Teeth selectionTeeth selection Dr.Suresh V Dr.Suresh V

contentscontents IntroductionIntroduction Evolution in anterior teeth selectionEvolution in anterior teeth selection Methods of teeth selectionMethods of teeth selection Dentogenics Dentogenics Golden proportionGolden proportion Evolution in posterior teeth selectionEvolution in posterior teeth selection Factors in selecting a posterior toothFactors in selecting a posterior tooth Review of literatureReview of literature ConclusionConclusion References References

Introduction Introduction

An acceptable cosmetic effect in any dental restoration has An acceptable cosmetic effect in any dental restoration has always been regarded as a important to good dentistry. A always been regarded as a important to good dentistry. A well made prosthesis will fail if it is deficient in this respect.well made prosthesis will fail if it is deficient in this respect.

Teeth selection in complete denture process plays a huge Teeth selection in complete denture process plays a huge role in great prosthetic success and a great patient – role in great prosthetic success and a great patient – operator relationship.operator relationship.

Since ages various methods and guidelines are put forth to Since ages various methods and guidelines are put forth to achieve the best prosthetic out come.achieve the best prosthetic out come.

The evolution …The evolution … During the ivory age and early porcelain period ,teeth were During the ivory age and early porcelain period ,teeth were

selected or created mostly by dimensional measurements of selected or created mostly by dimensional measurements of the denture space and arch size with little regard to esthetics.the denture space and arch size with little regard to esthetics.

J W White in 1872 – projected correspondence and harmony J W White in 1872 – projected correspondence and harmony theory, temperamental theory was fading out of medicine but theory, temperamental theory was fading out of medicine but white reached over and suggested that temperaments called white reached over and suggested that temperaments called for similarity of form in faces and teeth.for similarity of form in faces and teeth.

The temperamental theory is a theory of fluids of the body, The temperamental theory is a theory of fluids of the body, especially the blood ,the phlegm and the bile. It was conceived especially the blood ,the phlegm and the bile. It was conceived by the Hippocrates in 5by the Hippocrates in 5thth century BC and was used by the century BC and was used by the medical profession in diagnosis and treatment planning.medical profession in diagnosis and treatment planning.

Tempermental theoryTempermental theory

W.R. Hall in 1887 projected Typal form concept , this was W.R. Hall in 1887 projected Typal form concept , this was the initiation of geometric theory later. The basis of this the initiation of geometric theory later. The basis of this classificationclassification

Major basis - a) labial surface curvatureMajor basis - a) labial surface curvature

b) outline form and neck widthb) outline form and neck width

Minor basis – labiolingual inclination of the upper incisors Minor basis – labiolingual inclination of the upper incisors in in

relation to the profile types.relation to the profile types.

Berry’s biometric ratio method (1906); projected the Berry’s biometric ratio method (1906); projected the outline form of the inverted central incisor tooth closely outline form of the inverted central incisor tooth closely approximated the outline form of face . Hence the outline approximated the outline form of face . Hence the outline form of face indicated the outline form of the anterior teeth form of face indicated the outline form of the anterior teeth to be chosen .to be chosen .

Berry’s further investigation led to the finding of – Berry’s further investigation led to the finding of –

Maxillary central incisor was 1/16Maxillary central incisor was 1/16thth width of the face width of the face and and

1/201/20thth its length. its length.

Since 1985 J. Leon Williams wanted revolution in teeth Since 1985 J. Leon Williams wanted revolution in teeth selection process , later in 1909 he proposed the technique selection process , later in 1909 he proposed the technique to build wax occlusal rims of proper height and form, with to build wax occlusal rims of proper height and form, with patient’s lips at rest, marked the location of corner of patient’s lips at rest, marked the location of corner of mouth ,high lip line, lower lip line ,and after removing the mouth ,high lip line, lower lip line ,and after removing the occlusal rim the distal end of second molar is marked.occlusal rim the distal end of second molar is marked.

Using a fleximeter the distance between the markings Using a fleximeter the distance between the markings were read.were read.

Although Hall had proposed earlier about Typal theory it Although Hall had proposed earlier about Typal theory it was neglected for twenty five years , williams did a was neglected for twenty five years , williams did a extensive study in 1914 to give three basic typal forms – extensive study in 1914 to give three basic typal forms – ovoid ,tapering, square.ovoid ,tapering, square.

He studied in extracted human teeth and skulls .He studied in extracted human teeth and skulls .

According to him it was “combination forms” According to him it was “combination forms”

tapering or ovoid or both inblended into squaretapering or ovoid or both inblended into square

square or ovoid or both inblended into taperingsquare or ovoid or both inblended into tapering

square or tapering or both inbleded into ovoidsquare or tapering or both inbleded into ovoid

The photograph were distributed among dentist and face form The photograph were distributed among dentist and face form were used as guide.were used as guide.

Young emphasized on teeth selection based on emotion, Young emphasized on teeth selection based on emotion, mental imagery and stored knowledge.mental imagery and stored knowledge.

Nelson in 1920 projected “palatal vault form” ,in this Nelson in 1920 projected “palatal vault form” ,in this technique the mid palatal shape was determined to select a technique the mid palatal shape was determined to select a tooth shape .tooth shape .

In 1936 photometric method was proposed by wright, in this In 1936 photometric method was proposed by wright, in this using ausing a

photograph of the patient with natural teeth and establishing photograph of the patient with natural teeth and establishing a ratio by comparative computation of measurements of like a ratio by comparative computation of measurements of like areas of the face and photograph is done and using a simple areas of the face and photograph is done and using a simple mathematical formulas the teeth is selected.mathematical formulas the teeth is selected.

““Anthropometric – cephalic index method” projected by Anthropometric – cephalic index method” projected by sears in 1941, was based on the fact that the width of the sears in 1941, was based on the fact that the width of the upper central incisor could be determined by dividing either upper central incisor could be determined by dividing either the transverse circumference of the head by 13 or by the transverse circumference of the head by 13 or by bizygomatic width by 3.3. bizygomatic width by 3.3.

““Bioform technique” proposed by the dentist ‘s supply Bioform technique” proposed by the dentist ‘s supply company in 1950, was based on the geometric outline company in 1950, was based on the geometric outline forms of face and teeth –the ‘house’ classification for 4 forms of face and teeth –the ‘house’ classification for 4 basic , 3 combination typal forms and 3 dimensional basic , 3 combination typal forms and 3 dimensional harmony of tooth form and face form were considered.harmony of tooth form and face form were considered.

The “Trybyte mould selector” method was advocated by The “Trybyte mould selector” method was advocated by the dentist’s supply company.the dentist’s supply company.

On the edentulous cast measurement in millimeters was On the edentulous cast measurement in millimeters was made using the incisive papilla as a focal point of triangle made using the incisive papilla as a focal point of triangle and the distance measured from the papilla to the hamular and the distance measured from the papilla to the hamular notches and inter distance between hamular notches were notches and inter distance between hamular notches were found . found .

