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TOOTH SELECTETION
ANTERIOR TEETH: for esthetics
POSTERIOR TEETH: for function/occlusion
GUIDES:
Existing dentures
Photos, facial characteristics, sex, age, personality, their
preference
Arch size and shape
MEASURING EXISTING TEETH
TOOTH SIZE SELECTION:
HIGH LIP LINE: indication INCISO-GINGIVAL LENGTH ( useful:
photos or pre-exraction cast)
CORNERS OF MOUTH: use AUTO-RULE ( the ruler) to pick a
MOULD ( works for DENTSPLY teeth only!!!)
SHAPE SELECTION:
Tooth shape does NOT necessarily correspond to facial
shape ***NO PROVEN absolute male/female characteristics
TRUBYTE system : good starting point
BLUELINE system ( from IVOCLAR-VIVADENT)0 : very simple
and versatile
--------USE EXISTING TEETH AS GUIDE ( do they look
good?)
---------USE COMMON SENSE, OBSERVATION ( square
ovoid for big facetapered tooth for pointy face)
SHADE SELECTION:
PORTRAIT SHADE GUIDE
USE EXISTING SHADE AS GUIDE : and patient complexion and
sclera of eye
Average shade: B2
Top numbers ( A, B, C,D) on tabs: corresponds to VITA
PORCELAIN shade
Bottom numbers ( P: portal) : # for ordering
*****DONT SHOW ALL SHADES TO
PATIENT ( they will pick the whitest) ..show 2-3 shades under
lip ( color perception affected by background) :
Labiodental sounds: f, v
Produced by contact between max incisors and
posterior 1/3 of lower lip .SO CANT SET MAX TEETH TOO
POSTERIORLY OR LABIALLY !!!
Linguopalatal sounds: s, sh
Contact between tip of tongue and palate at rugae
area with a small space for air escape .iF SPACE IS TOO SMALL: a
whistle results , if space too broad and thin: s sounds like sh
( sounds like a lisp)
Average values:
max incisal length of central is 22mm average ( from labial
sulcus adjacent to labial frenum) ..mand : 18mm
labial incisal position: width of tooth neck labially lingually:
DISTANCE from center of incisal papillae to labial surface of central
incisor : 7mm average..(but somewhat influenced by demographics of
patient) female: young 8, middle 7, old 6male: young 6, middle 5,
old 4
Almagauge: a unique tool that records the incisal length and
labial position of patients existing anterior denture teeththis info can
be transferered to the dental LAB to facilitate the positioning of WAX
RIM ( initial contour)
locate tip of plunger into center of incisial papillae and
record the distance to the incisal edges ( TO GET INCISAL
LENGTH OF TOOTH)
at the same time: record distance from center of incisal
papillae to LABIAL SURFACE OF CENTRAL INCISOR ( WIDTH
OF TOOTH/labial incisal distance)
Papillameter: ( use same instrument as above)
RESET flat platform inside mouth and up against the incisal
papillaerecord distance ( vertically )at the rest and during
a smile communicating this info to LAB aids tin the
fabrication of the max wax rim length .
Papillimeter record can be adjusted to REFLECT the
patients age, sex, lip length (PRINT LIP LENGTH AND INCISAL
DISPLAY TABLE page 71 and know this!!!! )
Smile line: follow contour of lower lip, AVOID REVERSE SMILE
LINE!!! , young female have greater curvature of smile line, older
males have less
Max OCC RIMS : POSTION for anterior denture teeth has been
tentatively established during the CLINICAL REFINEMENT of max occ
rim. IF RIM HAS BEEN NPROPERLY MODIFIED TO PROVIDE ADEQUATE
LIP SUPPORT and PROPER PHONETICS: it can now be a guide to the
actual placement of denture teeth.
___________
POSTERIOR TOOTH SELECTION : SELECTED UPON FUNCTIONS!!! ,
(WHILE ANTERIOR TEETH ARE SELECTED UPON ESTHETICS!!!**),
consider:
RESIDUAL RIDGES CONDITIONS :RESORBED OR FLABBY ridges:
diff to get accurate intraoral records and permit movement of denture
bases during function ..the poorer the record base stability, the
less cusp height is indicated*** exceptions: some patients with
highly resorbed ridges retain superb tongue control and reasonably
stable denture base, if they are vertical chewers, rather than wide
envelope grinders, they will PREFERE and BE ABLE to handle cusp
fossa teeth, THEY ARE IDEAL candidates for LINGUALIZED
OCCLUSAL SCHEMES.MUST ONLY USE FLAT TEETH FOR FLAT
RIDGES ***
FOR roburst ridge ( a lot of height left) : use teeth
with GREATER CUSPAL INCLINATIONScan use flat teeth too ***
PHYSICAL CONDITION OF PATIETN: if poor neuromuscular control:
diff accommodation to anatomic occlusionsbest served with
MONOPLANE OCC SCHEMES ( ZERO DEGREE)
PATIENTS WHO CLENCH OR BRUX: anxious, nervous
people..tramatic to supporting structurs when anatomic posterior
denture teeth are used.. BEST SERVED WITH MONOPLANE OCC
SCHEMES too.
