selecting denture teeth. place reference marks on the occlusion rims to aid in tooth selection and...

Selecting Denture TeethSelecting Denture TeethSelecting Denture TeethSelecting Denture Teeth

Place reference marks on the Place reference marks on the occlusion rims to aid in tooth occlusion rims to aid in tooth

selection and placementselection and placement

Place reference marks on the Place reference marks on the occlusion rims to aid in tooth occlusion rims to aid in tooth

selection and placementselection and placement

Reference Marks for Selecting Reference Marks for Selecting Anterior TeethAnterior Teeth

Reference Marks for Selecting Reference Marks for Selecting Anterior TeethAnterior Teeth

• Technician sets the teeth without seeing patientTechnician sets the teeth without seeing patient

• Wax rim contours aid selection and setting:Wax rim contours aid selection and setting:

– Occlusal vertical dimensionOcclusal vertical dimension

– Angulation of facial rims affects lip supportAngulation of facial rims affects lip support

– OverjetOverjet

• Technician sets the teeth without seeing patientTechnician sets the teeth without seeing patient

• Wax rim contours aid selection and setting:Wax rim contours aid selection and setting:

– Occlusal vertical dimensionOcclusal vertical dimension

– Angulation of facial rims affects lip supportAngulation of facial rims affects lip support

– OverjetOverjet

Maxillary Reference MarksMaxillary Reference MarksMaxillary Reference MarksMaxillary Reference Marks

Midline PositionMidline PositionMidline PositionMidline Position

• Critical reference

• #7 wax spatula

• Score a line parallel the facial midline

• Mark both rims

• Critical reference

• #7 wax spatula

• Score a line parallel the facial midline

• Mark both rims

Guidelines for Guidelines for Setting Anterior Setting Anterior

TeethTeeth

Guidelines for Guidelines for Setting Anterior Setting Anterior

TeethTeethHigh Lip LineHigh Lip Line

Corner of MouthCorner of Mouth

Angulation is as Angulation is as important as midlineimportant as midline

• Mark midline on the wax• Mark midline on the wax

Midline of Teeth = Facial MidlineMidline of Teeth = Facial MidlineMidline of Teeth = Facial MidlineMidline of Teeth = Facial Midline

Corners of the MouthCorners of the MouthCorners of the MouthCorners of the Mouth

• Mark corners at rest (#7 wax spatula)

• Position of distal of the canines

• Mark corners at rest (#7 wax spatula)

• Position of distal of the canines

Corners of the MouthCorners of the MouthCorners of the MouthCorners of the Mouth

• Measure circumference between marks with Trubyte Auto-Rule

• Size of 6 anterior teeth read off ruler (mm or by letter code A, B, etc.)

• Measure circumference between marks with Trubyte Auto-Rule

• Size of 6 anterior teeth read off ruler (mm or by letter code A, B, etc.)

High Lip LineHigh Lip LineHigh Lip LineHigh Lip Line

• Highest point of upper lip when smiling

• Cervical necks lie at or above this line

• If shorter teeth are selected, esthetics compromised

• Highest point of upper lip when smiling

• Cervical necks lie at or above this line

• If shorter teeth are selected, esthetics compromised

Palatal MidlinePalatal MidlinePalatal MidlinePalatal Midline

• Through middle of incisive papilla & mid-palatal raphe

• Extend onto land area

• Check for symmetry

– If not symmetrical, adjust rim

• Through middle of incisive papilla & mid-palatal raphe

• Extend onto land area

• Check for symmetry

– If not symmetrical, adjust rim

Midline & Canine ReferenceMidline & Canine ReferenceMidline & Canine ReferenceMidline & Canine Reference

• Line passing through distal of incisive papilla

• Perpendicular to the palatal midline

• Intersects cusp tips of the canines

• Line passing through distal of incisive papilla

• Perpendicular to the palatal midline

• Intersects cusp tips of the canines

Natural Natural DentitionDentition

Distal Aspect of the Incisive PapillaDistal Aspect of the Incisive PapillaDistal Aspect of the Incisive PapillaDistal Aspect of the Incisive Papilla

