INTRODUCTION

An acceptable cosmetic effect in any dental restoration has always been regarded as important to good dentistry. A well-made prosthesis will fail if it is deficient in this respect. Esthetics includes the appreciation and response to the beautiful in art and nature. Esthetics has been given many definitions in dentistry but according to Young. It is apparent that beauty, harmony, naturalness and individuality are major ualities! of esthetics. "he dentist must visuali#e

esthetics in relation to the patient and then translate that visuali#ation into an acceptable esthetic result. "he success of his efforts depends upon his artistic ability, his powers of observation and his e$perience. "he selection of anterior teeth for an edentulous patient is a most important and often difficult problem for the dentist. %e should select teeth which not only embody the proper form and si#e, but the most ideal shade as well. "he art of selection of teeth for edentulous patients has been lost in the ma#e of tooth guides, folders and pamphlets and the numerous methods of selection advocated by researchers. An attempt has been made in this seminar to briefly describe the various methods advocated in the literature and to reach a practical method. &

'or the sa(e of clarity and simplicity, the matter has been dealt with under the following sub headings. Introduction )eview of *iterature o Evolution of "echni ues o +entogenics o "he ,olden -roportion +iscussion .onclusion

REVIEW OF LITERATURE
I) Evolution of Techniques Young in &012 described the evolution of various techni ues used in the selection of the anterior tooth mold. Technique 1 +uring the ivory age and early porcelain period, teeth were selected or created mostly by dimensional measurements of the denture space and arch si#e with little regard to esthetics. Technique 2 "echni ue of 3.orrespondence and %armony4 projected by 5.6. 6hite in &78/. 9y this time, the temperamental theory was fading out of medicine but white reached over and suggested that the temperaments called for similarity of form in faces and teeth. "he temperamental theory is a theory of the fluids of the body, especially the blood, the phlegm and the bile. It was conceived by %ippocrates in the 1th century 9. and was used continuously by the medical profession in diagnosis and treatment until the nineteenth century, when it gave way to demonstrate science.

.holeric temperament ; predominance of yellow bile characteri#ed by anger, irritability, a jaundiced view of life. 9ody structures are small and finely te$tured. <elancholic ; due to predominance of blac( bile and characteri#ed by depression. -hlegmatic temperament ; due to abundance of phlegm in respiratory passages. Alleged to ma(e people stolid, apathetic and undemonstrative. A physical decline occurs due to phlegm in the blood. =anguine temperament ; attributed to a predominance of blood and characteri#ed by cheerfulness and optimism. )ed comple$ion, large body, strong musculature and vigorous action. "his was the introduction of the temperamental theory into dentistry ; but it was not widely used till after &771 when temperamental forms of teeth were manufactured as named sets!. Technique 3 "he "ypical form! concept projected by 6.). %all in &778. "his was the initiation of the geometric theory later presented by 6illiams.

"he basis of this classification was two-fold, the major basis was the tooth4s labial surface curvatures >transverse and gingivo-incisal?, outline form and nec( width. %all gave the classification of overall tapering and s uare. "he minor basis was the labio-lingual inclination of the upper incisors in relation to profile types. "his classification apparently e$erted little influence on practice procedure at that time. Technique 4 "he temperamental techni ue! was the first techni ue of selecting tooth form from the point of view of influence and universal acceptance. It re uired several years to associate and establish dental characteristics of the temperaments and to incorporate them in manufactured tooth forms, this occurred by &771. +entists li(e 'lagg, *aycoc(, %utchinson, @ingsley et al and artists li(e <adame =chimmelpeini(, spur#heim and 5ac ues contributed to the development and acceptance of this theory. %owever, only rarely could two dentists agree on e$actly what the theory meant, what it taught and what it re uired. It had an intangible uality which could not be defined in any authoritative way.