The total length in millimeters is input into The total length in millimeters is input into

Methods of teeth selectionMethods of teeth selection Pre extraction recordsPre extraction records Diagnostic casts Diagnostic casts Recent photographs Recent photographs Radiographs of teeth Radiographs of teeth

Post-extraction examinationPost-extraction examination– Size and form of edentulous foundation.Size and form of edentulous foundation.– Matching teeth to faceforms and arch forms. If patient is Matching teeth to faceforms and arch forms. If patient is

already a denture wearer, mouth should be examined with the already a denture wearer, mouth should be examined with the dentures in the mouth giving importance to physiological and dentures in the mouth giving importance to physiological and esthetic aspects.esthetic aspects.

Form of anterior teethForm of anterior teeth– Based on face form:Based on face form:

Based on arch formBased on arch form

– Based on profile of the faceBased on profile of the face The labial surface of the tooth viewed from the mesial The labial surface of the tooth viewed from the mesial

aspects should show a contour similar to that when viewed aspects should show a contour similar to that when viewed in profile.in profile.

The labial surface of the tooth viewed from the incisal The labial surface of the tooth viewed from the incisal aspect should show a convexity or flatness similar to that aspect should show a convexity or flatness similar to that seen when the face is viewed from under the chin or from seen when the face is viewed from under the chin or from the top of the head.the top of the head.

Based on anthropometric systemBased on anthropometric system Bizygomatic widthBizygomatic width = estimated width of maxillary central = estimated width of maxillary central

incisors.incisors.

1616 Bizygomatic widthBizygomatic width = approximate width of six anterior = approximate width of six anterior

teethteeth

3.33.3

Based on marking on the corners of mouthBased on marking on the corners of mouth

Dentogenic conceptDentogenic concept

A woman is a woman from her finger tips to her smile , and A woman is a woman from her finger tips to her smile , and a man is a man from his fists to smile .a man is a man from his fists to smile .

The purely mechanical and mathematical approach to The purely mechanical and mathematical approach to tooth selection is largely responsible for the neuter gender tooth selection is largely responsible for the neuter gender “denture look” “denture look”

Dentogenic and sex factorDentogenic and sex factor Frush and Fisher in 1955 were the first to introduce Frush and Fisher in 1955 were the first to introduce

“dentogenic restoration” to dental community.“dentogenic restoration” to dental community. Dentogenics described a denture that is eminently suitable Dentogenics described a denture that is eminently suitable

to the wearer in that it adds to the person’s charm, to the wearer in that it adds to the person’s charm, character, dignity or beauty in a fully expressive smile.character, dignity or beauty in a fully expressive smile.

According to the authors sex identity in dentures carried a According to the authors sex identity in dentures carried a greater significance in achieving better esthetics.greater significance in achieving better esthetics.

Feminine form is characteristically spherical with a Feminine form is characteristically spherical with a roundness, smoothness and softness, whereas the roundness, smoothness and softness, whereas the masculine form is cuboidal , with hard, muscular, vigorous.masculine form is cuboidal , with hard, muscular, vigorous.

The procedure therefore is to select a basically feminine or The procedure therefore is to select a basically feminine or masculine mould and then harmonize it to the individual masculine mould and then harmonize it to the individual patient depending upon the personality and age factors by patient depending upon the personality and age factors by modifying individual teeth.modifying individual teeth.

When the dentogenic concept evolved , the full meaning of When the dentogenic concept evolved , the full meaning of esthetics was carried into the 3esthetics was carried into the 3rdrd dimension : dimension :

The wearer of a dentogenic restoration must have inner The wearer of a dentogenic restoration must have inner sensibility of well being.sensibility of well being.

The viewer of the dentogenic restoration must perceive The viewer of the dentogenic restoration must perceive beauty or a fulfillment of the wearer’s personality in his beauty or a fulfillment of the wearer’s personality in his smile .smile .

Then the dentists who created the dentogenic restoration Then the dentists who created the dentogenic restoration would feel deeply rewarded.would feel deeply rewarded.

When the laterals are nearly as broad as the other front When the laterals are nearly as broad as the other front teeth the denture is said to have strong or masculine teeth the denture is said to have strong or masculine appearance , when the laterals are narrower then it depicts appearance , when the laterals are narrower then it depicts feminine or delicate.feminine or delicate.

Lateral incisor – if rotated to show its mesial surface gives Lateral incisor – if rotated to show its mesial surface gives softness and youthful appearance to the smile. If rotated softness and youthful appearance to the smile. If rotated mesially the effect of smile is hardened.mesially the effect of smile is hardened.

The authors described a procedure called depth girding, The authors described a procedure called depth girding, which involves the accentuation of the third dimensional which involves the accentuation of the third dimensional depth to eliminate the flat appearance of the artificial upper depth to eliminate the flat appearance of the artificial upper anterior teeth.anterior teeth.

The depth grinding is done on the mesial surface of the The depth grinding is done on the mesial surface of the central incisors only .They are the widest , longest and most central incisors only .They are the widest , longest and most noticeable in the six anterior teeth.noticeable in the six anterior teeth.

With a soft stone , the mesiolabial line angle of the central With a soft stone , the mesiolabial line angle of the central incisor is ground in a definite and flat cut , following the same incisor is ground in a definite and flat cut , following the same curve as mesial contour of the tooth in order to move the curve as mesial contour of the tooth in order to move the deepest visible point of the tooth further lingually .after this deepest visible point of the tooth further lingually .after this cut has been made careful rounding and smoothing of the cut has been made careful rounding and smoothing of the sharp line angle is made.sharp line angle is made.

It is necessary to develop the desired effect in depth grinding It is necessary to develop the desired effect in depth grinding by a consideration of these main factors – a flat thin narrow by a consideration of these main factors – a flat thin narrow tooth is delicate looking and fits delicate woman and involves tooth is delicate looking and fits delicate woman and involves little depth grinding , wheras a thick , bony , big sized tooth, little depth grinding , wheras a thick , bony , big sized tooth, heavily carved on its labial face is vigorous and is to be used heavily carved on its labial face is vigorous and is to be used exclusively for men. this involves rather severe depth grinding.exclusively for men. this involves rather severe depth grinding.

Depth grinding reduces the width of the central incisors Depth grinding reduces the width of the central incisors according to the severity of grinding accomplished . Therefore according to the severity of grinding accomplished . Therefore to maintain, the normal harmony of contrast in size between to maintain, the normal harmony of contrast in size between the six anterior teeth, a larger central incisor of the same mold the six anterior teeth, a larger central incisor of the same mold should be selected.should be selected.

