Anterior & Posterior Tooth Arrangement Manual DensPLy Tie to your business TRuBYTE |Suggested procedures for the arrangement and ai Uae a a 0 Contains guidelines for use, a glossary of key terms and suggested arrangement and articulation procedures Table of Contents Pages Anterior Teeth 28 40° Posterior Teeth... 2.0.2... e eee 9-10 33° Posterior Teeth .....0.0. 0.0.0.0... 1112 30° Posterior Teeth... 0.2... eevee eee IHS 22° Posterior Teeth... 0.0.0.2 2.2.2. 1617 20° Posterior Teeth . 18-19 10° Posterior Teeth 2022 0° Posterior Teeth... 0.0... eee ee ee eee 28-25 lingualized Teeth... 0.2.2... eee eee. 2631 Appendix... 0.0.0. e cece cece eee sees 3238 (©2005 DENTSPLY Intemational Inc. Al rights reserved.Trubyte” Anteriors Description: Exceptional esthetics, plus an infinite vari ety of moulds to satisfy any need Indications For Use: Any full or partial denture case; also ideal for use in implant prosthetics and provi: sional restorations. F Factors to Consider in the Esthetic Arrangement of Trubyte® Anterior Teeth Dm cae maxillary anterior teeth Anteroposterior positioning of anterior teeth is an impor: tant factor in esthetics since the teeth give support fo the lips, cheeks, and other tissues of the oral cavity. The replacement of arificial teeth in the original position of the natural teeth is frequently not stressed or simply over looked. Too often resorbed residual ridges are used os the primary indicator for tooth position. Because of what may be extreme changes in shape ond size, 0 resorbed, residual ridge is @ questionable landmark for either functional or esthetic tooth position, Setting artificial teeth directly over the f resorbed makes the developm: ics extremely difficult to achieve. Thi natural teeth seldom occupy the socalled “over the ridge” pos tion. Dental restorations, complete dentures in particu: lar, will not normally be esthelcally pleasing if teeth are improperly positioned The loss of bone structure after tooth removal is usually greater on the buccal/labial aspects of the maxillary idge than on the palatal aspect. Therefore, the ridge Center is mare palatal, smaller and different in shape than it was previously ‘The overall heights may vary, depending on the anotomi: cal dif vidual patients and on th degree of ve bite) incorporot the anterior tooth arrangement. An thumb is discussed on page bottom of column 2.These matrix studios further damonstrote the relationship between tooth pesition and ridge resorption, and proper Ridge resorption is a major factor in the lip suppor, Fig. 1 shows a crosssec tion ofthe matrix and cast made before natural teth ‘nfero-posterorly, and be ofthe were removed. Figure 1 SE In Fig. 2 the cast hos been trimmed to simulate a normal ‘emount of ridge resorption in Natural Tooth Position / the anterior area Figure 2 "A" illstes the positon ofthe In Fig. 3.0 graphic ills rnatral central incisor and its tion is provided of what reloionship to the ridge. happens to tooth positon ing when the teth ore set Position After "up and back” on the Figure 3 Loss/Removal resorbed ridge. “B" illsrates the same ridge ‘These figures illustrate the exten! to which an aificial immediately afer removal of tooth set on the resorbed ridge may deviate from its true the tooth. Dotted lines indi: natural position. This “on the ridge" positon ofthe teeth cate position of he natural ‘cannot provide proper lip ond facial tissue suppor. a fete i ed oat a els - / RE orem mise tore Direction of Resorption So nectuamnceae, ‘occlusl is inthe anterior area, and positioning ofthe The direction of resorption is up and back. In °C" the solid line Idenifies the resorbed ridge; the dotted line, the exiginal contour «ental nésr tet for preliminary tooth rangement. of the ridge. a Proper vertical positioning of artificial teeth accord- ing to averages. Improper Positioning of Teeth “D' illustrates one of the most common errors in anterior tooth positioning - positioning the teeth over the resorbed ridge without considering the ‘original position of the natural i teeth . 