Artificial teeth selection & arrangement

Appearance &function Can not be restored with artificial teeth unless they are placed in the position was formerly occupied by the natural teeth .
Goals of teeth arrangement: to have front teeth look good. Allow the patient to speak clearly. To have all the teeth positioned for best function , comfort ,stability & retention of dentures.

 Complete denture tooth position & selection is guided by anatomical landmarks recorded in impression (models) & during registration(occ.rim)

Reference Marks for Selecting Anterior Teeth

Technician sets the teeth without seeing patient Wax rim contours aid selection and setting Land marks on the occlusal rim during registration:

- up.& l. labial contours(Angulation of facial rims affects lip support) -midline Occlusal vertical dimension -smile lip line( high lip line is marked on occlusion rim when the patient smiles) Canine prominence

Maxillary Reference Marks

Midline Position
Critical reference #7 wax spatula Score a line parallel the facial midline Mark both rims

Midline of Teeth = Facial Midline

Mark midline on the wax

Guidelines for Setting Anterior Teeth

High Lip Line
Corner of Mouth

Angulation is as important as midline

High Lip Line

Highest point of upper lip when smiling

Cervical necks lie at or above this line

If shorter teeth are selected, esthetics compromised

 The 4 landmarks which is determined in stone models : 1-max.incisive papilla guide to midline for max. central incisor& position of incisor & cuspid 2-mandibular premolar ridge guide the buccolingual position of premolar 3-RMPretromolar pad height &4- width guide the height & width of posterior teeth

Palatal Midline
Through middle of incisive papilla & midpalatal raphe Extend onto land area Check for symmetry If not symmetrical, adjust rim

Midline & Canine Reference

Line passing through distal of incisive papilla
Perpendicular to the palatal midline Intersects cusp tips of the canines
Natural Dentitio n

Distal Aspect of the Incisive Papilla

The papilla is used in locating the anterioposterior position of max.ant. teeth (incisal edges are usually 8-10mm anterior to the center of papilla) Canines tips should be located in coronal plane passing through posterior border of papilla

Mandibular Reference Lines

Center of ridge Posterior

1/2 way up retr omolar

Mandibular Cast

Land Area Occlusion rim Center of ridge Anterior

Setting Anterior Teeth

Setting Anterior Teeth

Incisal edges of central incisors & canines at level of the occlusal plane

Max. central incisors are critical teeth to set: as they are the most visible ,establish midline, provide esthetic support of patients lip.

The contact point should coincide with the midline of the face.. The incisal edge should touch the mandibular occlusion rim.
The long axis of the tooth should be perpendicular to the horizontal plane (occlusal plane or the mandibular occlusion rim

1.

The long axis should incline

slightly distally.

2.

The cervical portion of the

tooth should incline slightly

lingually. 3. The incisal edge of the lateral should be raised approximately 1 mm from the mandibular occlusion rim.

1. The incisal edge of the canine should touch the mandibular occlusion rim. 2. The long axis should be perpendicular to the occlusal plane. The cervical third of the labial portion of the canine should incline buccally to achieve some prominence. 3. The mesiolabial aspect of the canine should be visible when viewed from the anterior. This will be accomplished by tilting the neck of the canine slightly to the distal (in addition to being tilted to the buccal).
Arrangement of Anterior Teeth

The canine is an important tooth as it forms the corner of the dental arch , max. canine has two planes on facial surface; mesial plane should follow the contour of ant. Teeth while distal plane will be in line with posterior teeth. Place the canine so that the anterior one half of incisal edge is in symmetry with lateral & central incisors as it curve around the labial contour of wax

Arrangement of Anterior Teeth Dr Ban Ahmed Abdul Hameed

When viewed facially, all maxillary anterior teeth are tilted mesially, with the lateral incisor inclined the most and raised about 1 mm above the plane. When viewed laterally, the incisors are depressed at the cervical, with the lateral incisor being the most depressed, and the canine being straight with the long axis perpendicular to the occlusal plane.

