**Complete Dentures**
Preclinical
THE UNIVERSITY OF
**WESTERN** Oral Health Centre
**AUSTRALIA** of Western Australia
**Anterior**
**Tooth**
**Arrangement**
# Complete Denture Overview
### Treatment Schedule
| Visit | Operator | Procedure |
| -------- | ---------- | --------------------------------------------------- |
| Visit 1 | Clinician | Patient evaluation & primary impressions |
| | Laboratory | Diagnostic casts & special trays |
| Visit 2 | Clinician | Secondary impressions |
| | Laboratory | Bead & box, master casts, base & rims |
| Visit 3 | Clinician | Contour rims, OVD, MMR, **shade & mould selection** |
| | Laboratory | **Articulation & tooth setting** |
| Visit 4 | Clinician | Wax try-in |
| | Laboratory | Finalisation & processing |
| Visit 5 | Clinician | Assessment & issue |
| | | Instructions for care |
| Visit 6 | Clinician | Post operative review, post insertion instructions |
**Anterior Tooth Arrangement**
**Facial Aesthetics**
Successful alteration of dentofacial form requires an understanding of facial aesthetics.
The patient's presenting complaint is important, as is an understanding
of the patient’s:
❖ Perception of his/her dentofacial appearance
❖ Motivation for seeking treatment
❖ Realism of his/her expectations from treatment; and
❖ Likely level of co-operation, as well as support of the family and friends
Naini & Gill, 2008
Side profile image with numbered facial landmark labels.
Facial Aesthetics
Typical Facial Proportions
* Facial height to width (white):
o Males = 1.35:1
o Females = 1.30:1
* Bizygomatic width (white):
o = 70% facial height (white)
* Bitemporal width (**red**):
o = 80 – 85% bizygomatic width
* Bigonial width (**blue**):
o = 70 - 75% bizygomatic width
Naini & Gill, 2008
**Facial Aesthetics**
**Typical Facial Proportions**
* **Vertical facial thirds:**
* Are approximately equal
* **Lower facial third:**
* May be greater than middle third especially in males
* **Lower facial third can be further subdivided with:**
* Upper lip forming one third
* Lower lip and chin forming remaining two thirds
Naini & Gill, 2008
**Facial Aesthetics**
**Typical Facial Proportions**
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
- **Transverse face:**
- Can be divided into equal fifths
- Each fifth equals one eye width
- **Nasal alar base:**
- Should equal the intercanthal distance
- **Mouth width:**
- Equals the distance between the medial iris margins
- **Dental Midline:**
- Should be within 2-4 mm of facial midline
Naini & Gill, 2008
**Facial Aesthetics**
**Dental Midlines**
THE UNIVERSITY OF
WESTERN AUSTRALIA
Oral Health Centre
of Western Australia
Naini & Gill, 2008
**Facial Aesthetics**
**Complete Dentures**
Conventional Aesthetic Norms
* The denture provides adequate lip support
* Normally the occlusal plane is parallel to the interpupillary and ala-tragal lines
* Dental midline should not vary from facial midline by more than 2 – 4 mm
* The size, form, texture, colour and arrangement of the teeth harmonise with the patient’s facial features:
* Maxillary central incisors are approximately 9 – 12 mm in length
* Vermillion show of lower lip slightly more than upper lip
* Lower lip should cover incisal third of maxillary incisors
* Competent lips can be comfortably held together at rest
* There should be 2-4 mm exposure of maxillary incisors at rest
Naini & Gill, 2008
**Facial Aesthetics**
**Incisal Display**
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        THE UNIVERSITY OF
                                                                                                                                                    WESTERN Oral Health Centre
