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TEETH SELECTION

Teeth selection is very important as the selection of the appropriate size ,shape, occlusion , form and color / shade of the artificial teeth determines the Aesthetics and the function of the denture. Aesthetics is a pleasurable feeling created within an individual against the
perception of an object.

Objectives In Teeth selections

The teeth ,should be in harmony with the

surrounding tissues. They should maintain the vertical dimension. They should be efficient for mastication. Posterior teeth should be selected based on function whereas the anterior teeth are selected predominantly based on aesthatics.

General Considerations in Teeth Selection

The following principles should be considered prior to teeth selection: . The patient should be seated upright with his facial muscles relaxed. The operator should sit in front of the patient and adequate lighting should be used. Light source can be daylight, neon light or fluorescent light. The selection of artificial teeth for a complete denture can be divided into two sections: Anterior teeth selection Posterior teeth selection

ANTE RIORTEETH SELECTION Anterior teeth play an important role in the aesthetics of a patient. they are not subjected to heavy occlusal load like the posteriors. Hence, aesthetic is given more importance during anterior teeth selection. the following facters are also considered during the selection of anterior teeth: size of the teeth form of the teeth colour \shade of the teeth

Size of the Anterior Teeth

the tooth size should be appropriate to the size of the face and sex of the patient. the following methods are used as a guide to select the size of the teeth Methods using pre-extraction records Methods using a anthropological measuremnts of the patient. Methods using anatomical land marks. Methods using theoretical concepts. Other factors.

Methods Using Pre -extraction Records

The pre-extraction records like diagnostic casts, photographs ,radiograph , teeth of close relatives and preserved extracted teeth can be used to determine the size of the artificial teeth.

diagnostic casts
They are prepared before the extraction of the teeth. the operator can obtain an idea about the size and shape of the teeth from these casts. the actual size and shape required can be determined but the shade of the teeth cannot be determined using this method.

Pre-extraction photographs Photographs showing the lateral, anterior and .anterolateral views of the patient should be taken before extraction .these photographs must show at least the incisal edges of the anterior teeth. This method is useful to determine the exact width and outline of the teeth.

Pre-extraction radiographs This is usualIy obtained from the patient previous dentist. Radiographic errors are a major limitation to this method. The occlusogingival height and the outline of the teeth can be recorded. But the Color and size cannot be accurately determined. because the radiograph is a two-dimensional image.

Teeth of close relatives This method is usually is followed only if the other records are not available. The size .and contour of the patient's son or daughter's tooth is taken as a reference.

Preserved extracted teeth This this is the best method to determine the size of the anterior teeth. The exact details about the size and contour can be recorded from this method.

Methods using Anatomical Landmarks

various anatomical landmarks like the size of the maxillary arch and location of the canine eminences, buccal frenal attachments, corners of the mouth and ala of the nose can be used to determine the size of the artificial teeth.

Size of the maxillary arch The distance between the incisive papilla and the hamular notch on one side is added with the distance between two hamular notches. This gives the combined width of all the anterior and posterior teeth of the maxillary arch

Location of canine eminence A canine eminence is formed in the region between the canine and the first premolar after extraction of teeth. The distance between the two canine eminence is measured along the residual ridge. This measured value gives the combined width of the anterior teeth

Location of the buccal frenal attachments The attachments of the buccal frenumn are marked on the residual ridge. The distance between the two marking recorded along the residual ridge gives the combined width of the maxillary anteriors

Location of the corners of the mouth The corner of the mouth marks the distal end of the canine. The corners of the mouth are recorded on the occlusal rim and the distance is measured between these markings. the anterior teeth are set within these markings

location of the ala of the nose The patient is asked to sit upright and look straight. A line passing through the midpoint between the eyebrows and the lateral end of the ala of the nose extended onto the occlusal rim gives the combined width of the anterior teeth

Methods Using Theoretical Concepts

The following theoretical concepts proposed by various authors can be used to determine the size of the anterior teeth. winklers concept According to winkler, the teeth should be selected based on three different views, namely, physiological, psychological and bio- mechanical

Typical form Theory: This theory helps to determine the size and form of the anterior teeth. According to him, the shape of the teeth should be inverse of the shape of the face that id if the face tapers downwards the teeth should taper upward.

Other factors other factors that influence the size Of the teeth are Size of the face. . Inter-arch spacing Distance between the distal ends of the maxillary cuspids length of the lips Size and relation of the arches.

Form of anterior teeth

The form or outline of the anterior teeth can be determined using the following factors: Shape of the patients face or facial form. Patients profile. . Dentogenic concept and aesthetics

Shape of the Patients Face or Facial Form this is based on typical form theory according to him, the facial Form can be described as one among the following four types: Ovoid . tapering Square Combination of the above. The teeth selected should be in harmony with the facial form.

Patients Profile
The Patient may have a convex, straight or a concave profile. The labial form of the anterior teeth should be similar to the facial profile of the Patient. For example, the labial form should be straight for patient with a straight profile, convex for a patient with a Convex profile

Dentogenic concept
1- sex 2-Personality 3-age

1-Sex
The form or shape of the teeth differs in males and females. The differences in the shape of the anterior teeth in males and female are: In females, the incisal angles are more rounded and the teeth have a lesser angulation. In The males ,the incisal angles are rounded to a lesser degree and teeth are more angular

The incisal edge of the central incisors is parallel to the lips and the laterals are above the occlusal plane in males. But the incisal edges of the central and lateral incisors follow the curve of the lower lip in females

The distal surface of the centrals are rotated posteriorly for females. The mesial surface of the Lateral incisors are rotated anteriorly in relation to the centrals in females

