16.

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) :

Check shade of existing denture ask if want

same shade.allow patient to view shade against lip with
mirrorobtain approval
*****SQUINT TESET: check for VALUE ( brightness) ,
if look to white while squinting, suggest LOWER VALUE
..squinting reduces HUE influence ..MISMATCH IN VALUE
MORE NOTICABLE THAN IN HUE OR CHROMA!!!*****
***TEETH DARKEN WITH AGE .CORRELATION WITH
SKIN AND HAIR COLOR IS SUSPECT VITA C SHADES
ARE GREYISH!!!
ANTERIOR TEETH SELECTION: most manufactures have concept
of dividing tooth moulds according to shapes ( square, taper, ovoid)
but its ANTIQUATED
1) SQUARE TOOTH MOLDS: this angular shape : central
incisor is DOMINANT and GINGIVO-INCISAL CURVATURE
is MODERATE? .OFFERS MAXIMUM LIGHT
DEFLECTION , BOLD EFFECT
2) TAPERING : ROUNDED CONTOURS which TAPER towards
CERVICAL RIDGE..MODERAGE GINGIVO-INCISAL CURVATURElarge
triangular incisior slightly TRIANGULAR IN SHAPE
3) OVOID: PRONOUNCED GINGIVO-INCISAL CURVATURE,
DISPERSE LIGHT REFLECTION so SOFTENED APPEARANCE
ANTERIOR TEETH: dentogenics concept
.CONTEMPORARY MOULD GUIDE DESIGN ( blueline MOULD GUIDE
system) more logical sequence to selection , IMMEDIATE
RECOGNITION of form and sizes ( frush and fisher, esthetic system) :
Sex: male: rugged with square teeth and bold central
incisors
Female: pronounced curvatures, rounded point
angles
PERSONALITY: VIGOROUS OR DELICATE
.PERSONALITY TOOTH: MAX LATERAL INCISOR ( varies the most in
size, form, position)
AGE:
Young: TAPERED, OVOID , rounded teeth
Middle: somewhere between young and old
Old: SQUARE, sharp corners

****example: 60 yr Hispanic female, medium buid, average

ridges, ovoid face form, 50mm measurement D6-D11 around
the curve, high smile line, good muscular coordination:
blueline mould guide system:
eliminate BOLD, small and large
eliminate HIGH CUPS TEETH 22 and 33 degrees
eliminate 0 degree MONOPLANE POSTERIORS ( because
she has good ridges)
eliminate SMALL AND LARGE ORTHOLINGUALS( cuz shes
medium sized person.)
eliminate SHORTER VERSIONS OF MEDIUM RANGE ( high lip
line so get rid of short teeth)
NOW ONLY 2 MOLDS left ; pick best one
__________
***canine to canine measruemtn roughly similar in length from
tuberositiy to tuberosity in maxilla

ANTERIOR TEETH WIDTH MEASURMENT:

use ALAMETER ( form selector) to approximate width of anterior
six teeth. ( but may have drawbacks if used as only guide cuz of race
variability)
SEQUENCE OF ANTERIOR TOOTH SELECTION:
SIZE: selection of size: most cirtical factor in anterior tooth
selection!! 2 methods:
WAX-RIM/RULER TECHNIQUE: shape and contour the wax
rim so that it mimics the desired position of anterior teeth.wax
rim should extend about 1-2mm below lip .place mark at junc
of commissure of lips representing approx. the DISTAL PROXIMAL
surface of canine ( several manufactures have specific
guidelines for this measurement: to help selecting appropriate
sized anterior tooth mould)
FACIAL-METER TECHNIQUE: in most patients, a proportional
relationship exists between width of nose and max anterior teeth
size.FACIAL METER ( IVOCLAR VIVADENT) : interprets this
measurement and gives a suggested list of tooth moulds that fit
into patients individual inter-alar measurementit measures
widest dimension of nose and lists the appropriate moulds into
SMALL, MED, AND LARGE CATEGORIESeach set of teeth has an
alphanumberic code associated with it