                                                                                                                                                    AUSTRALIA                       of Western Australia
**rest**                  **posed**                  **spontaneous**
**Factors affecting incisor exposure:**
* Upper lip length
* The “smile curtain” – defined as the muscular ability to raise the upper lip
* The vertical position of the anterior maxilla and incisor teeth
* The anteroposterior position of the anterior maxilla and incisor teeth
* The inclination of the maxillary incisor teeth
* Maxillary incisor crown length
* The vertical level of the gingival margins on the labial surface of the maxillary incisor crowns
The vertical exposure of the incisors
at rest should be 2-4 mm and on
smiling the entire crown of the
maxillary incisors should be exposed
Naini & Gill, 2008
<p style="font-family: 'Open Sans', sans-serif; font-size: 11.5pt; color: #4387a6; "><b>Anterior Tooth Selection</b></p>
<div style="background-color:#E3DFD4; width: 330px; height: 165px; display: flex; flex-direction: column; justify-content: flex-start; align-items: flex-start; padding-left: 20px; padding-top:20px;">
<p style="font-family: 'Open Sans', sans-serif; font-size: 14pt; color: #000000; margin: 0;">Anteriorly</p>
<p style="font-family: 'Open Sans', sans-serif; font-size: 14pt; color: #000000; margin: 0; padding-top: 10px;">Aesthetics is the most important factor</p>
<p style="font-family: 'Open Sans', sans-serif; font-size: 14pt; color: #a9a9a9; margin: 0; padding-top: 25px;">Posteriorly</p>
<p style="font-family: 'Open Sans', sans-serif; font-size: 14pt; color: #a9a9a9; margin: 0; padding-top: 10px;">Function is the most important factor</p>
</div>
**Anterior Tooth Selection**
**Determining Factors**
* **Size**
* Length
* Width
* **Form** (as per J. Leon Williams)
* Square
* Tapering
* Ovoid
* **Texture**
* Mimic surface features of natural teeth
* **Shade**
* For edentulous patients refer to colour of hair, skin & eyes
* Gradation from gingival margin (darker) to incisal tip (more translucent)
* Variation between pairs of anterior teeth, centrals < laterals < canines
* **Material**
* Porcelain
* Composite resin
* Acrylic Resin
**Anterior Tooth Selection**
**Size**
**Pre-extraction records**
* remaining teeth
* photographs with teeth in place
* radiographs of teeth
* measure existing denture
**Anatomic averages**
* width of philtrum = 2 centrals
* 16:1 ratio between length & width of face and upper centrals
* canine to canine width on occlusal rim
* ala width corresponds to mid canine to mid canine width
**Modifying factors**
* inter-ridge space
* reduced oral commissure
* upper and lower lip lengths
calculate with this formula
width of upper six anterior teeth (photo) / Interpupillary width (photo) = width of upper six anterior teeth / Interpupillary width (actual)
**Anterior Tooth Selection**
**Size**
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
Transfer markings from maxillary rim
Measure inter-canine width on maxillary rim
Measure height of smile line
**Anterior Tooth Selection**
**Form**
Selection by facial shape
Face outline can be classified into **four**
**main groups** with **three primary**
**modifications** of the basic face forms
which reflect a softening or ovoid
influence
**square**
**square ovoid**
**square tapering**
**square tapering ovoid**
**tapering**
**tapering ovoid**
**ovoid**
**Anterior Tooth Selection**
**Form**
Selection using anatomical cast
Oval alveolar ridge
Pointed alveolar ridge
Square alveolar ridge
oval anterior tooth shape
triangular tooth shape
square anterior tooth shape
THE UNIVERSITY OF
WESTERN AUSTRALIA
Oral Health Centre
of Western Australia
**Anterior Tooth Selection**
**Selection of IPN Anterior Teeth**
Mould Guide
**THE UNIVERSITY OF**
**WESTERN**
**AUSTRALIA**
Oral Health Centre