Technique 5 9erry4s biometric ratio method ; &0AB. 9erry projected in &0A: that the outline form of the inverted central incisor tooth closely appro$imated the outline form of the face. "herefore the outline form of the edentulous face indicated the outline form of the anterior teeth to be chosen for a denture patient. 9erry4s continued investigation into the correlation between faceform and tooth form resulted in the discovery that the ma$illary central incisor was &C&Bth the width of the face and &C/Ath its length. =ubse uent research by <.<. %ouse and others proved the &C&Bth width ratio but the &C/Ath length ratio which was fre uently not possible to use due to interference by ridge bul(. +ifficulty in practical applications discouraged the use of this techni ue. <avros(oufis et al in &07& concluded that the inter-alar nasal width is a reliable guide for selecting the mold of anterior teeth. "he tips of the canines were found to lie on a projection of two perpendicular lines drawn from the outer surfaces of the nasal alae. "hus the mesiodistal width of the artificial anterior teeth should be determined by adding 8mm to the patient4s nasal width.

"hey found no relationship between the nasal width and the totalCoverall width of the four incisors. "he authors advocate that the tips of the canine be set on a line which passes through the posterior border of the incisive papilla which proved to be a stable anatomic land mar(. "he incisive papilla can also be used as a guide for arranging the labial surface of the central incisors at &Amm anterior to the posterior border of the papilla. @ern in &0B8 studied various anthropometric parameters of tooth selection by e$amining over BAAA s(ulls. %e concluded thatD &. "he bi#ygomatic measurement did not show a high percentage

consistency ratio to the width of the crowns of the ma$illary central incisors. /. Eor did the s(ull length measurement prove reliable for the determination of the length of the ma$illary central incisor crown. =ignificantly consistent ratios were found to occur inD &. "he nasiomenton >internasal and nasofrontal sutures and the chin? measurement and the length of the ma$illary central incisor crown showed a &&D& ratio in 7& per cent of s(ulls. %owever this has little significance in edentulous patients whose nasiomenton measurements

depends on the degree of mouth opening and the orientation of the occlusal plane. /. "he cranial circumference and the widths of the ma$illary anteriors showed a ratio of &AD& in 0& percent of s(ulls. "his has been reported by =ears also. :. 0:F of s(ull showed e ual or near e ual measurements between the nasal widths, nasal aperture and the width of the four ma$illary incisors. 2. "he ma$illary and mandibular anterior teeth showed a high percentage ratio of 1D2 in 0AF of s(ulls. =ears also reported similar findings. Technique 6 .lapp4s tabular dimension table method! ; &0&A. "eeth were selected based on the overall dimension of si$ anterior teeth arranged on the 9onwill circle and the vertical tooth space available in the patient. A table with illustrations of molds allowed the dentist to select and specify the mold to be used by number.

Technique 7 Galderrama4s <olar tooth 9asis! was projected in &0&:. "his method of only historical value used varying measurements between combinations of cusp points to indicate the si#e of the individual and overall tooth measurements. "he basic problem with this techni ue is that edentulous patients have no molars. Galderrama also predicted a selection of tooth si#e on a &C2 th increment of the si#e of a 9onwill triangle, determined by measuring the edentulous mandible. Technique 8 .igrande &0&: advocated the use of the outline form of the fingernail to select the outline form of the upper central incisor. "he si#e was modified to meet the re uirements of tooth space and other relationships. Technique 9 "he ,eometric method or *aw of %armony. 6illiam4s "ypal form method! projected by 5. *eon 6illiams in &0&2 is based on the geometric pattern created by the outline form of the bony face frame ; the ovoid, s uare and tapering forms. 6illiam arrived at this classification after e$tensive anthropological study and was able to interest a

manufacturer. "he +entist4s supply company to produce his systemati#ed molds of teeth. "hus the typal form method or geometric method of anterior tooth selection gained universal acceptance. %owever further investigation by 6right in &0:B, 9ell in &087 and <avros(ufis et al in &07A invalidate this method of selection. 9ut this method is probably still the way in which most dentists select anterior artificial teeth. Technique 10 Young proposed the selection of tooth form by <old guide sample! as the &Ath techni ue >in appro$imate chronological order?. Technique 11 6avrin Instrumental ,uide "echni ue! presented in &0/A was based on 9erry4s 9iometric ratio method and 6illiam4s "ypal form teeth but its use was limited to a single manufacturer4s product. Technique 12 <a$illary Arch outline form! projected by Eelson in &0/A. "his techni ue assumed that the arch outline form was a valid method since it was related to an individuals anatomy. "his was invalidated by changes in arch form due to resorption.

