ANTERIOR TEETH

SELECTION AND ITS

ARRANGEMENT

Presented by:
Reading well kharmawlong
 Introduction
Following the mounting of casts in the articulator and
determining the type of occlusal scheme, the next procedure in
the fabrication of complete denture is the selection of artificial
teeth. Anterior teeth are primarily selected for aesthetics while
posterior teeth are selected for mastication. However, both must
function in harmony to each other and with the surrounding
oral environment. The type of occlusal scheme planned also
dictates the selection of posterior teeth.
Though there is again no single rule of the thumb to decide the
selection, it certainly requires artistic skills in addition to
scientific knowledge.
Objectives:
 To establish harmony with the surrounding tissues.
 Maintenance of vertical dimension
 Aesthetic acceptability.
 Masticatory efficiency.
Selection of anterior teeth:
The anterior teeth are selected according to the following
factors;
 Size of the teeth
 Form of teeth
 Color /Shade of the teeth
Size:
The following factors guides and contribute to
anterior teeth selection.
 Size of face and head
   
Berry’s biometric index:
The average length of the
maxillary central incisors is
determined by dividing the
length of the face (is a
measure of the distance from
the hairline to the lower
edge of the bone of the chin,
with the face at rest) by 16.
i.e.,
Width of the upper CI
  Anatomical landmarks
 Mark or pin is placed at the corners of the
mouth on the wax occlusal rims. The width of
the maxillary anterior arch is determined by
measuring the distance from the two marks
with a flexible ruler.
 Parallel lines are extended fro the lateral
surfaces of the ala of the nose onto the
maxillary occlusal rim. This lines tentatively
gives the position of the apex of canine teeth
indicating the width of the maxillary anteriors.
 Through the distal borders of the incisive
papilla a line is drawn perpendicular to the
midline of the palate and continued to the
edge of the master cast. The tips of the canine
teeth should lie near the point of intersection
of this line with the labial surface of the
occlusal rim. A flexible ruler can be used to
measure this distance.
 If the cuspid eminences are evident, a line placed at its
distal termination in the cast gives a measure of the
anterior maxillary arch. If the eminences are not evident,
the buccal frenum can be used as a guide for the arch.

 Maxillomandibular relations:
• In class III arches, the mandibular anterior teeth are
selected larger than normal.
• In class II arches, the mandibular teeth are selected
smaller than normal.
 Contour of the residual ridge:
• The artificial teeth should be placed to follow the contour
of the residual ridges that existed when natural teeth
were present. Thus the sixe of the anterior teeth are
selected according to its position
The loss of contour as a result of resorption, accident or
surgery may make this a difficult task. Resorption of the
maxillae anteriorly is in vertical and palatal direction, while
posteriorly it is in a vertical and medial direction. Resorption
of the mandible anteriorly is in a vertical and lingual direction
while posteriorly it is downward and outward.
• There may also be relationship between the form of the
residual ridge and the form of the teeth- square, tapering
and ovoid.
 Vertical dimension between the ridges
This determine the length of the teeth. When
space is available, it is more aesthetically acceptable
to use teeth that are long enough to eliminate the
display of denture base.
 Lips:
 This again guides the selection of length of maxillary
anterior teeth
 At rest, the relationship of the incisal edges of the central
incisors to the lip line is as follows;
Type of individual Amount of teeth exposure below the lip line at
rest
Young female 3mm
Young male 2mm
Middle aged 1-1.5mm
Elderly 0-2mm above lip line at rest