36,37, 38 In "E," with drawing “A" superimposed over drawing “D," the denture with teeth sot over the ridge is compared to the original positon of the Figure 4 natural contol. The loss of vertical dimension and lip sup- port, ond resulting loss in (Note that the teeth in the schematic drawing above are esthetics, is the most common result. labial to the residual ridges.)The relationship of the arch form to tooth Ce eu Notre tends to harmonize the form of maxillary centrals with the form of the face, the dental arch, and the ‘arrangement of anterior feeth. Persons with dominantly square faces often have mainly square arrangements of moslly square-shaped teeth, In general these some har- ‘monious principles also apply fo the square tapering, topering, and ovoid types. Key anlar ig suse io dtrmine ech am defo resorption of maxillary ridge. Tooth Arrangement in the Square Arch Inthe Square Arch form, the two centrals are usually set to an almost straight line across the font ofthe arch The laterals are olso positioned with a neary full labial ‘spect and exhibit very litle rotation. This helps give prominence to the conines. The radius of squore arches fends fo be wider than, for example, tapering arches. This provides sufficient room for placement ofthe incisor teeth without crowding or lapping. veal n the Square arongement th ual effet is {sly stight ram carn to aie. The eth so tnd tobe stright p and do, rather tan sping. The full or oar il labil surface presente bya six near {eth gives broad effec wich sin hormony wth Figure 5, Mould 12G is illsrated. ‘ounces Other appropriate mould forms ae listed in the IPA ‘Mould Chart, Form #4343-A and in the Individualized Aer Arongement brochure, Form #3900. Tooth Arrangement in the Tapering Arch ‘A.common feature here is the rotation of the centrals on their long axis inward ot the distal, which sets the two teeth at an angle, Rotation and lapping of teeth is offen observed because there is less space in this arch than in ‘ony other type, and crowding is result. This often reduces the amount of labial surface visible. Inthe Toprng ah, the cena ins ee oe found tobe grater distance foward ofthe cnines than in ther types of arches, A Tapering arrangement does not appear as wide os oth ers, however, it's usualy in harmony wih the narrowing effect visible in the lower third ofthe tapering face. The laterals are offen roised from the occlusal plane and depressed atthe gingival. In addition, the necks of the canines atthe gingival are offen quite prominent. The incisal tips ofthe canines may be at the same height or slightly above the incisal edges ofthe laterals Figure 6, Mould 446 is ilskated. ‘A Tapering orrangement may also exhibit some “slope;” thot is, the inisals of the centrale and laterals are project ed forward, and the cervical area of canines is brought out. Tooth Arrangement in the Squore Tapering Arch The Square Tapering arrangement combines characterises of the Square and Tapering forms, modifying both. It has «@ characteristic Square placement ofthe centrals, but i set ina “sofier’ arrangement. The Square Tapering arrange- ment may not exhibit the illusion of fullness or width os does the Square, and usually the canines exhibit more dis- tal rotation than in @ Square arrangement {Ege The contral reset prominent, withthe laterals and con- ‘ines elevated. There may be litle or no rotation ofthe cen- ey ‘nos combined with atypical Toerng efector rotation of = laterals ond conines. Figure 7. Mould 22G is illustrated. Tooth Arrangement in the Ovoid Arch The Ovoid arrangement exhibits definite curvature; rote tion is seldom observed. Ege The contains inthe Ovid ont ach re often set vel forward ofthe canines, in a postion betwen that of lay ‘the Suae ond the Tapering arches. A,ypical Ovoid alignment shows o fullness of labial sur face from canine to canine. This, in conjunction with set ting the teeth to the curved arch, gives a broad effect that is in harmony with @ round Ovoid face.Figure 8. Mould 656 is illusroted Figure 8A illusrotes the average cntereposterior distance from the center ofthe incisive popila fo the labial surface ofthe centrale, bosed 6 the tooth form selected Sm Square atm Steed Fram opoing eu Five important factors ore involved in positioning onterior teeth. They are 1. Anterior slope - Labicl incination 2. Mase rclnaon “Maso di i 5 Inferiorsuperor positioning to a horizontal plane - ‘Above below plane of occlusion a 44, Rotation on o long oxis - Turning tooth on its center 5, ene ppostioning - How for labially or lin ually [in oF out the anterior or posterior leeth are ply, at) pos 3 Proximal View - Anterior Slope (On