Anterior teeth selection /dental continuing education course

ANTERIOR TEETHANTERIOR TEETH
SELECTIONSELECTION
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
IntroductionIntroduction
Selection of anterior teethSelection of anterior teeth
SizeSize
FormForm
ColourColour
MaterialMaterial
Dentogenic conceptDentogenic concept
Review of literatureReview of literature
ConclusionConclusion
BibilographyBibilography

IntroductionIntroduction
Anterior teeth selection and arrangement is anAnterior teeth selection and arrangement is an
area of prosthodontics where art dominatesarea of prosthodontics where art dominates
science,where esthetics is the major concern,andscience,where esthetics is the major concern,and
where knowledge must be applied to create a pleasingwhere knowledge must be applied to create a pleasing
appearance while simultaneously maintaining oralappearance while simultaneously maintaining oral
function.function.

 The anterior teeth are primarily selected to satisfyThe anterior teeth are primarily selected to satisfy
esthetic requirements.esthetic requirements.
 Posterior teeth's are selected to satisfy masticatoryPosterior teeth's are selected to satisfy masticatory
functional requirements.functional requirements.
 Technically, the anterior teeth are composed of 6Technically, the anterior teeth are composed of 6
maxillary and 6 mandibular teeth's.maxillary and 6 mandibular teeth's.

Sometimes maxillary first premolar is consideredSometimes maxillary first premolar is considered
more for esthetics than for masticatory function.more for esthetics than for masticatory function.

Patients expect 3 basic things from their completePatients expect 3 basic things from their complete
denturesdentures..
– Favorable appearance.Favorable appearance.
– Comfort.Comfort.
– Chewing abilityChewing ability..

There are four main considerations in selecting theThere are four main considerations in selecting the
anterior teeth.anterior teeth.
Tooth sizeTooth size
Tooth shapeTooth shape
ColorColor
Tooth materialTooth material

Size of teethSize of teeth

PRE-EXTRACTION GUIDES -PRE-EXTRACTION GUIDES - wrightwright
PHOTOGRAPHS.PHOTOGRAPHS.
RADIOGRAPHS.RADIOGRAPHS.
DIAGNOSTIC CASTS.DIAGNOSTIC CASTS.
TEETHS OF RELATIVES.TEETHS OF RELATIVES.
EXTRACTED TEETH.EXTRACTED TEETH.

photographsphotographs

New denturesNew dentures
made withmade with
the help ofthe help of
oldold
photographphotograph
•65 years:
Poor
esthetics
old
dentures.
Natural
teeth at 20
years

TEETH OF RELATIVESTEETH OF RELATIVES

 Diagnostic castsDiagnostic casts
 Preserved extracted teethPreserved extracted teeth
 Pre extraction radiographsPre extraction radiographs

Methods using landmarksMethods using landmarks

Anthropological measurementsAnthropological measurements
Bi-zygomatic width: Berry, Williams, House

Length of central incisorLength of central incisor
Facial measurement methodFacial measurement method
Distance from the hair line to the gnathionDistance from the hair line to the gnathion
in millimeters with the face at rest and dividein millimeters with the face at rest and divide
this by 16.this by 16.

INCISIVE PAPILLA-HAMULAR NOTCH-HAMULAR NOTCH

CANINE EMINENCE / BUCCAL FRENUMCANINE EMINENCE / BUCCAL FRENUM

INTER CANTHAL DISTANCEINTER CANTHAL DISTANCE
 Considered as a reliable anatomic dimension
because 93% of intercanthal dimension growth has
been achieved in 5 years of age.
 The maturity is reached between 8-11 years
Average dimension 28-35 mm

ALA OF NOSE –ALA OF NOSE – PICARDPICARD

It falls in the rangeIt falls in the range
28-45mm28-45mm
Since anterior teethSince anterior teeth
are arranged in anare arranged in an
arc. the divider hasarc. the divider has
to be opened by 3-to be opened by 3-
4mm more than4mm more than
the value of thethe value of the
nose width.nose width.