Dentogenics and personality Dentogenics and personality factorfactor

In 1956 , Frush and Fisher discussed another aspect of In 1956 , Frush and Fisher discussed another aspect of dentogenic – the personality of the patient . They stated that dentogenic – the personality of the patient . They stated that foundation for the dentogenic restoration is the personality foundation for the dentogenic restoration is the personality of the patient – simply because the male and female tooth of the patient – simply because the male and female tooth form is a refinement of that tooth form which has its form is a refinement of that tooth form which has its inception in the personality factor.inception in the personality factor.

They devised the personality spectrum and explained the They devised the personality spectrum and explained the precise prosthodontic application of the otherwise abstract precise prosthodontic application of the otherwise abstract word personality – by 3 divisionsof the personality spectrum.word personality – by 3 divisionsof the personality spectrum.

1.1. Delicate – fragile, frail , opposite of robustDelicate – fragile, frail , opposite of robust

2.2. Medium pleasing – normal, moderately robust, healthy and Medium pleasing – normal, moderately robust, healthy and intelligent appearing.intelligent appearing.

3.3. Vigorous- the opposite of delicate, hard , aggressive, Vigorous- the opposite of delicate, hard , aggressive, muscular type.muscular type.

The personality spectrum can be used in our artistic endeavor The personality spectrum can be used in our artistic endeavor to inject a variety of tooth form and tooth position, at the to inject a variety of tooth form and tooth position, at the comprehensive level of individual patient personality analysis.comprehensive level of individual patient personality analysis.

A small percentage of patients are delicate , slightly larger A small percentage of patients are delicate , slightly larger percentage are vigorous, the remaining majority of the percentage are vigorous, the remaining majority of the patients fall into the medium section of the personality patients fall into the medium section of the personality spectrum.spectrum.

The use of dentogenic concept has made easier, by The use of dentogenic concept has made easier, by considering the smile as the primary objective . The smile, considering the smile as the primary objective . The smile, personality trait and the personality spectrum is used in personality trait and the personality spectrum is used in selection of the mould category.selection of the mould category.

Dentogenic – age factorDentogenic – age factor It was considered in 1957 by the same authors. It was considered in 1957 by the same authors. The dignity of the advancing age must be appropriately The dignity of the advancing age must be appropriately

portrayed in the denture by careful tooth color selection and portrayed in the denture by careful tooth color selection and mould refinementmould refinement

Lighter shades are considered appropriate for young people and Lighter shades are considered appropriate for young people and darker shades are considered for older people.darker shades are considered for older people.

Also bluish incisal tinges are preferred for the young people and Also bluish incisal tinges are preferred for the young people and greyish shades for the older.greyish shades for the older.

Mould refinement is done by producing worn incisal edges and Mould refinement is done by producing worn incisal edges and cuspid tips, attritional and abrasional facets, development of cuspid tips, attritional and abrasional facets, development of diastemas to indicate tooth loss and subsequent drifting.diastemas to indicate tooth loss and subsequent drifting.

The environment of the tooth were arranged is also The environment of the tooth were arranged is also important, the matrix of the artificial tooth should be important, the matrix of the artificial tooth should be meaningful and not repetitive and inartistic.meaningful and not repetitive and inartistic.

With very life like material available ,we can even feature With very life like material available ,we can even feature the interdental papillae in a realistic manner.the interdental papillae in a realistic manner.

In youth interdental papillae are finely stippled and pointed In youth interdental papillae are finely stippled and pointed and tight against the tooth, as age increases the attached and tight against the tooth, as age increases the attached gingiva looses stippled appearance and appear edematous gingiva looses stippled appearance and appear edematous and smooth, even shortening of the papillae can be and smooth, even shortening of the papillae can be depicted by raising the gingival line.depicted by raising the gingival line.

Again in 1958 Frush and Fisher propounded the Dynesthetic Again in 1958 Frush and Fisher propounded the Dynesthetic interpretation of the dentogenic concept.interpretation of the dentogenic concept.

Dynesthetics is a compound word, ‘dyn’ is from the greek Dynesthetics is a compound word, ‘dyn’ is from the greek word ‘dynamis’ meaning power. It implies word ‘dynamis’ meaning power. It implies movement ,action ,change ,and progression in the esthetic movement ,action ,change ,and progression in the esthetic phase of prosthodontics.phase of prosthodontics.

The application of dynesthetics allows a denture to be a The application of dynesthetics allows a denture to be a work of art rather than an artifact.work of art rather than an artifact.

Rules that govern dynesthetics are: Rules that govern dynesthetics are:

1.1. The toothThe tooth

2.2. Its positionIts position

3.3. Its matrix (visible denture base)Its matrix (visible denture base)

Dynesthetics outline:Dynesthetics outline:

Physiologic shade selectionPhysiologic shade selection Lip supportLip support Midline Midline LabioversionLabioversion Speaking lineSpeaking line Smiling lineSmiling line Position of incisors and cuspidsPosition of incisors and cuspids spaces between teethspaces between teeth Buccal corridorBuccal corridor

Dynesthtics outline :Dynesthtics outline :

1.1. Physiologic shade selection- Physiologic shade selection-

As age advances there is accumulation of tobacco tar, food As age advances there is accumulation of tobacco tar, food pigments, and bacterial discoloration. as this pigments, and bacterial discoloration. as this occurs ,various degree of color texture changes occur in occurs ,various degree of color texture changes occur in the incisal edges, therefore in creating the illusion of the incisal edges, therefore in creating the illusion of natural dentition for a older patient ,a darker shade is natural dentition for a older patient ,a darker shade is preferred but this does not imply in all cases, since few preferred but this does not imply in all cases, since few people might not smoke , take light pigmented foods, in people might not smoke , take light pigmented foods, in such case shade should be selected lighter. such case shade should be selected lighter.

Midline : face usually slant one way or another and it is Midline : face usually slant one way or another and it is difficult to see a true midline in a dentition. Therefore an difficult to see a true midline in a dentition. Therefore an eccentric midline is acceptable in denture if it not to eccentric midline is acceptable in denture if it not to exaggerated.exaggerated.

Labio version : most pleasing effect is obtained when the Labio version : most pleasing effect is obtained when the long axis of the central incisors are either vertical or with long axis of the central incisors are either vertical or with slight labial inclination, this determination is made when slight labial inclination, this determination is made when the patient is standing in normal posture.the patient is standing in normal posture.

Speaking line: it is the vertical composition of the anterior Speaking line: it is the vertical composition of the anterior teeth, it should be noticed when the patient is speaking .teeth, it should be noticed when the patient is speaking .