average, the central J incisor, when set at approx: mately the same angle as nat ural tet, will be ot on inclino- fon slighty ofset from vertical The incisal edge will contact the occlusal plane The slope of the lateral incisor is often slightly more accentvat ed than that ofthe central The incisal edge ofthe lateral may be slightly raised (superior to) about 1/2 mm from the occlusal plane. The conine may be set promi- rently, often to a line ot right angles to the occlusal plane, with the incisal edge set on or slighty above the plane. TConine Figure 9¢ Frontal/Facial View - Mesiodistal Inclination ‘The desirable angulation to the median line may be corre: lated fo the form of the arch and ofthe tooth. Generally the Square Arch form and tooth, and the Ovoid Arch form cond tooth, may be set fo approximately the same angule- ‘Sere Figure 108 The Topering forms are often set toa slightly greater ongu- Eqornpeng ng Figure 108 Any technique concerning the preliminary arrangement of teeth is based upon average conditions. Many times prac- fical considerations dicate modificotions in these methods in order to cope with individual diferences in oral and facial anatomy. However, if bosic principles are followed, they wil be « workable foundation for @ harmonious arrangement Occlusion Rims. ‘A wax occlusion rim is fabricated and defines the position, size ond shape of the teeth to be replaced. Critical infor. mation abou the patien'’s correct vertical dimension of ‘occlusion, occlusal registration and the general arrange- ment of the denture teeth are indicated on the occlusion rims, From this wax “template,” a technician can proceed to position and orrange the teeth in the iitol setup. 1. Place the central incisors in postion with incisal edges touching the occlusal plane or a mandibular occlusion rim (Fig. 11), Figure 112. Position the laterals with the incisal edge raised approx: imately 1/2 to 1 mm (Fig. 12) rm Figure 12 3, Place the canines withthe incisal tip close to or touching the occlusal plane, and tl the cervical third buccally to give it prominence. Often, the mesiolabial aspect of the canine is visible when viewed from the anterior. In natu, the postion of the canine teeth plays on impor: tant par in the esthetic appearance of the dentition. in a denture they play an equally important role. They have esthetic and functional influence on both the anterior and posterior loth arrangements (Fig. 13) Figure 13, Positioning of maxillary canines Figures 14 ond 15 show the importance of the proper positioning of the upper canines. Figure 14, Viewed from the anterior, the mesiolabial su face of he conine is prominent, ond the gingival oneshird is posiioned more focally than the incisal one third Figure 15. Frofile or side view emphasizes the almost vertical long axis and position of the conine Ree eee LAY Cg In nature there are a number of conditions which may be observed that directly affect the individual arrangement ‘ond esthetic appearance of natural dentition Sofiness ino tooth arrangement is @ reduction of the labial surfoce in terms of its visual appearance. A rounded mesiodisiol curvature of the tooth combined with on ovoid culine of the tooth appears softer thon a lat tooth with more angulariy. rounded form is for softer tothe eye than a straight line or flat plane. ‘A characteristic ofthe bold, vigorous face is the dominant size ond alignment of the teeth. The relatively lorger size ofthe lateral incisors and canines, and ther staight bold ‘arrangement, are important considerations in achieving the effect of strength. Vigor and boldness are not neces sarily solely masculine characterises, since strong, bold faces may be found in many female patents The following drawings illstate the principe of tooth positioning for visual effec. In drawing 16, two central incisors are normally posi- tioned. Viewed from the front, these teeth would look nor- mal in their size or relation to each other. _ In drawing 168, the Wwe centrals ZT S o © have been positioned with the rmesials slightly more prominent cond withthe distals rotated inword- ly 50 they are less prominent Viewed from the front view, the teeth in “B" would look smaller than those appearing in “A.” The illusion is created by merely rotat ing the teeth, giving them 0 some- what smaller and softer look To further soften this