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Teeth Selection PDF
Teeth Selection PDF
Teeth Selection PDF
DOI 10.1007/s13191-011-0058-9
REVIEW ARTICLE
Received: 11 November 2010 / Accepted: 5 April 2011 / Published online: 30 April 2011
Ó Indian Prosthodontic Society 2011
Abstract Esthetic replacement and physiological tooth History of Anterior Teeth Selection
arrangement made the complete denture biologically
compatible and desirable. Proper placement of tooth should During the ivory age, teeth were selected, mostly by
be functional and esthetically pleasing to enhance the dimensional measurements, with slight consideration given
psychology of the patient. This article reviews the evolu- to face form or other qualities.
tion of concepts for teeth selection and the recent tech- The geometric classification of face form and profile,
niques employed for selecting anterior teeth for complete which was projected by Madame Schimmelpeinik in 1815
dentures. for artists use was considered in dentistry for esthetic teeth
selection. The ‘‘correspondence and harmony’’ concept
Keywords Esthetics Selection Teeth was projected by J.W. White in 1872. The basis of this
concept was that the temperaments called for a character-
istic association of the tooth form and color, and that
Introduction harmony called for a corresponding proportion and size of
tooth to that of the face, and a tooth color in harmony with
Esthetics is the primary consideration for patients seeking facial complexion; that both form and color were modified
prosthetic treatment. The size and form of the maxillary to be in harmony with sex and age. The dentist problem
anterior teeth are important not only to dental esthetics but was to correlate and supplement these various field values
also to facial esthetics. The goal is to restore the maxillary into a dental temperamental classification useful for
anterior teeth in harmony with the facial appearance. selecting the tooth mould.
However, there is little scientific data in the dental litera- The ‘‘Temperamental technic’’ of selecting tooth form
ture to use as a guide for defining the proper size and shape should be considered the fourth technique chronologically
of anterior teeth or determining normal relationships for yet the first technique from the point of view of influence
them [1]. According to Young ‘‘it is apparent that beauty, and universal acceptance [3]. The ‘‘Typal form concept’’
harmony, naturalness, and individuality are major quali- projected by W.R. Hall in 1887 [4]. Hall gave the first
ties’’ of esthetics [2]. measurements of the typal tooth forms.
‘‘Berry’s biometric ratio method’’, was projected in
1906 [5]. He discovered that the proportions of the upper
central incisor tooth had a definite proportional ratio to face
proportions. The tooth was one sixteenth of the face width
and one twentieth the face length.
Clapp’s ‘‘Tabular Dimension Table Method,’’ was pre-
sented around 1910 [6]. This method was based on
M. Vasantha Kumar S. C. Ahila (&) S. Suganya Devi
selecting tooth size from the overall dimension of six
Department of Prosthodontics, SRM Dental College,
Ramapuram, Chennai 78, India anterior teeth and the vertical tooth space present in the
e-mail: ahilasc@yahoo.co.in patient. ‘‘Molar Tooth Basis,’’ was projected by
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J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13 9
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10 J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13
ask the patient to relax with the lips closed. With a sharp equal to or within 0.5 mm of the measurements of the four
marker, mark at the corner of the lips. The vertical line maxillary anterior teeth.
drawn from this mark coincides with the pupil of the eye. Mavroskoufis and G.M. Ritchie [32] gave a formula for
The distance between the marks following the contour of the selection of the mesiodistal width of the anterior
the arch marked in millimetres is the combined width of six artificial teeth (A = N ? 7 mm) where N is the nasal
maxillary anterior teeth. width.
Maxillomandibular Relations Any disproportion in size Inner Canthal Distance as a Guide The inner canthal
between the maxillary and mandibular arches influences distance (Fig. 3) is defined as the distance between the
the length, width and position of the teeth. This is of medial angles of the palpebral fissures [33]. Abdullah in
importance in class II and class III maxillomandibular 2002 [34] has proposed a formula to calculate the width of
relations. the central incisor from the inner canthal distance. The ICD
was found to be greater than the combined width of max-
Contour of the Residual Ridge The artificial teeth should
illary central incisors. Thus the ICD was multiplied by
be placed to follow the contour of the residual ridges that
0.618. the resultant product was then divided by 2 to obtain
existed when natural tooth were present. As resorption
the width of a single central incisor. FCIW = ICD/
occurs there is alteration in the contours of the ridge.
2 9 0.618.
Vertical Distance Between the Ridges The length of the
teeth is determined by the available space between the
existing ridges. It is advisable to use a tooth long enough to
Form of Teeth
eliminate the display of the denture base.