• Provides verification & tooth size selection

• Use to verify the symmetry

• On average, facial of central incisors should be 8-10 mm anterior to this line

• Provides verification & tooth size selection

• Use to verify the symmetry

• On average, facial of central incisors should be 8-10 mm anterior to this line

Mandibular Reference LinesMandibular Reference LinesMandibular Reference LinesMandibular Reference Lines

Mandibular Reference LinesMandibular Reference Lines

aa

1/2 way up1/2 way upretromolarretromolarCenter of ridgeCenter of ridgePosteriorPosterior

Center of ridgeCenter of ridgeAnteriorAnterior

MandibularCastLand AreaLand AreaOcclusion rimOcclusion rim

aa

1/2 way up1/2 way upretromolarretromolarCenter of ridgeCenter of ridgePosteriorPosterior

Center of ridgeCenter of ridgeAnteriorAnterior

MandibularCastLand AreaLand AreaOcclusion rimOcclusion rim

Middle of Retromolar PadsMiddle of Retromolar Pads

• Occlusal plane intersects

• If occlusal plane is too low - tongue biting

• Too high - strain as tongue struggles to replace the food bolus

• Occlusal plane intersects

• If occlusal plane is too low - tongue biting

• Too high - strain as tongue struggles to replace the food bolus

Center of Posterior RidgeCenter of Posterior RidgeCenter of Posterior RidgeCenter of Posterior Ridge

• Maxillary lingual cusps should be centered over this line

• Ensures denture stability

• Reduces fulcruming forces during function

• Maxillary lingual cusps should be centered over this line

• Ensures denture stability

• Reduces fulcruming forces during function

Center of Anterior RidgeCenter of Anterior RidgeCenter of Anterior RidgeCenter of Anterior Ridge

If anterior teeth are too facial to center of ridge, fulcruming tilting and dislodging occur

If anterior teeth are too facial to center of ridge, fulcruming tilting and dislodging occur

Selecting Anterior TeethSelecting Anterior TeethSelecting Anterior TeethSelecting Anterior Teeth

• Combination of science and art

• Measurement, formulas etc. are a starting point

• Use vision and common sense

• Combination of science and art

• Measurement, formulas etc. are a starting point

• Use vision and common sense

Tooth Size SelectionTooth Size SelectionTooth Size SelectionTooth Size Selection

• Use existing teeth as a guide:

– Too big or small?

– If so, use your own judgment

– Does patient like them? Do you?

• Use existing teeth as a guide:

– Too big or small?

– If so, use your own judgment

– Does patient like them? Do you?

Tooth Size SelectionTooth Size SelectionTooth Size SelectionTooth Size Selection

Use existing teeth as a guide:

– If acceptable, measure width and length

– Compare to Trubyte mould guide chart

• Central incisors dimensions listed

• Tooth photos are life size

Use existing teeth as a guide:

– If acceptable, measure width and length

– Compare to Trubyte mould guide chart

• Central incisors dimensions listed

• Tooth photos are life size

Measuring Existing TeethMeasuring Existing TeethMeasuring Existing TeethMeasuring Existing Teeth

Tooth Size SelectionTooth Size SelectionTooth Size SelectionTooth Size Selection

• High Lip Line - indication of inciso-gingival length

• Pre-extraction cast or photographs can be useful

• High Lip Line - indication of inciso-gingival length

• Pre-extraction cast or photographs can be useful

Tooth Size SelectionTooth Size SelectionTooth Size SelectionTooth Size Selection

• Corners of Mouth - use the Auto-Rule to pick a mould

• Corners of Mouth - use the Auto-Rule to pick a mould

Shape SelectionShape SelectionShape SelectionShape Selection

¯ Tooth shape does not correspond to facial shape

¯ Trubyte system good starting point

¯ No proven male/female characteristics

¯ Tooth shape does not correspond to facial shape

¯ Trubyte system good starting point

¯ No proven male/female characteristics

Shape SelectionShape SelectionShape SelectionShape Selection

• Use existing teeth as a guide - do they look good

• USE COMMON SENSE & OBSERVATION

• Use existing teeth as a guide - do they look good

• USE COMMON SENSE & OBSERVATION

Use Negative SpaceUse Negative SpaceUse Negative SpaceUse Negative Space

• Look at interproximal embrasure and papilla shape to assist in determining tooth shape