MOUTH WIDTH-MOUTH WIDTH- SILVERMANSILVERMAN

GENERAL GUIDEGENERAL GUIDE
Upper anterior teeth whose overall width is lessUpper anterior teeth whose overall width is less
than 48mm are relatively small teeth. Those listed asthan 48mm are relatively small teeth. Those listed as
over 52mm are relatively large teeth.over 52mm are relatively large teeth.

MC ARTHURMC ARTHUR did a study on patients and averagedid a study on patients and average
mesiodistal width of maxillary central incisor was :mesiodistal width of maxillary central incisor was :
In young patients – 8.87 mm.In young patients – 8.87 mm.
In adults due to proximal wear – 8.67 mm.In adults due to proximal wear – 8.67 mm.
In denture patients – 8.36 mm.In denture patients – 8.36 mm.

MAXILLO-MANDIBULAR RELATIONSMAXILLO-MANDIBULAR RELATIONS
In protruded mandible the anterior teeth's are frequentlyIn protruded mandible the anterior teeth's are frequently
larger than normal.larger than normal.
In retruded mandible, the mandibular anterior teeth areIn retruded mandible, the mandibular anterior teeth are
frequently smaller.frequently smaller.
In protrusion the face is usually longer and longer facesIn protrusion the face is usually longer and longer faces
usually require longer teeth's.usually require longer teeth's.

VERTICAL DISTANCE BETWEEN THEVERTICAL DISTANCE BETWEEN THE
RIDGESRIDGES
The length of teeth is determined by the space betweenThe length of teeth is determined by the space between
the ridges.the ridges.
When space is available it is advisable to use long teeth.When space is available it is advisable to use long teeth.

LipsLips

TjanTjan did a study on 454 dental students anddid a study on 454 dental students and
concluded that:concluded that:
10 % - high lip line10 % - high lip line
70 % - average smile line70 % - average smile line
20 % - low lip line20 % - low lip line

GOLDEN PROPORTION – Lombardi, LevinGOLDEN PROPORTION – Lombardi, Levin
1.618 x 62 /100 =1.0

GOLDEN PERCENTAGE -GOLDEN PERCENTAGE - SNOWSNOW
23% 15% 12%

Winklers concept on estheticsWinklers concept on esthetics
Physiological- biologicalPhysiological- biological
PsychologicalPsychological
biomechanicalbiomechanical

Leon williams theoryLeon williams theory

Temperamental theory – dr sparzheimTemperamental theory – dr sparzheim
Sanguinous -Sanguinous - blood dominance –blood dominance – long thin narrowlong thin narrow
teethteeth
Melancholic –Melancholic – black bile dominance from spleenblack bile dominance from spleen
short, broad , tapering incisor teethshort, broad , tapering incisor teeth
Choleric –Choleric – yellow bile dominance from liveryellow bile dominance from liver
Phlegmatic -Phlegmatic - watery fluid elaborated from brainwatery fluid elaborated from brain

Selection Of FormSelection Of Form

Selection Of Form(shape or mold).Selection Of Form(shape or mold).
• Form of artificial anterior teeth should harmonize with theForm of artificial anterior teeth should harmonize with the
shape of the patients face.shape of the patients face.

4 basic Outlines of faces4 basic Outlines of faces
• This was first considered important by williams and houseThis was first considered important by williams and house
and loopand loop (Leon Williams classification)(Leon Williams classification)
– SquareSquare
• Square taperingSquare tapering
– TaperingTapering
– ovoidovoid