****based on tooth morphology , a TOOTH

MOULD can have SOFT ( rounded arch form, rounded
tooth corners, anteriors closely follow lower lip, laterals
overlap centrals, smaller laterals and cuspids , SHARP
CANINES) or BOLD ( more angular OUTLINES, LARGER
laterals and canines, SQUARE ARCH FORM, centrals
overlap laterals, BLUNT CANINES ) characteristics.
****sometimes we see bold characteristics that
we didnt expect , and they dont complement
appearance.
MOULD FORM: soft or bold forms ( fisher and frush)
LENGTH : least important , but major concern for high lip line
SHADE : 2 principles: YELLOW and GRAYto harmonize between
skin color, hair , eye color, age, personality , activity , patient desires
(NEED TO EDUCATE PATIENTS!!)check shade of existing denture
and discuss their desires with respect to tooth shadeASK IF THEY
PREFERE SAME SHADE OR LIGHTER OR DARKER SHADE. place guide
up against face and select a shade that blends with skin tone, hair
color and sclera/eye colorthen let patient view chosen color against
their lip with a mirrorOBTAIN APPROVAL!!!! And need to know
what they like or dont like about their existing denture!!!
COMBINATION OF MATERIALS: avoid selecting porcelain
anteirior teeth combined with acrylic resin posterior teeth!!
Wear of resin posterior teeth leads to excessive anterior teeth
contacts, tipping dentures anteriorly and increasing ridge
resorption !!!!
****do size first then shade last

ANTERIOR TOOTH PLACEMENT: consider:

Pattern of max ridge resorption: after extraction, resorption is
from LABIAL TOWARDS LINGUAL. Therefore, anterior teeth should NOT
be placed directly over the ridge ( not adequate support)
Phonetics: anterior teeth, tongue , lips that act as part of valving
mechanisms which modifies the flow of air to produce speech
sounds.
Labial sound: P, B
If lips are not supported properly by teeth: defective

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

setting, requires FREQUENT FOLLOWUP AND MAY REQURE MORE

FREQUENT RELINES to maintain proper occ . ( high maintainance)
Lingualized ( lingual contact only? ): we set this in labwe
use MONOPLANE AND ORTHOLINGUAL AT SCHOOL..ortholingual and
orthoplane are brand names..they are same as monoplane and zero
degree, work like mortar and pestle..
Lingualized: better than monoplane!!!...indications:
HIGH ESTHETIC, severe mand ridge atrophy, displaceable supporting
tissues, malocc, previous SUCCESSFUL denture with lingualized occ.
advantages: freedom of non-anatomic teeth, potential for
BILATERAL BALANCE, centralizes vertical forces, minimizes
tipping forces, facilitates BOLUS PENETRATION ( mortar and
pestle effect)
non-anatomic ( balancing ramp): balancing: in eccentric:
working and non working sides touch ( not desirable in natural
dentition)
Non anatomic ( flat cusps, MONOPLANE OCC) : grooves
help triturate food INDICATIONS: POOR RESIDUAL RIDGES, poor
neuromuscular control ( bruxers, CP), previously successful with
MONOPLANE dentures , ARCH DISCREPANCIES ( class 2 or 3 or cross
bite immediate dentures) EXCEPT when opposing natural dentition!!!
.POTENTIAL POOR FOLLOW UP !!!****
Advantages: reduction of horizontal forces..CR
can be developed as an area instead of a point ( vertical
dimension doesnt change) FREEDOME OF MOVEMENTcan
develop SOLID OCC despite arch alignment discrepancies ,
easily adapted to situations prone to denture base shifting,
easy to set and adjust teeth.
Disadvantages: NO vertical component to aid in
shearing during mastication ( limits foods pt can eat) occ adjustment
impairs EFFECIENCY unless spillways and cutting edges restoredmay
complain of LACK OF POSITIVE INTERCUSPATION positionsomewhat
esthetically limited ( dont look like natural teeth)
***blue line teeth: offers best monoplane.
_________________________
17. COMPLETE DENTURE ESTHETICS
NEED PERFECT SYMMETRY!!! ( view set up from many angles:
anterior, occ)

Sometimes asymmetry may be harmonious with the rest of patients

look , and look natural
BIGGEST COMPLAINT: APPEARANCE
DIFFERENCE between dentists/techs and patients opinions ( patients
want whiter teeth).resolve by: SEE WITH THE EYE, OBSERVE WITH
THE MIND ..***LISTEN TO PATIENTS AND GET THEM INVOLVED
IN ESTHETIC PREFERENCE!!!
Patients more ready to PERCEIVE A CHANGE instead of IMPROVEMENT
can be guided to desire what before was unknown to them
EACH STEP HAS AN AESTHETIC CONSEQUENCE:
Impressions: proper cheek and lip support obtained with
correctly molded IMPRESSIONS.
Lip support, lip thickness and removal of wrinkles: cant get
if no good final impressions need to consider begins at the
BORDERMOLDING STAGE!!! ( first step in creating support) ..adding
resin to the finished denture does not always give a proper result
Improper lip support: related to COMBINATION SYNDROME
( see long posteriors and short anteriors; grandma munster look) :
can do REVERSE OCC PLANE correction
Occ plane : natural look if correct use camper plane when
doing complete denture .tilted plane : unnatural
Teeth should RISE gradually along the occ plane
toward the back : impression of distance correctly aligned occ
plane more natural than FLAT occ plane
VDO/OVD: vertical dimension of face in occ is responsible for the
harmony between lower third of face and the face as a whole
..sometimes getting correct Vertical dimension is a GRADUAL
process
Long term EDENTULISIM: undergo mand deformation and
PROGENIC ( PSEUDO CLASS 3) appearance ( bun chin ) than cannot be
completely corrected with denture.. ( *incorrect VDO makes bun chin
more pronounced.loss of VDO: more exaggerated class 3 )
CR: influences ANTERIOR ESTHETICS of denture ( inter max
relations on HORIZONTAL PLANE also affect aesthetic ) : In CR, mand is
retruded with mand positioned anterior to that position ( insufficient
CR) , the facial profile will unavoidably change ( usually caused from