of Western Australia
TRUBYTE **"BioBlend"** VACUUM FIRED ANTERIORS
SQUARE
SQUARE TAPERING
TAPERING
TRUBYTE **"BioBlend"** VACUUM FIRED ANTERIORS
TAPERING OVOID
SQUARE TAPERING OVOID
**Mould Guide**
**377770**
**Anterior Tooth Selection**
**Selection of IPN Anterior Teeth**
Mould Guide
**TRUBYTE**®
**BIOBLEND IPN**/**BIOBLEND Plastic** Upper Anteriors
THE UNIVERSITY OF
**WESTERN** Oral Health Centre
**AUSTRALIA** of Western Australia
**Square**
Mould Number | Length of Central Without Collar | Width of 6 Anteriors on Curve | Articulates with Lower Mould
---|---|---|---
11D | 10.25 | 8.00 | 47.00 E
11D | 11.25 | 8.75 | 52.00 R
11H | 11.50 | 9.25 | 55.00 S-W
12E | 10.50 | 8.50 | 48.00 N
12G | 10.75 | 9.25 | 52.50 R
13E | 9.50 | 8.25 | 48.50 H
**Square Tapering**
Mould Number | Length of Central Without Collar | Width of 6 Anteriors on Curve | Articulates with Lower Mould
---|---|---|---
21C | 10.25 | 7.75 | 45.00 C
21D | 10.50 | 8.00 | 47.50 F
21E | 12.00 | 9.00 | 51.00 O
21G | 12.00 | 9.75 | 56.00 W
21H | 13.00 | 10.00 | 56.00 U
21J | 12.50 | 10.25 | 58.00 K-L
21K | 11.00 | 8.75 | 51.00 P
22C | 10.00 | 7.75 | 45.00 C
22E | 11.00 | 8.50 | 49.00 H
**Square Ovoid**
Mould Number | Length of Central Without Collar | Width of 6 Anteriors on Curve | Articulates with Lower Mould
---|---|---|---
22G | 10.00 | 8.50 | 53.00
22H | 12.25 | 9.25 | 54.00
24F | 12.00 | 8.25 | 50.00
21G | 10.25 | 8.75 | 53.00
31F | 12.50 | 8.50 | 51.00
32B | 9.25 | 7.50 | 44.00
32E | 10.00 | 8.25 | 49.00
32G | 11.50 | 9.00 | 54.00
**Tapering**
Mould Number | Length of Central Without Collar | Width of 6 Anteriors on Curve | Articulates with Lower Mould
---|---|---|---
41P | 9.50 | 7.50 | 45.00 C
42D | 10.25 | 8.00 | 46.50 F
42F | 10.50 | 8.50 | 50.00 H
42G | 10.50 | 8.75 | 52.00 P
42H | 11.25 | 9.00 | 55.00 S
43D | 8.75 | 7.75 | 46.00 C
43F | 9.50 | 8.75 | 50.00 H
44G | 11.50 | 8.25 | 48.50 F
45F | 10.75 | 9.50 | 51.50 D
45H | 11.25 | 8.75 | 54.00 R
**Anterior Tooth Selection**
Selection of IPN Anterior Teeth
**First number:**
**Classification**
1. Square
2. **Square Tapering**
3. Square Ovoid
4. Tapering
5. Tapering Ovoid
6. Ovoid
7. Square Tapering
Ovoid
**Second number:**
**Proportion & Contour**
Proportion Facial
of the Tooth Contour
1. Long Straight
2. **Medium Straight**
3. Short Straight
4. Long Curved
5. Medium Curved
6. Short Curved
**Letter:** **Width of Six**
**Anterior Teeth on Curve**
B. less than 44.00 mm
C. 44.00 to 45.50 mm
D. 45.50 to 48.00 mm
E. **48.00 to 49.00 mm**
F/x. 49.00 to 51.50 mm
G. 51.50 to 54.00 mm
H. 54.00 to 56.00 mm
J. 56.00 mm or greater
Some moulds may
vary from this standard.
Please consult mould
chart dimensions.
## Anterior Tooth Selection
<br>
**Mould Availability (OHCWA)**
<br>
### Upper Anteriors
**12E**
Portrait - Bioform
50.00
**M N**
18.50
45.50
10.60
**12G**
Portrait - Bioform
53.00
**G R V**
9.15
49.00
10.60
**21C**
Portrait - Bioform
45.50
**C**
17.70
42.00
10.00
**22C**
Portrait
44.50
**C**
17.70
41.00
9.85
**32B**
Portrait
44.00
**C**
17.50
40.50
9.20
**42G**
Portrait - Bioform
52.00
**O P**
18.70
48.00
10.40
**43F**
Portrait Bioform
49.00
**M N X**
18.80
45.50
9.60
**54F**
Portrait - Bioform
49.00
**J N**
18.65
45.00
11.50
**74H**
Portrait - Bioform
54.00
**K1**
19.00
50.00
12.25
### Lower Anteriors
**C**
Portrait - Bioform
35.00
14.90
31.50
9.00
**J**
Portrait - Bioform
40.50
15.50
35.50
10.25
**M**
Portrait - Bioform
39.50
15.05
35.00
8.80
**N**
Portrait - Bioform
38.00
15.20
33.50
9.10
**W**
Portrait - Bioform
42.00
15.75
39.00
10.25
**KEY**
ARTICULATION
**21C**
**C**
Maxillary Anterior Suggested Mandibular
Curve / Straight
45.50/4200
Shades
Portrait IPN available in all 24 + 3 shades, Bioform IPN
check mould/shade availability on page 19.
