TOOTH SELECTION IN

REMOVABLRE DENTURE
• Definition: The selection of a tooth or teeth of a
shape, size and color to harmonize with the
individual characteristics of a patient.
• Dentists’ responsibility ––should not assign the
task to the technician
• Categories
– Shape or mould
– Shade or colour
• Classification of patients:
1. Patients with remaining natural teeth
2. Patients who have old denture
3. Patients without remaining natural teeth and without
old denture
 Objectives
1. Esthetics
2. Masticatory function
3. Correction of speech defects
4. Preservation of the remaining tissue and
muscle tone
Guide to Anterior teeth selection

1. Pre-extraction guides

2. Post extraction guides

3. Guidelines relating to anterior tooth

positioning
1. Anterior teeth selection (Use previous
Rec)
Pre-extraction guides

a) Study cast, Photographs & Radiographs

i) Consider photographs taken when subject was dentate or
wore dentures which were admired by the patient AND
teeth showing
ii) Consider biologically/chronologically-induced age-
changes (More ↑tooth show in the young than old)

b) Previous partial dentures

 Anterior teeth selection--

The two photographs show the subtle facial and dental

changes which can occur from late youth to middle age
 Selection of upper anterior teeth

Template above assist in formulating the (horizontal) width of the

upper six anterior teeth where a photograph of the patient when
dentate is available
Guidelines to the selection of replacement of upper anterior teeth
2. Anterior teeth selection (Use previous
Rec)

Guides:
1. Post extraction guides
• Extracted teeth
• Old dentures of the patient
3. Anterior teeth selection (No P/record)

• Guidelines relating to anterior tooth positioning

is used and these guidelines are centered on the
fact that the (six) upper anterior teeth should:
1. Appropriately support the upper lip
2. Occupy that area of the upper anterior arch
bordered by the corners of the mouth
3. Allow for individualization where indicated,
eg rotation, imbrication or spacing.
Anterior teeth selection (No P/record)--

Factors considered:

1.The of size (width) of the anterior teeth

2.Length of the anterior teeth

 1. Selection of size (width)
Methods used:
a. Size of the face and head
b. Size of the maxillary arch
c. Maxillomandibular relations
i. In class I – Normal relationship, the teeth in one
arch are compatible with the teeth in the other arch.
ii. In class II – The mandible is retruded and the
mandibular teeth are frequently smaller
iii. In class III – The mandible is protruded, the face is
longer and the mandibular teeth are frequently
larger than normal
 a) Size of the face and the head
• Width of maxillary central incisor = 1/16 bizygomatic width
of the face

• Width of the alae of the nose

- If the base of the nose is wide the central incisor should be wide, if
the root of the nose is narrow the lateral incisor should be
narrow

• Cranial circumference
• Size of maxillary arch
• Not dependant in severe resorption
 b) Size of the maxillary arch
•Corners of the mouth = Canine to canine measurement
•The distance measured between the two commisures (angles of
the mouth ) will represent the width of the upper six anteriors from
the distal surface of the canine to the distal surface of the other
canine. A mark is placed at occlusion rim at each corner of the lips
when the patient is relaxed
NB: 1. Can use a floss or flexible ruler
2. This is approximately the circumference of the
upper rim from one canine point to the other plus 8–10 mm.
•Select from those moulds that lie within 1 mm of the
selected inter-canine distance.
 b) Size of the maxillary arch

1. Using the position of the corners

of the mouth
2. Extending a line from the inner
canthus of the eye via the lateral
border of the alar cartilage onto
the upper rim when the patient
is smiling.
 Determines canine position

Dental floss used to give an acceptable

guideline for the position of the canine tip
b) Size of the maxillary arch
• Flexible ruler used to
measure the (labial)
circumference of the arc
from one canine tip to
the other.
• As tooth mould charts
for anterior teeth give
dimensions from the
distal of one canine to
the other, 8–10 mm
should be added to the
above measurement, to
cater for the distal ‘half’
of each canine
 b) Size of the maxillary arch
• Incisal papilla & cuspid eminences Distance =
width of six maxillary anterior teeth
– Line drawn from the distal termination of the
eminence (or anterior to buccal frenum
attachment) following the contour of the ridge ,
reaching the anterior border of incisal papilla,
then terminate distal to canine eminence of
opposite side
 2. Length of the anterior teeth
Definition: - The height of the central incisors from the
incisal edge to the highest point on the labial face of the
tooth corresponding to the highest point of the crown (in mm)