• Look at interproximal embrasure and papilla shape to assist in determining tooth shape

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Shade SelectionShade SelectionShade SelectionShade Selection

• Portrait shade guide

• Use existing teeth as a guide

– Shade B2 is close an average shade

– Top number (A, B, C, D) on tabs corresponds to Vita porcelain shade

– Bottom number (P) is Portrait # for ordering

• Portrait shade guide

• Use existing teeth as a guide

– Shade B2 is close an average shade

– Top number (A, B, C, D) on tabs corresponds to Vita porcelain shade

– Bottom number (P) is Portrait # for ordering

Shade SelectionShade SelectionShade SelectionShade Selection• Don’t show all shades to patient

• Patients will pick the whitest

• Show 2 or 3 shades under lip– Colour perception affected by background

• Don’t show all shades to patient

• Patients will pick the whitest

• Show 2 or 3 shades under lip– Colour perception affected by background

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Check Shade Against the Patients Face Check Shade Against the Patients Face

•Check shade of existing denture Check shade of existing denture •Ask if patient wants same shade or changeAsk if patient wants same shade or change•Allow patient to view shade against lip with mirrorAllow patient to view shade against lip with mirror•Obtain patient approvalObtain patient approval

Squint TestSquint TestSquint TestSquint Test

• Check for value (brightness)

• Squinting reduces the influence of hue

• If the teeth look too bright while squinting, suggest something less bright

• Check for value (brightness)

• Squinting reduces the influence of hue

• If the teeth look too bright while squinting, suggest something less bright

Shade SelectionShade SelectionShade SelectionShade Selection

• Teeth darken with age

• Correlation with skin and hair colour is suspect

• Vita ‘C’ shades are greyish

• Teeth darken with age

• Correlation with skin and hair colour is suspect

• Vita ‘C’ shades are greyish

Patient Chooses Shade with Patient Chooses Shade with Input from DentistInput from Dentist

Patient Chooses Shade with Patient Chooses Shade with Input from DentistInput from Dentist

• Patient

– owns the dentures

– will look at them every day

• Offer your opinion, don’t persuade

• Patient

– owns the dentures

– will look at them every day

• Offer your opinion, don’t persuade

Disinfect Shade TabsDisinfect Shade Tabs

Denture Tooth MaterialDenture Tooth MaterialDenture Tooth MaterialDenture Tooth Material

• Porcelain teeth less common now

• Acrylic easier to set and adjust

– Last life of denture (5-7 years)

• Porcelain teeth less common now

• Acrylic easier to set and adjust

– Last life of denture (5-7 years)

Denture Tooth MaterialDenture Tooth MaterialDenture Tooth MaterialDenture Tooth Material

Porcelain

Less wear

More translucent

Brittle - fracture easily

Don’t bond to base (stain, fall out)

Difficult to set, adjust

Porcelain

Less wear

More translucent

Brittle - fracture easily

Don’t bond to base (stain, fall out)

Difficult to set, adjust

Acrylic

New acrylics wear better

Improved translucency with layers

More resilient - Less breakage

Chemically bonds to base

Quieter

Easier to set/adjust

Gum sticks

Acrylic

New acrylics wear better

Improved translucency with layers

More resilient - Less breakage

Chemically bonds to base

Quieter

Easier to set/adjust

Gum sticks

Selecting Posterior Tooth FormSelecting Posterior Tooth FormSelecting Posterior Tooth FormSelecting Posterior Tooth Form

