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POSITIONING THE TEETH: The wax rims should be sculpted to properly support the lips; the midline of maxilla

should be marked on the cast using incisive papilla (not frenum). Also mark the esthetic midline on the maxillary wax rim. The two midlines are usually ther same. Central Incisors: Time and care must be taken in positioning the central incisors as they are the key teeth in the arch. If their positions are correct the positions of all the other teeth will be more nearly correct. Their placement controls the midline lip support smiling line composition and to a large extent the phonetic display for the patient. 1. Position the two centrals in the wax rim using the cast midline incisive papilla and the incisal edge of the wax rim as guides. The labial frenum is not a reliable guide to the midline. The two centrals must be generally parallel to the long axis of the face. !ne central may be placed slightly ahead of the other and the long axis varied slightly for a more natural effect. "rom a side view check the labiolingual position and inclination and ad#ust as necessary. The cervical one third of the teeth and gingival contours provide the lip support. $. %e will observe the length position and angulation of the centrals at tryin when the patient is speaking and at rest position. 3. IMPORTANT: %e will describe optional customi&ing as we discuss each tooth. 'owever set up all teeth for an initial tryin ITHO!T A"TERING THEM# !nce the $atient acce$ts the shade si&e and appearance then an% only then can alterations& as noted can be done if patient is interested( '. The $ro(i)al contact $oints may be ground slightly to flatten them and shift the contact point lingually. This gives more embrasure depth and a more natural effect. The incisal e%*es can be ground to a degree commensurate with the expected wear pattern of the natural teeth. "ateral incisors: The lateral incisors are the $ersonality teeth. )mall laterals with rounded incisal edges give a softer effect while larger s*uarish laterals are more rugged. +. ,osition the laterals so that they are slightly shorter than the centrals depending upon age. The younger the patient the more accentuated the s)ilin* line. +. Mesiolin*,al rotation suggests a rugged broad face or -vigorous- effect. .ary the amount of rotation on each side ("ig. /0).

"ig. /0. Mesiolingual rotation of maxillary lateral incisors. Grind lingual of the central incisor's distal keeping the distal curvature. Do not grind the lateral incisor 3. 301. Mesiola-ial rotation is appropriate for a more narrow facial effect or crowded anterior arch ./i*.

/i*. The canine should be rotated to show its )esial s. It has three basic positions. +. The edge of the upper teeth should follow the curve of the lower lip. The cer5ical should be slightly out to the labial and the incisal should be slightly -toed in-. 2ary the lon* a(es of the laterals."ig.lar Anteriors: The positions of the lower anteriors are of esthetic importance to most patients since they are displayed in speech and laughter. 2iastemas placed between laterals and centrals are effective in creating a more rugged effect. The distal prominence of the cuspid should be barely visible or hidden by the height of contour. /1.r4ace as viewed from the front. '. The Man%i-.s$i% Position: The position of the cuspid determines the anterior arch form and it also completes the -smile line-. 3. /. The C. "rom a side view the lon* a(is should be nearly 5ertical . Mesiolabial rotation of the lateral incisors. Do not grind the central incisor. 'ave patient smile and observe the 3s)ile line3. "ig. See text for the three key positions. +. Grind lingual of the lateral incisor. 5se study casts to demonstrate to your patient (and yourself) how natural teeth have varying axial . +. The maxillary canine is the cor nerstone for the maxillary display. /4. 361.

Make certain patient accepts both the teeth and the concept of !naturali"ing! them. SE"ECTION O/ POSTERIOR TEETH: The two general categories of posterior teeth are anatomic and nonanatomic. 371.rsi5e $ositions while deciding where to grind. Cro ding or a fe diastemas can be introduced to make the mandibular anterior teeth much more natural in appearance. At 5?@A the following are available> +. )ee illustration for suggestions for individuali&ing anterior tooth arrangements . 9e$th *rin% the $ro(i)al to shift the contact lingually for more natural effects.ntil a4ter an initial tryin when the patient confirms that this is indeed an acceptable tooth and shade selection( The alterations are completed and the esthetic portion of the tryin confirmed.res to create an aging effect. The resultant cast will be a guide in the lab.inclinations.st wait .ette (tooth outline) for more rugged s*uared rounded or petite effects. "ig. $./i*. /6. =onanatomic (monoplane flat) . :ove the teeth in e(c. 9rind to increase or decrease e)-ras. Grin%in* 4or I)$ro5e% Characteri8ation: +) 2o not grind teeth if you are uncertain of the patient7s acceptance( $) 5se the straight slow8speed handpiece with medium si&e green wheel stone to #udi ciously grind the reinforced resin anterior tooth for further characteri&ation. Alterations are finali&ed with a burlew rubber s)oothin* wheel on a straight handpiece mandrel followed by a high shine $olish. .sto) alterations ). a) b) c) d) 9rind incisal e%*es to simulate wear. =ote> If the patient especially likes the esthetics of the existing dentures it will be helpful to make an impression of the exterior. All c.sthetic alterations should match functional movement. <eshape silho.