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??)

****( 7mm labial to

----------------------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??)

----mesial flare: esthetically

UNACCEPTABLE FOR CENTRALS!!! Mesial more prominent than distals
( hugging each other closely???)
****neck position:
deflection: neck outreflection: neck in
***keep the necks at the same level labially
------------------MAX LATERALS:
***LABIAL-PALATAL INCLINATION: neck TUCKED in
toward the palata: SOFT CHARACTERIZATION.......neck
PERPENDICULAR to palatal: BOLD.
***MESIAL DISTAL INCLINATION: DISTAL INCLINATION
OF LONG AXIS of lateral ( tip pointing mesial toward centrals).
MESIAL INCLINATION NOT ACCEPTABLE!!!
****ROTATION:
SOFT CHARACTERISTIC : mesial flare
( mesioversion) of lateral incisors , MOST common in females , (where
the mesial of lateral is not aligned with arch, but flare out /come out a
little ( to show off its mesial out)
BOLD: distal flare
----------CANINES:
****PALATAL INCLINATION: neck out ( show itself out)
***the facial surface of the tooth should never be upright or labially
inclined ..neck of canine is out to create the curvature of arch
****MESIAL DISTAL INCLINATION: 15 degrees
inclination, long axis of canine is inclined slightly toward the distal
NOTE : NEVER TO MESIAL!
***MESIAL FLARE: naturally created by following arch
form.distal flare: NOT acceptable.
___________
DIASTEMAS:
______

DENTURE BASE ANATOMY:

Gingival height of different teeth in the arch: CANNOT BE
WAXED AT SAME HEIGHT ( straight across) : common mistake!!
LATERALS : always SHORTER than centrals or canines
CANINE: always LONGER than premolar , same height or
higher than centrals
Characterization
________________
TOOTH CHARACTERIZATON:
Gold, amalgam composite,
Staining kits: can be used to further characterize denture teeth
( more age appropriate ) most common areas to stain: INCISAL
EDGES, CRAZE LINES, INTEPROXIMAL CONTACTS and ROOTS at gingival
level
GREATEST HEIGHT OF FREE GINGIVAL MARGIN: slightly
DISTAL to MESIODISTAL CENTER of tooth
____________________________
GINGIVAL CHARACTERIZATION:
Acrylic of VARIOUS SHADES can be used to mimic GINGIVAL
COLORATION ( these colors are layered into the flask prior to packaging
..some discoloration/yellowing of base as it ages)
GINGIVAL STAINING: staining kits
Gingival tinting ( yellow)
__________
LAB PRESCRIPTION: patient demographics: sex, personality, age,
phtohts, preextraction casts, existing dentures ..so lab can
fabricate one thats more appropriate
LAB COMMUNICATION: communicate with ANTERIOR DENTURE
SIMULATION MODESL : can be fabricated with various tooth molds,
shades and charactiations placed under patients lip for trying most
apppriate look

18.TRIAL DENTURE INSERTION

CHECKLIST: ***MUST BE IN SEQUENCE

Check VERTICAL DIMENSION off OCC and REST
Prove CENTRIC RELATION ( CR ) RECORD
Make PROTRUSIVE RECORD***
Eval ESTHETICS and PHONETICS
POSTERIOR PALATAL SEAL

1) VERICAL DIMENSION AND REST:

METHODS OF ASSESING VDO/OVD
Physiologic REST position
Phonetics and esthetics
Swallowing
Comparison with old denture
**********dont need to save toungue depressor or record
measurement sin mm you will be taking measurements from
2 NEW POINTS , different places on the face
VERIFY occ VERTICAL DIMENSION and INTEROCCLUSAL DISTANCE:
Same tech used previously
Critical to measure and feel 2-4mm of interocc distance
NO TOOTH CONTACT during closest speaking space ( used
for final test to determine if VERTICALD DIMENSION chosen is
correctuse S sound and count 60-70)