A guide to vertical composition using the incisal edges in A guide to vertical composition using the incisal edges in relation to lip line is : relation to lip line is :

a) young woman 3 mm below lip line at resta) young woman 3 mm below lip line at rest

b) young man 2 mm below lip line at restb) young man 2 mm below lip line at rest

c) middle age 1.5mm below the lip line at restc) middle age 1.5mm below the lip line at rest

d)old age ,senility o mmbelow lip line tod)old age ,senility o mmbelow lip line to

2 mm above lip line at rest2 mm above lip line at rest

Smiling line : the smiling line is the curve whose path Smiling line : the smiling line is the curve whose path follows the incisal edges of the central incisors up and back follows the incisal edges of the central incisors up and back to the incisal edges of the lateral incisors to tips of the to the incisal edges of the lateral incisors to tips of the cuspids.its arc is determined by the age of the patient and cuspids.its arc is determined by the age of the patient and decreases as patient gets older.decreases as patient gets older.

Central incisors position : these are the corner stones of the Central incisors position : these are the corner stones of the tooth position, if this tooth position is right all the other tooth position, if this tooth position is right all the other teeth position will be right.teeth position will be right.

Their shape is controlled by the physical personality of the Their shape is controlled by the physical personality of the patient , and their position determines the strength and patient , and their position determines the strength and action of the dentogenic composition.action of the dentogenic composition.

One central incisor is always placed bodily ahead or behind One central incisor is always placed bodily ahead or behind the other, from this point a various degree of rotation ,labial the other, from this point a various degree of rotation ,labial inclination and axial divergence will produce effects of inclination and axial divergence will produce effects of additional strength, activity, and vigor to entire dental additional strength, activity, and vigor to entire dental composition. composition.

Lateral incisors : the position of this tooth is subordinated in Lateral incisors : the position of this tooth is subordinated in importance that of the central incisors. its rotation will importance that of the central incisors. its rotation will either harden or soften the dental composition. either harden or soften the dental composition.

The right and left lateral incisors should have asymmetric The right and left lateral incisors should have asymmetric long axes and when positioned least portion of the tooth is long axes and when positioned least portion of the tooth is seen while speaking.seen while speaking.

In dentogenics , this is considered as the personality tooth, In dentogenics , this is considered as the personality tooth, as sex determination comes from either rounding incisal as sex determination comes from either rounding incisal edge for feminine and squaring incisal edge for masculine edge for feminine and squaring incisal edge for masculine effect.effect.

The cuspid position : this tooth controls the size of the The cuspid position : this tooth controls the size of the buccal coridor, it should be carefully positioned so as to buccal coridor, it should be carefully positioned so as to dominate the lateral incisor and to complete the desired dominate the lateral incisor and to complete the desired upward curve of the smiling line.upward curve of the smiling line.

Basic requirements while placing the tooth are : Basic requirements while placing the tooth are :

a) tooth should be rotated to show its mesial surfacea) tooth should be rotated to show its mesial surface

b) the cervical end should be outb) the cervical end should be out

c) when observed from side , the long axis of the cuspids c) when observed from side , the long axis of the cuspids shouldshould

be vertical.be vertical.

Spaces : between the anterior and posterior teeth is Spaces : between the anterior and posterior teeth is extremely effective , but their size must be artistically and extremely effective , but their size must be artistically and hygenically formed or they will become unsightly hygenically formed or they will become unsightly repositories for food , plaque and calculus.repositories for food , plaque and calculus.

Rules to be observed while giving spaces are : Rules to be observed while giving spaces are :

a) all spaces must be V – shaped to shed fooda) all spaces must be V – shaped to shed food

b) a diastema between central incisors is unsightly and b) a diastema between central incisors is unsightly and should be avoided in aged patients.should be avoided in aged patients.

c) diastemas should be asymmetrically placed on either c) diastemas should be asymmetrically placed on either side of the dental arch.side of the dental arch.

d) the width of the diastema should be controlled , so as d) the width of the diastema should be controlled , so as not to appear unsightly at any instance.not to appear unsightly at any instance.

Buccal corridor : it is the space created between the buccal Buccal corridor : it is the space created between the buccal surface of the posterior teeth and the corner of the lips surface of the posterior teeth and the corner of the lips when the patient smiles.when the patient smiles.

It begins at the cuspid , and its size and the shape are It begins at the cuspid , and its size and the shape are controlled by the position and slant of the cuspid even controlled by the position and slant of the cuspid even though the actual corridor exist posterior to the cuspid though the actual corridor exist posterior to the cuspid tooth. tooth.

Buccal corridor present in the natural dentition, its inclusion Buccal corridor present in the natural dentition, its inclusion in dentogenics accomplishes an added illusion of reality.in dentogenics accomplishes an added illusion of reality.

Richard E. Lombardi (1973) stated about – Richard E. Lombardi (1973) stated about –

composition, unity,unity with composition, unity,unity with variety, dominance,mold requirements,colour in denture variety, dominance,mold requirements,colour in denture esthetics and shade selection.esthetics and shade selection.

As the amount of contrast increases , visibility increases As the amount of contrast increases , visibility increases and when contrast decreases the visibility decreases, the and when contrast decreases the visibility decreases, the study of relationship existing between the objects made study of relationship existing between the objects made visible by the contrast is called composition.visible by the contrast is called composition.

The prime requisite of composition is unity means “one-The prime requisite of composition is unity means “one-ness”ness”

Two types of unity are static and dynamicTwo types of unity are static and dynamic If a denture is of static type placed on a dynamic living If a denture is of static type placed on a dynamic living

human makes it unnatural and unpleasing esthetics.human makes it unnatural and unpleasing esthetics. Segregating forces must be introduced into the dental Segregating forces must be introduced into the dental

composition to produce dynamic unity.composition to produce dynamic unity.

Hogarth’s line of beauty has been cosidered as outstanding Hogarth’s line of beauty has been cosidered as outstanding example of the unity with variety.example of the unity with variety.

Dominance is the prime requisite to provide unity.one Dominance is the prime requisite to provide unity.one shape, colour, or line must dominate.shape, colour, or line must dominate.

The mouth is the dominant feature of the face, the central The mouth is the dominant feature of the face, the central incisor selected should be larger than the lateral incisor to incisor selected should be larger than the lateral incisor to dominate the composition. dominate the composition.

The dominance of the dental composition may be increased The dominance of the dental composition may be increased by making it more visible.by making it more visible.

Which may be done by -Increasing the mold size,using Which may be done by -Increasing the mold size,using lighter shade, placing teeth far anteriorly, and increasing lighter shade, placing teeth far anteriorly, and increasing the exposed gingivoincisal length.the exposed gingivoincisal length.

The relationship of width to length of a tooth is important , The relationship of width to length of a tooth is important , because if two teeth are of same width and different length, because if two teeth are of same width and different length, the longer the tooth will appear to be narrower.the longer the tooth will appear to be narrower.

Repeated ratio : The width of the golden mean rectangle is Repeated ratio : The width of the golden mean rectangle is one side of a square ;its length is one half the square plus the one side of a square ;its length is one half the square plus the diagonal of the half the square.diagonal of the half the square.