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Technique 13 6right4s -hotometric method! proposed in &0:B was based on using a photograph of the patient with natural teeth and establishing a ratio by comparative computation of measurements of li(e areas of the face and photograph. "he simple un(nown mathematical fomula could be used to select teeth or to create correct vertical dimension. <inute inaccuracies in measurements tended to diminish greatly the reliability of the techni ue so it has enjoyed little usage. Technique 14 "he multiple choice method! introduced by <yerson in &0:8 was based on a need for a selective range in labial surface characteristic of transparent labial and mesial surfaces, varying surface colour tone, and chracteri#ation of teeth by time and wear. %armony of tooth si#e and shape with face si#e and shape was associated with this techni ue. Technique 15 =tein4s coordinated si#e techni ue! presented in &02A was based on the coronal inde$ of 8A to &AA commonly used in prosthetic on 2 model teeth representing the range of ma$imum fre uency of use and on the common variability in si#e of individual natural teeth. "he inde$ is the width percent of the length. "he variability is A.1mm H model si#e varied from 8./ to 7.8 mm.

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Technique 16 Anthropometric ; .ephalic inde$ method! projected by =ears in &02& was based on the fact that the width of the upper central incisor could be determined by dividing either the transverse circumference of the head by &: or the bi#ygomatic width by :.:. "ooth length was in proportion to face length. Technique 17 'rame %armony method! by the 5usti company in &020, is based on the fact that the si#e and proportions of the teeth are in harmony with the general bony proportions of the s(eleton. "he overall tooth si#e is selected by a mathematical formula, &C8th the total dimension of the upper and lower edentulous ridges, with the dimensions of the individual anterior teeth correlated with a developed table of tooth dimensions to give the indicated over-all dimension. Ither characteristic of tooth form are based on genetics, and the comparison of such dental ualities of a near relative. Technique 18 9ioform techni ue! proposed by the +entist4s =upply company in &01A is based on the geometric outline forms of face and teeth ; the %ouse! classification for 2 basic and : combination typal forms, and :-dimensional harmony of tooth form and face form. It is associated with the tabular and mold guide systems. "his is currently in use.

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Technique 19 "he "rubyte tooth indicator! or =election Indicator Instrument! method advocated by the +entist4s supply company which is correlated with 6illiam4s and %ouse4s "ypal form theory and the "abular techni ue. Technique 20 %ouse instrumental method! of projecting typal outline and profile silhouettes onto the face by means of a telescopic projector instrument and silhouette form plates. "his was correlated with designated mold numbers and si#e variation. "his was proposed by %ouse in &0:0 and by the +entist4s =upply company in &01A. Technique 21 Automatic instant selector guide! of the Austenal company in &01& correlated form, si#e and appearance in such a manner that only a single reading was re uired to select the appropriate tooth mold based on dimensions of denture space and harmony of face and tooth form. "hese were the twenty one techni ues detailing the evolution of the selection of anterior teeth as described by Young in &012. "hen in =eptember &011 'rush and 'isher created a revolution in the field of dental esthetics by the introduction of +entogenics. In a series of si$

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articles published between &011 and &010 they described various means to more natural dentures and many tips on how to avoid the 3denture loo(4. @rajice( in &01B proposed methods involving the duplication of the patient4s natural teeth either before or after e$traction. @lein >&0BA?, %ayward >&0B7?, @afandaris and "heodoros >&082? suggested incorporating the patient4s natural teeth in the denture. Gan Gictor in &0B: proposed the mold guide cast techni ue.