RELATION BETWEEN TOOTH SHAPE AND ARCHRELATION BETWEEN TOOTH SHAPE AND ARCH
SHAPESHAPE

Patients profilePatients profile

SELECTION OF SHADE.SELECTION OF SHADE.
COLOR HAS 4 QUALITIES:COLOR HAS 4 QUALITIES:
Hue –Hue – it denotes specific color produced by a specificit denotes specific color produced by a specific
wavelength of lightwavelength of light
Saturation -Saturation - it is the amount of color per unit area of anit is the amount of color per unit area of an
objectobject
Brilliance –Brilliance – it denotes the lightness or darkness of an objectit denotes the lightness or darkness of an object
TranslucencyTranslucency – it is the property of an object to partially– it is the property of an object to partially
allow the passage of light through itallow the passage of light through it

Hue and brilliance of teeth is influenced by :Hue and brilliance of teeth is influenced by :
AgeAge
HabitsHabits
ComplexionComplexion
Color of eyesColor of eyes
Color of hairColor of hair

Hallarman, 1971Hallarman, 1971
• There is no correlation between tooth color andThere is no correlation between tooth color and
– Natural hair colorNatural hair color
– eye color.eye color.
• Canines are darker than central incisorsCanines are darker than central incisors
• Color darkens with age.Color darkens with age.
• Females have lighter natural teeth.Females have lighter natural teeth.

Selecting the colorSelecting the color

Squint testSquint test
• Helpful in evaluating colors of teeth with theHelpful in evaluating colors of teeth with the
complexion of the face.complexion of the face.
• With the eyelids partially closed to reduce light,theWith the eyelids partially closed to reduce light,the
dentist compares prospective colors of artificial teethdentist compares prospective colors of artificial teeth
held along the face of the patient.held along the face of the patient.
• The color that fades from the view first is the one thatThe color that fades from the view first is the one that
is least conspicuous in comparison to the color of theis least conspicuous in comparison to the color of the
face.face.

Selection of tooth material.Selection of tooth material.
• Conventional acrylic resinConventional acrylic resin
advantagesadvantages
disadvantagesdisadvantages
• Porcelain.Porcelain.
advantagesadvantages
disadvantagesdisadvantages

Dentogenic conceptDentogenic concept
By frush and fisher in 1957By frush and fisher in 1957
Also called SPA theoryAlso called SPA theory
• SexSex
– malemale
– FemaleFemale
• PersonlityPersonlity
– Vigrous delicateVigrous delicate

Age :Age :
Muscle toneMuscle tone
VisibilityVisibility
Abraded teethAbraded teeth
Gingival recessionGingival recession
Color of teethColor of teeth

Review of literatureReview of literature

This study was conducted to determine the relationship
between interpupillary distance, interalar distance and the
width of the mouth to be used as a guide during selecting
the width of the six anterior teeth. J. Prosthet. Dent. 1991,
65-250-4.
1.A high significant difference between all measurements in
both sexes.
2. To estimate the combined width of the maxillary anterior
teeth, he suggest the average multiplying factor of 1.56 to
interalar width which was found in his study.
3. The authors suggest the use of more than one measurement
in the selection of the anterior teeth.

THE RELATIONSHIP BETWEEN FACIAL REFERENCESTHE RELATIONSHIP BETWEEN FACIAL REFERENCES
AND MESlODlSTAL WIDTH OF MAXILLARY ANTERIORAND MESlODlSTAL WIDTH OF MAXILLARY ANTERIOR
TEETH . ADJ oct 1995; vol 20; no 1.TEETH . ADJ oct 1995; vol 20; no 1.
A total of 439 patients were examined to determineA total of 439 patients were examined to determine
if there is a correlation between the width of the maxillaryif there is a correlation between the width of the maxillary
anterior: teeth and four anatomical facial references. Theanterior: teeth and four anatomical facial references. The
bizygomatic width, interpupillary distance, intraalar width andbizygomatic width, interpupillary distance, intraalar width and
the width of the mouth. All measurements done by using athe width of the mouth. All measurements done by using a
modified Boley gauge except themodified Boley gauge except the bizygomaticbizygomatic which was donewhich was done
by using a face bow.No correlation was found between theby using a face bow.No correlation was found between the
measurements for the population as whole, nor when themeasurements for the population as whole, nor when the
population was divided accordingly to sex.population was divided accordingly to sex.

