SETTING OF ARTIFICIAL TEETH

Setting of anterior teeth

Anterior artificial teeth are arranged in temporary bases. Even when great care is
taken to select the proper size, form and shade for a particular patient, an unnatural
denture can still be created if care is not taken during tooth arrangement. The
general pattern of bone loss, though modified by individual variations, is essentially
upwards and backwards for the maxillary anterior residual ridge and downwards for
the mandibular anterior residual ridge. Therefore, maxillary artificial anterior teeth
must be arranged anteriorly and inferiorly to the residual alveolar ridge to occupy
the position formerly occupied by the natural teeth.

Sequence of anterior teeth arrangement:

Most acceptable methods for arranging artificial teeth begin with the arrangement
of the maxillary central incisors, these teeth maintain the central line as indicated
by the dentist and most sequence requires the arrangement of all the maxillary
anterior teeth, other methods alternant between the maxillary and mandibular
teeth: maxillary central incisors, mandibular central incisors, maxillary lateral
incisors, mandibular lateral incisors. Many dentist and technician set the maxillary
anterior teeth then mandibular anterior teeth this method allows to check the
esthetic factor earlier.

Position of anterior artificial teeth

The teeth lip relationship varies between individual where the position of the teeth
and the mobility of the lips influence the amount of teeth exposed during smiling.
Usually the incisal edges of the upper incisors is placed 2-3mm bellow the rest
position of the upper lip at the time of the registration of the jaw relationship ,the
upper bite rim have been adjusted to provide a suitable support for the upper lip.

Guide lines of artificial teeth arrangement:

Maxillary cast:
1.
A line is drawn parallel to the frontal plane that touches the anterior margin
of the Incisive papilla, aids in the positioning of the upper central incisors.
2.
The midline follows the mid palatal suture and bisects the incisive papilla; this
line is perpendicular to line 1.
3.

The canine eminence line is recorded on the cast when it's present.

Mandibular cast:
1.
A line is drawn parallel to the frontal plane bisecting the residual ridge, aids in
positioning of the mandibular central incisors.
2.

A point designates the distal of the mandibular canines.

3.
A line follows the crest of the residual ridge from the canine point to the
middle of retromolar pad, aids in the buccolingual position of the mandibular
posterior teeth.
4.
A line that bisects the vertical height of the retromolar pad aids in
establishing the vertical position of the occlusal surfaces of the posterior teeth.
Importance of anterior teeth arrangement:
1.

Proper lip support.

2.

Permit satisfactory phonetics.

3.

Pleasing esthetics.

Also an important role is to set the teeth in place where they grow.

MAXILLARY ANTERIOR TEETH:

Maxillary central incisors

The criteria for arrangement of maxillary anterior teeth are as follows:

1.
The long axis of the tooth should be perpendicular to the horizontal plane
(occlusal plane or the mandibular occlusion rim).
2.

The contact point should coincide with the midline of the face.

3.

The incisal edge should touch the mandibular occlusion rim.

4.
The facial surface of the central incisors should be 5-9 mm anterior to the
center of the incisive papilla.

Figure 5-1: The long axis of the tooth shows slight distal inclination to the
perpendicular.

Figure 5-2: The neck of the tooth should be slightly depressed.

Figure 5-3: Arrangement of upper anterior teeth follows the contour of the lower lip.

Figure 5-4: The facial surface of the upper central incisor is located about 1 cm to
the incisive papilla.

Figure 5-5: Upper central incisor in place

Maxillary lateral incisor

1.
The long axis of Maxillary lateral incisor shows slightly more distal inclination
than the central incisor.
2.

The cervical portion of the tooth should incline slightly lingually.

3.
The incisal edge of the lateral should be raised approximately 1 mm from the
mandibular occlusion rim.
4.

The neck is depressed more than central incisor

Figure 5-6: The long axis of Maxillary lateral incisor shows slightly more distal
inclination than the central incisor.

Figure 5-7: The neck is depressed more than central incisor.

Figure 5-8: Upper lateral incisor in place.

Maxillary canine
1.

The incisal edge of the canine should touch the mandibular occlusion rim.

2.

The long axis should be perpendicular to the occlusal plane.

3.
The cervical third of the labial portion of the canine should incline buccally to
achieve some prominence.

4.
The mesiolabial aspect of the canine should be visible when viewed from the
anterior. This will be accomplished by tilting the neck of the canine slightly to the
distal (in addition to being tilted to the buccal).
5.

The neck of canine is prominent.

Figure 5-9: The neck of canine is prominent.

Figure 5-10: Lateral view of upper anterior teeth.

Figure 5-11: Upper canine in place.