2) Prove CENTRIC RELATION ( CR ) RECORD;

METHODS TO VERIFY MOUNTING:
Insert dentures and hold lower in position with index
fingers
RETRUDE MANDIBLE and CLOSE INTO CENTRIC RELATION
( if theres SEPARATION of posterior teeth in CR : then CR is incorrect ,
error : posterior edges of bases contacted when CR was being
made..fix: a NEW interocclusal record must be made , and LOWER
CAST REMOUNTED to the upper using new record )
OBSERVE any shift in UPPER DENTURE
Look for EVEN CONTACT of the POSTERIOR TEETH
BILATERALLY
__________________
MINIMAL REGISTRATION MATERIAL:

Improves record accuracy: less resistance during closure, reduces

chance of deflection when checking record
TO OBTAIN CENTRIC RELATION VERIFICATION RECORD:
RECLINE chair, ( help retrude mandible)
STABLIZE mandibular BASE with index fingers ( thumbs under
mandible ) : bimanual tech
REHEARSE closing with patient
GENTLY CLOSE into compound , just short of tooth contact
***OPPOSING CUSPS SHOULD NOT PENETRATE
CUSPAL INDENTAIONS IMPROVE ACCURACY compared to FLAT
WAX RIM
ENSURE RECORD IS FULLY SET
LOOSEN ARTICULATOR CENTRIC LOCK
SEAT both RECORD BASES onto the mounted master casts and
interdigitate teeth into record
ACCURATE MOUNTING:
Teeth interdigitate perfectly ( no space around the cusps)
CONDYLAR BALL should contact fossae wall
***If either criteria not met, remake record
MAKING CENTRIC RELATION VERIFICATION RECORD , USING
ISOFUNCTIONAL COMPOUND:
Soften the compound over burner
Place compound onto OCC SURFACES of mandibular POSTERIOR
TEETH
TEMPER in water bath ( 110degrees) and SMOOTH with WET
GLOVED FINGER
Remove and TRIM record so that only INDENTATIONS from cusp
tips are present
****If CR IS OFF, REMOUNT NEEDED ( remount max or
mand or both? )
Max remount if: FACEBOW transfer was inaccurate
.mandibular must also be reounted
Mand remount if: inaccurate CR recording ..must get new
interocclusal record. ( most common)
VERIFICATION OF NEW CR RECORD:
Place new record onto master casts
Loosen centric locking screw

***If max teeth contact indentations exactly as they did in

mouth, you have proven that your original CR was correct
****articulator must CLOSE in HINGE position , WITHOUT
condylar displacementcondyles must remain full SEATED
against the posterior wall of fossae , with teeth in MAXIMUM
INTERCUSPATION at CR. If not , MANDIBULAR cast must be
remounted using new record.
SECOND RECORD:
Used to correct an INACCURATE mounting
Mand cast removed from mounting ring
Mounting plaster ground thinner, but NOT completely removed
from mand master cast
Cast remounted, using NEW RECCORD

3) MAKE PROTRUSIVE RECCORD: gives condylar guidance for

articulator
PRACTICE making protrusive movement with patient
Mand : must be brought forward 5-6mm short of tooth contact
while maintaining the mandible in midline

4) EVALUATE ESTHETICS AND PHONETICS: DONT OVERLOOK

PROBLEMS!!! ( diff to change after processing, inform patient that if
changes are made after try in apt, will have substantial lab fees that
patient will have to bear!!!****have patient sign that he approves
of appearance, func, feel for TRIAL DENTURE)
however, for teeth that are too long : can grind off PRIOR to
final processing
VERIFY PHONETICS:
------Fricative sounds f, v : clearly, with MAX INCISAL EDGES
against LOWER LIP ( anterior of wet line).MAX INCISAL
EDGES should just touch POSTERIOR 1/3 of LOWER LIP
Count 50-60 ( fifty five)
--------Sibilant sounds s, z, t, ch, sh ( sixty six, Mississippi)
Count from 60-70.also verifies CLOSEST SPEAKING SPACE
( which should be 1-2mm max)
INCISORS SHOULD APPROACH END TO END RELATIONSHIP
while making these sounds, if not: error in overjet .. ( while normal
relationship in CR is : max anterior and mand: posterior)

