Setting Anterior Teeth Esthetics & Phonetics

View from anterior, occlusal View from many angles Look for Symmetry View from anterior, occlusal View from many angles

Symmetry Perfect Symmetry Gross Asymmetry

Facial Asymmetry 2 Left Sides “Normal” 2 Right Sides

Smile Asymmetry 2 Left Sides “Normal” 2 Right Sides

Setting Anterior Teeth Incisal edges of central incisors & canines at level of the occlusal plane Laterals placed approximately 0.5 mm above the occlusal plane

Cervical necks tilt posteriorly from the central incisor to the canine

The greatest height of the free gingival margin is slightly distal to the mesiodistal center of the tooth

Setting Mandibular Anteriors Lower anterior teeth incline similar to the maxillary teeth

Setting Mandibular Anteriors Incisal edges are placed at the same level Even with the occlusal plane

Setting Mandibular Anteriors No overbite for monoplane or lingualized setups

Canines should be tilted more posteriorly than other teeth, with a more prominent cervical neck

Bucco-Lingual Tilt Maxillary Anterior Teeth Facial surface of central is perpendicular occlusal plane Neck of lateral is depressed Neck of canine is prominent Central Canine

Bucco-Lingual Tilt Mandibular Anterior Teeth Central is proclined Lateral is more upright Canine has a prominent neck Central Canine

Anterior Tooth Setup Check symmetry with reference lines Anterior teeth don’t contact in centric position Grazing contacts in excursions Overbite = 0mm Overjet = 2mm

No Anterior Contact in Centric Insufficient Correct Excessive

Dentist Sets Incisal Guidance Overjet & Overbite Avoid too much overbite or too little overjet Increasing overbite steepens the angle, separating posterior teeth more quickly Increasing overjet shallows the angle, separating the posterior teeth less quickly

Canine Offset Check for one half tooth offset between maxillary & mandibular teeth Ensures posterior teeth have normal cusp to fossa relationship for lingualized occlusion

Improper offset results in a space or half tooth replacement Cannine Offset Correct Improper offset results in a space or half tooth replacement Insufficient

Phonetic Assessment Maxillary centrals should lightly touch vermilion border of lower lip for ‘F’, ‘V’ sounds ‘S’ sounds - incisal edges should approximate each other

Intraoral Assessment of Anterior Teeth Incisal edges of maxillary incisors should follow line of lower lip when smiling (‘smile line’)

Follow the ‘Smile line’

Placing & Moving Anterior Teeth Crown removing forceps to bodily move and tilt teeth Grind record base/tooth if record base is impairing ability to position properly

Intraoral Assessment of Anterior Teeth Nasolabial angle ≈ 90° If insufficient support, the vermilion border will be reduced

Intraoral Assessment of Anterior Teeth Junction of oral mucosa (glossy) should just be visible when lips are slightly separated If not visible - insufficient support Lips meet at junction of oral & transitional epithelium

Intraoral Assessment of Anterior Teeth Excessive block-out of record base will push the lip out at the height of the vestibule, distorting appearance

Lisping Too much horizontal overlap Anterior teeth too far labially Can’t approximate incisal edges Anterior teeth too far labially Spaces allow air leakage

Lisping Palatal contour too constricted Arch form too broad Remove wax to provide more room Arch form too broad Experiment with placement of wax

Anterior Teeth Not Identical Position of Natural Teeth Slightly altered position from precursors Denture stability compromised No anchorage from roots

Avoid the ‘Denture Smile’ Teeth too small Teeth not showing Too straight across anterior “Chiclets”

Central & lateral incisors must begin to turn along the curvature of the arch

Circumference Follows Arch Shape

Facial Support, OVD & Tooth Setup Can Dramatically Affect Appearance

Effect of Incisor Length

Variation of Appearance with Different Dentures

Variation of Appearance with Different Dentures