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DENTOGENICS
'rush and 'isher in the first, of a series of si$ articles, published in &011 introduced the dental community to +entogenic restorations!. According to them, there was nothing in the field of esthetics that had not been considered before. Yet a vacuum e$isted and the 3+enture loo(4 prevailed. +entogenics describes a denture that is eminently suitable to the wearer in that it adds to the person4s charm, character, dignity or beauty in a fully e$pressive smile. +entogenics then means the art, practice and techni ues used to achieve that esthetic goal in dentistry. "he authors describe the origin of the concept ; 'rush in &01/ met in Jurich, =wit#erland, a master sculptor by the name of 6ilhelm Jech ; who ground and formed teeth for his dentist father. Jech e$perimented with the molding, spacing and arrangement of teeth in artificial dentures with an artist4s concept of what belonged in the mouth of a living human. %is wor( inspired 'rush to ta(e a new loo( at denture prosthetics and the =wissedent foundation was established in *os Angeles, .alifornia in &01/, from where through seminars and wor(shops, the concepts of dentogenics have disseminated. 'rush and 'isher in &01B advocated se$ identity in dentures by the application of +entogenics!. According to them, the feminine form is characteristically spherical with a roundness, smoothness and softness that is

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typical of women. 6hereas the masculine form is cuboidal, with the hard, muscular, vigorous appearance which is typical of men. "he procedure therefore is to select a basically 3'eminine4 or 3<asculine4 mold and then harmoni#e it to the individual patient depending upon the personality and age factors by modifying individual teeth. "he authors describe a procedure they call depth grinding which involves the accentuation of the third dimensional depth to eliminate the first appearance of the artificial upper anterior teeth. 6ith a soft stone, the mesiolabial line angle of the central incisor is ground in a definite and flat cut, following the same curve as the mesial contour of the tooth in order to move the deepest visible point of the tooth further lingually. After this cut has been made, a careful rounding and smoothing of the sharp angle made by the stone must be accomplished and a perfect polish must be given to the ground surface. It is necessary to develop the desired effect in depth grinding by a consideration of these main factors ; A flat thin, narrow tooth is delicate loo(ing and fits delicate women and involves little depth grinding. 6hereas a thic(, 9ony!, big si#ed tooth, heavily carved on its labial face is vigorous and is to be used e$clusively for men. "his involves rather severe depth grinding. 'or the average patient, a healthy women or a less vigorous man, the depth grinding will be an average between delicate and vigorous, the feminine

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or masculine characteristics being given by other tooth shaping, incisal grinding and the positioning of the teeth. +epth grinding reduces the width of the central incisors according to the severity of grinding to be accomplished. "herefore, to maintain the normal harmony of contrast in si#e between the si$ anterior teeth, a larger si#ed central incisor of the same mold should be selected. Again in &01B, 'rush and 'isher discussed another aspect of +entogenics ; the personality of a patient. "hey stated that the foundation for dentogenic restorations is the personality of the patient ; simply because the basic 3male4 or 3female4 tooth form is a refinement of that tooth form which has its inception in the personality factor. *i(ewise age is a refinement of the personality factor. "hey devised the personality spectrum and e$plained the precise prosthodontic application of the otherwise abstract word personality ; by the : divisions of the personality spectrum. &. +elicate ; meaning fragile, frail, the opposite of robust.

/. <edium pleasing ; meaning normal, moderately robust, healthy and of intelligent appearance. :. Gigorous ; meaning the opposite of delicate, hard and aggressive in appearance, the e$treme male animal, muscular type almost primitive, ugly.