In S and Z sounds: POSTERIOR S SPACE ( in mandible? ) : 2-3mm

FORWARD MOVEMENT
Space between top and bottom in posterior: 1.5 to 3mm space
..anterior and posterior teeth should not touch ( except for
incisors???_)
THERE SHOULD BE NO HISSING OR AIR LOSS
EASIER TO ASSESS: teeth have replaced bulky rims crowded
tongue space can adversely affect phonetics
LISPING: NON-UNIFORM overjet of the anterior teeth!! Diastemas
between teeth, palatal contours, diamond-shaped openings between
incisors ( between top and bottom)
********IF HAVE NOT WORN DENTURES FOR EXTENDED
PERIOD , OR DRAMATIC CHANGES ( contour, tooth position,
vertical dimension) : allow patient to read out loud for 5-10
min to assess PHONETICS AND COMFORT
ESTHETICS :
****checklist: amount of incisal display, accuracy of midline,
angle of cocc plane, harmony of max teeth with smile line
proper soft tissue profile, contours, lip support,
display of vermilion border, correct NAOLABIAL ANGLE
ask patients for their OPINION , PRIOR to voicing
yours!! Avoids biasing patient, have family or friend attend the wax try
in !!!
if you or poatient have reservations about
appearance: resolve PRIOR to fanil processing, NEVER attempt to
persuade a patient out of a concern cuz problems will come later if
they dont like it
******get approval when you characterize
anterior teeth!!!
-----------ANTERIOR TOOTH CHARACTERIZATON:
HOLLOW the LINGUAL surface of LATERAL INCISOR , to obtain a
proper overlap
****youthful characters: ANTERIOR SETUP FOLLOWS LIP LINE ,
POINTED CANINES, LARGE INCISAL EMBRASURES ( what is that??)
------------MANDIBULAR ANTERIOR TEETH ARRANGEMENT

5) POSTERIOR PALATAL SEAL: determined using JUDGMENT AND

ANATOMIC LANDMARKS
completes the border of max complete denture
produces POSITIVE PRESSURE onto the displaceable tissues near
the JUNCTION of hard an soft palate
compensates from POLYMERIZATON SHRINKAGE of resin denture
bases.
----DRAW A LINE 1mm ANTERIOR to the POSTERIOR
EXTENSION of denture
----DRAW A SECOND LINE, ANTERIOR TO FIRST, IN A
BUTTERFLY PATTERN
----carve the bead seal with cleoid/discoidshould be
1mm deep, should feather out to HAMULAR NOTCH ( and not
extend onto tuberosities or torus)
DENTURE BASE CONTOURS; affect PHONETICS, COMFORT AND
RETENTION!!!
SHOULD BE CONCAVE!!! ( helps tongue and buccinators
muscle ot control denture base better than convex )
Ensure that denture base is NOT unduly thick or thin
( excesss bulk: impair comfort fee between index finger and thumb
bases too thin: weakened )
should not be able to see through!!!
________________________________
PATIENT INPUT:
USE OPEN ENDED questions:
How do you like the appearance? ( not : dont the new
denture look great?)
*********If patient sounds UNCONVINCED: ask more questions!!!
Do NOT rush this step

FINAL WAX TRY-IN:

Confirm that prescribed changes are acceptable
Further alterations if needed
DIASTEMAS should be closed
PHONETICS should be acceptable

LAB PRESCRIPTION:
REQUEST: PROCESSING, FINISHING AND POLISHING
Lab remount of the dentures
Adjustment of OCC to compensate for
processing changes
_________________

19. ARRANGING ANTERIOR DENTURE TEETH

KEY POINTS TO REMEMBER:
1: Labial surface of WAX RIM corresponds to labial surface of
TOOTH
2: BUCCO-OCCLUSAL corner on wax rim corresponds to INCISAL
EDGE of tooth
3: the FLAT HORIZONTAL SURFACE of wax rim corresponds to
OCCLUSAL PLANE of denture setup
4. REMOVE enough wax to allow adequate access to tooth
5: dont take away too much wax ( mess up occlusal plane)
6: dont go on the next step before the current step is perfect
7: observe and eval the PLACEMENT of each tooth from ALL
ANGLES ( frontal/sagittal/horizontal)
ARMAMENTARIUM:
Bunsen burner, metal occlusal plane ( must be at same level as
highest point of retromolar pad***?) , straight handpiece with acrylic
burswax, pink baseplate, 7a wax spatula, 31 wax spatula
___________________________
ANTERIOR ANGULATION FRONTAL PLANE: ***note: INCISAL EDGES of
teeth must conform to edge of wax rim ( labial contour when looking
occlusally) .wax cleaned out from LINGUAL of teeth.OCCLUSAL RIM
still present to maintain occ surface of setup
CENTRALS: slight DISTAL TILT, incisal edge FLAT against occ
planeLABIAL SURFACE : UP AND DOWN
LATERALS: MORE DISTAL TILT, incisal edge 0.5-1mm ABOVE
occ plane .NECK DEPRESSED RELATIVE TO CENTRAL
CANINES: VERY SLIGHT DISTAL TILT, cusp tip ON occ plane ( same
level with CENTRALS) .NECK PROMINENT compared to LATERALS
.BODY STRAIGHT UP AND DOWN in sagittal plane
ANGULATION OF MANDIBULAR ANTERIORS:

CENTRALS; STRAIGHT UP AND DOWN.NECK DEPRESSED

LATERALS: SLIGHT DISTAL TILTL.NECK FLAT
CANINES: GREATER DISTAL TILT
.NECK PROMINENT
.only want to see MESIAL HALF !!!!
*************1mm vertical and horizontal overlap between
arches
______________________________
DENTURE OCCLUSION:
There are DIFFERENT OCCLUSAL SCHEMES available for complete
denture patients ( diff relations of cusps, fossae , occ surfaces)
DIFF BETWEEN NATURAL AND COMPLETE DENTURE OCCLUSION:
Natural: retained pdl, units MOVE INDEPENDTENTLY, malocc
effects NOT IMMEDIATE, non-vertical forces affect only teeth involved
and usually well tolerated, incising doesnt affect posteriors, bilateral
balance is RARE, tactile sensitivity.
Denture: mobile bases on mucosa, teeth move AS UNIT, malocc
affects entire base immediately, non-vertical forces affects ALL TEETH
and is traumatic, incising affects all teeth attached to base, bilateral
balance is often desired for base stability, decreased tactile sense
GOALS OF COMPLETE DENTURE OCC:
Minimize trauma to the supporting structures
Preserving remaining structures
Enhances STABILITY of denture
FACILITATE ESTHETICS AND SPEECH
Restores mastication efficiency to a reasonable level
TYPES OF COMPLETE DENTURE OCC:
BILATERAL BALANCE : WE PREFER, cuz it limits TIPPING of
dentures during parafunctional movements. The STABLE
SIMULTANEOUS CONTACT of opposing upper and lower teeth in
CENTRIC position with a SMOOTH BILATERAL GLIDING CONTACT to any
ECCENTRIC position within the normal range of mand function,
developed to lessen or limit tipping or rotation of the denture bases in
relation to the supporting structure.traditionally achieved with
ANATOMIC POSTERIOR denture teeth, but can be with NON-ANATOMIC
teeth using BALANCING RAMPS or by manipulating the COMPENSATING
CURVE :

Bilateral balanced denture occ with ANATOMIC POSTERIOR

DENTURE TEETH ( note: anatomic ( 30 degree or more) or semianatomic ( 10-20 degrees) denture teeth differ primarily in the degree
of cuspal inclination and precision of their intercuspated relationships) :
Bilateral posterior centric contact
Centralized forces
Balanced occ to minize tipping :
objective in setting anatomic or semi anatomic
POSTERIOR teeth is to create a BALANCED OCC. We
wish to ensure that ALL POSTERIOR TEETH contact in
EXCURSIONS as well as the anterior teeth.
To ensure BILATERAL BALANCE : an ANTERIORPOSTERIOR CURVE is placed in the arch, called
COMPENSATING CURVE, which is analogous to CURVE
OF SPEE in natural dentition
In addition: a MEDIO-LATERAL CURVE is
palced from side to side, the curve of Wilson.
***cast landmarks: to check denture set
up: mark indicating midline, crest of ridge, and midpoint of the
retromolar pad.3 landmarks used to determine THE PLANE OF OCC :
----MIDPOINT of retromolar pads bilaterally as
marked (and on land) : place clear glass or plastic
slab on mand record base to represent plane of
occ..then set remaining max anterior teeth ***
---2 lines on the PLASTIC PLANE indicating
CREST OF ALVEOLAR RIDGE: used to position the
posterior denture teeth to insure that the mand
posterior teeth are centered over the ridge ***
occ plane:
max Premolars: long axis should
perpendicular to occ plane , and buccal
and lingual cusp TIPS should touch occ
plane ( will ensure adjacent marginal
ridges will be on the same level) the
lingual cusp tips should also contact the
LINE INSCRIBED ON THE PLASTIC PLANE
indicating the CREST of MAND RIDGE
( will ensure that when the opposing
mand denture teeth are properly
positioned and in occ, their central fossae
will be CENTRERED over the MAND
RIDGE)