PREVIOUS DENTURE OCC: if present dentures have ANATOMIC
teeth which have not been severely ground or worn ,and alveolar
ridges are not serverely resorbed, cusped teeth can be used if
existing denture teeth have been worn flat: USE MONOPLANE
RIDGE RELATIONSHIP: a skeletal class 2 relationship: needs NONANATOMIC posterior teeth or at minimum mandibular denture teeth
WITH OPEN FOSSAE which permit MULTIPLE CONTACT POSTIONS
( anterior-posterior) WITHOUT OCC INTERFERENCES.when greater
width of mandibular arch requires a crossbite, NON-ANATOMIC
mandibular posterior teeth are often used with MAX buccal cusps
opposing the mandibular central fossae.
Class 2 retrognathic patient: habitually push mandible
forward so want MONOPLANE
Class 3 prognathic patient: mand doesnt move forward
and back much.
IMMEDIATE DENTURES (first set of dentures): many dentate
patients, esp those with SEVERELY WORN DENTITIONS : have
discrepancy between ICP ( intercuspal postion) and RCP ( retruded
cuspal postion) .REMOVAL of natural teeth: will permit and encourage
a RETRUSIVE SHIFT in mandibular posture a NON-INTERCUSPATED
denture tooth form like LINGUALIZED OR MONOPLANE would give the
FREEDOM for patient to REESTABLISH the CORRECT MAXILLO-MAND
relationship
OPPOSING ARCH :
SINGLE DENTURE OPPOSING NATURAL DENTITION: will
require CUSP TEETH!! Since artificial teeth have their own
morphology , they do NOT occlude well against natural teeth (unless
natural teeth are recontoured via ENAMELOPLASTY to better receive
the prosthetic teeth ) .in case of MAX DENTURE opposing MAND
NATURAL TEETH ( in combination syndrome) : most likely :
PRACTICAL OCC SCHEME will use the MANDIBULAR BUCCAL
CUSPS ( natural) as the functional cusps opposing the max
fossae.
Denture occ options:
Semi-anatomic: low cusp angles
Anatomic ( cusps) : indications: good residual ridges, well
coordinated patient, previously successful with anatomic dentures,
denture OPPOSES NATURAL DENTITION, when lingualized occ is desired
*****ANATOMIC OR SEMI-ANATOMIC : advantages: definite
point of positive intercuspation maybe developed, esthetically
similar to natural dentition, tooth to tooth and cusp to cusp
balanced occ can be achieved, maintains some shearing ability
after moderate wear.
Disadvantages: diff to set, less adaptable to arch
relation discrepancies, horizontal force development due to cusp
inclinations, harmonious balanced occ is LOST with denture base
denture teeth wearing out, mand closes futher along its arc of closure
causes chin to appear to protrude , more wrinkles )
Placement of anterior teeth:
MAX ANTERIORS: need artistic skill in addition..by
observing natural teeth ( females : delicate rounded gingival
contoursmales: rugged)
Individualized characteriaton:
With age: grind incisal edges and prox contatcs
Masculine: angular outlines, sharp lateral
contours, larger laterals and canines
Feminine: rounder outlines, smooth lateral
contours, smaller laterals and canines
Personality tooth: lateral incisors..( females:
labioversonmales: linguversion)
MAND ANTERIORS: vertical overlap , horizontal overlap
antero-posterior inclination ( in prox view) ..inclination of long axes
Setting mand anteriors: similar inclination as max,
INCISAL EDGES placed at same level, (EVEN WITH OCC PLANE).(print)
***characterization: print all tables..
lingual??)
----------------------CENTRALS:
*** labial-palatal inclination:
class 1: central incisors perpendcular to ridge
class 2: central incisors slightly palatally inclined
class 3: central incisors slightly labially inclined
** mesio-distal inclination: NO TILTING ( straight up and
down)
**rotation :
----basic setup: centrals follow
the curve of the arch ( occlusally) , gives a soft look to the set up
----distal flare: creates a highlight on the
center of teeth, thereby giving BOLDNESS to a setup. ( pointing at
each other??)
LAB PRESCRIPTION:
REQUEST: PROCESSING, FINISHING AND POLISHING
Lab remount of the dentures
Adjustment of OCC to compensate for
processing changes
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