14. The Arrangement of Teeth for Esthetics eee As Very few bodies are symmetrical, Fang are usually asymmetrical in size acy shape; the shoulders are rarely the sana shape or height; and it is unusual to vec natural teeth that are symmetrical in size, form, or arrangement. Arrangement to meet esthetic require: ments is usually associated” with ‘the composition, size, shape, and color of the six anterior teeth. However, the horizon- tal and vertical positions of the Posterior teeth are intimately involved in facial expression, In many situations the maxillary first and second bicuspid are as important to appearance as the central and lateral incisors as one sees when many people smile or laugh (Fig, 1-1), To arrange artificial teeth that will encourage the acts of smiling and laughing is a science and an art. These acts are encouraged when all of the artificial teeth are arranged in harmony with the surrounding features of an in- dividual. ‘The general features and asymmetries should be observed and recorded during the first appointment with the patient. he terior teeth are (0) The sizeof the fase tees Of Available interarch’ space. (3) the measured distance between the slistal Of the right and left maxillary cuspids, using the arch and incisal. papilin sy measuting guides, (4) the length of the 'ips, and (6) the size and relation of the arches\'The hue and the brilliance of teeth are inflienced by (1) age; (2) habits, (@) complexion, and (4) color of the eves, ‘These factors were discussed in Chapter Fig. 141. The number of visible teeth varies between individuals. Females usually expose more maxillary teeth than do mules. 343summarized, here 12 and fier the eathetie requirement The crvonality, (8) £0 1) age. (2) 208. G) Be coe fnevie Factor, and (8) artistic reflet Age in each individual, age changes take ay, and . » exception. Te arrange samosy ith theee changes sce will be unntial AMAs muscle tonus decreases, the posi- sions ofthe teeth fox support 0 the lips Sve more ettcal The lips tnd cheeks are supported by’ teeth, not by denture borders Thedenture borders re contoured Yo the vibes, ad the teeth are arranged to support the lips and the cheeks (Fig, 48-2), If the the teeth are Fig. 142. Denture borders and tooth posi- tions must be compatible with the surround. ing oral environment to provide support for this patient's lips and cheeks, nfuenced by Fe. 143. Horizontal 0% fancusp form posterior lap (arrows) for f 14-3). ‘The inte o: therefore, the mandibular teeth eee nore watble, That mandibular anterior teeth. are more visible than maxillary anterior teeth does not neces- sarily indicate that the teeth have been positioned incorrectly in a vertical direc- tion. Increased visibility can result from loss of muscle tonus, which can allow the lower lip to sag and the upper lip to drop. Teeth abrade with age. The central and lateral incisors abrade in a straight line (Fig. 14-44). The cuspids abrade in a curve (14-4B), The abrasion of the in- cisal edges of the anterior teeth flattens the arch. This is in harmony with the flattening of the lips as the Cupid’s bow. of the upper lip disappears, and the fullness of the lower lip diminishes with, the aging processes (Fig. 14-4C). ‘The wearing away of the natural teeth at the contact points creates spaces be- tween the teeth. The migration of teeth. also creates spaces. To simulate the wear by positioning the artificial teeth creates a natural appearance. However 2 , to posi tion the artificial teeth in abnormal posi- }Fig. 14-4. Abrasion of teeth, A. The central ‘and lateral incisors are abraded in a straight line. B. The cuspid is abraded in a crescent. ©. The flat lip and the abrasion of the central and lateral incisors are in harmony. tions that result from migration of the natural teeth may not be acceptable in function or in appearance (Fig, 14-5), ‘The smiling line is sharp in young people and Jess sharp in ol : To attempt to make the teeth of the older patient visible to the same extent ‘Tho Arrangement of Tooth for Bathtiey 348 they sare visible when he wos young ‘may reult Ina improper verieal post tion of the occlusal plane (Pig. 14- 5 tno cade ith an be reproduced b ‘Jong toh, contouring he Positioning the tooth properly Pip 1 palittiral tect of older persons have ean that support restorations he restorations can be duplicated and Fic. 14:5. The original contour of the natu- al teeth was approximated. The positions of the teeth were not duplicated. Compare the contour and arrangement of the artificial teeth, A, with that of the natural teeth they replaced. B.rapusof complete Pe a6 Fis. 146. A. A natural smile, B. A forced smile. The lack of muscle tonus is evident, the teeth can be placed faccentuate or lessen the Sex The sex of an individual infyy ‘ia Gente of ibe boelog et Toe eaare diferent nd hah Peeper ut tea re dierent. Square ft Soe wi mall and an ry avockied wilt ae ea 18) The features vary, then ms y Bat oe eet eel) aes sone cena Zod hen tho toth a acre Panitone ofthe incinal eden tase oot tae neal of te (eth, andthe poate the body of the teth refect fem and/or mescililly. ‘A study of the positions of natural tne events the fllowing 2 Roundness ofthe arh form dena femininity, and squareness denotes masculinity. 