This results in a rectangle in which the length / width ratio is This results in a rectangle in which the length / width ratio is 1.618/1.1.618/1.

This ratio has been explored in relation to the mouth and as a This ratio has been explored in relation to the mouth and as a repeated ratio for the horizontal division of the area of the repeated ratio for the horizontal division of the area of the mouth, it has proved to be too strong for the dental use.mouth, it has proved to be too strong for the dental use.

If the same ratio between the width of the central incisor and If the same ratio between the width of the central incisor and lateral incisor is repeated between the lateral and the lateral incisor is repeated between the lateral and the amount of cuspid shown, and between the cuspid and amount of cuspid shown, and between the cuspid and bicuspid, each tooth size will be different (variety) but related bicuspid, each tooth size will be different (variety) but related (unity) because of the same ratio. (unity) because of the same ratio.

Golden proportion…Golden proportion…

Dominance must be exhibited by using a central incisor of Dominance must be exhibited by using a central incisor of sufficient size to dominate the composition, teeth must not sufficient size to dominate the composition, teeth must not be set on a static cure of circle but on a dynamic line similar be set on a static cure of circle but on a dynamic line similar to Hogarth’s line and teeth must be set with regard to to Hogarth’s line and teeth must be set with regard to repeated ratio to provide unity with variety .The teeth must repeated ratio to provide unity with variety .The teeth must be modified to harmonize with the patient’s age, sex and be modified to harmonize with the patient’s age, sex and personality to provide subjective unity.personality to provide subjective unity.

According to Richard E. Lombardi – teeth selected on the According to Richard E. Lombardi – teeth selected on the premise of face shape are as good as or better than those premise of face shape are as good as or better than those of any of the other systems, but such selection is definitely of any of the other systems, but such selection is definitely not the exact science.not the exact science.

The guide for selecting the size of the central incisors is The guide for selecting the size of the central incisors is 16:1head:tooth ratio16:1head:tooth ratio

Negative space : they provide the illusion of teeth by Negative space : they provide the illusion of teeth by portraying the dark space of the mouth behind the teeth.portraying the dark space of the mouth behind the teeth.

By altering the shape of the incisal edges, the contrast By altering the shape of the incisal edges, the contrast against the black back ground brings the dynamism and against the black back ground brings the dynamism and realism to the smile.realism to the smile.

Color in denture estheticsColor in denture esthetics Three main components :Three main components : Hue : characteristics of the color that gives the identity.Hue : characteristics of the color that gives the identity. Intensity : describes how much of the actual pigment is in the Intensity : describes how much of the actual pigment is in the color been described.color been described. Value : describes the lightness or the darkness of a color.Value : describes the lightness or the darkness of a color.

Factors affecting color :Factors affecting color :1.1. Lightness or darkness of the tooth is affected by the amount of Lightness or darkness of the tooth is affected by the amount of

light striking the tooth that will be reflected to the eye of beholder.light striking the tooth that will be reflected to the eye of beholder.2.2. The texture of the tooth (incisogingival angulation or smoothness The texture of the tooth (incisogingival angulation or smoothness

of surface)of surface)3.3. The back ground against which the color is seen has a definite The back ground against which the color is seen has a definite

effect on the color concerned( a darker background makes a color effect on the color concerned( a darker background makes a color seems lighter than the same color against a light back ground)seems lighter than the same color against a light back ground)

4.4. Lighter objects appear larger (closer) than the darker objects.Lighter objects appear larger (closer) than the darker objects.

Unlike anterior teeth , posterior teeth are selected from Unlike anterior teeth , posterior teeth are selected from

Occlusal schemes selected for each individual Occlusal schemes selected for each individual patients.patients.

Bucco lingual width of toothBucco lingual width of tooth

Mesio distal length availableMesio distal length available

Posterior teeth selectionPosterior teeth selection

History of development of posterior tooth forms : History of development of posterior tooth forms : Alfred Gysi designed the 1Alfred Gysi designed the 1stst anatomic porcelian tooth.(1914) anatomic porcelian tooth.(1914) He studied numerous natural dentition and came to a He studied numerous natural dentition and came to a

conclusion that anatomic posterior teeth should have 33conclusion that anatomic posterior teeth should have 33°.°.

In 1932 Pilkington and Turner anatomic tooth of 30In 1932 Pilkington and Turner anatomic tooth of 30° ° angulation.angulation.

According to them the cusps are of tetrahedral form with According to them the cusps are of tetrahedral form with transverse grooves between them having the buccal and transverse grooves between them having the buccal and lingual portions in alignment and the apices of the cusps all lingual portions in alignment and the apices of the cusps all lying on the surface of sphere.lying on the surface of sphere.

Gysi recognised that his anatomic tooth will not suite all Gysi recognised that his anatomic tooth will not suite all type of ridges , so he designed “cross bite”,in which type of ridges , so he designed “cross bite”,in which maxillary cusp were almost eliminated .maxillary cusp were almost eliminated .

He described this occlusal scheme as “mortar and pestle” He described this occlusal scheme as “mortar and pestle” action.action.

Victor sears (1927) designed the “channel” tooth, in this Victor sears (1927) designed the “channel” tooth, in this the maxillary occlusal suraces consisted of a deep channel the maxillary occlusal suraces consisted of a deep channel that run mesiodistally the entire length of the four posterior that run mesiodistally the entire length of the four posterior teeth.teeth.

The lower posterior teeth were half the bucco- lingual width The lower posterior teeth were half the bucco- lingual width of the standard anatomic teeth and were with single central of the standard anatomic teeth and were with single central ridge that ran entire length of the occlusal table, they ridge that ran entire length of the occlusal table, they articulated with the central channels of the maxillary teeth.articulated with the central channels of the maxillary teeth.

This permitted unlimited protrusive glide and with limited This permitted unlimited protrusive glide and with limited lateral guide.lateral guide.

Avery brothers (1930) introduced the “scissors bite” Avery brothers (1930) introduced the “scissors bite” technique.technique.

In this anteroposteriorly the occlusal surfaces were In this anteroposteriorly the occlusal surfaces were locked,the occlusal surface was determined by the locked,the occlusal surface was determined by the inclination of the condylar path.inclination of the condylar path.

They were free during latreal excursions and meant only for They were free during latreal excursions and meant only for shearing food.shearing food.

In 1937 Max Pleasure’s scheme proposed to modify In 1937 Max Pleasure’s scheme proposed to modify

the lower posterior teeth occlusal surfaces to athe lower posterior teeth occlusal surfaces to a

reverse curve by tilting the tooth buccally .reverse curve by tilting the tooth buccally .

John Vincent in 1942 introduced a change inJohn Vincent in 1942 introduced a change in

materials by using metal inserts in resin posteriorsmaterials by using metal inserts in resin posteriors

Sosin in 1961 replaced maxillary second bicuspid Sosin in 1961 replaced maxillary second bicuspid and first & second molars with cleat shaped vitalliumand first & second molars with cleat shaped vitallium forms called forms called cross-bladescross-blades..