Figure 5-12: Upper anterior teeth (one side only).

Figure 5-13: Front view of upper anterior teeth (one side only).

Figure 5-14: Wax removal to set the central incisor of the other side.

Figure 5-15: Setting the left central incisor.

Figure 5-16: Setting the left lateral incisor.

Figure 5-17: Front view of upper anterior teeth.

Mandibular anterior teeth

The incisal guide angle is the angle formed by a line drawn through the incisal
edges of the maxillary and mandibular incisors in a horizontal plane.
In complete denture treatment this angle is determined by the person arranging the
artificial teeth.
In denture fabrication the mandibular incisors should not touch the maxillary
incisors in centric relation.
The incisal guide angle should be kept as low as possible to allow free movement of
the teeth in eccentric jaw movements without compromising denture stability.

Figure 5-18: Incisal guide angle.

The incisal guide angle:

It is the angle formed by a line drawn through the incisal edges of the maxillary and
mandibular incisors in a horizontal plane.

Overbite (vertical overlap):

It is the vertical extension of the upper anterior teeth over the lower teeth in a
vertical direction when the opposing posterior teeth are in contact in centric
occlusion.

Overjet (horizontal overlap):

It is the projection upper anterior teeth beyond their antagonist in a horizontal
direction.

Figure 5-19: Vertical and horizontal overlaps.

Mandibular Central Incisors:

1.
The long axis of the mandibular central incisor should be set perpendicular to
the occlusal plane.
2.

Arrange the anterior teeth.

3.
Set the mandibular central incisors so that the maxillary incisors cover them,
1 mm vertically and 1 mm horizontally (1 mm horizontal and vertical overlap) if you
are using anatomic posterior teeth.
4.
The contact point of mandibular incisors should coincide with the midline of
the maxillary teeth.
5.
In horizontal view the distal edge rotated towards lingually to have the arch
curvature.

Figure 5-20: Mandibular anterior teeth.

Figure 5-21: Lateral view of mandibular central incisor.

Figure 5-22: Mandibular central incisor in place.

Mandibular lateral incisors

1.
The long axis of the mandibular incisor should be slightly inclined distally at
the cervical portion of the tooth.
2.

The occlusal height should be the same at the central incisors.

Figure 5-23: Front view of mandibular lateral incisor.

Figure 5-24: Lateral view of mandibular lateral incisor.

Figure 5-25: Mandibular lateral incisor.

Mandibular canines
1.
The long axis of the mandibular canine is nearly perpendicular to the occlusal
plane with a slight distal inclination.
2.
The tip of the canine should be at the same occlusal height as the mandibular
central and lateral incisors.

Figure 5-26: Front view of mandibular canine.

Figure 5-27: Lateral view of mandibular canine.

Figure 5-28: Mandibular canine in place.

Figure 5-29: Upper and lower anterior teeth.

Arch Form:
In some instances, such as when a large horizontal overlap (Class II) creates
phonetic problems, a compromise position for the mandibular incisors may be
necessary. The limit of compromise on a mandibular denture is the labial border. You
will make the mandibular denture unstable if you arrange the mandibular incisors
any further labially than the labial border.
Anterior teeth are set to follow the arch form of the patient's residual ridges.
The incisal edges of the anterior teeth should be set to correspond to the shape of
the arch. A square arrangement is indicated for a square-shaped maxillary residual

ridge, a tapering arrangement for a tapering ridge form, and an ovoid arrangement
for an ovoid arch.

Figure 5-30: arrangement of upper anterior teeth should follow the arch form.

Figure 5-31: Horizontal overlap.

Procedures:
There are many different ways to arrange anterior teeth. This procedure is a
technique to guide you in your first attempts. Use the occlusion rim as your guide to
the labial contour and height. Complete the tooth arrangement to the best of your
ability, evaluating it based on the criteria provided in this manual. Consult the
Prosthodontics faculty in your Clinic for assistance.

i.
Locate the midline on the maxillary occlusion rim. Extend this mark onto the
land area of the maxillary cast with a pencil. Usually, this line coincides with the
center of the incisive papilla.
ii.
Using a warmed knife cut enough wax from the right side of the maxillary
occlusion rim to allow you to position the right central incisor.
iii.
Arrange the upper central incisor with its mesial edge at the midline
previously marked using the occlusion rim remaining on the left as a guide. Also,
use the guidelines presented in the beginning of this section. It may be necessary to
grind on the record base with a rotating instrument. It may also be necessary to
adjust the ridge lap portion of the denture tooth.
iv.

Seal the tooth in position on the lingual surface with wax.

v.

