to the buccal side of the canines. 5. Setting the mandibular posterior teeth too far to the lingual side in the 2nd molar region which cause tongue interference and mandibular denture displacement 6. Failure to establish the occlusal plane at the proper level and inclination. 7. Establishing the occlusal plane by an arbitrary line on the face. 87 ARRANGEMENT
  88. 88. CONCLUSION Teeth selection should be in harmony in color, shape and size with the patient’s face, sex and age for a successful fabrication of complete denture prosthesis with a natural looking also pleasing appearing teeth. Teeth should be positioned in harmony with intraoral and circumoral muscle activity and adjusted so that they occlude and articulate evenly. Several different prosthetic tooth molds have been produced, and each has some purported advantages. In the absence of a clear advantage, dentists should use tooth molds that are esthetically pleasing and have a simple procedure to set up. 88 ARRANGEMENT
  89. 89. REFERENCE 1. Judson. C. Hickey (DDS, M. Sc.), Charles L. Bolender (DDS, MS), George A. Zarb (DDS, MS) : Boucher’s Prosthodontic Treatment for edentulous patients. 9th Edn. The c. v. mossy co,1985: 324-364, 427-457. 2. Sheldon winkler: essentials of complete dentures prosthodontics. 2nd edn, W. B. Sauders company, 3. Charles M. Heartwell, Jr; Arthur O. Rahn: Syllabus of Complete Dentures, Fourth edition,pg 293-346; published by Lea & Febiger Philadelphia 4. Omkar Shetty, Sabita Ram: Dentogenic concept Part-I, II: Scientific Journal: Volume-I, 2007: Volume-II, 2008. 89 ARRANGEMENT
  90. 90. 90
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SELECTION AND ARRANGEMENT OF ARTIFICIAL TEETH FOR COMPLETE DENTURE PROSTHESIS,

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