1. Selecting Denture Teeth
This presentation includes images from the UCLA/APC/Ivoclar Educational Curriculum

2. Place reference marks on the occlusion rims to aid in tooth selection and placement

3. Reference Marks for Selecting Anterior Teeth
Technician sets teeth without seeing patient
Wax rim contours & reference lines provide
Occlusal vertical dimension
Angulation for lip support
Horizontal overlap (Overjet)
Guide for size & positions of teeth

4. Maxillary Reference Lines

5. Lines Used for Selecting & Setting Anterior Teeth
High Lip Line
Selecting Size
Corner of Mouth
Angulation is as important as position
Setting Teeth

6. Midline Position Critical reference #7 wax spatula
Score a line parallel facial midline
Mark both rims

7. Midline of Teeth = Facial Midline
Use floss, tongue blade, spatula as aid
Mark midline on the rim

8. Corners of the Mouth Mark corners at rest (#7 wax spatula)
Position of distal of the canines

9. Corners of the Mouth
Measure circumference between marks with Trubyte Auto-Rule
Size of 6 anterior teeth read off ruler (mm or by letter code A, B, etc.)

10. High Lip Line Highest point of upper lip when smiling
Cervical necks lie at or above this line
If shorter teeth are selected, esthetics compromised
Teeth Too Short

11. Proper Display of Neck of Central Incisors at High Smile Line

12. Palatal Midline Through center of incisive papilla & mid-palatal raphe
Extend onto land area
Check for symmetry
If not symmetrical, adjust rim

13. Midline & Canine Reference
Line passing through distal of incisive papilla
Perpendicular to palatal midline
Intersects cusp tips of canines
Natural Dentition

14. Distal Aspect of the Incisive Papilla
Provides verification & tooth size selection
Use to verify symmetry
On average, facial of central incisors should be 8-10 mm anterior to this line

15. Mandibular Reference Lines

16. Mandibular Reference Lines

17. Middle of Retromolar Pads
Occlusal plane intersects
If occlusal plane is too low - tongue biting
Too high - strain as tongue struggles to replace food bolus

18. Center of Posterior Ridge
Maxillary lingual cusps should be centered over this line
Ensures denture stability
Reduces fulcruming forces during function
If rim is not centered around lines, adjust

19. Anterior Denture Teeth Relation to Residual Ridge
Natural anteriors proclined facial to ridge
Post-extraction, resorption occurs preferentially on facial

20. Anterior Denture Teeth Relation to Residual Ridge
If place anterior denture teeth directly over ridge, less lip support, poor esthetics
So normally set slightly anterior to ridge

21. Center of Anterior Ridge
If anterior teeth are too facial to center of ridge, fulcruming, tilting and dislodging occur

22. Reference Line Video

23. Selecting Anterior Teeth
Combination of art & science
Measurements, formulas etc. are starting points
Use vision & common sense

24. Tooth Size Selection Use existing teeth as a guide: Too big or small?
If so, use your own judgment
Does patient like them? Do you?

25. Tooth Size Selection Use existing teeth as a guide:
If acceptable, measure width & length
Compare to Trubyte mould guide chart
Central incisors dimensions listed
Ant. tooth photos are life size

26. Measuring Existing Teeth
Use Boley Gauge to measure both length & width in mm

27. Matching Natural Appearance
High Lip Line - indication of inciso-gingival length
Pre-extraction cast or photographs can be useful to match natural teeth

28. Auto Rule for Size Selection
Corners of mouth – use Auto-Rule to pick a mould
Read either mm or ‘mould letter’

29. Original Dentsply Categorization of ‘Ovoid’ Facial Types
Shape Selection
Tooth shape does not correspond to facial shape
Trubyte system good starting point
No proven male/female characteristics
Original Dentsply Categorization of ‘Ovoid’ Facial Types

30. Shape Selection Use existing teeth as a guide - do they look good
USE COMMON SENSE & OBSERVATION

31. Use Negative Space
Look at interproximal embrasure and papilla shape to assist in determining tooth shape

32. Dentsply System

33. Dentsply System Mould Availability Dimensions
Matching Mandibular Mould(s)

34. Dentsply System Selected Maxillary Anterior Mould
Matching Mandibular Mould(s)
Matching Posterior Moulds by Cusp Angle

35. Selecting Denture Teeth
If existing denture/natural teeth look good:
Select best match to shape & size (height, width) of central incisor
Confirm width of 6 anterior teeth similar to existing
Use mould guide to select corresponding mandibular anterior and posterior moulds

36. Selecting Denture Teeth
If existing denture teeth need to be changed:
Use width of 6 anterior teeth for selection (A,B,C…) based on best size and shape guestimate for central incisors
Use mould guide to select corresponding mandibular anterior and posterior moulds