effect, @ rub- ber wheel may be used to round the distoincsal surface of either tooth, thereby introducing a slight degree of asymmetry Figure 168,In drowing 16C the some wo central incisors are placed to make the teeth look larger, creat ing the illusion of boldness or strength, This is accomplished by Figure 16 rotating the mesial in ond the dis tal out fo show more facial surface. Ifthe laterals are also depressed slightly behind the centrols, the boldness of the tooth arrangement is furher accentuated. Ths illusion may be made even stronger by grinding the teeth incisally to leave the distoncisal area prominent. De et EL mandibular anterior teeth llustrations 17 and 18 show an anterior view ofthe lower anterior teeth arranged in average horizontal alignment of their incisal edges. Note thatthe long axis of the central incisors is perpendicular tothe plane. The long axis of the lateral incisors is inclined slightly tothe distal atthe neck The long axis of the canines is inclined more to the disto buccal at the neck Figure 19 Figure 20 Figures 19 and 20 ilustate how to achieve greater char Ccierizaion; lower anteriors should be rotated and lapped with no two long axes of he teth parallel to each other The horizontal plane used for the alignment of lower anterior teeth may be above the occlusal plane, a distance usually described as the verical over- 1st lop or overbite (Fig. 21). The } es vertical overlap of the teeth may |_| | be influenced by the esthetic J cand phonetic needs of the seat patient. Anterior teeth should Pr or also be arranged in harmony Figure 21 with various degrees of incisal guide table angulation, Fig. 22 shows @ proxi: mal view of the lower ‘anteriors indicating their average antero- posterior inclinations to «a horizontal plane, CL aero Cn aaa Although there ore varying methods and guides in the crrangement of aficial anterior teeth, inthe final analysis it's the overall visual effect of he teeth inthe mouth ofthe patient, created by their shape, size, color, and poston, that determines acceptonce or rejection, The teeth must {ull he Esthetic, Phonetic and Functional cequirements of the individual patient. This is why a wax tryin and accep: tance of the denture arrangement by the patient is so. important ‘A wide variety of patient communication materials ond denture selection aids are available from DENTSPLY Trubyte. These materials will help educate patients and assist in the delivery of essential information from the den fist othe laboratory, that will ulimately improve case sueAsymmetry and its influence on tooth Ce aud ‘Another aspect of intrest in tooth arrangement is the relo- by positioning one central slghlly anterior tothe other. tionship of focial asymmetry. Few faces will be observed This is shown in natucal dentition (Fig. 22) with te symmetry ofthe lef and right side. Many faces, which appear on frst observation fo be symmetrical, on Characterization ofertfcial tooth arrangements - using closer study will be found to have differences. Similarly ‘arymmekry, spacing, crowding, lapping, ond grinding these diferences may be observed in the arrangement of modifications - should be approached with caution. Pre the teeth. (Compare Fig. 21 with Fig. 22.) ‘extraction study casts and photographs are the best guides for these individualized touches. This is an orea of com- Asymmetry may be brought about by os litle os the plete denture treatment which is more inthe realm ofthe depression or rotation of a canine. Al times it may be atic than the scientific and requires patient acceptance ‘accompanied by a difference in the size ofthe laterals, or Figure 21. Smile created using only the Figure 22. Notural smile showing asymmetry right side ofthe natural smile in Fig. 22EuroLine 40° Post . osteriors Description: Fully anatomical, long crown form Indications For Use: Ideal for use with partial dentures, in com- bination cases and implant overdentures; also for use in full dentures. Ridge Type: Healthy ridge with minor resorption. Recomme: Trubyte® Portrait? IPN® Euroline* 40" posterior teeth ore fully anatomical. They were designed by master dental technicians in Europe and are moulded in York, Pennsylvania, Their wider, deeper occlusal table ond longer crown form integrate more completely with natural dentition. This young anatomic form makes them ideally