7.2. Complete Denture

8/3/2019 7.2. Complete Denture

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Selecting Teeth For Patients’ DenturesSelecting Teeth For Patients’ Dentures



Place reference marks on thePlace reference marks on the

occlusion rims to aid in toothocclusion rims to aid in tooth

selection and placementselection and placement



Reference Marks for SelectingReference 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



Maxillary Reference MarksMaxillary Reference Marks



Midline PositionMidline Position

• Critical reference.

• #7 wax spatula.

• Score a line parallel thefacial midline.

• Mark both rims.



Guidelines forGuidelines for

Setting AnteriorSetting Anterior

TeethTeethHigh Lip LineHigh Lip Line

Corner of MouthCorner of Mouth

Angulation is asAngulation is as

important as midlineimportant as midline



• Mark midline on the wax.

Midline of Teeth = Facial MidlineMidline of Teeth = Facial Midline



Corners of the MouthCorners of the Mouth

• Mark corners at rest

(#7 wax spatula)

• Position of distal of

the canines



Corners of the MouthCorners of the Mouth

• Measure circumference

between marks with Ruler.

• Size of 6 anterior teeth read

off ruler (mm or by letter

code A, B, etc.)



High Lip LineHigh Lip Line

• Highest point of upper lip

when smiling.

• Cervical necks lie at orabove this line.

• If shorter teeth are selected,

esthetics compromised.



Palatal MidlinePalatal Midline

Lines Thru middle of incisive

papilla & mid-palatal

raphe:• Extend onto land area

• Check for Rim symmetry:

– If not symmetrical,

adjust rim.



Midline & Canine ReferenceMidline & Canine Reference

• Line passing through distal of

incisive papilla.

•Perpendicular to the palatalmidline.

• Intersects cusp tips of the

canines.

NaturalNatural

DentitionDentition



Distal 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 6-8 mm

anterior to this line



Mandibular Reference LinesMandibular Reference Lines

1/2 way up1/2 way upretr omolarretr omolar

Center of ridgCenter of ridgPosteriorPosterior

Center of ridgeCenter of ridge

AnteriorAnterior

Mandibular

Cast

Land Ar eaLand Area

Occlusion rimOcclusion rim



Middle of Retromolar PadsMiddle of Retromolar Pads

• Occlusal plane intersects.

• If occlusal plane is too low - tongue

biting occurs.• If too high - strain as tongue

struggles to replace the food

bolus.



Center of Posterior RidgeCenter of Posterior Ridge

• Maxillary lingual cusps should be

centered over this line.

•Ensures denture stability.

• Reduces fulcruming forces during

function.



Center of Anterior RidgeCenter of Anterior Ridge

If anterior teeth are too facial to

center of ridge:

- fulcruming tilting and

dislodging occur.



Selecting Anterior TeethSelecting Anterior Teeth

• Combination of science and art.

• Measurement, formulas etc used as starting

point.

• Use vision and common sense.

• Involve patient in the selection process.



Tooth 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:

– If acceptable, measure width and length.

–Compared to .mould guide chart.

• Central incisors dimensions listed.

• Tooth photos are life size.

• Teeth longer than wide.



Measuring Existing TeethMeasuring Existing Teeth




• High Lip Line - indication of

inciso-gingival length.

• Pre-extraction cast or

photographs can be useful.




• Corners of Mouth - use the Ruler to pick a

mould.



Shape SelectionShape Selection

¯ Tooth shape does not

correspond to facial

shape.

¯ Trubyte system good

starting point.

¯ No proven male/female

characteristics.



Shape SelectionShape Selection

• Use existing teeth as aguide - do they look

good.

• Conformity between Faceshape and tooth shape

better.

•William & Lee Methods.

• use common sense &

observation.

Determine the general outline of the face.



Determine the general outline of the face.Four Basic Classes / Types of Faces:

- Square, Square-tapering, Tapering, and Ovoid.

- Face shape assessmed with a flat transparent plasticdevice. This may also be determined by visual

inspection and judgment.

- Three points are considered:

POINT A - across the forehead two-thirds up from

the eyebrow line.

POINT B – at tragus of ear or middle of the face.

POINT C - at the angle of the jaw.



If the lines through points A, B, and C on each side of the face are parallel, the basic form is square.



If the lines through A, B, and C cover at the angle of the jawthe basic form is tapering.



If lines through A, B, and C form an arc with the greatest

width through point B, the basic form is ovoid.



Use Negative SpaceUse Negative Space

• Look at interproximal embrasure and papilla

shape to assist in determining tooth shape.

QuickTime™ and a TIFF (Uncompressed) decompressor

are needed to see this picture.





Shade 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.






• Don’t show all shades to patient.• Patients will pick the whitest.

• Show 2 or 3 shades under lip.

– Colour perception affected bybackground.







Check Shade Against the Patients FaceCheck Shade Against the Patients Face

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



Squint TestSquint Test

• Check for value (brightness).

• Squinting reduces the influence of hue.

• If the teeth look too bright while squinting,

suggest something less bright.




• Teeth darken with age.

• Effect of Smoking / Food Habits.

• Correlation with skin and hair. colour is

suspect.

• Vita ‘C’ shades are greyish.

• Red shade Warm (Life-like).

• Bluish / Grayish / Dull life less.



Patient Chooses Shade withPatient Chooses Shade with

Input from DentistInput from Dentist

• Patient:

– owns the dentures.

– will look at them every day.

• Offer your opinion, don’t persuade.

• If insist, record approval with sign.



Disinfect Shade TabsDisinfect Shade Tabs



Denture Tooth MaterialDenture Tooth Material

• Porcelain teeth less common now.

• Acrylic easier to set and adjust:–Last life of denture (5-7 years).



Denture Tooth MaterialDenture Tooth Material

PorcelainLess wear.

More translucent.

Brittle - fracture easily.

Don’t bond to base.

Stain, fall out.

Difficult to set, adjust.

Sufficient IM Space.

AcrylicNew acrylics resist 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 Form

•

•



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

• Used 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.)

• Jaw size discrepancies (Class III).

• Severe ridge resorption.

• Uncoordinated jaw movements.• Poorer esthetics, due to lack of cuspal inclines.



Non-Anatomic TeethNon-Anatomic Teeth

• No overbite.

• Normal overjet (1-2mm).



No tooth form has been provenNo tooth form has been proven

most efficient - most patient can’tmost efficient - most patient can’t

discern a differencediscern a difference



Posterior Tooth SelectionPosterior Tooth Selection

• Match size & shade to anteriors.

• Determine distance from distal of

canine to ascending ramus (29,

30 mm, etc).



Posterior Tooth SelectionPosterior Tooth Selection

• Buccolingual size can affect

the tongue space:

– smaller teeth if tongue

space is limited.



Prescribing Denture TeethPrescribing Denture Teeth

¯ Use paper mould guides

(Draw maps).

¯ Infection control.



SummarySummary

• Selecting Teeth For Patients’ Dentures:

– Advise patient don’t persuade.

– An art, minimal science.

– Use common sense.

– Use old denture as a starting point.

–Look at dentate patient esthetics.

– Participate in Seminar / Exercise.

S i E iSeminar Exercise



Seminar ExerciseSeminar Exercise

• Work in pairs in seminar / exercise groups.

• Select shade for Partners / Friends.

• Use maxillary cast and Boley gauge to select:

–tooth mold that best approximates partner /

Friend.

• Select corresponding mold for mandibular teeth.

•Complete Prescription / Mapping for teeth.

• Have faculty seminar leader check & sign.

7.2. Complete Denture

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