 In speech, the incisal edges of the maxillary anterior

should contact the lower lip at the junction of the moist
and dry surfaces of the vermilion border, when the
patient pronounces the letter “f”.
 Pre-extraction records:
These can provide information regarding the size and form of both
anterior teeth. These include:
 Facial photographs: provide general information about the width
and outline form of the anterior teeth through an algebraic
proportion. By comparing factors like interpupillary distance of
patient in photo and in person with the tooth width in photo, the
actual width of the anterior teeth can be calculated.
 Diagnostic casts: casts of the patients natural or restored dentition
provide information, which is useful to select the size and form.
 Radiographs: they can provide information regarding
the size and form.
 Teeth of close relatives: Sons or daughter tooth size,
color and arrangement can be effectively used in
selecting and arranging artificial teeth for their parents.
 Extracted teeth: also provide information about the size
and form but should not be used for selecting color.
Form and contour of the face
 Form and contour of the face:
 The form of a tooth should conform to
the contour of the face as viewed from
the front and side profile. Patient may
have straight, convex and concave profile
(to determine the facial profile; forehead,
base of the nose and chin points are
considered)so the labial form of the
anterior teeth should be similar to their
facial profile.
 According to Leon William’s
classification, facial forms can be
categorized as square, square-tapering,
tapering and ovoid when viewed from
front Three areas in the face are
considered for this – temporal, zygomatic
and angle of the mandible. According to
him, the shape of the teeth should be
inverse of the shape of the face.
Methods Used to Select Artificial Anterior Teeth for
the Edentulous Patient: A Historical Overview –
Selten et al, Int J Prosthodont 1999:12:51
Concluded that to date, no universally
reliable method of determining tooth form has been
found. The Williams classification (1914) is the most
universally accepted method of determining anterior
tooth form.
Dentogenic concept:
Dentogenic is the art, practice and technique used to achieve aesthetic
goal in dentistry.
• Given by Dr. John Frush an Dr. Fisher in 1957

• Also known as SPA (Sex, Personality and Age) concept because

selection of 6 anterior teeth depends on SPA factors.

 Sex:
Expression of feminine characteristics:
 Roundness, smoothness and softness is typical of women, so it

should be included in the denture.

 Incisal edges are more rounded and tooth have lesser angulation.

 Cervical margins are less prominent in females

Sex interpretation by tooth positioning:

 The incisal edges of CI, LI follow the curve of lower lip in females.

 Distal surface of CI is rotated posteriorly.

 Mesial surface of LI is rotated anteriorly in relation to the CI.

Expressions of masculine characteristic:
 Cuboidal, hard, vigorous, muscular appearance is typical of males.
 Incisal angles are rounded to a lesser degree, tooth are more angular.
 Incisal teeth are 0.5=1 mm above the occlusal plane.
 Mesial end of LI is hidden by CI which makes canine more prominent.
 Cervical region are more prominent in males.
 Personality:
refers to the characteristic or predictable ways the
individual responds to life situation, his or her attitude or
habits.
More squarish, large teeth for vigorous and rounded and
small teeth for delicate persons are selected.
Personality is explained in Prosthodontics application in 3
division of personality spectrum;
I. Delicate: means more fragile, frail opposite of robust.
II. Medium pleasing: means a normal, moderately
robust, healthy appearance.
III. Vigorous: means opposite of delicate which is hard
and aggressive in appearance.
 Performance of individual tooth in personality
appearance:
 The CI being in the front and centre of the mouth plays the
leading role over their accentuation leading to the desired
action of the smile.
 The LI being co-ordinated with central incisor in central
position has an important aspect to control, convey the
hardness or softness of the look, the vigorous or delicate
personality.
 The cuspid must dominate the LI in terms of color, form
and position and their treatment conveys a strong or
pleasant modern accentuation or an ugly primitive
accentuation to the smile.
 Age:
with age, the teeth wear at the incisal edges and interproximal
surfaces. Labial surfaces seems flatter and appears squarer. The
same should be considered while selecting the teeth.
Other include;
 Overlapping increases within the physiologic limit of the

patient.
 Interocclusal distance become less as age advances.