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA of Western Australia
**Anterior Tooth Selection**
**Shade Determination**
Factors to consider
❑ When discussing shade selection with a patient **do not** let them select directly from the shade guide
❑ The shade, or colour, of the teeth should be in harmony with the patient
❑ There is a definite correlation between complexion and tooth shade
❑ Natural teeth darken with age
❑ Black- or grey-haired patients usually have more blue or grey shades in their teeth
❑ Blondes & redheads will often have more yellow and brown shades in their teeth
**Anterior Tooth Selection**
**Shade Determination**
IPN Shade Guide
THE UNIVERSITY OF
WESTERN
AUSTRALIA
Oral Health Centre
of Western Australia
Portrait**®** IPN**®**
DENTSPLY
TRUBYTE
Anterior Tooth Arrangement
**Anterior Tooth Arrangement**
---
**Principles**
* Proper placement of teeth should be functionally as well as aesthetically pleasing
* The contour of the maxillary arch and the arrangement of the individual teeth make the most crucial contribution to the appearance of the face
* The goal of setting artificial teeth is quite simply to put them where the natural teeth were (Bissau, 1992)
* Occlusion is not the only important factor when arranging teeth
**Anterior Tooth Arrangement**
**Tooth Positioning**
Standard Angulations
SQUARE
SQUARE-TAPERING
TAPERING
OVOID
THE UNIVERSITY OF
**WESTERN** Oral Health Centre
**AUSTRALIA**
of Western Australia
**Anterior Tooth Arrangement**
**Tooth Positioning**
Standard Angulations
**Anterior Tooth Arrangement**
**Tooth Positioning**
Gerber
THE UNIVERSITY OF
**WESTERN** Oral Health Centre
**AUSTRALIA** of Western Australia
The contour of the nasal baseline serves as a guideline for tooth positioning
**Anterior Tooth Selection**
**Tooth Positioning**
Arrangement by facial shape
**0000**
**Facial Harmony**
**Gysi**
**Physiognomy**
**Williams**
**00**
**ΔΟ**
THE UNIVERSITY OF
WESTERN Oral Health Centre
AUSTRALIA
of Western Australia
Selection by constitution (Kretschmer)
42G - tapering
TAPERING
CENTRAL
**Anterior Tooth Arrangement**
**Tooth Positioning**
Maxillary Teeth
# Anterior Tooth Arrangement
## Tooth Positioning
### Incisal Guide Angle
**Defined as:**
The angle made to the horizontal by a line drawn, in the sagittal plane, between the incisal edges of the upper and lower incisors.
**A – B = Incisal Guide Angle**
In complete dentures the mandibular incisors should not touch the maxillary incisors in intercuspal position
The purpose of horizontal and vertical overlap of the incisor teeth is to facilitate aesthetics, phonetics and function of balance in protrusion
**VERTICAL OVERLAP**
**HORIZONTAL OVERLAP**
**Anterior Tooth Arrangement**
**Tooth Positioning**
Mandibular Teeth
**THE UNIVERSITY OF**
**WESTERN** Oral Health Centre
**AUSTRALIA**
of Western Australia
**Flashback**
**Road Mobile Clinic**
Circa 1960's. Still around today
Fully self-contained dental clinic.
Prime mover with 50 KVA generator used to transport two identical trailers.
Clinic had three rooms – surgery, waiting room and laboratory – and a plant room
**Flashback**
**Road Mobile Clinic**
Surgery equipment
1. Stand-up dental chair, Operating light, X-ray unit, Belt drive low speed motor and handpiece, Bracket table
2. Writing desk, Cabinetry, Limited bench space, Handbasin
3. Autoclave, Sterilising area, Refrigerator, High speed unit
1
2
3
**Thank**
**You**
**Any questions?** &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;**Contact me**
**Dr Ian Lander** &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;**ian.lander@uwa.edu.au**