Levin modified this scheme by reducing theLevin modified this scheme by reducing the size of the cross-blade to the maxillarysize of the cross-blade to the maxillary lingual cusp. lingual cusp.

Non anatomic or Cuspless teethNon anatomic or Cuspless teeth In 1929 Hall was the first to design cuspless teeth he called In 1929 Hall was the first to design cuspless teeth he called

inverted cusp toothinverted cusp tooth..

Myerson also design cuspless posterior teeth called Myerson also design cuspless posterior teeth called True-True-cuspcusp. It had a series of transverse buccal lingual ridges with . It had a series of transverse buccal lingual ridges with sluice ways between them. sluice ways between them.

In 1934 Nelson described teeth as In 1934 Nelson described teeth as chopping blocks, chopping blocks, which which were flat occlusal surfaces with numerous ridgeswere flat occlusal surfaces with numerous ridges

In 1939 Swenson designed a posterior tooth In 1939 Swenson designed a posterior tooth

called called nonlock.nonlock.These were essentially flat teethThese were essentially flat teeth

with Sluice ways for shredding and allowingwith Sluice ways for shredding and allowing

food to clear the occlusal table. food to clear the occlusal table.

In 1946 Hardy designed a metal insert upper and In 1946 Hardy designed a metal insert upper and

lower posterior which he called lower posterior which he called Vitallium occlusalVitallium occlusal. .

Three types of posterior teeth :Three types of posterior teeth :

Anatomic – 33 Anatomic – 33 °°

Semianatomic - 20 °Semianatomic - 20 °

Non anatomic - 0 °Non anatomic - 0 °

Anatomical molds usually are selected for bilateral balanced articulationAnatomical molds usually are selected for bilateral balanced articulation

Nonanatomical or cusp less teeth are generally the choice Nonanatomical or cusp less teeth are generally the choice in the nuetrocentric occlusionin the nuetrocentric occlusion

lingualised concept utilises anatomic teeth for the maxillary lingualised concept utilises anatomic teeth for the maxillary and monoplane or semianatomic teeth for the mandibleand monoplane or semianatomic teeth for the mandible

Anatomic teethAnatomic teeth

AdvantagesAdvantagesPenetrates food more easilyPenetrates food more easilyResists the rotation of denture bases through cuspResists the rotation of denture bases through cusp interdigitationinterdigitationProvides better estheticsProvides better estheticsActs as a guide for proper jaw closureActs as a guide for proper jaw closure

DisadvantagesDisadvantagesMore occlusal disharmony during settling and difficult toMore occlusal disharmony during settling and difficult to correct by adjustmentcorrect by adjustmentPrecise jaw closure and base stability required for Precise jaw closure and base stability required for interdigitationinterdigitationIncreased horizontal forcesIncreased horizontal forcesDifficult to adapt to abnormal jaw relationshipsDifficult to adapt to abnormal jaw relationships

Non Anatomic teethNon Anatomic teeth

AdvantagesAdvantagesDoes not lock the mandible in one positionDoes not lock the mandible in one position

Minimizes horizontal stress because of the absence of inclined Minimizes horizontal stress because of the absence of inclined planesplanes

Adapts easily to Classes II and III jaw relationsAdapts easily to Classes II and III jaw relations

More easily adjusted after changes in vertical and horizontal More easily adjusted after changes in vertical and horizontal relationsrelations

Easier to arrange in cross biteEasier to arrange in cross bite

DisadvantagesDisadvantagesPoor estheticsPoor esthetics

Decreased masticatory efficiencyDecreased masticatory efficiency

More difficult to obtained balanced occlusionMore difficult to obtained balanced occlusion

There are four major patient factors to be considered, along There are four major patient factors to be considered, along with their influence on the selection for anatomic, with their influence on the selection for anatomic, semianatomic, nonanatomic and mold combinations of semianatomic, nonanatomic and mold combinations of teeth.teeth.

4 factors4 factors Neuromuscular control Neuromuscular control

Anteroposterior jaw relationshipAnteroposterior jaw relationship

Mediolateral jaw relationshipMediolateral jaw relationship

EstheticsEsthetics

Neuromuscular controlNeuromuscular control

During the registering and transferring of entire jaw relation During the registering and transferring of entire jaw relation position from the patient to the articulator, the dentist has position from the patient to the articulator, the dentist has the opportunity to assess the muscle control capabilities of the opportunity to assess the muscle control capabilities of the patient. If little difficulty is encountered during these the patient. If little difficulty is encountered during these procedures, use of the anatomic or semianatomic molds are procedures, use of the anatomic or semianatomic molds are acceptable. If however the muscle control of the patient is acceptable. If however the muscle control of the patient is questioned and the dentist experience great difficulty in questioned and the dentist experience great difficulty in registering transferring and verifying the several jaw registering transferring and verifying the several jaw registration records, then molds with precise interdigitation registration records, then molds with precise interdigitation would not be indicated.would not be indicated.

Anteroposterior jaw relationshipsAnteroposterior jaw relationships

Anatomic and semianatomic teeth are designed to Anatomic and semianatomic teeth are designed to interdigitate in the normal class I skeletal and molar interdigitate in the normal class I skeletal and molar relationship. As long as the patient presents clinically with an relationship. As long as the patient presents clinically with an anteroposterior jaw relation position that is a skeletal class I, anteroposterior jaw relation position that is a skeletal class I, the cusp teeth may be arranged and adjusted to provide the the cusp teeth may be arranged and adjusted to provide the balanced occlusal concept. Skeletal class II patients may balanced occlusal concept. Skeletal class II patients may position the mandible in several anteroposterior jaw positions position the mandible in several anteroposterior jaw positions . Even though the recording and transfer of the retruded . Even though the recording and transfer of the retruded centric jaw relation position may be reproducible, these centric jaw relation position may be reproducible, these patients bring their mandible forward to some anterior patients bring their mandible forward to some anterior position that usually is not repeatable. The patient will position that usually is not repeatable. The patient will experience multiple deflective occlusal contacts as he or she experience multiple deflective occlusal contacts as he or she moves to one of the anterior position. moves to one of the anterior position.

Midiolateral jaw relationshipsMidiolateral jaw relationships

The patient with a skeletal class III jaw relations will present The patient with a skeletal class III jaw relations will present similar problems in tooth selection and arrangement as similar problems in tooth selection and arrangement as those observed with class II skeletal relationship. Any those observed with class II skeletal relationship. Any attempt to arrange Anatomic and Semianatomic teeth with attempt to arrange Anatomic and Semianatomic teeth with a different mediolateral contacts other than class I relation a different mediolateral contacts other than class I relation will usually cause multiple deflective occlusal contacts. will usually cause multiple deflective occlusal contacts.

