11. Anterior Tooth Selection11. Anterior Tooth SelectionEleni Roumanas DDSEleni Roumanas DDS

Division of Advanced Prosthodontics, Division of Advanced Prosthodontics, Biomaterials and Hospital DentistryBiomaterials and Hospital Dentistry

UCLA School of Dentistry UCLA School of Dentistry andand

Frank Lauciello DDSFrank Lauciello DDSIvoclar VivadentIvoclar Vivadent

This program of instruction is protected by copyright ©. No portion of This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.any information storage or retrieval system, without prior permission.

Anterior teethAnterior teeth are primarily selected to satisfy are primarily selected to satisfy esthetic requirementsesthetic requirementsPosterior teethPosterior teeth are primarily selected to satisfy are primarily selected to satisfy masticatory masticatory

requirements/ occlusionrequirements/ occlusion

Anterior Tooth SelectionAnterior Tooth Selection

Morphology(Mold)Morphology(Mold)SizeSizeColorColorTooth PlacementTooth Placement

There are no rules of thumb; however there are anatomic There are no rules of thumb; however there are anatomic landmarks and manufactures aids that can be used as guideslandmarks and manufactures aids that can be used as guides..

Anterior Tooth SelectionAnterior Tooth Selection

GuidesGuidesPreextraction recordsPreextraction records- - photosphotos, , diagnostic castsdiagnostic casts, old , old x-raysx-raysPostextraction recordsPostextraction records--existing denturesexisting dentures ie tooth size, ie tooth size,

placement, shade, VDO, occlusal planeplacement, shade, VDO, occlusal planePts. facial characteristicsPts. facial characteristics, , arch sizearch size

• Pt. preferencesPt. preferences

Anterior Tooth SelectionAnterior Tooth Selection

Careful evaluation of existing dentures

1)1) Patient’s perception of their appearance.Patient’s perception of their appearance.2)2) Your perception of the esthetic needs of the patient.Your perception of the esthetic needs of the patient.

Dentogenics/DynestheticDentogenics/Dynesthetic concepts of concepts of Fisher and FruschFisher and Frusch::They integrated the selection of teeth into an esthetic They integrated the selection of teeth into an esthetic system governed by the age , sex and personality of the ptsystem governed by the age , sex and personality of the pt..

a) a) Sex:Sex: malemale- rugged with square teeth & bold central incisors- rugged with square teeth & bold central incisors femalefemale- pronounced curvatures, rounded point angles- pronounced curvatures, rounded point angles

b) b) Personality:Personality: vigorous or delicate vigorous or delicate““Personality toothPersonality tooth”-the maxillary lateral incisors vary ”-the maxillary lateral incisors vary more in size, form and position than any other toothmore in size, form and position than any other tooth

c) c) Age:Age: YoungYoung- tapered, ovoid, rounded teeth- tapered, ovoid, rounded teeth MiddleMiddle Old- square, sharp corners

Tooth Form/Mold:Tooth Form/Mold:

DelicateDelicate

Rounded arch formRounded arch form

Rounded tooth cornersRounded tooth corners

Anteriors closely follow the Anteriors closely follow the lower liplower lip

Laterals overlap centralsLaterals overlap centrals

Smaller laterals andSmaller laterals and cuspids

Sharp caninesSharp canines

Delicate vs Rugged Characteristics:Delicate vs Rugged Characteristics:

There are no hard and fast rules.There are no hard and fast rules.

Square arch (unexpected in females)Square arch (unexpected in females)DiastemaDiastemaModerate tooth wearModerate tooth wearStainingStainingGingival recessionGingival recession

Natural Dentition- FemaleNatural Dentition- Female

Delicate vs Rugged Characteristics:Delicate vs Rugged Characteristics:

RuggedRugged

•Angular outlinesAngular outlines•Larger laterals and caninesLarger laterals and canines•Square arch formSquare arch form•Centrals overlap lateralsCentrals overlap laterals•Blunt caninesBlunt canines

Square archSquare archSquare centralsSquare centralsRounded laterals in labioversion( considered a female characteristic)Rounded laterals in labioversion( considered a female characteristic)Crowding Crowding Gingival recessionGingival recession