 Old age people show blunt smile line and pathologic

migration of teeth.
 Diastema is more often seen in the month of the adult in

advancing years due to drifting of teeth resulting from the

premature loosening of permanent teeth
 Due to decrease in muscle tone, sagging of the cheek and

lower lip occurs. To prevent cheek biting horizontal overlap

of the posterior teeth can be increase.
Colour:
A phenomenon of light or visual perception that enables one to
differentiate otherwise identical objects (GPT 8).
Dimension:
Colour has three dimension according to the Munsell system- Hue
(dominant color), Brilliance or value (denotes the lightness or darkness of
color), Chroma (denotes the intensity of the color).
Translucency is a fourth dimension, which is the property of an object that
permits the passage of light through it.
Factors:
The following parameters assist in selecting the color of the artificial teeth;
 Colour of the hair, eyes and skin:
I. Individuals with blue, green or light coloured eyes and fair skin are given
teeth with lighter shade, while those with black or dark eyes and ruddy
complexion are given darker teeth.

II. Some has also suggested a relation between colour of the hair and tooth
colour, but this is very unreliable guide as the patient could be dyeing the
same.
III. Though there is no specific correlation between the above factors and tooth
colour, in general the selected artificial tooth colour or shade should be in
harmony with these factors.

 Age:
I. With increasing age the colour becomes progressively darker.
II. In young age the pulp chamber are large with increase in blood supply
however, with age the teeth become more opaque and dark due to
secondary dentin formation which reduces the size of the pulp chamber.
i. As weary occurs on the teeth as a result of age, the tooth
also becomes smoother and reflects more light. But the
attrition at the incisal edges contributes to decreased
translucency with age.
ii. Teeth also pick up stains with age and become darker
and browner.
 Sex:
Darker shade is generally selected for men and lighter
shade for women.
 Selecting colour:
The shade of the artificial teeth for complete denture
is selected by placing the shade tab in the following
areas:
 Along the side of the nose- establishes the hue,
value and Chroma.
 Under the lip with only the incisal edge exposed-
reveals the effect of the colour when the patient's
mouth is relaxed.
 Under the lip with only the cervical end covered
and mouth open- simulates the exposure of the
teeth as in a smile
The squint may be helpful in evaluating the colour of
the teeth with complexion of the face. With the eyelid
partially closed to reduce light, the dentist compares
the selected shade tabs by holding them along the face
of the patient. The colour that fades from view first is
the one that is least conspicuous and is harmony with
the colour of the face.
 Selection of tooth material
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.
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.
ACRYLIC TEETH : PORCELAIN TEETH :
 Not brittle, but poor
 Brittle, more resistance to
abrasion
abrasion resistance.  Excellent (does not stain).
 Esthetic very good.  Mechanical bonding by pins
 Chemical bonding or undercuts holes.
with denture base.  Difficult to grind and polish.
 Easily ground and
 More forces to the mucosa.
polish.
 Clicking on contact.
 Much lower than acrylic
 Transmit fewer forces causes stresses in acrylic
to the mucosa. denture base.
 No clicking on contact.
 Thermal expansion
same as acrylic denture
base.
 Teeth Arrangement
Arrangement of teeth is dictated by the setting principles
of individual teeth, anatomical landmarks and dentogenic
concept. The ridge relation and the need to arrange the teeth
in balanced occlusion also influence the procedure. The teeth
should occupy the potential denture space or neutral zone.
Factors influencing teeth arrangement:
I. Anatomical landmarks
II. Dentogenic concept
III. Ridge relation
IV. Balanced occlusion
V. Neutral zone
Anatomical landmarks:
 Residual ridge:
Maxillary teeth are positioned labial to the ridge and mandibular teeth on
the crest of the ridge due to resoprtive pattern of the ridge.
 Arch form:

Teeth arrangement especially of the maxilla varies with the arch form-
square, tapering or ovoid and the general rule is to follow the contour of
the arch
1. Square arch: the arrangement is almost on a straight line (slight curve)
from canine without much rotation. The full face of all the maxillary
anteriors should be seen to give broad effect.
2. Tapering arch: the central incisors are placed much forward than
canine and also rotated distally. Lateral incisors are also rotated,
raised from occlusal plane and depressed at the gingival margin. Neck
of the canine are prominent.
3. Ovoid arch: arrangement has a definite curvature and central incisors
are set forward of canine (not as much as a tapered arch). There is not
much rotation and canine will not be very prominent.
 Retromolar pad:
The line extending from the tip of the lower canine to the upper 2/3 rd of
the retromolar pad will determine the height of the lower posterior
teeth(occlusal plane). If the plane is too low, it causes tongue biting or too
high plane can cause instability and strain as tongue struggle to place the
food bolus back on occlusal table.
 Parotid duct:

Maxillary first molar should be placed below the orifice of the parotid
gland.
 Rugae:

The labial surface of the canine is normally 10.5mm from the lateral aspect
of the large pair of anterior rugae
 Incisive papillae:

A line through the incisive papilla and the midline of the raphae
determine the midline of the denture teeth. The distance from the middle
of the incisive papilla to the labial surface of the maxillary CI is typically
8-10mm
A line drawn perpendicular to the midline of the palate, through the
centre of the incisive papilla intersects the cusp tips of the canine.
In young persons, a line connecting tips of canines transverses the incisive
papilla
With advancing age due to increased alveolar ridge resorption, lines
moves posteriorly and may eventually pass through the distal extent of the
papilla.
 Nose:
The distance between the tips of the canines is the same as the width of the
base of the nose. In order to visualize buccal corridor space, canines are
positioned immediately inferior to the side of the nose.
 Philtrum:
The width of the central incisor approximates the width of the Philtrum.
Dentogenic concept:
Ridge relation:
Principles of individual teeth arrangement according to ridge
relations in centric occlusion can be classified into the following
types;
 Teeth relation for class I ridge relation

 Teeth arrangement for class II ridge relation

 Teeth arrangement for class III ridge relation

Teeth arrangement for class I ridge relation:

Traditionally, the maxillary anterior teeth are arranges followed
by the mandibular anterior. Maxillary posterior and mandibular
posterior are then added and arranged.
Arrangement of maxillary anteriors:
It is arranged in corresponding to 2D plane i.e., horizontal and
vertical plane. In patient’s cases it is arranged in its natural
position by contouring the occlusal rim.
1. Central incisor:
While positioning the tooth in the vertical plane the incisal
edges should contact the occlusal (horizontal plane) plane also
the tooth should be parallel to the vertical axis.
The maxillary teeth should slope labially about 10-15 degree
when viewed from the side. The 15 degree angulation is more
pronounces in the incisal half of the CI and the cervical margin
should be within the occlusal rim. The position of the CI when
viewed lingually is not straight but follows the arch.
2. Lateral incisor:
Its long axis slopes more towards the midline with the
incisal edges about 0.5-1 mm short the occlusal plane. A
mesiolabial rotation usually looks good in a female or delicate
patient and is called a ‘soft’ lateral. This makes the tooth look
narrower and enlarged the embrasures.
For a man and for a more vigorous effect, a mesiolingual
rotation, called the ‘hard’ lateral makes the tooth look wider.
It is inclined labially about 20 degrees when viewed from the
side. The lingual view reveals distal margin of CI overlap the
mesial margin of the lateral incisor due to its rotation. The
distal surface follows the curvature of the arch.
3.Canine:
Its long axis is parallel to the vertical axis when viewed from
both front and side. The cervical margin of the canine is more
prominent when compared with CI and LI. It is less for
patient with a square face and more if the face is tapering. The
tip of the canine contacts the occlusal plane. When viewed
from front only the mesial slope of canine is visible. The
bulbous cervical half of the tooth provides its prominence.
When viewed from the buccal side, only the distal slope is
visible. On palatal view, the arrangement follows the arch
form.
Similarly, the teeth are arranged on the opposite
side of the rim. Maxillary teeth arrangement is
thus completed.
Glass plate relation of maxillary anteriors
cervical margin of the canine is higher than that
of central and lateral incisors. Arch symmetry is
shown in either side of the midline.
*Note:
 While arrangement of teeth, it should not

leave any mirror image of its own.