. -. )ince artificial teeth have their own morphology they will not occlude well against natural teeth unless the natural teeth receive selective enameloplasty to better receive the prosthetic teeth. Anatoline (an ++A cuspal angle) e. I))e%iate %ent. . /. (retruded cuspal position. <emoval of the natural teeth will permit and encourage a retrusive shift in mandibular posture.a.ilkington Turner. Anatomic a. ?onsiderations for selecting cusp or flat occlusions> 1. -<ationale. <idge relationship> A class II s:eletal relationship re*uires nonanatomic or cusp8to8open8fossae teeth which permit multiple contact positions without occlusal interferences. .(/BA) (as used in preclinical prosthodontic occlusion course) c. $.atients with $oor coor%ination have difficulty accommodating to anatomic occlusions. :etal occlusal ('ardy7s cutters) band in a three tooth resin block.porcelain flat teeth. Resor-e% or 4la--y ri%*es make accurate intraoral records difficult to obtain and permit movement of denture bases during function. '.mandibular for cusp8fossae scheme. b.ral teeth the most likely practical occlusal scheme will use the mandibular buccal cusps as the functional cusps opposing maxillary fossae.. //A b. (intercuspal position) and <?. Ce aware that some patients with a highly resorbed mandibular ridge retain superb tongue control and a reasonably stable denture base.hysical condition of the patient> .(& which can be especially traumatic with anatomic posteriors. 2ebilitating diseases create oral conditions which also may contraindicate the use of anatomic teeth. If the existing denture teeth have been worn flat nonanatomic teeth may be the better choice. Pre5io. Eoung well coordinated patients with good edentulous ridges.re o$$osin* )an%i-. The poorer the registration base stability the less cusp height is indicated. $BA (avoid> difficult to set up. 2entures made with interlocking cusp teeth may interfere with this change. $. Age is a factor since adaptability may decrease with age. Anxious nervous individuals are more apt to -r. angled faces not true cusps) d.s %ent.lar nat.T maxillary opposing -Anatoline.> Anatomic Teeth> +.re against a natural dentition will re*uire cusp teeth 8 usually semi8anatomic teeth (-Anatoline-) of a hardened resin ()@: or similar). $. If so cusp8fossae or monoplane teeth should be used when both arches are involved. %hen the greater width of the mandibular arch re*uires a crossbite nonanatomic posteriors are often used or cusp8fossae with the upper buccal cusps opposing the lower fossae.re occlusions> If the present dentures have anatomic teeth which have not been severely ground or worn and the alveolar ridges are not greatly resorbed anatomic teeth can be used. In the case of a )a(< illary %ent. 3. If they are also vertical chewing patients rather than wide envelope grinders they will prefer and be able to handle cusp8fossae rather than monoplane teeth. centric #aw relation). ?ombination> . !pposing natural teeth. T! )5::A<ID. A sin*le %ent.res: :any dentulous patients especially those with worn out dentitions have a discrepancy between I?.

Avoid using opposing plastic flat teeth on dentures.ilkington Turner posteriors. "or . ?lass II or ?lass III #aw relations with crossbite situations (if crossbite cusp8fossae are not used). The ($) in $/B designates . %e will mostly . )olid posterior occlusion seats and stabili&es the denture enhances retention and minimi&es anterior ridge resorption. The edges get dull *uickly and the patient will complain the flat plastic teeth do not effectively masticate. 3.oorly coordinated patients. The )@: posteriors will not be too abrasive for a sin*le %ent. <esorbed and unstable or mobile alveolar ridges. .si&e and shade maxillary cutters vs. Si8e: 2on7t depend on the manufacturers7 charts. F. %ith extensive modification such as the cusp 8 fossa occlusion which is described later. %here existing denture teeth are nonanatomic or anatomic teeth have been severely worn.Ts use $/B ) : or @. Materials: A lastin*& sta-le %ent. Sha%es: . 2etermine occlusal form and which si&e best fit in your patient7s posterior ridge space.re occl. /. The posterior teeth should be made from a more wear resistant material than the anterior material so the patient does not gradually develop an anterior premature contact. 5se this transposition chart. !ften / posterior teeth are used in each *uadrant. The 'ardv7s cutter bars in blocks representing a premolar and two molars must oppose monoplane (BA) -<ationale. I. These are reinforced resins. "or -<ationale. 2epending on the space available use $ premolars and + molar or + premolar and $ molars. $.osterior teeth do not follow the Cioblend system of anterior tooth shades./.sion re*uires preservation of posterior centric occlusal stops and the vertical dimension of occlusion. ) short : medium @ long. =onanatomic Teeth> +.flat porcelain nonanatomic posteriors usually use /+:.re opposing natural teeth.se 2entsply7s Trubyte brand 3IPN3 anteriors with the presumably more wear resistant 3S"M3 $osteriors.osterior T$ T+B T++ T+3 T+/ T+0 T$/ T+$ TF T+4 T+6 T$B .porcelains (-medium. It is important that you choose posterior teeth from the selection book and from the posterior mold guide. Immediate dentures when indicated. F. The /B means that the F posteriors measure /B mm.= Cioblend +BB +B$ +BF +B0 +B4 +B6 ++B ++$ ++/ ++F ++0 ++4 )@: . Cioform )hade 00 mold /+: BA -<ationale. from the mesial of the first premolar to the distal of the second molar. %hen previous successful dentures have cusp teeth (not worn excessively).porcelain mandibular teeth).