2, The incisal edges of the maxillary 2 at Ei nie int Of ‘the Fig. 14-7. Natural contours of the gingiva were reproduced in the maxillary denture base.‘Tho Arrangement mement of Teeth for Esthetics 347 8 Fia. 148. A. Square features of the male, Note the positions of the central und lance incisors, the prominence of the cuspids, ond the square arch, B, Curved features of the female. The curves of the angles of the teeth, the relations of the lateral and central in. sisors, and the rotations of the cuspids in o distal direction form a curved arch, anterior teeth of females follow the curve of the lower lip (Fig. 14-9). 3. The incisal edges of the maxillary ‘teeth of males are related to the lower lip in the following manner: the central. incisors are on a horizontal plane paral- lel with the lip, the lateral incisors are above the pasate the cuspids are on the plane (Fig. 14-9C). _ . Viewed from in front, the distal Surfaces of ; females are usually rotated in a posterior direc- tion (Fig. 14-10A). The labial surfaces of the central incisors of males are not usually rotated (Fig. 14-108). Fig. 14-9. Incisal edges of maxillary ante- rior teeth. A. The inci ‘curve of the lower lip. B. Acceptable curva- ture id 2) as guide for arrar ve and function; J.C, Compari-‘948 Syllabus of Complete Dentures 4 Inthe arrangement for females the mesial surface of the lateral incisor i offen seen in an anterior relation to the distolabial surface of the central in cisor, The distal surface of the lateral incisor is rotated ina posterior direc tion, The smile is softened as a result of this arrangement (Fig. M-11A), For the male, the mesial surface of the lateral is often hidden behind the distal surface of the central incisor, The distal surface of the lateral incisor is rotated very slightly in a posterior direction (Fig. 14-128), The cuspid is made more prominent as a result of this arrange- ment. 6, The distal surfaces of the cuspids for females are rotated in a post direction; therefore, the mesial the labial surfaceis exposed when viewed Fic. 14.10. Compare the central incisors, the curvature of the lower lip, and the rela- tion of the incisal edges and tips of the buccal cusps of the bicuspids with the lips of the female in A with those of the male in B. :- 5 = tee = pia. 141. A diogrommatic orrangement of the mosiilary central and Lateral inesort Jor'the female, A, and the male, B. from the front (Fig. 14-10A). The cuspids for males are rotated less in @ posterior direction. As a result, the mesial two, thirds of the labial surface is exposed when viewed from the front Fig. 14-208), Ina lateral view the cuspids for both sexes are vertical to the occlusal plane; any deviation from this is in a posterior direction at the neck of the tooth (Fig, 14-124). When viewed from the inferior direction, the necks of the cuspids are in a slightly more labial position than the incisal edges (Fig. 14-128). The m illary first bicuspids are contoured and positioned to conform with the cuspids (Fig. 14-12). Frequently the main con- cern in arranging the first bicuspid in a ‘maxillary denture for a female patient is esthetics rather than function because a ‘woman usually exposes more maxillary teeth than a man when speaking, er ean Personality ‘The personality of people is expressed in their habitual patterns and qualities of behavior. Their personalities can be influenced by the appearance of their teeth. The shy person may be shy be- cause he is ashamed of the appearanceFig, 1412, A. Lateral view showing the long axis of the cuspid slightly to the distal ofits neck. B. Inferior view showing the neck of the cuspid more labial than its incisal edge. C, Maxillary first bicuspid arranged princi- pally for esthetics. of his teeth. Self-consciousness is possi- ble with either natural or artificial teeth. An unselfconscious person may have had natural teeth pleasant in ap- pearance or dentures with natural the velop 1h for Esthetics 349 appearing artif {Bbeating artificial eth. tis the obign ntist to arrange the atti onality (Fy i. 14-19), Fig, 14-13. The personality