Natural Dentition- MaleNatural Dentition- Male

Must Must harmonizeharmonize with face and arch size with face and arch sizeAny Any disproportion in arch sizedisproportion in arch size influences the length, width influences the length, width and position of the teethand position of the teethVertical distanceVertical distance between the ridges- use a tooth long between the ridges- use a tooth long enough to minimize the display of the denture baseenough to minimize the display of the denture baseMark high Mark high lip linelip line and canine lines on the occlusion rim and canine lines on the occlusion rimat the time the jaw relations are recorded. These guide linesat the time the jaw relations are recorded. These guide linesprovide information about the gingivoincisal length and total provide information about the gingivoincisal length and total mesiodistal width of the maxillary six anterior teethmesiodistal width of the maxillary six anterior teeth

SizeSize Of Anterior Teeth Of Anterior Teeth

• Shape and contour the wax rim so that it mimics the shape Shape and contour the wax rim so that it mimics the shape and contours of the finished denture with the anterior teeth.and contours of the finished denture with the anterior teeth.

• The wax rim should extend 1-2 mm below the lip line.The wax rim should extend 1-2 mm below the lip line.

•Mark the canine line at the corner Mark the canine line at the corner of the lips and measure the distanceof the lips and measure the distancewith a flexible rulerwith a flexible ruler

SizeSize of the Anterior Teeth of the Anterior Teeth

Ivoclar-VivadentIvoclar-VivadentFacial MeterFacial Meter

SizeSize of the Anterior Teeth of the Anterior Teeth

In the majority of pts., a relationship exists In the majority of pts., a relationship exists between the inner canthus measurement between the inner canthus measurement and the distance between distals of the and the distance between distals of the maxillary laterals. This measurement can maxillary laterals. This measurement can then be carried directly to select the properthen be carried directly to select the propermaxillary anterior teeth.maxillary anterior teeth.

--two principal colors are two principal colors are yellowyellow and and graygray-harmony between the color of the skin, hair & eyes-harmony between the color of the skin, hair & eyes

GuidesGuides1.1. ComplexionComplexion2.2. Hair colorHair color3.3. Eye colorEye color4.4. AgeAge5.5. Personality & activityPersonality & activity6.6. Patient desires Patient desires 7.7. Need to educate pts.Need to educate pts.

ColorColor Or Shade Of Anterior Teeth Or Shade Of Anterior Teeth

ColorColor Or Shade Of Anterior Teeth Or Shade Of Anterior Teeth

The ChromascopThe Chromascop® is the shade standard for the Ivoclar Vivadent® is the shade standard for the Ivoclar VivadentProduct lines including IPS Empress, IPS design, composite restorativeProduct lines including IPS Empress, IPS design, composite restorativeMaterials etc.Materials etc.

A-D ShadeA-D Shade A1A1 A2A2 A3A3 A3.5A3.5 A4A4 B1B1 B2B2 B3B3 B4B4 C1C1 C2C2 C3C3 C4C4 D2D2 D3D3 D4D4

ChromascopChromascop 120120 130130 210210 230230 340340 110110

040040

130130 210210 310310 ------ 430430 510510 ------ ------ 420420 ------

Shade Comparison ChartShade Comparison Chart

ColorColor Or Shade Of Anterior Teeth Or Shade Of Anterior TeethCheck the shade of the pts. existing dentureCheck the shade of the pts. existing denture

and discuss their desires with respect to the and discuss their desires with respect to the tooth shade. Would they prefer the same tooth shade. Would they prefer the same shade, a shade that is lighter or darker.shade, a shade that is lighter or darker.

Place the guide up against the pts. face and Place the guide up against the pts. face and select a shade that blends with their skin tone, select a shade that blends with their skin tone, hair color and sclera/eye color.hair color and sclera/eye color.

Once you have selected a color allow the pt.Once you have selected a color allow the pt.view it against their lip with a mirror and give their view it against their lip with a mirror and give their approval.approval.