Lips Labial surface of the maxillary anterior teeth sup- Three factors are used as guides in the selection of anterior
ports the relaxed lip. Frequently incisal edges extends tooth form.
inferior to or slightly below the lip margin. When the teeth
Form and Contour of the Face The shape of the artificial
are in occlusion and lips closed the labial incisal third of
tooth should harmonise with the patient’s facial form [35].
the maxillary anterior teeth supports the superior border of
The classification of tooth forms by Leon Williams, though
the lower lip. In speech, incisal edges of maxillary anterior
not scientifically correct, is undoubtedly the simplest and
teeth contacts the lower lip at the junction of the moist and
the most useful guide. Leon Williams claimed that the
dry surfaces of the vermilion border [26].
shape of the upper incisors bears a definitive relationship to
Nasal Width as a Guide Boucher [27] and Hoffman et al. the shape of the face. He classified the form of the human
[28, 29] referred to the nasal index as a guide to select the face into three types: square, tapering and ovoid forms.
anterior teeth as it relates the inter alar width to the space The operator imagines two lines, one on either side of
available for setting the anterior teeth. the face, running about 2.5 cm in front of the tragus of the
Wehner et al. [30] suggested that the ‘‘parallel lines’’ ear and through the angle of the jaw.
extended from the lateral surface of the ala of the nose onto
Square––lines are almost parallel
the labial surface of the upper occlusal rim could be used to
Tapering––lines converge towards the chin
give an estimation of the midline vertical axis of the upper
Ovoid––lines diverge towards the chin
canine teeth.
Kern [31] made measurements on 509 dried skulls and The other method of determining the tooth shape is by
found that most of the measurements of nasal width are the use of a trubyte tooth indicator. Place the indicator on
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J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13 11
the patient’s face, allowing the nose to come through the plane of vision. White light of wavelength between 380
central triangle. Center the pupils of the eye in the eye slots and 750 nm in the electromagnetic spectrum is considered
and hold the indicator with its central line coinciding with suitable. Eyes fatigue to color perception very rapidly, for
the median line of the face. this reason they should not be focused on a tooth more than
In Square form––the sides of the face will approxi- few seconds. The teeth and the shade guide should be
mately follow the vertical lines of the indicator. In square placed at a distance of 6–8 feet.
tapering, the upper third of the lower 2/3rds will taper
inward. In tapering faces, the side of the face from the Dimensions of Color
forehead to the angle of the jaw will taper at an inward
diagonal. Ovoid faces will be best determined by exam- The factors controlling color can be controlled into three
ination of the curved outline of the face against the straight basic variables: observer variables, object variables and
vertical of the indicator. light source variables [39]. This is referred to as geometric
metamerism or a conditional color match. The shade of the
Facial Profile To determine the facial profile, observe the
central incisor has been selected from an appropriate shade
relative straightness or curvature. The facial profile is
guide. In choosing this shade, the dentist should consider
determined by three points. The forehead, the base of the
the age of the patient, the individual complexion pattern,
nose and the prominent point of the chin [36].
and the patient’s desires. Acceptable color values of teeth
Straight—three points are in line always represent compromises between these three factors.
Curved—points of the forehead or chin are recessive. The three dimensions of color are Hue, Value and chroma
[40]. Hue describes the dominant color of an object. Value
Based on these three points the profile can be straight,
describes the lightness and darkness of a color. Chroma
convex or concave. The labial surface of the tooth viewed
describes the degree of saturation of the particular color.
from mesial should show a contour similar to that when
The shade tabs usually includes these three dimensions to
viewed in profile. The labial surface of the tooth when
help the clinician and the laboratory technician to select an
viewed from the incisal should show a convexity or flatness
appropriate teeth to match the patient’s appearance.
similar to that seen when the face is viewed from under the
Light is the origin of color- the primary in the triad of
chin or from the top of the head.
source, object, and observer- it is infrequently considered
Sex Curved facial features are associated with feminity, as such by people viewing color [41, 42]. Incandescent
and square features are associated with masculinity [37]. light, which is commonly used in the home and in most
Since there is harmony between tooth form and face form, operatory lamps, emits a great deal of energy in the red
it follows that tooth of female are ovoid or tapering than yellow area of the spectrum and very little in the blue area.
square. Therefore if we illuminate samples of red, yellow and blue
under the incandescent light source, we will see that the red
and yellow are very strong and highly saturated. While the
Color of Anterior Teeth blue is weak and lacking in saturation. Natural day light is
considered to be a best source.