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"he personality spectrum can be used in our artistic endeavour to inject a variety of tooth form and tooth position, at the comprehensive level of individual patient personality analysis. A small percentage of patients are delicate, and a slightly larger percentage are vigorous. "he remaining majority of patients fall into the medium section of the personality spectrum, but all of these have either vigorous or delicate tendencies. "he use of the dentogenic concept is made easier by considering the smile as the primary objective personality trait of the patient. "his primary objective personality trait and the personality spectrum is used for the selection of the mold category. "hese fundamental shapes must then be subjected to the refining procedure of se$ and age modifications. "he age factor in dentogenics, considered by 'rush and 'isher in &018, determines the selection of the shade of the mold to be used in the denture. *ight shades are considered appropriate for young people and dar(er shades are considered esthetic for older people. Also bluish incisal tinges are preferred for the young and grayish shades for the older. <old refinement is done by producing worn incisal edges and cuspid tips, attritional and abrasional facets, development of diastemata to indicate tooth loss and subse uent drifting. "hus the dignity of advancing age may be portrayed in the denture.

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In &017, 'rush and 'isher propounded the +ynesthetic interpretation of the dentogenic concept. +ynesthetics is a compounded word. "he prefi$ 3dyn4 is from the ,ree( word 3dynamis4 meaning power. It implies movement, action, change and progression in the esthetic phase of prosthodontics. "his dynamic value has been described as ma(ing the difference between an artifact, any object without life-li(e effect! such as a spoon, and a wor( of art or visual objects that are alive in meaning such as a statue. "herefore the application of dynesthetics allows a denture to be a wor( of art and have a life-li(e effect against a denture lac(ing artistic treatment and thus remain an artifact. "he dynesthetic techni ues are rules which concern the : important divisions of denture fabrication. &. "he tooth. /. Its position. :. Its matri$ >visible denture base?. "he selection and modification of the tooth according to dentogenics has already been described. "he positioning and denture base considerations are beyond the scope of this seminar.

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THE GOLDEN PROPORTION If particular interest is the so called ,olden proportion that e$ists between the perceived widths of the upper anterior teeth. *ombardi in &08: and *evin in &087 demonstrated that the width of the central incisor is in golden proportion to the width of the lateral incisor. "he width of the lateral incisor to the width of the canine is also in golden

proportion as is the width of the canine to the first premolar. "he golden proportion e$ists when the ratio between a larger part 394 >for e$ample? to a smaller part 3A4 >for e$ample? is &.B&7.

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DISCUSSION
A practical approach to the selection of the anterior teeth is to consider the si#e, form and color.
SIZE:

<ay be determined fromD -re e$traction records.

<ar(ing the corners of the mouth on the occlusal rim gives the width of the B anterior teeth.

<ar(ing the inter alar width on the occlusal rim gives the width of the B anterior teeth from cuspid tip to cuspid tip.

*ength may be determined by noticing visibility of the incisal edges and relating this to lip length and dentogenics.

FORM:

Inspite of the body of research that invalidates 6illiam4s "ypal theory, clinically, it is observed to provide esthetic results and as stated by 6illiam Ibservance of this rule will always give you perfect harmony ; the harmony of opposition of line!.

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"he form may also be selected considering first the personality of the patient and then modified according to the se$ and age of the patient to individuali#e the mold. -re e$traction records may also be of value in the selection of the form of the anterior teeth.
COLOR:

.olor of the teeth is to be determined by the s(in coloring of the individual. "he color selected should be so inconspicuous so as not to attract attention to the teeth. "he s uint test may be helpful in evaluating colors of the teeth with the comple$ion of the face. 6ith the eyelids partially closed to reduce light, the dentist compares prospective colors of artificial teeth held along the face of the patient. "he color that fades from view first is the one that is least conspicuous in comparison with the color of the face. "he age of the patient will also effect the color of the teeth. "he general rule is that dar(er teeth are more appropriate in older patients and lighter teeth are more harmonious in young patients. "his rule however must be overruled for the patient who does not smo(e and ta(es food of slight pigmentation and may continue to have a relatively light tooth body together with the normal color te$ture. "his is an application of dentogenics to the color selection.

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CONCLUSION
"he selection of anterior teeth is an important part of the esthetic phase of denture fabrication. It is essential not to be embroiled by the various techni ues aimed at ma(ing the tas( easier. 6hat is necessary is the development of an esthetic sense by the observation of natural dentitions in response as well as in function so as to be able to create dentures that are living things ; belonging to a human being and not just mere artifacts that are poor replicas of what has been lost.