of the patient ‘and the esthetic arrangement of the teth are in harmony for the attractive female in A and the happy male in B.Cosmetic Factor onal volves perso neatly n dresses ‘wellgroomed. he the arial tet en ment these iar i comple a dvised to 8€- forts fect wever ti i ved teeth of matching tect delicmtrange them in a pleasing stout fet ‘woman who uses 10 aa not manicure her aa med. It seep hr hale wall-roamed, I hace nav fol tath forthe 1 by a eeprves and halt and wil ate .d clothing. The teeth would cheer setting. and _ ith bushy. Un or unpre rot harmonize Wil tin srould therefore appear more artifla On the other hand, it would be 8 fake for the dentist to confuse the pa wat use cosmetics ber vent ne miginy teat withthe Tabualy sloppy person. Atlempts to amity ae improve the face wih cos tics may make poorly arranged teth ete noticeable. The dentist should not Since for too exact a reproduction of the arrangement of the natural teeth trten he makes dentures forfich a pac tent Modifications of the natural ar Tangement may help to improve the pa- tients appearance. Artistic Reflection Artistic reflection is the arrangement of the teeth to reflect the dentist's con- cept of what he thinks appears natural for the patient. The artistic ability of the dentist is often taxed to achieve a com- position of teeth that harmonizes with the surrounding features and is accept- able to the patient. It is not advisable to force a composition of teeth on a Patient just because it meets your be consider me one wiling to snd unt the edvantages he Pasarticular positions oth tm Peequirements have the pe vod (Fig. 14-14) Fig. 14-14. A, The diastema had been ac- cepted for years as part of this patient. B. The diastema was reproduced in the teeth Of the denture at the request of the patient.maxillary Fie. 14.15, Reproducing natural arrangement of Many positions in which the mas feclVary the slant of the long axis 14-15). 6 1 co ee seer he proetaati ea xillary The Arrange of Toth for B wt 1 ‘£ Useaneccentsiomidtine(ig.18:18), 5. Place one central and lateral inet S0r Pacallel to the midline and rotate the ther central and lateral incisors slightly ‘m @ posterior direction (Fig. 14-15) ¥e maxillary central incisor slightly in an an other central 7. Place the n central incisor in and the neck of th in an anterior din 8 posterior disection 1 other central incisor ection (Fig. 1415), 8. Greate asymmetry for the maxillary ight and left cuspids. Rotate one in more posterior direction than the other (Fig. 1426). Place the neck of one ina ‘more labial direction than the other (Fig. 14-16) 9. Create a good smiling line by the central incisors. of natural teeth. Note the asymmetry in the metry as related to the teeth arranged to create asymmetry. midline of the face. © and D. Frontsillary cuspid are symmetry. Notice the tween the eheoks and. the buceal ees ofthe posterior teeth The posterior ‘harmony with the ae ind the cheeks. fe, 1416, The teeth are place icing of the maxillary posterior focth mediolaterally in relation to the cheek. Whon the teeth are placed too far laterally, the buceal corridor i elim: inated, resulting in a harsh, ugly, and proper p toothy app The similarity in shope and size ofthe mandibular anterior teeth presents. a Fro, 14-17, The mandibular anterior teoth core frequently overlooked in arrangements for esthetics. The incisal edges of tho orti- ficial tooth can be altered by grinding to appear like the incisal edges of these natural teeth. The artificial tooth can he rotated and overlapped in a manner similar to the natural teeth, Observe the ‘asymmetry the cuspids, Nem Rb jtioning for esthetics. Thy io can be enhanced by Tnncisal edges (Pig. 14-17), {overlapping the teeth to ir appoarance (Pig. 14.17), imnotry in the divergen: ‘aurfaces of the ing 0 i creat aciaor and the cusptd on the oe (eg. 14-18), (8) varying th ane thon of tie long axis (Fig. 14 "ha ee arenes rroetiat it must not be delegated to ixiliary personnel who have not studied the patient, Opinions of othe ticularly of the patient's fa people considered close associates, are Vnluublo aids to composition of the teeth {or osthotics. Facial features, manner- jms, facial expressions, and tooth posi- tions are inherited. The position of daughters or a son's natural teeth can be ‘an oxcellent guide when positioning the teeth for the parents. The dentist is the only one who has had an opportunity and the experience to evaluate all of these factors and can therefore meet the esthetic requirements of the patient, Fie, 14.18, variation in frequently seen in the ai natural toeth, Asymmetry, diastema, and « direction of the long axis an rangement of th