Bilmeyer and Saltzman defined color as the result of the
physical modification of light by colorants as observed by Other Pre-Extraction Records as a Guide
the human eye and interpreted by the brain [38]. Light is
physical, colorants are chemical, the eye is physiologic, Photographs [43], diagnostic casts, teeth of close relatives,
and the brain, of course, is psychologic. Actually, the eye pre-extraction intra-oral radiographs and extracted teeth.
as a receptor interfaced with the brain as an interpreter is
psychological in nature. The definition of color is indica-
tive of the variables inherent in seeing and controlling Discussion
color.
When a tooth is viewed for the purpose of determining Happiness is a state of mind. It is brought about by a
its color, two principle colors––yellow and grey––are feeling of well-being, security, harmonious relations with
evident. The yellow is more dominant in the gingival third others, and confidence in one’s self. The dentist should
and the grey is more prominent in the incisal third. The render the patient, the confidence that none of these fine
position of the patient and source of light are very impor- senses will be in jeopardy. The development of a pleasing
tant in color selection [38]. The patient should be in upright oral and facial expression for the patient depends upon the
position. The dentist should be in a position so that the dentist ability to replace the dentures, both in contour and
teeth are viewed in a plane perpendicular to the dentist color [22, 44]. Furnas [45] stated, ‘‘esthetics in full denture
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12 J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13
construction, as employed by at least 90 per cent of the 7. Valderrama J (1913) Fundamental errors in anatomic articulators.
men in general practice, can only said to be conspicuous by Dent Cosmos 55:1205–1215
8. Graber RL (1913) Esthetics of prosthetic dentistry. Dental
its absence.’’ This statement shows the importance of Review 27:1085 Cigrande Ibid., Discussion p 1160
anterior teeth selection. 9. Williams JL (1914) A new classification of natural and artificial
Imitating nature with denture involves the application of teeth. Dentists supply Co, New York City
three basic principles, each one dependent upon the suc- 10. Wavrin JA (1920) A simple method of classifying face form.
Dent Digest 26:331 414: 531
cessful application of the others. 11. Wright WH (1936) Selection and arrangement of artificial teeth
for complete prosthetic dentures. J Am Dent Assoc 23:2291–2307
1. The anterior and posterior teeth should be replaced in
12. Nelson AA (1925) The selection of mold and hue of teeth for
the same natural position from which they came artificial restoration. Dent Items Interest 5:775
relative to the lips, the cheeks and the tongue. 13. Mycrson S (1935) A new system for tooth selection. Ideal tooth,
2. The basic anatomy of the dental arches should be Inc, Cambridge
14. House MM (1939) Form and color in denture art. House and
fashioned about these teeth in all its natural contours.
Loop, Whittier, p 17
3. The exposed surfaces of the denture should then be 15. Stein MF (1936) Williams classification of artificial tooth forms.
tinted by an approved method to more closely imitate J Am Dent Assoc 23:512
the color of living tissue. Color is dependent upon 16. Sears VH (1941) Selection of anterior tooth for artificial dentures.
J Am Dent Assoc 28:928
form, and successful color effects can only be made if
17. A manual for plastic teeth (1949) H.D. Justi & sons Inc., Phila-
the contours of the natural basic anatomy are present. delphia, p 8
18. Trubyte bioform teeth (1950) Dentist Supply Co, New York City
Certain proportion has evolved in history to describe the 19. Trubyte tooth indicator (1950) Dentist Supply Co, New York City
facial esthetics. Proportion is the study of harmony of 20. Frush JP, Fisher DR (1955) Introduction to dentogenic restora-
structures in space [46–48]. The esthetic proportions are tions. J Prosthet dent 5:586–595
golden proportion [49] which exist from ancient times. 21. Young HA (1954) Selecting the anterior tooth mould. J Prosthet
dent 4:748–760
Now in the recent years recurrent esthetic proportions are 22. Pound E (1954) Lost fine arts in the fallacy of ridges. J Prosthet
argued [50, 51]. Esthetics may continue to be ignored in Dent 4:6–16
favour of the mechanical principles of function, but not 23. Frush JP, Fisher RD (1958) The dynesthetic interpretation of
without sacrifice of a pleasing and harmonious expression. dentogenic concept. J Prosthet Den 8:558–581
24. Land LS (1996) Anterior tooth selection and guidelines complete
denture esthetics. In: Winkler S (ed) Essentials of complete
denture prosthodontics, 2nd edn. Ishiyaku Euro America Inc., St.