• The lips Vs Length of the anterior teeth

– High lip line (when the patient smiles) : cervical third of anterior
teeth
– Low lip line (when the patient relaxed) : incisal third of anterior
teeth

• Highest point on the labial aspect of the crown should lie 1

mm above the high smile line
• Photograph of
unprepared upper right
central incisor from a
mould (A).
• The modified tooth (B)
has been adjusted to suit
the patient by grinding
away the incisal
translucency.
• The clinician should
compensate for this in
selecting the mould
• The scribing of the high smile line on the wax rim helps the
clinician to determine the height of the central incisor tooth
• Care should be taken to compensate for tooth wear
 Others
• Guide --
– Inverted shape of the face
– Shape of the edentulous maxillary arch
• Both have no scientific credence
Inverted shape of the face: Williams’ guideline to tooth selection by
relating upper central incisor form to frontal appearance of the face
has no scientific credence
Guidelines to the selection of replacement of upper anterior teeth
 Form of anterior teeth
• The form & contour of the face
1. Square
2. Taper
3. Ovoid
• Sex
– Curved features = female
– Square features = male
• Age
– Older age = outline more square
 Color or shade of anterior teeth
• Patients age
– Aged Darker teeth
– Young Lighter teeth.
•   Patients complexion
– Light teeth for dark skin, blue eyes
– Dark teeth usually for light skin and black eyes.
 The following facts are true for nearly
all natural teeth
a. The neck of the tooth has a more pronounced
color than the incisive edge.
b. The incisive edge if not worn, is more transluscent
than the body of the tooth and is usually of a
bluish shade (composed entirely of enamel)
c. The upper central incisors are lightest teeth in the
mouth followed by the laterals and canines.
Posterior teeth are usually uniform in color.
d. Teeth darken slightly with age.
 Aid for selecting the shade
1. Shade guides – The shade guide tooth should be
moistened and selection made in the normal
light.
a. Outside the mouth along the side of the nose.
b. Under the lip with the incisal edge exposed c.
Under the lip with only the cervical end covered
and the mouth open
 Aid for selecting the shade
2. Follow existing dentition
3.Careful and deliberate consultation with
patients
4. Considerations
– Age (teeth tend to become darker with age
although this is not always absolute)
– Patient preference
– Skin color (usually darker skin whiter teeth)
– Canine teeth slightly darker than incisors
Anterior artificial teeth
Vita shade guide:
a)arranged according to colour
b)according to lightness
 Selection of lower anterior teeth
Guide
1. Pre-extraction records
2. Manufacturers’ mould charts to equate the lower
anterior teeth to the selected upper anterior teeth
– Tooth moulds for lower anterior teeth have the equivalent
three measurements to upper anterior teeth
– Choose the mould that is appropriate for each patient,
taking age, facial form and patient perceptions into account.
3. Create a functionally-generated profile of the lower
denture space (sometimes called the neutral-zone
impression technique), identify the position of the
lower canines (via the angle of the mouth) and then
measure the canine-canine distance.
 Posterior teeth Selection

• Shade of posterior teeth should harmonize

with the shade of anterior teeth (bicuspids)
 Size & number of posterior teeth
• Buccolingual width
– This is less than that of the natural teeth to reduce
the size of food table but should not lose the
support for cheeks, & not great enough to
embarrass the tongue or encroach on a normal
buccal corridor
 Size & number of posterior teeth--
• Anteroposterior dimensions
– Anteroposterior dimensions of posterior teeth are
determined by the edentulous area between the
distal of canine and the maxillary tuberosity in
maxillary arch and between the distal of canine and
the ascending area of the mandible in mandibular
arch.