 Anterior-posterior positioning is guided by

the central pin. This pin should not touch the

embrasure of labio-incisal edge.
 Another guide is the CPC line. Here the

labio-incisal edge of incisors should be 8-

10mm away fro the CPC line
 Inclination of the incisors should be within

the borders.
 Labio-incisal edge should fall on the labio-

vestibular sulcus of the mandibular cast.

 Arrangement of mandibular anteriors
Here block of wax from canine to canine line is
cut out after measuring the cervico-incisal
length of the teeth to be arranged;
For the Central incisor:
Its long axis inclines slightly towards the
vertical axis from the front view but mesio-
labially at an angle of 20 degree from the side
view. The incisal edges is about 0.5-1 or upto
2mm above the occlusal plane.
From incisal view it follow the arch form.
For the lateral incisor:
Its Long axis is less vertically inclined than the
CI when viewed from the front and less mesio-
labially when viewed from the side. The incisal
edges is 2mm above the occlusal plane. From
the incisal view it follow the same arch form.
3. Canine:
 Its long axis is mesio-labially inclined than the
CI and LI when viewed from the front. The
incisal margin is 2mm above the occlusal plane.
 From the lateral view, the incisal half of the

canine is slightly lingually tilted and the

cervical half is more prominent when viewed
from the side.
 The distal slope of the mandibular canine is

below and behind the mesial slope of the

maxillary canine.
Similarly the teeth are arranged on the other side
of the arch. The incisal edges of all the teeth from
canine to canine are in the same plane.
*Note:
 Antero-posterior positioning of the mandibular
anterior is guided by the palatal surface of
maxillary anteriors.
 Maintain 1-2mm of horizontal overlap.
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.
Vertical overlap (over bite):
The maxillary anterior teeth overlap the
mandibular anterior teeth and this overlapon the
vertical axis is called the vertical overlap.