Conclusion Louis, pp 200–216
25. Heartwell CM, Rohn AO (2002) Tooth selection. In: Textbook of
complete dentures, 5th ed. BC Decker, pp 305–319
Dental art does not occur automatically. It must be pur- 26. Alexander LM (1963) Clinical applications of concepts of func-
posely and carefully incorporated into the treatment plan tional anatomy and speech science to complete denture Pros-
by the dentist. This artistry strives to soften the marks thodontics. J prosthet dent 13:204–227
imposed upon the face by time and enables people to face 27. Zarb GA, Bolender CL, Hickey JC, Carlsson GE (1998) Selecting
artificial teeth for the edentulous patient. Textbook on bouchers
their world with renewed enthusiasm and confidence. Art prosthodontic treatment for the elderly, 10th edn. BI Publications
in collaboration with science of denture construction eases Pvt Ltd, New Delhi, pp 330–351
the geriatric patient in maintaining physical and psycho- 28. Hoffman W Jr, Bomberg TJ, Hatch RA (1986) Interalar width as
logical health. guide in denture tooth selection. J Prosthet Dent 55:219–221
29. Gomes VL et al (2009) Interalar distance to estimate the com-
bined width of the six maxillary anterior teeth in oral rehabili-
tation treatment. J Esthet Restor Dent 21:26–36
30. Wehner PJ, Hickey JC, Boucher CO (1967) Selection of artificial
teeth. J prosthet dent 18:222–232
References 31. Kern BE (1967) Anthropometric parameters of tooth selection.
J Prosthet Dent 17(5):431–437
1. Hasanreisoglu U et al (2005) An analysis of maxillary anterior 32. Mavroskoufis F, Ritchie GM (1980) The face form as a guide for
teeth: facial and dental proportions. J Prosthet Dent 94:530–538 the selection of maxillary central incisor. J Prosthet Dent
2. Gomes VL, Gonclaves LC, do Prado CJ et al (2006) Correlation 43(5):501–505
between facial measurements and mesiodistal width of the ante- 33. Masuoka N, Muramatsu A, Aaiji Y et al (2007) Discriminative
rior teeth. J Esthet Restor Dent 18:196–205 thresholds of cephalometric indexes in the subjective evaluation
3. Clapp GW (1955) How the science of esthetic tooth form of facial asymmetry. Am J Orthod Dentofacial Orthop
selection was made easy. J Prosthet Dent 5:596 131:609–613
4. Hall WR (1887) Shapes and sizes of teeth in American system of 34. Abdullah MA (2002) Inner canthal distance and geometric pro-
dentistry. Lea Bros and co, Philadelphia, p 971 gression as a predictor of maxillary central incisor width.
5. Berry FH (1905) Study of prosthetic art. Dent Mag. 1:405 J Prosthet Dent 88:16–20
6. Clapp GW (1922) Twentieth century mold book. Dentist’s Sup- 35. Faure JC, Rieffe C, Maltha JC (2007) The influence of different
ply co, New York facial components on facial esthetics. Eur J Orthod 131:609–613
123
J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):7–13 13
36. Davis NC (2007) Smile design. Dent Clin North Am 51:299–318 45. Furnas IL (1936) Esthetics in full denture construction. J Am
37. Lee JH (1962) Dental esthetics. The pleasing appearance of Dent Assoc 23:3
artificial dentures. John Wright and Sons, Ltd, Bristol 46. Ricketts RM (1982) The biologic significance of the divine
38. Billmeyer FW, Saltzman M (1966) Principles of color technol- proportion and the Fibonacci series. Am J Orthod 81:351–370
ogy. John Wiley & Sons Inc, New York 47. Marquardt SR, Stephen R (2002) Marquardt on the golden
39. Lombardi RE (1973) The principles of visual perception and their Decagon and human facial beauty. Interview by Dr. Gottlieb.
clinical application to denture esthetics. J Prosthet Dent J Clin Orthod 36:339–347
23:358–382 48. Levin EI (1978) Dental esthetics and golden proportion. J Pros-
40. Hegenbarth EA (1989) Creative ceramic color: a practical sys- thet Dent 40:244–252
tem. Quintessence publishing Co, Inc, Chicago, pp 39–41 49. Qualtrough AJ, Burke FJ (1994) A look at dental esthetics.
41. Saleski CG (1972) Color, light and shade matching. J Prosthet Quintessence Int 25:7–14
Dent 27:263–268 50. Rosentiel SF, Ward DH, Rashid RG (2000) Dentists’ preferences
42. Sellen PN, Phil B, Jagger DC, Harrison A (1999) Methods used to of anterior tooth proportion–a web based study. J Prosthodont
select artificial anterior teeth for the edentulous patient: a his- 9:123–136
torical overview. Int J Prosthodont 12:51–58 51. Ward DH (2001) Proportional smile design using the recurring
43. Mc Cord JF, Grant AA (2000) Registration: stage III- selection of esthetic dental (red) proportion. Dent Clin North Am 45:143–154
teeth. Br Dent J 188:660–661
44. Krajicek DD (1960) Natural appearance for the individual den-
ture patient. J Prosthet Dent 10:205
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