shade is almost always used and is in stock at 5?@A. :odification consists of creating enhanced mandible fossae especially at the mandibular distal triangular fossae to accept the maxillary cusps in mortar8pestle arrangement . -<ationales. ?ross )ection :odification <elation After :odification ?usp fossa before "ig.BA . -:edium. $#ilkington%Turner& S'M maxillary teeth are set in lingual("ed) cusp%to%fos% sae occlusion against modified *natoline S'M mandibular posteriors.osteriors These posteriors are a compromise between cusp and non cusp teeth with opposing angled planes rather than cusps and fossae.(=onanatomic) .osteriors> These are semi8anatomic low cusps teeth with the cusp tips milled off. 2epending on the circumstances or philosophy of the . '=1.Ts and modified )@: semi8anatomical (-Anatoline-) mandibular posteriors.BA teeth. 9enerally the mandibular first premolar or a resin premolar with a flattened lingual cusp is set between the maxillary canine and the :! segment to improve the esthetics. The cutters are available in light medium or dark shades. At 5?@A their use is discouraged. #. The anatomlines are especially useful for opposing somewhat worn natural teeth. They are difficult to set and do not offer a clear centric occlusion.:etal !cclusal (:!) ('ardy7s ?utters)> These segments represent a / tooth unit. They are plastic with an exposed metallic ribbon which more efficiently cuts food. T. Sho n in order+ cross section before modification) after modification and cusp fossa relation $BA . ?usp 8 fossa !cclusion> 5sually consists of )@: maxillary . -<ationale. FB./i*. 5se $/B : maxillary with //B : Anatoline mandibular posteriors. "unctional (porcelain) and Anatoline ()@:) . 5se them only in the maxillary arch opposing porcelain -<ationale.orcelain have no lateral interferences when contacts are made in forward or lateral positions.osteriors> These posteriors are designated as monoplane because the occlusal surfaces have completely flat contact areas and are usually set on one plane.

lace the teeth in the wax rims using cast landmarks and the occlusal wax rims as guides. F$. They are more wear resistant than plastic but less so than the similarly shaped porcelain BA <ationales. )et teeth according to methods described in class and text. The food cutting potential of <ationale porcelain monopolane teeth lies in the sharpness of the edges si&e of the central fossae and buccal8lingual sluiceways. The )@: reinforced resin e*uivalent are called )@: :onoplanes./i*. The blades of plastic flat teeth do not remain sharp so are inefficient.dentist balancing cups (-ramps-) may or may not be used to maintain anterior and posterior contacts during excursions. Settin* Teeth: :ark the midline of the maxillary cast and the ridge guidelines and retromolar pads7 occlusal plane guidelines . The teeth are set to follo the ax rim hich as sculpted to support the patient's face and the posterior landmarks for the occlusal plane $retromolar pads&. The posterior elevation of the occlusal plane is indicated by encircling the retromolar pads and indicating the top of the middle third. "ig. A diamond bur or stone will recut grooves to restore their efficiency. '+1. .teeth the fossae become shallower the flat areas wider and the escape grooves disappear. After ad#ustment of -<ationale. ./i*. '11. :ark the occlusal plane landmark on the retromolar pad area and the centers of the mandibular alveolar ridges. "ig. The ridge crest land marks are marked on the mandibular cast. 5se the marks on the cast and the metal plane to determine the occlusal plane is correct . F+.