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BIBLIOGRAPHY
&. 9E** ).A. D "he geometric theory of selection of artificial teeth D Is it valid K. 5A+A 08 D B:8, &087. /. .*A-- ,.6. D %ow the science of esthetic tooth form selection was made easy. 5. -rosthet. +ent. 1 D 10B, &011. :. +orland4s Illustrated <edical +ictionary. 6.9. =aunders, /7 th Ed. -g &BBB. 2. 'EEE, *I+E*I6, ,I<=IE >&070? D .linical +ental -rosthetics, : rd Ed., 6right. 1. ')L=% 5.-. and 'I=%E) ).+. D Introduction to dentogenic restorations. 5. -rosthet. +ent. 1 D 17B, &011. B. ')L=% 5.-. and 'I=%E) ).+. D %ow dentogenic restorations interpret the se$ factor. 5. -rosthet. +ent. B D &BA, &01B. 8. ')L=% 5.-. and 'I=%E) ).+. D %ow dentogenics interpret the personality factor. 5. -rosthet. +ent. B D 22&, &01B. 7. ')L=% 5.-. and 'I=%E) ).+. D "he age factor in dentogenics. 5. -rosthet. +ent. 8 D 1, &018.

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0. ')L=% 5.-. and 'I=%E) ).+. D "he dynesthetic interpretation of the dentogenic concept. 5. -rosthet. +ent. 7 D 117, &017. &A. %AY6A)+ +.E. D Lse of natural upper teeth in complete dentures. 5. -rosthet. +ent. &0 D :10, &0B7. &&. %I.@EY 5..., JA)9 ,.A., 9I*EE+E) ..*., >&071? D 9oucher4s prosthodontic treatment for edentulous patients, 0th Ed., <osby, =. *ouis. &/. %EA)"6E** ..<. and )A%E A.I. >&07B? D =yllabus of complete dentures, 2th Ed., *ea and 'ebiger, -hiladelphia. &:. @E)E 9.E. D Anthropometric parameters of tooth selection. 5. -rosthet. +ent. &8 D 2:&, &0B8. &2. @A'AE+A)I= E.<. and "%EI+I)IL ".-. D .omplete denture techni ue using natural teeth. 5. -rosthet. +ent. :: D 18&, &082. &1. @*EIE I.E. D Immediate denture prosthesis. 5. -rosthet. +ent. &A D &2, &0BA. &B. @)A5I.E@ +.+. D -ersonali#ed acrylic resin anterior teeth. 5. -rosthet. +ent. B D /0, &01B. &8. *EGIE E.I. D +ental esthetics and the ,olden proportions. 5. -rosthet. +ent 2A D /22, &087. /1

&7. <AG)I=@IL'I= '. et. al D "he face form as a guide for the selection of ma$illary central incisors. 5. -rosthet. +ent. 2: D 1A&, &07A. &0. <AG)I=@IL'I= '. et. al D Easal width and incisive papilla as guides for the selection and arrangement of ma$illary anterior teeth. 5. -rosthet. +ent. 21 D 10/, &07&. /A. -I.A)+ ..'. D .omplete denture esthetics. 5. -rosthet. +ent. 7 D /1/, &017. /&. =EA)= G.%. D =election of anterior teeth for artificial dentures. 5A+A /: D &1&/, &0:B. //. GAE GI."I) A. D "he mold guide cast ; It4s significance in denture esthetics. 5. -rosthet. +ent. &: D 2AB, &0B:. /:. 6)I,%" 6.%. D =election and arrangement of artificial teeth for complete dentures. 5A+A /: D //0&, &0:B. /2. YILE, %.A. D =electing the anterior tooth mold. 5. -rosthet. +ent. 2 D 827, &012.

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CONTENTS
Introduction )eview of *iterature +entogenics +iscussion .onclusion 9ibliography

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