--positioned in the same general area on the natural teethpositioned in the same general area on the natural teeth-this position was tentatively established during the clinical -this position was tentatively established during the clinical refinement of the maxillary refinement of the maxillary occlusal rimocclusal rim to provide adequate to provide adequatelip support and proper phoneticslip support and proper phonetics-used to its maximum potential when accomplished at -used to its maximum potential when accomplished at chairsidechairside-the arrangement has to fulfill certain -the arrangement has to fulfill certain biomechanical needsbiomechanical needs as well as esthetic onesas well as esthetic ones

PlacementPlacement of Maxillary Anterior Teeth of Maxillary Anterior Teeth

Considerations:Considerations:MidlineLip supportVermilion borderPhonetics- f, v, s soundsBuccal corridorCanine eminance- arch type, square, tapered, ovoid Incisal papilla- to labial of central incisor 8-10 mmVertical and horizontal overlap- 1.5 mmGenerally 1-2 mm of the incisal portion of the maxillary

central incisor is visible below the relaxed lipSmile line- follow contour of lower lipOcclusal Plane

Anterior Tooth Anterior Tooth PlacementPlacement

Anterior MaxillaAnterior Maxilla Following extraction, Following extraction,

resorption is from resorption is from buccal-labial towards buccal-labial towards the lingual.the lingual.

Anterior teeth should not be placed directly over the ridgeAnterior teeth should not be placed directly over the ridge

Anterior Tooth Anterior Tooth PlacementPlacement

Incisal length

Almagauge

Anterior Tooth Anterior Tooth PlacementPlacement

The incisal length and width can be measured with the The incisal length and width can be measured with the use of the Almagauge.use of the Almagauge.

Labial incisal distance- Labial incisal distance- This is generally 8-9 mm anterior This is generally 8-9 mm anterior to the incisive papilla.to the incisive papilla.

Anterior Tooth Anterior Tooth PlacementPlacement

Anterior Tooth Anterior Tooth PlacementPlacement

The measurements can them be The measurements can them be used to help guide the initial contour used to help guide the initial contour of the wax rim.of the wax rim.

Average Value PositionsAverage Value Positions Labial incisal positionLabial incisal position

FemaleFemaleYoung 8Young 8Middle 7Middle 7Old 6Old 6

MaleYoung 6Middle 5Old 4

Incisal lengthIncisal length is on the average is on the average 22mm from the labial sulcus 22mm from the labial sulcus

Patient Factors:Patient Factors:Lip Length vs. Incisal DisplayLip Length vs. Incisal Display

Sex & AgeSex & AgeFemaleFemale MaleMale

Young +2Young +2 +1+1Middle +1Middle +1 0 0Old 0Old 0 -1 -1

Vig, JPD 1978Vig, JPD 1978

10-20mm10-20mm 3-4mm3-4mm

20-25mm20-25mm 2mm2mm

26-30mm26-30mm 1mm1mm

30 & over30 & over 00

Lip LengthLip Length Incisal DisplayIncisal Display

follow contour of lower lipfollow contour of lower lipavoid reverse smile lineavoid reverse smile lineyoung female has greater curvature of smile lineyoung female has greater curvature of smile lineolder males have less curvature of smile lineolder males have less curvature of smile line

Male

Female

Reverse curve

Greater curvature

Lesser curvature

Smile LineSmile Line

PapillameterPapillameter

Determining The Smile LineDetermining The Smile Line

Using the OPA ruler or Papillameter place Using the OPA ruler or Papillameter place the flat end inside the mouth and up against the flat end inside the mouth and up against the incisal papilla, the lower lip line can be the incisal papilla, the lower lip line can be recorded at rest position and the high liprecorded at rest position and the high lipis recorded during a smile.is recorded during a smile.

Communicating this information to the Communicating this information to the laboratory aids in the esthetic arrangement laboratory aids in the esthetic arrangement of the maxillary anterior teeth.of the maxillary anterior teeth.