Anatomic Teeth Anatomic Teeth (10°, 20°, 30°, 40°)(10°, 20°, 30°, 40°)

Anatomic Teeth Anatomic Teeth (10°, 20°, 30°, 40°)(10°, 20°, 30°, 40°)

• Use for patients with:

– Esthetic concerns

– Coordinated jaw movements

– Denture opposing natural teeth

• Use for patients with:

– Esthetic concerns

– Coordinated jaw movements

– Denture opposing natural teeth

20°10° 30°

Non-Anatomic TeethNon-Anatomic Teeth(0°, Rational, Monoline, etc.)(0°, Rational, Monoline, etc.)Non-Anatomic TeethNon-Anatomic Teeth(0°, Rational, Monoline, etc.)(0°, Rational, Monoline, etc.)

• Jaw size discrepancies (Class III)

• Severe ridge resorption

• Uncoordinated jaw movements

• Poorer esthetics, due to lack of cuspal inclines

• Jaw size discrepancies (Class III)

• Severe ridge resorption

• Uncoordinated jaw movements

• Poorer esthetics, due to lack of cuspal inclines

Non-Anatomic TeethNon-Anatomic TeethNon-Anatomic TeethNon-Anatomic Teeth

• No overbite

• Normal overjet (1-2mm)

• No overbite

• Normal overjet (1-2mm)

No tooth form has been proven No tooth form has been proven most efficient - most patient can’t most efficient - most patient can’t

discern a differencediscern a difference

No tooth form has been proven No tooth form has been proven most efficient - most patient can’t most efficient - most patient can’t

discern a differencediscern a difference

Posterior Tooth SelectionPosterior Tooth SelectionPosterior Tooth SelectionPosterior Tooth Selection

• Match size & shade to anteriors

• Determine distance from distal of canine to ascending ramus (29, 30 mm, etc.)

• Match size & shade to anteriors

• Determine distance from distal of canine to ascending ramus (29, 30 mm, etc.)

Posterior Tooth SelectionPosterior Tooth SelectionPosterior Tooth SelectionPosterior Tooth Selection

• Buccolingual size can affect the tongue space

– smaller teeth if tongue space is limited

• Buccolingual size can affect the tongue space

– smaller teeth if tongue space is limited

Prescribing Denture TeethPrescribing Denture TeethPrescribing Denture TeethPrescribing Denture Teeth

¯ Use paper mould guides

¯ Infection control

¯ Use paper mould guides

¯ Infection control

Prescribing Denture TeethPrescribing Denture TeethPrescribing Denture TeethPrescribing Denture Teeth

• Dentsply Trubyte Portrait

– Acrylic Teeth

– Layers of acrylic - improved translucency

– IPN - improved wear resistance

• Dentsply Trubyte Portrait

– Acrylic Teeth

– Layers of acrylic - improved translucency

– IPN - improved wear resistance

SummarySummarySummarySummary

• Selecting denture teeth

– advise patient don’t persuade

– an art, minimal science

– use common sense

– use old denture as a starting point

– look at dentate patient esthetics

– Seminar exercise

• Selecting denture teeth

– advise patient don’t persuade

– an art, minimal science

– use common sense

– use old denture as a starting point

– look at dentate patient esthetics

– Seminar exercise

Seminar ExerciseSeminar ExerciseSeminar ExerciseSeminar Exercise

• Work in pairs in seminar groups

• Select shade for partners

• Use maxillary cast and Boley gauge to select tooth mold that best approximates partner

• Select corresponding mold for mand. teeth

• Complete prescription for teeth

• Have faculty seminar leader check & sign

• Work in pairs in seminar groups

• Select shade for partners

• Use maxillary cast and Boley gauge to select tooth mold that best approximates partner

• Select corresponding mold for mand. teeth

• Complete prescription for teeth

• Have faculty seminar leader check & sign