L21-Chikunov-Selecting and Arranging Denture Teeth.pdf

Igor Chikunov DDS Lecture Objectives • Factors that influence complete denture esthetics • Criteria used for selecting the mould of anterior and posterior denture teeth • Use of mould selection guide • Pre-extraction records (photos, diagnostic casts, old x-rays) • Existing dentures • Patient’s...

Igor Chikunov DDS Lecture Objectives • Factors that influence complete denture esthetics • Criteria used for selecting the mould of anterior and posterior denture teeth • Use of mould selection guide • Pre-extraction records (photos, diagnostic casts, old x-rays) • Existing dentures • Patient’s facial characteristics • Patient’s sex, personality, age • Arch size and shape • Patient’s preferences Factors influencing denture teeth selection Incisal length Intercanine distance High Smile line Lip support/profile Plane of occlusion Vertical dimension at rest/of occlusion • Phonetics • • • • • • Amount of Incisal edges showing with lip at REST Vermilion border of the lower lip at the junction of the moist & dry mucosa F sound “fifty-five” Phonetic Considerations The anterior teeth, tongue, and lips act as a part of the valving mechanism which modifies the flow of air to produce speech sounds Labial sounds: “p” “b” • if the lips are not supported properly by the teeth these sounds may be defective Labiodental sounds: “f” “v” • are produced by contact between the maxillary incisors and the posterior one-third of the lower lip Linguopalatal sounds: “s”, “sh” • are made by contact between the tip of the tongue and the palate at the rugae area with a small space for the escape of air Plane of occlusion • Determined anteriorly by the max incisor teeth • Harmony with the lower lip Plane of occlusion • and posteriorly by the retromolar pads Arch form Arch form Verify • Vertical dimension at rest/ of occlusion • Incisal length • Phonetics (closest speaking space) Intercanine Distance Select the mould of the teeth Mould guide • Let’s say you got these measurements: – 47 mm Intercanine distance – 7.0 mm High smile line Posterior Teeth Selection Posterior Teeth Selection • Mesiodistal Width • Occlusogingival Height of cusp • Cuspal Inclination Posterior Teeth Selection • Mesiodistal dimension: – Determined by area b/w: • Distal of the mandibular canines • Ascending area of the mandible or distal of the second molar Posterior Teeth Selection: Number • 2 digit number represent the mesio-distal width of the maxillary posterior teeth Note: 20 ˚ & 33 ˚ have only two digit mold numbers Posterior Teeth Selection • • • • X = avg width of upper posteriors Y = avg width of lower posteriors U = avg depth of upper left first molar L = avg depth of lower left first molar Posterior Teeth Selection: Letter • Letter = occlusal gingival height – S = SHORT: 7 – 8.5mm – M = MEDIUM: 8.5 – 10mm – L = LONG: > 10mm – LS = LONG BUCCAL/SHORT LINGUAL Posterior Teeth Selection: First number in 3 digit number • Identified by occlusal tooth form: – 2 = 30˚ PilkingtonTurner (PT) – 3 = 10˚ Anatoline – – – – 4 = 0˚ Monoline 5 = 22˚ Biostabil 6 = 0˚ Portrait 7 = 40˚ Euroline Portrait Note: 20 ˚ & 33 ˚ have only two digit mold numbers Classification of Tooth Form Current classifcation: 1. ANATOMIC: 30 degree or more 2. SEMI-ANATOMIC: 10-20 degree 3. NON-ANATOMIC: 0 degree Indications Non-anatomic Anatomic • Poor Residual Ridges • Good Residual Ridges • Poor Neuromuscular control (Bruxers, CP etc.) • Well Coordinated Patient • Existing Dentures with Monoplane teeth or Severely worn occlusion • Arch discrepancies • Class II or III or Cross-bite • Immediate Dentures except opposing natural dentition • patients with poor follow-up • Previously successful with anatomic dentures • Denture opposes natural dentition Non-anatomic Advantages Disadvantages • Reduction of horizontal forces • No vertical component to aid in shearing during mastication • CR can be developed as an area instead of a point • Freedom of movement • Can be uses with arch discrepancies • Easy to arrange and adjust • Do not penetrate the food well theory • Lack of definitive intercuspation • Less Esthetic compared to anatomic Anatomic/Semi-anatomic Advantages Disadvantages • Definite intercuspation • Difficult to set • Esthetically similar to natural dentition • Less adaptable to arch relation discrepancies • Tooth-to-tooth and cusp-to-cusp balanced occlusion can be achieved • Horizontal force development due to cusp inclinations • Penetrates food more easily • Harmonious balanced occlusion can be lost with denture base settling • Requires a remounting procedure to adequately adjust the occlusion • Frequent follow-up and relines to maintain proper occlusion Let’s look back at Anterior Teeth Selection Gender Feminine: – Curved, delicate – Ovoid, tapering – Lat incisor smaller than males/average Masculine: – Square – Strong – Large Age • Youth • Middle-Aged • Aged Age • Youth – Mammelons – Lighter – Pointed cusp tips • Aged – Wear – Darker – Worn cusp tips 1-square 3-short/straight E-48-50mm of width 31- mesio-distal width M- medium 8.5 – 10mm