suited for use in removable partial dentures and combina: tion cases, Portrait Euroline Posteriors are similar to BioStabil poster- «8 in buecolingual and ridge lap design. This fullorm tooth wil fil © space and fit on @ natural ridge with more stobilly and will more easily inlerdigitate with opposing natural dentition and fixed bridge restorations. Using 30" incisal and condy/lar guidance, the deep cusp/fossa angles can be ortanged to maximize efficioney cand minimize intececence. A definite occlusal stop in the central fossa area and an open ridgegroove pathway pro vide more freedom of movement in lateral excursions, as compared to other European posterior designs. These teeth may be arranged with « compensating curve for bilateral balanced occlusion with complete dentures Bolancing contacts may be achieved on all teeth except the first bicuspid. Either the lowers or the uppers can be set fist, When setting the upper leth firs, follow the direc tions provided here. If seting the lower teth fist, use a Trubyle 20° Template erp un Ud Bilateral Balanced Occlusion ‘The relationship ofthe cusps of the moxillry posterior teeth may be related to a fat occlusal plane for easy ii tial positioning and later occlusion and orficulation with the mandibular posterior teeth, if necessary. An illustration of initial positioning of each tooth and the relationship of each cusp toa flat plane are shown in Figs. 1 and 2. Aww Figure 2. Proximal view Figure 2B. Cusp view1. Place the maxillary premolars with their long axes at 5. Follow the same procedure in placing the posterior Fight angles fo the occlusal plane {Fig 1). slight teeth on the opposite side. mesial inclination is also acceptable, The buccal cusps of the premolars should touch the plone ond the lingo ‘A straight edge may be used on the facial to align the cusp of the maxillary 1st premolar should be raised ‘buccal ridge of the first and second premolars and the proximately 1/2 fo | mm obove the plane (Figs. 1 mesiobuceal ridge of the fist molar (Fig. 3), cond 2) 2. The first and second molars may be Step 3 tetwih heir lng axon incined Ch Rot slightly mesially. Ge ure 3, Occlusal surface view 3. The mesiobuccal cusp and the mesi- lingual cusp of the frst molar fed ~UngulTngve dots) are approximately 1/2 to 3/4 Se ae ental The buccal ridges ofthe molars may be similarly aligned, bout ongled slightly inward. This isan average arrange- cand Step 3 ilsoton. Cran ment ond modifications can be made os inlvduol condi 4, The second molar is se to follow the °) ‘ons indicate position of the first molar. The dis- awk He) folingual cusp and the distobuccol cusps [green dots) are approximate. Unalngie ly 1-1/2 mm above the plane (Figs. 1, 2, 2B and Step 4 illustration), Euroline” 40° Posteriors The Completed Tooth Arrangement In All Relations ES igure 5. Cross section Figure 6, Centic occlusion, lingual view. cof centric occlusion Le Metis isl Figure 8. Cross secion Figure 9. Working occlusion, lingual view. ‘of working occlusion Figure 10. Bloncing poston, bucal view, Figure 11. Ciessscion "Figure Beercing poston, nual view ‘of balancing occlusion. te: enema sho ee res Medion may be made ned er phe ato, 10Anatomical 33° Trubyte* osteriors Description: Fully anatomical, long crown forms and long buccal-short bite moulds available. Indications For Use: Ideal for use with partial dentures, in com- bination cases and implant overdentures; also for use in full dentures. Ridge Type: Healthy ridge with minor resorption. Trubye” Anatomical 33° Posteriors are idealy designed for complete dentures and removable porfal dentures which oppose natural teth. They are o standard of excel lence for maxilary and mandibular complete dentures where on anatomical tooth form is preferred or indicated. Cusp contours ae comparable 1o those of moderately worn natural teeth. Their inclinations and well defined sulci provide pathways which are adaptable to most requirements in complete and partial denture constetion Ce Ld ed The procedures described are normal methods Occasionally, compromises must be made for mechanical reasons dictated by the conditions present. It may be necessary, fr the purpose of creating required tongue room, to alter the position of he posterior teeth The master carvings of Trubyle® 33° posterior teeth were planned to simplify occlusion and articulation. The