EstheticsEsthetics:: The cusp is a part that contributes to The cusp is a part that contributes to naturalness, especially the buccal cusp. The “buccal naturalness, especially the buccal cusp. The “buccal corridor”, the region from the maxillary premolars corridor”, the region from the maxillary premolars posteriorly enhances a patients smile. A tooth mold with a posteriorly enhances a patients smile. A tooth mold with a buccal cusp form surely offers the greatest potential for a buccal cusp form surely offers the greatest potential for a pleasing natural appearance.pleasing natural appearance.

Lingualized occlusionLingualized occlusion

Lingualized occlusion can be used in most denture combinations. Lingualized occlusion can be used in most denture combinations.

It is particularly helpful when the patient places high priority on esthetics It is particularly helpful when the patient places high priority on esthetics but nonanatomic occlusal scheme is indicated by oral conditions such as but nonanatomic occlusal scheme is indicated by oral conditions such as severe alveolar resorption, a Class II jaw relationship, or displaceable severe alveolar resorption, a Class II jaw relationship, or displaceable supporting tissue. supporting tissue.

If the nonanatomic occlusal scheme is used, esthetics in the premolar If the nonanatomic occlusal scheme is used, esthetics in the premolar region are compromised. region are compromised.

With lingualized occlusion, the esthetic result is greatly improved while With lingualized occlusion, the esthetic result is greatly improved while still maintaining the advantages of a nonanatomic systemstill maintaining the advantages of a nonanatomic system

The selection includes The selection includes ShadeShade Buccolingual Buccolingual widthwidth

SizeSize Mesiodistal Mesiodistal lengthlength

NumberNumber Vertical Vertical lengthlength

FormForm

ShadeShade:: It should harmonize with the shade of the anterior teethIt should harmonize with the shade of the anterior teeth Bulk influences the shade of the teeth and for this reason it Bulk influences the shade of the teeth and for this reason it

is advisable to select a slightly lighter shade for the is advisable to select a slightly lighter shade for the bicuspids if they are to be arranged for esthetics. They may bicuspids if they are to be arranged for esthetics. They may be slightly lighter than the other posterior teeth but not be slightly lighter than the other posterior teeth but not lighter than anterior teeth.lighter than anterior teeth.

Size and number of posterior teeth :Size and number of posterior teeth : The size and number of posterior teeth are closely related The size and number of posterior teeth are closely related

to usage. These characteristics are dictated by the anatomy to usage. These characteristics are dictated by the anatomy of the surrounding oral environment and physiologic of the surrounding oral environment and physiologic acceptance of supporting tissues. The posterior teeth must acceptance of supporting tissues. The posterior teeth must support the cheeks and tongue and function in harmony support the cheeks and tongue and function in harmony with the musculature in swallowing and speaking as well as with the musculature in swallowing and speaking as well as in mastication. in mastication.

Buccolingual width of posterior teethBuccolingual width of posterior teeth The buccolingual width of artificial teeth should be greatly The buccolingual width of artificial teeth should be greatly

reduced from the width of natural teeth they replace.reduced from the width of natural teeth they replace. Artificial posterior teeth that are narrow in buccolingual Artificial posterior teeth that are narrow in buccolingual

direction enhance the development of the correct form of direction enhance the development of the correct form of the polished surfaces of the denture by allowing the buccal the polished surfaces of the denture by allowing the buccal and lingual denture flanges to slope away from the occlusal and lingual denture flanges to slope away from the occlusal surfaces. This occlusal form permits the tongue to maintain surfaces. This occlusal form permits the tongue to maintain the dentures in position on their residual ridges. the dentures in position on their residual ridges.

Narrow occlusal surfaces with proper escapeways for food Narrow occlusal surfaces with proper escapeways for food also reduce the amount of stress applied on food during also reduce the amount of stress applied on food during mastication to the supporting tissues of the basal seat. On mastication to the supporting tissues of the basal seat. On the other hand, the posterior teeth should have sufficient the other hand, the posterior teeth should have sufficient width to act as table upon which to hold food during width to act as table upon which to hold food during trituration. trituration.

Mesiodistal width of posterior teethMesiodistal width of posterior teeth The mesiodistal width of the posterior teeth are determined The mesiodistal width of the posterior teeth are determined

by the edentulous area between the distal of the by the edentulous area between the distal of the mandibular cuspids and the ascending area of the mandibular cuspids and the ascending area of the mandible. After the six mandibular anterior teeth have been mandible. After the six mandibular anterior teeth have been placed in their final position a point is marked on the crest placed in their final position a point is marked on the crest of the mandibular ridge at the anterior border of the of the mandibular ridge at the anterior border of the retromolar pad. This is the maximum extent posteriorly of retromolar pad. This is the maximum extent posteriorly of any artificial teeth on the mandibular ridge. In well formed any artificial teeth on the mandibular ridge. In well formed ridge the apex of retromolar pad is taken as posterior level ridge the apex of retromolar pad is taken as posterior level and in resorbed ridges the point where retromolar pad turns and in resorbed ridges the point where retromolar pad turns upward upward

Vertical length of buccal surfaces of posterior teethVertical length of buccal surfaces of posterior teeth It is best to select posterior teeth corresponding to the interarch It is best to select posterior teeth corresponding to the interarch

space and to the length of the anterior teeth. The length of the space and to the length of the anterior teeth. The length of the maxillary first premolars should be comparable to that of the maxillary first premolars should be comparable to that of the maxillary canines to have the proper esthetic effect.maxillary canines to have the proper esthetic effect.

Type of posterior teeth according to materialsType of posterior teeth according to materials Most artificial teeth are made of acrylic, porcelain or a Most artificial teeth are made of acrylic, porcelain or a

combination of acrylic resin and metal occlusal surfaces.combination of acrylic resin and metal occlusal surfaces. porcelain teeth are more resistant to abrasion and therefore porcelain teeth are more resistant to abrasion and therefore

maintain their luster longer than acrylic resin teeth.maintain their luster longer than acrylic resin teeth. Acrylic resin teeth can be altered and will bond with the denture Acrylic resin teeth can be altered and will bond with the denture

base for retention in instances of limited inter arch space.base for retention in instances of limited inter arch space. Acrylic resin teeth are preferred when the teeth in the opposing Acrylic resin teeth are preferred when the teeth in the opposing

arch have been restored with gold, as the porcelain has a higher arch have been restored with gold, as the porcelain has a higher coefficient of wear than gold. coefficient of wear than gold.

Acrylic posterior teeth should never be used in combination with Acrylic posterior teeth should never be used in combination with porcelain anterior teeth. The rate of wear of resin teeth in relation porcelain anterior teeth. The rate of wear of resin teeth in relation to that of porcelain teeth is such that the excessive forces from to that of porcelain teeth is such that the excessive forces from opposing tooth contact will eventually be developed in the opposing tooth contact will eventually be developed in the anterior part of residual alveolar ridges. anterior part of residual alveolar ridges.