• Why ascending area of the mandible in

mandibular arch?
– To place teeth on the ascending area of the mandible
would direct the forces at an inclined plane, which are
more dislodging than forces directed at right angles to
the support
Size & number of posterior teeth--
• Vertical height
– Height of the maxillary first premolar should be
comparable with that of the maxillary canines to
have the proper esthetic effect
 Occlusal form
• Cusp angles are measured from a horizontal
axis when the tooth is set with its long axis
perpendicular to the horizontal axis
• Based on occlusal form, posterior teeth
classified as:
– Anatomic teeth
– Semi-anatomic teeth
– Non anatomic teeth
– Special forms of teeth
 Anatomical teeth (Cusp form teeth )
• Are designed for the function of mastication.
• Their cusps are arranged so that during closing
movements they would shear & crush food when the
patient applies a reasonable biting force.
• Have cuspal inclinations greater than 0° and tend to
replicate.
• Such teeth may have cuspal angles set to 20°, 30°, 33°
or 45°.
• Indications
– In well formed ridges where good support and retention
can be expected.
– Where balanced occlusion is planned.
– Patient with good neuromuscular control.
Anatomical teeth (Cusp form teeth )--

Posterior teeth which have cusps

 Anatomical teeth--
Advantages:
• Ease in developing bilateral balanced articulation
between the maxillary & mandibular teeth during
eccentric movements
• Excellent esthetic quality
• Chewing usefulness
Disadvantages:
• Possible damage to the supporting tissues due to
deflective contacts when vertical dimension is lost
through resorption
• When bone loss occur lead to denture movement ,
discomfort, irritation of soft tissue & more bone
loss
 Non anatomical teeth (Monoplane
teeth)
• Are designed without cusps to allow for intercuspation
anywhere along the occlusal plane anteroposteriorly.
• Designed in accordance with mechanical principles
rather than from the anatomic standpoint.
• Indications
– They are indicated in flat ridge cases to minimize the lateral
destabilizing forces.
– When balanced occlusion is not planned.
– In abnormal jaw relationships or when it is difficult to record
centric relation as in patients with poor neuromuscular
control.
– Patients with cross bite tooth relations.
– Patients with deleterious habits such as bruxism.
 Non anatomical teeth--

Posterior teeth which are cuspless

 Non anatomical teeth--
Advantages:
• Freedom in movement
• Used in class II & class III jaw relation ships
• Closure of jaws over a broad contact area
• Minimal horizontal pressure
• Easier maintenance
• Fabrication of dentures with simple techniques &
articulators
Disadvantages:
• Lack of esthetic quality
• Less chewing efficiency
 Special/Hybrid teeth

Hybrid mould ie teeth which are modified to obtain the

benefits of non-anatomic and anatomic
 Factors to consider in selection
1. Occlusal factors
2. Stability factors
• Aesthetic factors
This patient clearly undertakes a range of border movements and
should be provided with balanced articulation
The occlusal tables on this lower denture are too large. First of all, the
excessive width of the molars is presenting lingual undercuts which
will de-stabilise the denture. In addition, the presence of the second
molar on the inclined plane of the ramus will induce a protrusive
movement
 Material composition of teeth
1. Acrylic resin teeth
• Less aesthetic
• Lighter
• Less resistant to wear & staining
• Less likely to chip or fracture
• Chemical means of retention with the denture base
• Used in cases of small inter arch distance. Why? Ease of occlusal reshaping
• Used in cases where the opposing teeth (natural or have metalic
restorations). Why?
2. Porcelain teeth
• More aesthetic
• Heavier
• More resistant to wear & staining
• More likely to chip or fracture
• Mechanical means of retention with the denture base
• Not used in cases of small inter arch distance. Why? No occlusal reshaping
• Not used in cases where the opposing teeth (natural or have metalic
restorations). Why?
• Dentists’ responsibility
– Photographs or favored dentures if possible
– Select lower to complement the upper
– Fulfill esthetic and functional requirements
– Good practice to produce study models prior to
extracting teeth