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