--the anterior teeth and tongue act as a part of the valvingthe anterior teeth and tongue act as a part of the valvingmechanism which modify the flow of air to produce mechanism which modify the flow of air to produce speech soundsspeech sounds

Labial sounds: “p” “b”Labial sounds: “p” “b”-if the lips are not supported properly by the teeth these-if the lips are not supported properly by the teeth these sounds may be defectivesounds may be defective

Labiodental sounds: “f” “v”Labiodental sounds: “f” “v”-are produced by contact between the maxillary incisors -are produced by contact between the maxillary incisors and the posterior one-third of the lower lipand the posterior one-third of the lower lip

Linguodental sounds: “th”Linguodental sounds: “th”-are produced by extending the tip of the tongue 3-6 mm -are produced by extending the tip of the tongue 3-6 mm beyond the incisal edges of the upper & lower anterior teethbeyond the incisal edges of the upper & lower anterior teeth

Phonetic ConsiderationsPhonetic Considerations

esthetics phoneticsAnterior Tooth Placement:Anterior Tooth Placement: “F” and “V” SoundsF” and “V” Sounds

The upper lip contacts the the The upper lip contacts the the wet-dry line of the lower lip during wet-dry line of the lower lip during speech production of “f” and “v” speech production of “f” and “v” sounds.sounds.

Linguopalatal sounds: “s”Linguopalatal sounds: “s”-the “s” sound is made by contact between the -the “s” sound is made by contact between the tip of the tongue and the palate at the rugae tip of the tongue and the palate at the rugae area with a small space for the escape of airarea with a small space for the escape of air--if the space is too small a whistle usually if the space is too small a whistle usually results and if the space is too broad an thin, results and if the space is too broad an thin, the “s” sound is replaced by th “sh” sound the “s” sound is replaced by th “sh” sound which sounds like a lispwhich sounds like a lisp

Phonetic ConsiderationsPhonetic Considerations

Material ConsiderationsMaterial ConsiderationsAvoid mismatching of materialsAvoid mismatching of materialsFor example: Porcelain anterior teeth combined with acrylic For example: Porcelain anterior teeth combined with acrylic resin posterior teeth.resin posterior teeth.

Why?Why?Excessive wear of the posterior teeth leads to Excessive wear of the posterior teeth leads to occlusal discrepancies, tipping of the dentures occlusal discrepancies, tipping of the dentures anteriorly and resorption of the alveolar ridge.anteriorly and resorption of the alveolar ridge.

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds“the ideal artificial tooth should be a reflection the ideal artificial tooth should be a reflection

of its natural model”of its natural model”

Ivoclar anterior moulds are based on an analysis of natural anterior teeth. They correspond to natural teeth in appearance, anatomy and function. They are purposely asymmetrical from one side of the arch to the other for a more natural appearance.

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth MoldsIvoclar anterior teeth are catagorized into square, tapering Ivoclar anterior teeth are catagorized into square, tapering and ovoid shapes.and ovoid shapes.

Square Tooth Molds:Square Tooth Molds:With this angular With this angular shape, the central shape, the central incisor is dominant incisor is dominant and the gingivo-incisal and the gingivo-incisal curvature is moderate. curvature is moderate. The square facial The square facial shape offers maximum shape offers maximum light deflection and light deflection and creates a bold effect.creates a bold effect.

Tapering:Tapering:Characterized by Characterized by rounded contours rounded contours which taper towardswhich taper towardsthe cervical ridge. the cervical ridge. Moderate gingivo-Moderate gingivo-incisal curvature. incisal curvature. Large triangular incisor Large triangular incisor slightly triangular in slightly triangular in shape.shape.

Ovoid:Ovoid:The teeth have a The teeth have a pronounced gingivo-pronounced gingivo-incisal curvature, incisal curvature, which tends to which tends to disperse the light disperse the light reflection and create a reflection and create a softened appearance.softened appearance.

Interproximal Interproximal embrasuresembrasures

The proximal contact points of Ivoclar teeth are in the same position as in their natural counterparts. They are placed in the incisal third instead of the mesial edge which helps to individualize each tooth.

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds

Mesial incisal line angle “bold”Mesial incisal line angle “bold”

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds““the ideal artificial tooth should be a reflection the ideal artificial tooth should be a reflection

of its natural model”of its natural model”

“the ideal artificial tooth should be a reflection of its natural model”

Height of contourHeight of contour

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds

Distinct cervical marginDistinct cervical margin

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds“the ideal artificial tooth should be a reflection the ideal artificial tooth should be a reflection

of its natural modelof its natural model”

““the ideal artificial tooth should be a reflection the ideal artificial tooth should be a reflection of its natural modelof its natural model”

Mandibular incisal edge wear Mandibular incisal edge wear

Ivoclar Denture Tooth MoldsIvoclar Denture Tooth Molds

The End!