max 1st molar: CURVE OF WILSON

and CURVE OF SPEE begin in the 1st
molar. This mesial lingual cusp tip of 1st
molar contacts the occ plane ( along with
the buccal and lingual cusps of the
premolars) but buccal cusp tips and
distal lingual cusp are elevated about .
5mm OFF the occ plane.
Max 2nd molar: CURVE OF SPEE is
continued by ELEVATING the 2nd molar
OFF the plane of occ, to an EVEN
GREATER DEGREE than 1st molar, about
15 degrees in average patientwhen
viewd from the distal it has a slight curve
of Wilson like the 1st molar
Mand 1st molar: mesial buccal cusp
tip should engage the embrasure
between the 1st molar and 2nd premolar
( max?). The adjacent marginal ridges of
the MAX premolar and molar should be at
SAME LEVEL for the lower molar to
properly engage them..on lingual side:
make sure max lingual cusp tips engage
the central fossa of mand molar.
Use a CLEAR PLASTIC RULER
and marks made on the cast: check to
ensure that the 1st molar is perfectly
centered over the ridge..AND the central
fossa of the molar is properly aligned
over the ridge.. ( if the central fossa is
either buccal or lingual to ridge: adjust
if all post teeth are too far on bucca:
tipping for denture and less stable)

***after repositioning this tooth :

focus on attention on the max posterior
teeth and REPOSTION them so that the
max 1 molar and 2nd premolar properly
OCCLUDE with mand 1st molar.

***balancing: IF LACK BALACING

SIDE CONTACTS at thiss stage: check
these in order: verify lingual centric,
check for working interferences on
opposite side
check contacts during BALANCING
EXCURSION: if lack of balancing side
contacts: maybe from: poor lingual
centric, working interferences on the
oppo side, particually in the 2nd molar
region.
***mand 2nd centric: position the
2nd molars in centric.. inapp. Positioning
and angulation of the 2nd molar scan
cause significant discrepancies in
working, balancing and protrusive, ..SO
MUST CHECK The EXCURSIONS
CAREFULLY!....check lingual centric:
make sure the lingual cusps of max 2nd
molar properly occludes with the central
fossa of the mand 2nd molar
**working: verify contacts : if lack
of working side contacts, may from: poor
buccal centric, insuff curve of Wilson,
working interferences in the 2nd molar
region, balancing interferences on the
opposite side ( check these in order!!)
MAND PREMOLARS : CENTRIC :
POSITION THE MAND PREMOLARS:
bucal cusp fo 1st premolar should
occlude with the adjacent marginal
ridges fo the amx 1 and 2nd
premolar..there should be a
space between mand 1st premolar
and the max canine?
**centric: verify premolars are in
solid centric occlusion, if lingual
centric contacts are lacking,
contacs in balancing position will
be lacking
**working: if lack of working side
contacts at this stage of setup:
check for balancing interferences

on the opposite side., verify bucal

centric, slightly increase curve of
Wilson wihout compromising
lingual centric
during lateral excursion into
working: with this cusp form: when
teeth are properly arranged, there
should be NO LINGUAL cusp
contacts between max and mand
teeth.
CENTRAL INCISORS:
Begin by setting the central
incisors . mesial surfaces should be
on midline.
OCC PLANE: perpendicular to
labial surface o f the mand incisors
Determining the amount of
VERTICAL AND HORIZONTAL
overlap: articulator is placed in
working and protrusive position,
and position of the central incisiors
adjusted to permit PASSIVE
CONTACT during lateral excursions.
***DONT INTRODUCE
ANTERIOR GUIDANCE INTO THIS
SETUP
LATERAL INCISORS AND CUSPIDS:
Position lateral incisors and
cuspids in the same fashion as the
central incisors. Take care not to
introduce anterior guidance.
Anterior teeth should be in ONLY
PASSIVE CONTACT DURING
LATERAL EXCURSIONS.
***maintain BILATERAL
BALANCE
***completed set up :
check to ensure contacts in
working, balancing, protrusive,
**trouble shooting:
lack of working side contacts:
very buccal centric. Restore centric
contacts as needed. INCREASES

CURVE OF WILSONeliminate any

ANTERIOR GUIDANCE present on
the working side ..check for
balancing interferences on the
opposite side and adjust.
Lack of balancing side
contacts: verify lingual centric
.restore missing contacts as
needed. Eliminate any anterior
guidance on the oppo side or
working side.check for working
interferences on the oppo side ,
esp in the 2nd molar region.
***NOTE: SETUP OF ANATOMIC
is the same for SEMI ANATOMIC
--- INCISAL EDGE of max central incisors