Bucco-Lingual Tilt
Maxillary Anterior Teeth
Facial surface of central is perpendicular occlusal plane Neck of lateral is depressed Neck of canine is prominent
Central Canine

Circumference Follows Arch Shape

Maxillary Canines
The canine has two planes on the labial surface [a mesial plane and a distal plane]. When viewed from the anterior only the mesial plane should be visible.

Note the prominence of the gingival third of max. incisors &canines. This gingival third is primarily responsible of lip support Depressing gingival third causes the upper lip to have flaccid appearance.

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Setting of all maxillary anterior teeth

When viewed from the occlusal the anterior teeth follow the curvature of the internal portion of the land area.
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Melt the wax in the area where the section was removed with a hot instrument. Set the maxillary central incisor, being careful to not disturb the midline as recorded by the remaining section of wax rim. Check its position with a flat plate.

Note that the central incisor contacts the flat plate resting on the occlusal plane. Set the rest of the anterior teeth on the right side according to the curve defined by the plastic ruler. The labioincisal line angle of the incisors should touch the ruler, as well as the midbuccal surface of the canine.

Note that the lateral incisor is set about 1mm above the occlusal plane.

then check to make sure the alignment is correct with the contour of the wax rim, using a flexible ruler. Set the teeth on the right side following the same procedures.

An anterior view of the maxillary anterior teeth shows that only the lateral incisors do not touch the occlusal plane . With the maxillary anterior teeth set, the patients midline is recorded and proper labial support is established.

The anterior teeth should not be positioned any further forward than the depth of the labial vestibule, determined by a line drawn from the depth of the vestibule and perpendicular to a line drawn parallel to the occlusal plane. The depth of the vestibule is the fulcrum point and the further forward a tooth extends beyond this point, the greater are the forces that tend to dislodge the denture.

Setting Mandibular Anteriors

Lower anterior teeth incline similar to the maxillary teeth

a. Mandibular central incisors

1. The long axis of the mandibular central incisor should be set perpendicular to the occlusal plane. 2. The contact point of mandibular incisors should coincide with the midline of the maxillary teeth. 3. Set the mandibular central incisors so that the maxillary incisors cover them, 1 mm vertically and 1 mm horizontally (1 mm horizontal and vertical overlap).

b. Mandibular lateral incisors

1. The long axis of the mandibular incisor should be slightly inclined distally at the cervical portion of the tooth. 2. The occlusal height should be the same at the central incisors.

Arrangement of Anterior Teeth

c. Mandibular canines
1. The long axis of the mandibular canine is nearly perpendicular to the occlusal plane with a slight distal inclination. 2. The tip of the canine should be at the same occlusal height as the mandibular central and lateral incisors.

For the standard setup : complete denture is designed with small overbite/ovejet so as to minimize dislodging forces on excrusions So it is preferable to set the lower ant. teeth just out of contact & this is accomplished by setting mand. Ant. Slightly down & back(1mmof overjet)

Mandibular Central Incisors Vertical overlap 1 mm (Overbite) Horizontal overlap 1-2 mm (Overjet)

Horizontal overlap is measured from the maxillary palatoincisal line angle to the mandibular labio-incisal line angle.
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When properly arranged, the long axis of the maxillary canine will coincide with the distal surface of the mandibular canine, when viewed from the facial. Alternatively, the mandibular canines can be arranged first in the proper relationship to the maxillary canines ( the cusp tip of the mandibular canine is placed between the maxillary canine and lateral). You then arrange the centrals and laterals in the remaining space.

Mandibular Canines

The canine is slightly inclined to the distal whereas the lateral incisor is relatively vertical.

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Setting of all mandibular anterior teeth

From the anterior view, the angulation of the mandibular anterior teeth should be as indicated.
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Arrangement of Anterior Teeth Dr. marwah salah