Review of literatureReview of literature ByronE.Kern (1967) – Anthropometric parameters of tooth ByronE.Kern (1967) – Anthropometric parameters of tooth

selectionselection

He studied over 6000 skulls and documented over 509 of He studied over 6000 skulls and documented over 509 of them, of which he selected skulls had full complement of them, of which he selected skulls had full complement of teeth and were ages of 22 to 46 .teeth and were ages of 22 to 46 .

His analysis were on bizygomatic width,skull length,bigonial His analysis were on bizygomatic width,skull length,bigonial width, internasal width, cranium circumference to that to width, internasal width, cranium circumference to that to the incisors width.the incisors width.

Significant results were found in comparison between nasal Significant results were found in comparison between nasal width of the skulls and cranium cicumference to that to width of the skulls and cranium cicumference to that to widths of maxillary central incisors width.widths of maxillary central incisors width.

Mavroskoufis (1980)- The face form as a guide for selection Mavroskoufis (1980)- The face form as a guide for selection of maxillary cetrl incisors.of maxillary cetrl incisors.

His investigations were on 70 subjects, standardised His investigations were on 70 subjects, standardised photography of full face and intra oral view of central incisors photography of full face and intra oral view of central incisors are recorded .are recorded .

Then slides created were projected to measure “apparent” Then slides created were projected to measure “apparent”

and “actual” face form to that to incisors.and “actual” face form to that to incisors. The results showed no relation between the face form and The results showed no relation between the face form and

maxillary central incisors form and its selection, instead maxillary central incisors form and its selection, instead dissimilarity of face form and tooth form were detected.dissimilarity of face form and tooth form were detected.

Fabiana Mansur Varjao (2005): Intercommissural width as a Fabiana Mansur Varjao (2005): Intercommissural width as a guide for selection of maxillary anterior teeth.guide for selection of maxillary anterior teeth.

cast were made from 160 subjects from 4 different racial cast were made from 160 subjects from 4 different racial groups , location of intercommisural width land marks were groups , location of intercommisural width land marks were made on the subjects and transffered to the cast .the made on the subjects and transffered to the cast .the distance between the corners of the mouth and the distal of distance between the corners of the mouth and the distal of the canines were measured on the cast and compared.the canines were measured on the cast and compared.

The result showed a weak correlation between them and The result showed a weak correlation between them and the author concluded that the use of corner of mouth for the author concluded that the use of corner of mouth for selection of artificial teeth as inaccurate.selection of artificial teeth as inaccurate.

Fabiana Mansur Varjao(2006):Nasal width as a guide in Fabiana Mansur Varjao(2006):Nasal width as a guide in selecting maxillary anterior teeth.selecting maxillary anterior teeth.

the author studied in 160 subjects in 4 different races, the author studied in 160 subjects in 4 different races, using a sliding caliper the nasal width and the intercanine using a sliding caliper the nasal width and the intercanine distance was measured. A selection error in clinical distance was measured. A selection error in clinical application due to this method was given as 0-2mm , 2-application due to this method was given as 0-2mm , 2-4mm, greater than 4mm.4mm, greater than 4mm.

The author concluded that intercanine distance and nasal The author concluded that intercanine distance and nasal width comparison was not accurate.width comparison was not accurate.

Conclusion Conclusion

There are two worlds , the world we can measure with line There are two worlds , the world we can measure with line and rule, and the world that we feel with our heart and and rule, and the world that we feel with our heart and imagination.imagination.

Teeth selection is an important part of denture fabrication, Teeth selection is an important part of denture fabrication, although various techniques is advised ,it is necessary to although various techniques is advised ,it is necessary to develop a esthetic sense by the observer so as the artificial develop a esthetic sense by the observer so as the artificial teeth will nearly look like a natural dentition (living thing) teeth will nearly look like a natural dentition (living thing) rather than artifacts that are poor replicas of what has rather than artifacts that are poor replicas of what has been lost. been lost.

References References

Frush and FisherFrush and Fisher : How Dentogenic restorations interpret the : How Dentogenic restorations interpret the

sex factor, J. Prosthet. Dent. 1956;6 :160-172sex factor, J. Prosthet. Dent. 1956;6 :160-172 Frush and FisherFrush and Fisher : How Dentogenic restorations interpret the : How Dentogenic restorations interpret the

Personality factor, J. Prosthet. Dent. 1956;6 :441-449Personality factor, J. Prosthet. Dent. 1956;6 :441-449Frush and FisherFrush and Fisher :The Age factor in Dentogenics, J. Prosthet. :The Age factor in Dentogenics, J. Prosthet.

Dent. 1957;7 :441-449Dent. 1957;7 :441-449Frush and Fisher: Frush and Fisher: The Dynesthetic interpretation of The Dynesthetic interpretation of

dentogenic concept, J Prosthet Dent : 1958;8;558dentogenic concept, J Prosthet Dent : 1958;8;558Richard E. Lombardi : Richard E. Lombardi : The principles of visual perception The principles of visual perception

and their clinical application to denture esthetics, J Prosthet and their clinical application to denture esthetics, J Prosthet Dent : 1973;29;324Dent : 1973;29;324

Byron E.Kern : Byron E.Kern : Anthropometric parameters of tooth Anthropometric parameters of tooth selection, J Prosthet dent :1967 : 17 :431selection, J Prosthet dent :1967 : 17 :431

Mavroskoufis F. Mavroskoufis F. : The face form as a guide for the selection : The face form as a guide for the selection of maxillary central incisors. J Prosthet Dent ; 1980 ;43;501 of maxillary central incisors. J Prosthet Dent ; 1980 ;43;501

Zarb - BolenderZarb - Bolender : Prosthodontic treatment for edentulous : Prosthodontic treatment for edentulous patients. Twelfth edition, 2004patients. Twelfth edition, 2004

Fabiana Mansur Vajrao : Fabiana Mansur Vajrao : IIntercommisural width in 4 racial ntercommisural width in 4 racial groups as a guide for selection of maxillary anterior teeth in groups as a guide for selection of maxillary anterior teeth in complete dentures ; Int J Prosthdon ;2005;18;513complete dentures ; Int J Prosthdon ;2005;18;513

Fabiana Mansur Vajrao: Fabiana Mansur Vajrao: Nasal width as guide in selection of Nasal width as guide in selection of anterior teeth : J Prosthodontics ; 2006 ;15;353anterior teeth : J Prosthodontics ; 2006 ;15;353

Boucher. C.O: Prosthodontic treatment for edentulous patients. Ninth edition

Sheldon Winkler: Essential of complete denture prosthodontics, 2nd Edition