NON-ANATOMIC OCCLUSION: non-anatomic lacks cuspal inclinations, to

reduce horizontal forces of occ.
NEUTROCENTRIC ( MONOPLANE ):
For non-anatomic teeth ,
This occ scheme: ;anterior-posterior plane of occ should be
parallel to the denture foundation area and NOT dictated by condylar
inclination
Plane of occ is completely flat and level. THERE IS NO
CURVEOF WILSON OR SPEE ( compensating curve)
NO vertical overlap of anterior teeth
When using this, PATIENT IS INSTRUCTED NOT TO INCISE
THE BOLUS.DeVan noted that THE PT WILL BECOME A CHOPPER, NOT
A CHEWER OR GRINDER.
When setting these teeth: the horizontal and lateral
condylar guidance should be set at ZERO.
Cast landmarks ( to check denture setup) : midline, ridge
crest, midpoint of retromolar pad. .same 3 landmarks to determine
plane of occ like in anatomic teeth.
ANTERIOR TEETH SETUP: NO VERITCAL OVERLAP, use clear
or plastic glass .horizontal overlap: in class 2 : mand travels
anterioriorly further IN FUNCTION than class 1, so more horizontal
overlap is needed for this func movementfor class 3 is the
opposite: need little or no horizontal overlap

POSTERIOR TEETH SETUP:

When setting these , horizontal and lateral condylar
guidance should be set at ZERO
Number and combination of the denture teeth
utilized varies depending on the arch length of patient
Mand occ talbe should end PRIOR to the ascending ramus
Distal surface of most posterior max denture tooth should
EXTEND 1-2mm distal to the most posterior mandibular denture tooth.
Position the posterior mand teeth OVER THE CREST
OF THE RIDGE . check to ensure they are set to a FLAT PLANE and on
the PLANE OF OCCsince there is NO vertical overlap of anterior teeth,
both anterior and posterior teeth ARE ON THE PLANE OF OCC.
Position max teeth
Check the horizontal overlap of the posterior teeth. It
should be large enough to prevent biting of the cheek and corner of
the mouth
(((NOTE: that the max PREMOLAR OF THE ivoclar
orthoplane is of sufficient length to harmonize with the cuspid.in
addition, the MARGINAL RIDGES of orthoplane premolars have been
lowered for excellent esthetics ( which usually is not associated with
non-anatomic teeth)))))
BOTH LINGUAL AND BUCCAL CUSPS CONTACT THE PLANE
OF OCC!!! ( premolars)
***verify again that ALL MAX TEETH ( except laterals
and cuspids) ARE ON PLANE OF OCC. Make correction. Once
completed, througoughly cool the wax before procedding to
next step
reestablish centric contacts as needed by manipulating the
MAND POSTEIROR TEETH. Make sure that incisal guide pin maintains
contact with incisal guide table when completed. While performing this
step DO NOT ALTER horizontal overlap of posterior teeth.
****NOTE CHRISTIANSENS phenomenon: the steeper
the condylar inclination the greater the posterior discrepancy
in excursion, AND THE GREATER NEED FOR BALANCING
RAMPS!!!
BALANCED ( BALANCING RAMP) :
Ramp made out of wax then resin

Concept: LATERAL OR TIPPING FORCES tend to have an

unfavorable effect on denture stability and on structures comprising
the denture foundation area
As such denture occ differs from ORGANIC OCC ( bilateral
balance vs anterior guidance ) in order to COMPENSATE FOR LACK OF
RETENTION, STABILITY AND SUPPORT when compared with natural
dentition
BILATERAL BALANCE decreases the transmission of
LATERAL TIPPING FORCES.***BILATERAL BALANCED OCC can also
be obtained with NONANATOMIC posterior teeth , if balancing
ramps are employed.
Monoplane occ attemps to further decrease tipping forces
by minimizing the effect of incline plane contact between the max and
mand. Denture.
Bilateral balanced occ when using ZERO degree cusped
teeth is obtained by using BALANCING RAMPS
*** iN ALL LATERAL EXCURSIONS : YOU SHOULD SEE AT
LEAST 3 POINTS OF CONTACT BILATERALLY ( right, left balancing ramp
and anterior incisors) .
Background:
sources of inclined plane contact:
cuspal inclines of max and mand denture teeth
vertical overlap of max and mand anterior
teeth
***monoplane occ attemps to minimize both
these sources of inclined plane contacts in order to MINIMIZE
TIPPING FORCES. BALANCING RAMPS ADDED TO COUNTERACT
CHRISTENSENS PHENOMENON
LINGUALIZED OPPOSING MONOPLANE WITH BALANCING RAMPS:
a similar concept is used when LINGUALIZED max teeth
oppose NONANATOMIC teeth in mandible.***in all lateral excursions
you should see at least 3 points of contacts bilaterally to maintain
BILATERAL BALANCE
MONOPLANE OCCLUSION ( NEUTROCENTRIC CONCEPT) :
( on other ppt)
***need more***