Arrange the right lateral and canine in the same manner.

vi.
Now, cut away the left side of the anterior portion of the maxillary occlusion
rim and arrange the left central, lateral, and canine teeth. Evaluate the position of
the incisal edges of these teeth relative to the plane of occlusion using a metal
occlusion template or its substitute.
vii.
Repeat the preceding operation to arrange the mandibular anterior teeth.
When you will be using 0 degree posterior teeth (ex., monoplane, Rational), the
incisal guide table is set at 0 degree and the anterior teeth are arranged so there is
no vertical overlap. No other adjustment of the incisal guide table is necessary.

When using posterior teeth with cuspal inclines, set the mandibular anterior teeth in
such a way that the maxillary anterior teeth have a horizontal overlap over the
mandibular teeth of 1 to 1.5 mm in normal jaw relations. The incisal guidance, and
therefore the incisal guide angle, is determined by the amount of horizontal and
vertical overlap of the anterior teeth established by the dentist.
viii.
When properly arranged, the long axis of the maxillary canine will coincide
with the distal surface of the mandibular canine, when viewed from the buccal.
Alternatively, the mandibular canines can be arranged first in the proper
relationship to the maxillary canines ( the cusp tip of the mandibular canine is
placed between the maxillary canine and lateral). You then arrange the centrals and
laterals in the remaining space.

ARRANGEMENT OF POSTERIOR TEETH

Arranging the Upper posterior Teeth:

i.
Place the right maxillary first premolar with its long axis at right angles to the
occlusal plane. The buccal and lingual cusps are placed on the plane.
ii.

Place the right maxillary second premolar in like manner.

iii.
Align the buccal surfaces of the premolars and the canine with the edge of
metal or plastic occlusal plane template.
iv.
The mesio-buccal and mesio-lingual cusps of the right maxillary first molar
touch the occlusal plane. The disto-buccal cusp is raised about 1/2 mm and the
disto-lingual cusp is raised about 1/2 to 3/4 mm above the occlusal plane.
v.
All of the cusps of the second molar are raised from the occlusal plane
following the position of the first molar. The mesio-buccal cusp should be about 1
mm from the occlusal plane.
vi.

Follow the same procedure in placing the posteriors on the opposite side.

Arranging the lower posterior teeth:

i.
Remove enough wax from the mandibular occlusion rim on the right side to
have space for the posterior teeth.

ii.
Mark the land areas of the mandibular cast with a pencil to serve as a guide
in tooth arrangement. After removing the mandibular record base, place a mark on
the land where the mandibular ridge turns superiorly (A).
This will represent the posterior limit for tooth arrangement
(Dont set teeth beyond this point).
iii.
With a pencil, use a ruler to mark the crest of the mandibular ridge from the
base of the retromolar pad to the canine area. This will identify the crest of the
mandibular ridge (B).

Figure 5-32: A line should be drawn from the center of the retromolar pad area to
the canine area.

Replace the mandibular record base and occlusion rim, and using a straight edge,
extend the previous markings onto the wax rim to serve as a guide when arranging
the maxillary teeth.

Repeat this procedure for the other side.

Figure 5-33: Level of posterior teeth in relation to retromolar pad area.

iv.
Set the right mandibular first molar in approximately its correct position but
slightly high in occlusion.

Close the articulator carefully to bring the mandibular molar into its proper position.

Guide it to the correct occlusal relation with the maxillary first molar and
maxillary second premolar

Making certain that the incisal guide pin remains in contact with the incisal
table during all excursions.
v.
Follow the same procedure in placing the right mandibular second molar and
second premolar.

vi.
In some instances, there is not sufficient space for the mandibular first
premolar.
For esthetic reasons, it is usually advisable to grind the mandibular first premolar to
fit the available space rather than altering the anteriors.
vii.

Follow the same procedure in placing mandibular teeth on the left side.

Figure 5-34: Buccal view of right maxillary first and second premolars with their long
axis at right angles to the occlusal plane. The buccal and lingual cusps are placed
on the plane

Figure 5-35: Lateral view of posterior teeth cusps relation to the occlusal plane.

Figure 5-36: Occlusal view of upper right premolars in place. Notice the relation of
the buccal cusps to canine.

Figure 5-37: Lateral view of upper right premolars.

Figure 5-38: Upper right first molar in place.

Figure 5-39: Upper right second molar in place.

Figure 5-40: Occlusal view of upper posterior teeth in place.

Figure 5-41: Balanced occlusion- working side contacts.

Figure 5-42: Balanced occlusion- non-working side contacts.

Figure 5-43: balanced occlusion- protrusive contacts.

Figure 5-44: Carving of post-dam on the upper cast.