relation Ship ofthe various cusps ofthe moxillary posterior teeth should be related to a lat occlusal plane for easy initial positioning and later occlusion and articvlation withthe mandibular posterior teeth. An illustration of inital posi Vioning of each tooth and the relationship of each cusp to « flat occlusal plane is shown in Figs. 1 and 2 I 4a4a Figure 1. Buccal view aAKRA Figure 2. Proximal view 1. Place the maxillary first premolar with its long axis at right angles to the occlusal plane. The buccal and lingual cusps are placed on the plane 2. Place the maxillary second premolar in o similar manner. Align the buccal surlaces ofthe premolars and the canine with the edge of an occlusal plane (se Figure 3). Figure 33. The mesiobuecal and mesiolingual cusps of the maxillary 5. Follow the some procedure in placing the posteriors on first molar touch the occlusal plane {red dos in Step 3) the opposite side, 6. An occlusal view ofthe positioning of Trubyte 33° 2 4 SoS chesk SPF cheat maxillary posteriors is ilustrated in Fig. 3, Page 11 oy an) 5) {A sraigh edge may be sed to align the labial ridge of ey do, the canine, the buccal ridge ofthe first and second premo- lars, and the mesiobuceal ridge of the fist molar. Uingoa Tongue Uingoa/Torgwe | The buccal ridges ofthe molars may be similarly aligned, The distobuecal cusp (green dol is roised about 1/2 but angled slightly inward. This is an overage arrange- mm and the distolingual cusp (green circle is raised ment, and modifications can be made as individval condi ‘bout 1/2 to 3/4 mm above the plane. tions indicate. 4. All the cusps of the second molar are raised from the ‘occlusal plane following the positon ofthe first molor (red circles). The mesiobuccal cusp (red dot) should be ‘about 1 mm from the occlusal plone, Trubyte 33° Posteriors - Articulation of mandibular first molar Bilateral bolanced occlusion contibutes greatly 1 the com Bear in mind thot the mandibular First molar is @ key tooth in fort and efficiency of complete dentures,- Without balance crticulation. IF careful atention is paid to the posiioning of this there may be grester resception, less elfciency, ond a recur. 100th, articulation ofthe remaining posteriors will be greatly faci rence of fore spots, Balanced occlusion can be occom- itoted. glhed wih miimum fe i eoch oh srg ino ction Anatomical 33° Posteriors The Completed Tooth Arrangement In All Relations BS Figure 5. Cross section cof centric occlusion [le ae Figure 8. Cross section cof working occlusion, ‘net Figure 10. Bolancing contact, buccal view igure 11. Cros secon Figure 12, Balancing conc, nguel view alancing Seclusion kn mo en ons nbd a rp in.Pilkington - Turner 30° Trubyte” * Posteriors Description: Fully anatomical, long crown forms and long buccal-short bite moulds available Indications For Use: Ideal for use with partial dentures, in com- bination cases and implant overdentures, also for use in full dentures. Ridge Type: Healthy ridge with minor resorption Trubyle Pikington-Turner 30° Posteriors ore designed to meet the anatomical requirements of the mandibular move ments of the majority of patients. They are particularly suitable for partial and complete dentures which oppose natural teeth, and for complete dentures in which a cuspal form is preferred, When the eral balance without cuspal interfer luded, they will have bila 1. The 5° buccal slope and the engineered buccal avert protects the cheeks and helps to virtually eliminate cheek biting The natural form and function of the 5° nog Pilkington-Turner Posteriors ore designed with a 5° buccal slope of the maxillary premolars, which follows nature's plan and greatly improves the esthetics of finished den: tures. ‘Studies of thousands of natural testh reveol the importance ofthis 5° slope in esthetics. Fig. 1 below shows two representative natural moxillary premolars compared with the PlkinglonTurner premolars, Note how closely the 5° buccal slope follows nature's plan, Figure 1. A greater degree of comfort and eff Pee Ue sd An important feature of Pilkington Turner 30° Posterirs is the adequate food table ond narrow occlusal contact Greater stability of the denture is provided by the shallow transverse or lateral angle ofthe teeth, Mastication is made easier and more efficient, assuring a new and greater degree of comfort to the patient