 In male the mesial end of the laterals are hidden by the centrals. This makes the canine very prominent in males only the mesial thirds of the canines are visible in females because they are rotated anteriorly whereas even the middle two-thirds of the canines are visible in males

Age The age of the patient is important in teeth selection because of the physiological and functional changes that occur in the oral tissues. The patient can be either younger middle-aged or old-aged. the following changes are observed with an advance in age of the patient:

 Old people usually have abraded teeth with worn out contacts. Hence, placement of contoured teeth may look artificial. Old patients have gingival recession .it can be reproduced in the dentures to provide a natural appearance. Old People show a blunt smile line and pathologic migration of teeth. the color of the teeth also changes with age. In old people, the enamel is abraded and the dentine which a yellow tinge is more visible

Personality the dentist should select and arrange the teeth so that it improves the patient personality The patient can be either vigorous or vigorous people. More squarish, large teeth are selected for vigorous people. The interiors should be in a flat plane for executives. For executives, the teeth should be relatively smaller and more symmetrically arranged

Color for Anterior Teeth

Before selecting the color for anterior teeth, some basic concepts about color should be understood. A single color can be described under four parameters. Hue. Saturation brilliance or value, Translucency.

HUE
It denote, a specific color produced by a specific wavelength of light. It should be in harmony with the patients skin color or else it will produce an artificial look for the denture.

It is the amount of colour per unit area of an object In other words, it denotes the intensity of the colour. Objects with highly saturated CoIour lack depth.

It denotes the Lightness or darkness of an object. In people with light skin color, teeth with lighter shades should be chosen and vice Versa.

It is the Property of object to Partially allow passage of light through it. Enamel has high brilliance and translucency: hence, artificial teeth should also show the same properties for a natural appearance.
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It is classified under two divisions, namely: Size of the teeth Form of the teeth.

The following factors are considered while selecting the size of the teeth: Buccolingual width. Mesiodistal length. Occlusogingival height.

Buccolingual width The buccolingual width of the artificial teeth should be decreased so that the buccal and lingual surfaces slope out from the occlusal surface to provide proper path of escapement of food during mastication.

It should be such that the forces from the tongue neutralize the forces of the cheek. If the buccolingual width increases, the forces acting on the denture will also increase, leading to increase in the rate of ridge resorption. Broader teeth encroach into the tongue space leading to instablity of the denture Also, the teeth should not encroach into the buccal corridor space to avoid cheek biting

MesiodistaI Length The mesiodistal length of each tooth should be elected such that the combined length of all the posterior teeth on that side of the arch does not exceed the distance between the canine and the retromolar pad

Occluso-gingival Height It is determined by the available inter-arch distance. The occlusal plane should be located at the midpoint of the interocclusal distance. Large teeth selected for cases with inadequate interocclusal distance appear artificial and require modification before arrangement.

Posterior teeth a available in different forms before we go into the details about each tooth form, we should discuss the factors that control the selection of the form of a tooth.

Factors that control the selection of the form of a tooth

Height of the residual ridge: shallow cusped teeth go better with shallow ridges

Patients age: Teeth with shallow cusps are preferred in older people. Ridge relationship:(monoplane teeth are preferred for cases with posterior cross bite or severe class II relationship

Morphologically teeth can be classified as: Cusp teeth Anatomic teeth Semi-anatomic or modified cusp or low cusp teeth Cuspless teeth Special forms

They have cusps and fossa like natural teeth. They are of two types, nanmly anatomic and semi- anatomic. Cusp teeth can be used in the following occlusal schemes: 1-bilateral balanced occlusion in centric and eccentric relation 2-balance in centric only

These teeth resemble normal newlyerupted teeth. They provide the best aesthetics and are the most commonly used type of artificial teeth. The cusps resemble normal dentition with an angle of 33. Anatomic teeth with 30 cuspal angulation are also available

Advantage of anatomic
O 1-esthetics
O 2-better food penetration O 3-decrease of vertical stresses O 4-harmony with muscles of mastication

and TMJ during functional and nonfunctional movements

Disadvantages of anatomic
O 1-precise technique required
O 2-greater lateral forces O 3-not long-lasting.required occlusal

adjustment O 4-difficult to tooth position in class II.III

are also known a modified cusp or low cusp teeth. They may have 20 or 10 cuspal angulation. 10 semi-anatomic teeth an commonly known as functional teeth They are used in cases with mild discrepancies in jaw relation. They are more flexible to arrange than anatomic teeth but they are not as flexible as non anatomic teeth

Advantages of semi-anatomic teeth

O 1-esthetics
O 2-good chewing efficiency O 3-less lateral force O 4functional occlusal balance

disdvantages of semi-anatomic teeth

O 1-

They are also known as 0 ,flat. or monoplane teeth. They have no cuspal angulation hence are very flexible to set. It is easy to set non-anatomic teeth in balanced occlusion. Cuspless teeth can be used for the following occlusal schemes Bilateral balance with a compensating curve. Flat plan-balance in centric only.
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Materials of teeth:- There are two main types: 1-Porcelain 2-Acrylic 3- Metal

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.

1-Brittle, more resistance to abrasion 2-Excellent (does not stain). 3-Mechanical bonding by pins or undercuts holes. 4-Difficult to grind and polish. 5-More forces to the mucosa. 6-Clicking on contact. 7-Much lower than acrylic causes stresses in acrylic denture base

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

1-Not brittle, but poor abrasion resistance. 2-Esthetic very good. 3-Chemical bonding with denture base. 4-Easily ground and polish. 5-Transmit fewer forces to the mucosa. 6-No clicking on contact. 7-Thermal expansion same as acrylic denture base

It is the tooth of choice for posterior tooth replacement. -Strength more than any other prosthetic tooth. -The frame work is of the Co-Cr then tooth should not be occluded heavily with the opposing gold restoration.