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.
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.
Teeth arrangement for class II ridge relation:
In class II the maxilla is prognathic or mandible is retrognathic with an
increased overjet of 5-6mm. The same principles of teeth arrangement is
followed with slight modification.
I. The teeth arrangement principles for the maxillary anterior are
similar for both class I and II.
II. The mandibular anteriors are placed with an increased overjet of 5-
6mm and overbite of 2mm.
III. Due to retruded position of the mandibular ridge with less space for
teeth, one premolar is removed in the mandibular arch while all teeth
are arranged in the maxillary arch.
Teeth arrangement for class III ridge relation:
In class III the mandible is prognathic or the mandible is
retrognathic, thus the overjet is reduced to almost 0-1mm.
The same principles of teeth arrngement is followed along
with slight modifications;
In case of anterior teeth arrangement, the principles are the
same except for the overjet which is virtually eliminated (edge
to edge) and the overbite which is also minimized. In order to
provide space for the maxillary posterior teeth, usually one
premolar is trimmed mesio-distally or removed from the
maxillary arch.
Concept of occlusal scheme:
It is contact relation of occluding surfaces of the maxillary
and mandibular teeth in static position. Articulation is the
dynamic contact relationship of the maxillary and
mandibular teeth.
There are several concept of occlusal scheme discussed for
the arrangement of artificial teeth in CD prosthesis.
According to the need of the clinical situation we have to
select the teeth and arranged it(some curve may be needed or
omitted).
They are group as;
1. Balanced occlusal scheme.
2. Non-balanced occlusal scheme.
3. Lingualised occlusal scheme.
Balanced occlusal scheme:
It refers to the bilateral stable, smooth and simultaneous contact of the
contacting surfaces of maxillary and mandibular teeth in centric and
eccentric position within the functional range of the mandibular
movement
Balanced occlusion during centric position:
In centric occlusion, only the working occlusal units are in contact. The
first bicuspid and the incisors have at least 1mm clearance when the teeth
are in centric occlusion. In the medio-lateral direction, the buccal surfaces
of the posterior teeth that extends over the lateral half of the residual
alveolar ridge are ground to have at least 1mm clearance with their
antagonists.
Eccentric balanced occlusal scheme :
 Developing balanced occlusion in protrusion;
In protrusive occlusion, the anterior teeth are edge to edge (this is done
by releasing the locking screws and rotating the track forwards or
backwards in semi-adjustable articulator- a working occlusion) and
contacts should be simultaneously established in the posterior teeth.
To achieve this, when we consider the factors affecting balance, condylar
inclination is obtained from the patient, hence it cannot be altered. The
incisal guidance should be as flat (close to 0 degree) as aesthetics and
phonetics will permit, so it can be manipulated limitedly. The occlusal
plane is governed by anatomical and functional consideration and also
cannot be altered. The two other factors-compensating curve and cuspal
inclination need to be adjusted to achieve protrusive balance.
The anteroposterior curve (curve of spee) influences the protrusive
balance. On protrusion, with anterior teeth in edge to edge, the mesial side
of the maxillary posterior is tilted down while the distal side of the
mandibular posteriors is tilted up until contact is made to create the
compensating curve but care should be taken not to lose the centric contact
in the process. This compensates for the Christensen’s phenomenon.
 Developing balanced occlusion in lateral excursion:
To achieve lateral balance, buccal cusps of the maxillary and
mandibular posterior teeth should contact on the working side, while the
mandibular buccal and maxillary palatal cusps of the posterior teeth
should contact on the non-working side.
Non-balanced occlusal scheme:
 Neutrocentric concept;
This concept involves somatic nervous system in control of the muscular
movement and proprioception. This concept maintain that the
anteroposterior plane of occlusion should be parallel with the plane of the
denture foundation and not dictated by the horizontal condylar guidance.
As a plane is a flat, a lever surface when teeth are arranged on a plane,
they are not inclined to form compensating curve. In a mediolateral
direction the teeth are set flat with no medial or lateral inclination. The
patient is instructed to avoid incising with the anterior teeth to prevent
sagittal condylar inclination. Because the form of the posterior tooth is
devoid of cusp, there is no projection above or below the occlusal plane.
Thus the horizontal condylar guidance of the articulator may be set at
zero. Since the teeth are not arranged for balancing contacts when the
jaws are eccentrically located, the lateral condylar guidance of the
articulator may also be set to zero.
 Spherical concept:
Here semi-anatomic teeth are used
 Organic concept

It helps to achieve the prosthetic needs of an individual

and it also helps to modify the teeth in natural occlusal
scheme. Here the occluding surface of teeth are modified
according to the patient needs to make it comfortable for
mandibular movement.
Lingualised balanced scheme:
It is a combination of balanced occlusal scheme and
neutrocentric concept.
Here maxillary cuspal teeth and mandibular flat teeth/
low cuspal inclination are used. The palatal cusp of the
maxillary posteriors will engage on he centric fossa of the
mandibular crest or PC line.
 CONCLUSION

Selection and Arrangement of teeth is an art based upon

biomechanical factors, governing the ultimate success of
dentures. Thus,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.
 REFERENCE
1. Winkler Sheldon: essentials of complete dentures
prosthodontics. 2nd edn, W. B. Sauders company.
2. Heartwell Charles M, Rahn Arthur A: Syllabus of Complete
Dentures, Fourth edition,pg 293-346; published by Lea & Febiger
Philadelphia.
3. Rangarajan V, Padmanabhan TV: Textbook of Prosthodontics,
First edition, pg 152-181, published by Elsevier, a division of
Reed Elsevier India Private Limited.
4. Omkar Shetty, Sabita Ram: Dentogenic concept Part-I, II: Scientific
Journal: Volume-I, 2007: Volume-II, 2008.