Use of Digital Photographs for Artificial Teeth SelectionUse of Digital Photographs for Artificial Teeth Selection
Coll. Antropol.Coll. Antropol. 28 (2004) 2: 857–86328 (2004) 2: 857–863
The technique of use of digital photography is ofThe technique of use of digital photography is of
proven value in calculating the width of a maxillary centralproven value in calculating the width of a maxillary central
incisor.The photographs using a simple digital camera shouldincisor.The photographs using a simple digital camera should
be taken from a distance of 70 cm to 1 m. Saving of suchbe taken from a distance of 70 cm to 1 m. Saving of such
photographs may be helpful in calculating dimensions ofphotographs may be helpful in calculating dimensions of
artificial teeth in future.artificial teeth in future.

ReferencesReferences
1.Complete denture prosthetics- john p sharry1.Complete denture prosthetics- john p sharry
2.Essentials of complete denture- sheldon winkler2.Essentials of complete denture- sheldon winkler
3.Syallabus for complete dentures – charles heartwell3.Syallabus for complete dentures – charles heartwell
4.Treatment planning for completely edentulous – boucher4.Treatment planning for completely edentulous – boucher
5. introduction to dentogenic restorations j prosthet dent 1955; 6;5. introduction to dentogenic restorations j prosthet dent 1955; 6;
586-595586-595
6. the age factor in dentogenics j prosthet dent 1956; 6; 160-1726. the age factor in dentogenics j prosthet dent 1956; 6; 160-172
7. how dentogenics interprets the personality factor j prosthet7. how dentogenics interprets the personality factor j prosthet
dent 1956;6; 441-449dent 1956;6; 441-449

8. the relationship between interpupillary distance, interalar8. the relationship between interpupillary distance, interalar
distance and the width of the mouth to be used as a guidedistance and the width of the mouth to be used as a guide
during selecting the width of the six anterior teeth. J. Prosthet.during selecting the width of the six anterior teeth. J. Prosthet.
Dent. 1991, 65-250-4.Dent. 1991, 65-250-4.
9. The relationship between facial references and mesiodistal9. The relationship between facial references and mesiodistal
width of maxillary anterior teeth. ADJ oct 1995; vol 20; no 1width of maxillary anterior teeth. ADJ oct 1995; vol 20; no 1
10. registration; stage 111 anterior teeth selection.10. registration; stage 111 anterior teeth selection. British DentalBritish Dental
JournalJournal 2000;2000; 188:188: 660–666.660–666.
11. biometric relationship between intercanthal dimension and11. biometric relationship between intercanthal dimension and
the width of maxillary anterior teeth j Indian prosthodont socthe width of maxillary anterior teeth j Indian prosthodont soc
july 2007; vol 7; iss 3.july 2007; vol 7; iss 3.
12.12. Qualitative and Quantitative Guides to the Selection andQualitative and Quantitative Guides to the Selection and
arrangement of the Maxillary Anterior Teetharrangement of the Maxillary Anterior Teeth J Prosthod 1992;J Prosthod 1992;
I; 106- 111.I; 106- 111.

13.Geometric and MathematicaProportions and their Relations to13.Geometric and MathematicaProportions and their Relations to
Maxillary Anterior TeethMaxillary Anterior Teeth
The Journal of Contemporary Dental Practice, Volume 7, No. 5,The Journal of Contemporary Dental Practice, Volume 7, No. 5,
November 1, 2006November 1, 2006
14. Digitized study of the correlation between the face and tooth14. Digitized study of the correlation between the face and tooth
shapes in young adult individualsshapes in young adult individuals
Brazilian Journal of Oral Sciences, Vol. 6, No. 22, 2007, pp.Brazilian Journal of Oral Sciences, Vol. 6, No. 22, 2007, pp.
1383-13861383-1386

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