1. Selecting Denture Teeth

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

3. Reference Marks for Selecting Anterior Teeth
Technician sets the teeth without seeing patient
Wax rim contours aid selection and setting:
Occlusal vertical dimension
Angulation of facial rims affects lip support
Overjet

4. Maxillary Reference Marks

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

6. Guidelines for Setting Anterior Teeth
High Lip Line
Corner of Mouth
Angulation is as important as midline

7. Midline of Teeth = Facial Midline
Mark midline on the wax

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

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

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

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

14. Mandibular Reference Lines

15. Mandibular Reference Lines

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

17. Center of Posterior Ridge
Maxillary lingual cusps should be centered over this line
Ensures denture stability
Reduces fulcruming forces during function

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

19. Selecting Anterior Teeth
Combination of science and art
Measurement, formulas etc. are a starting point
Use vision and common sense

20. 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?

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

22. Measuring Existing Teeth

23. Tooth Size Selection
High Lip Line - indication of inciso-gingival length
Pre-extraction cast or photographs can be useful

24. Tooth Size Selection
Corners of Mouth - use the Auto-Rule to pick a mould

25. Shape Selection Tooth shape does not correspond to facial shape
Trubyte system good starting point
No proven male/female characteristics

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

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

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

29. Shade Selection Don’t show all shades to patient
Patients will pick the whitest
Show 2 or 3 shades under lip
Colour perception affected by background

30. Check Shade Against the Patients Face
Check shade of existing denture
Ask if patient wants same shade or change
Allow patient to view shade against lip with mirror
Obtain patient approval

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

32. Shade Selection Teeth darken with age
Correlation with skin and hair colour is suspect
Vita ‘C’ shades are greyish

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

34. Disinfect Shade Tabs

35. Denture Tooth Material
Porcelain teeth less common now
Acrylic easier to set and adjust
Last life of denture (5-7 years)

36. 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

37. Selecting Posterior Tooth Form

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

39. 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

40. Non-Anatomic Teeth
No overbite
Normal overjet (1-2mm)

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

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

43. Posterior Tooth Selection
Buccolingual size can affect the tongue space
smaller teeth if tongue space is limited

44. Prescribing Denture Teeth
Use paper mould guides
Infection control

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

46. 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

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