37. Shade Selection Portrait shade guide Use existing teeth as a guide
Shade B2 is close to an average shade
Top number (A, B, C, D) on tabs corresponds to Vita porcelain shade
Bottom number (P) is Portrait # for ordering

38. Avoid Fatigue Only look at teeth for 10-15 sec at a time
Then look away at something light blue
Use patient bib
Otherwise ‘burn out’ colour vision
If don’t look away, shades begin to appear similar

39. Present Only a Few Tabs to Patient
Don’t show all shades to patient
Patients will almost always pick the whitest

40. Colour Perception Affected by Background
Surrounding colours affect perception of shade tabs
Present 2 or 3 shades under lip

41. 3 Colours: Orange, Pink, Green
How Many Colours? What are they?

42. Colour Perception Affected by Background

43. Patient Chooses Shade with Input from Dentist
owns the dentures
will look at them every day
Offer your opinion, don’t persuade

44. Check Existing Denture/Natural Teeth
Compare to existing denture or natural teeth
Ask if want same shade or change
Best not to vary in extreme from natural teeth if present

45. Check Shade Against Patient’s Face
Check shade against background teeth will be viewed
Progressively narrow shade choices

46. Narrow Choices
Remember not to stare at shade tabs for long

47. Squint Test Check for value (brightness)
Squinting reduces the influence of hue
If teeth look too bright while squinting, suggest something less bright

48. Finalizing the Shade Selection
Allow patient to view shade against lip with mirror
Obtain patient approval

49. Tooth Colour Teeth darken with age
Correlation with skin and hair colour is suspect
Vita ‘C’ shades are greyish
Don’t use terms ‘Darker’, ‘More Grey’, etc. (Alternative: ‘More colorful’)

50. Disinfect Shade Tabs After Use

51. Denture Tooth Material
Porcelain teeth difficult to obtain now
Acrylic easier to set and adjust
Improved wear resistance
IPN (interpenetrating polymer network)
Composite outer surface (Ivoclar BlueLine)
Last life of denture (5-7 years)

52. Denture Tooth Material
Acrylic
New acrylics wear better
Improved translucency with layers
More resilient - Less breakage
Chemically bonds to base
Quieter
Easier to set/adjust
Gum sticks
Porcelain
Less wear
More translucent
Brittle - fracture easily
Don’t bond to base (stain, fall out)
Difficult to set, adjust

53. Portrait IPN Acrylic Routine use in Dalhousie clinics
Don’t select porcelain
Don’t select Bioform or Bioblend moulds
If mould selected doesn’t come in Portrait, pick next closest mould

54. Selecting Posterior Tooth Form

55. Anatomic Teeth (10°, 20°, 30°, 40°) Use for patients with:
Esthetic concerns
Coordinated jaw movements
Denture opposing natural teeth
10°
20°
30°

56. Non-Anatomic Teeth (0°, Rational, Monoline, etc.)
Jaw size discrepancies (Class III)
Severe ridge resorption
Uncoordinated jaw movements
Poorer esthetics, due to lack of cuspal inclines

57. Setting Non-Anatomic Teeth
No vertical overlap (overbite)
Normal horizontal overlap (overjet) for denture teeth (1-2mm)

58. No tooth form has been proven most efficient - most patient can’t discern a difference

59. Posterior Tooth Selection
Match size & shade to anteriors
Determine distance from distal of canine to ascending ramus (29, 30 mm, etc.)

60. Posterior Tooth Selection
Buccolingual size can affect tongue space
use smaller teeth if tongue space is limited

61. Prescribing Denture Teeth
Use electronic or paper mould guides
Infection control

62. Prescribing Denture Teeth
Dentsply Trubyte Portrait
Acrylic Teeth
Layers of acrylic – improved translucency
IPN - improved wear resistance

63. Summary Selecting denture teeth advise patient don’t persuade
an art, minimal science
use common sense
use old denture as a starting point
look at dentate patient esthetics
Seminar exercise

64. Dentsply Paper/Electronic Mould Guide
Use plastic laminate guides in clinic
Find these parts in your guide:
Anterior Maxillary Mould Shapes & Sizes
Mould popularity
Corresponding mandibular anterior moulds
Posterior mould forms (100% actual size)
Corresponding posteriors for anteriors chart

65. Seminar Exercise Work in pairs in seminar groups
Select shade for partners
Use maxillary cast and Boley gauge to select tooth mould that best approximates cast/typodont
Select corresponding mould for mand. teeth
Complete prescription for teeth
Have faculty seminar leader check & sign