Comparison of zero degm teeth and anatomic

teeth on complete dentures

Allen A. Brewer, Colonel, USAF (DC),* Peter R. Reibel, Captain,
USAF (DC),** and N. Joseph Nassif, Major, USAF (DC)***
86th Tactical Hospital, APO New York, N. Y.

P rocedures based on judgment,

suspect. And this experimentation
not backed up by experimentation,
should be performed on a comparative
are always
basis.
The history of dentistry is a history of expediency research. What we have
does not work so someone makes great claims for what he has developed. Fre-
quently these claims are based on observation of one patient or observation of
many patients without comparison of the results of using a different instrument or
material or denture tooth.

EXPERIMENT
In this experiment, we made for each of 25 male patients two sets of complete
dentures that were duplicates, as nearly as possible, for each patient in every
respect but one, One set of dentures was made with zero degree porcelain teeth
and the other set with anatomic porcelain teeth. This was accomplished without
the patient’s knowledge. They were switched at intervals without informing the
patient. Observations were made as to the patients’ acceptance of and adaptability
to the different dentures. After a period of time, each patient was informed that
he had two sets of dentures. After a further period of time during which he wore
each set of dentures for alternate periods, his preference was noted.

This article represents the views of the authors and does not necessarily reflect the official
opinion of the Air Force Dental Service or of the Department of the Air Force.
Read before the Academy of Denture Prosthetics in Louisville and the American Pros-
thodontic Society in Dallas.
*Present affiliation, Chief, Central Dental Laboratory, Veterans administration Hospital.
Washington, D. C.
**Present affiliation, Teaching Associate in Prosthetics, Indiana University. School of
Dentistry, Indianapolis, Ind.
*“*Present affiliation, Graduate Student, The Ohio State University, College of Dentistry,
Columbus, Ohio.

28
Volume 17 Zero degree or anatomic teeth for complete dentures 29
Number 1

PLAN
In order to avoid the possibility of attributing the results to the skill or lack
of skill of any specific dentist or technician, three dentists each treated a similar
number of patients and the laboratory procedures were carried out by three differ-
ent technicians. To avoid the possibility that a specific impression technique could
be responsible for the result, three different impression techniques were used. The
patients would not be select patients but rather would be routine patients treated
as they presented for treatment. Thus we hoped to reproduce the procedures that
would be prevalent in almost any type of dental practice.

PROCEDURE
Examination and classification. The patients were examined from all relevant
aspects and notes were made of the local factors such as ridges, hard and soft tissues,
relationship of ridges, and floor of the mouth. The personality and attitude of the
patient, together with his dental and medical history, were also noted. The patients
were then classified from 1 to 4. Class No. 1 was designated as the easiest to treat,
with the best prognosis, and Class No. 4 was the most difficult. Classes No. 2 and
No. 3 were gradations on this scale.
Impressions. Three types of impressions were used:
1. An individual impression tray was formed in plastic on a cast obtained
from an irreversible hydrocolloid impression of the mouth. The proper outline
form was then adjusted at the chair. The mandibular impression was completed
by using modeling plastic on the ridge slopes and denture borders, and the border
molding was done by patient movement and manual manipulation by the dentist.
The maxillary impression was completed in the same manner, and then the palate
was cut out and this part of the impression was completed by painting accelerated
artificial stone into the palate. The impressions for 15 sets of the dentures were
made in this manner.
2. A custom impression tray was formed and adjusted in the same manner.
Irreversible hydrocolloid was used for making the final impressions in these trays.
The impressions for 5 sets of the dentures were made in this manner.
3. The completed impression was obtained by using irreversible hydrocolloid
in a stock tray. The impressions for 5 sets of the dentures were made in this
manner.
Denture bases. Artificial stone casts were poured in the impressions. For 15
of the patients, this cast was then duplicated using reversible hydrocolloid. Den-
ture bases were formed in wax, flasked, and processed in cold-curing resin. For
10 of the patients, the denture base was made on the original cast in the same man-
ner. This base was then duplicated by forming a new cast from a reversible hydro-
colloid impression of the base. Then another denture base was formed on this cast.
Mounting casts. One mounting cast was formed in either of the maxillary
denture bases and this was adequate for either denture base. Separate artificial
stone mounting casts were poured for each of the mandibular bases.
Articulator. A Hanau Model H articulator was used in the construction of
all dentures. An arbitrary face-bow was used to relate the maxillary denture bases
to the instrument.
30 Brewer, Reibel, and Nassif

Table I
Anatomic or zero degree teeth for complete dentures?

i ; /
’
In rertrd
Attitude Impressions I first
Reibel 1 23 I Philosophical 2 Irreversible hydrocolloid
and modeling plastic

3 Indifferent ‘,
w Irreversible hydrocolloid
and modeling plastic
Reibel 3 21 1 Philosophiral 1 Irreversible hydrocolloid Anatomic
and modeling plastic
Reibel 4 20 0 Optimistic 1 Irreversible hydrocolloid Anatomic
and modeling plastic

Reibel 5 31 3 Philosophical 2 Irreversible hydrocolloid Anatomic

and modeling plastic
Reibel 6 ?I 2 Indifferent 0
J Irreversible hydrocolloid Anatomic
and modeling plastic
Reibel 7 46 0 Optimistir 1 Irreversible hydrocolloid
and modeling plastic

Reibel n 31 2 Philosophical 2 Irreversible hydrocolloid hnatcmk

and modeling plastic
Reibel 9 28 II., Pessimistic Irreversible hydrocolloid
4

and modeling plastic

Reibel 10 35 1 Pessimistic 2 Irreversible hydrocolloid
and modeling plastic

Nassif 11 47 1 Pessimistic 1 Irreversible hydrocolloid Zero degree

and modeling plastic

Nassif 42 2 Indifferent :i Irreversible hydrocolloid Zero degrre

and modeling plastic
Nassif 22 0 Philosophical 1 Irreversible hydrocolloid Anatomic
and modeling plastic
Nassif 45 1 Pessimistic ‘4 Irreversible hydrocolloid Zero degree
and modeling plastic

Nassif 15 38 3 Indifferent 1 Irreversible hydrocolloid Zero degrw

and modeling plastic
For the zero degree dentures 16 through 25: No face-bow was used. The articulator

Nassif 16 ‘4 2 Philosophical 2 Stock tray and irrcvers- Anatcunic~

ible hydroc~olloid

Nassif 17 20 0 Optimistic :1 Individual tray and irre- Anatomic

versible hydrocolloid
Nassif 18 44 1 Philosophiral 2 Individual tray and irre- Zero degree
versible hvdrocolloid
 Volume 17 Zero degree OY anatomic teeth for complete dentures 31
Number 1

1 Week Never saw patient again-evacuated to States for

psychiatric therapy

2 Weeks 2 0 0 Seldom wore either

4 Months 21 3 3 x Look better

6 Months 19 2 2 x

3 Months 23 3 3 x

2 Months 12 5 5 x

1 Day 6 2 3 x

1 Month 5 4 4 Fit better, speak better,

feel better

2 Days 6 1 1 More comfortable

1 Week 10 4 5 More comfortable, more

room

2 Weeks 4 5 5 x

3 Days 2 1 0 x

1 Day 2 3 4 x

1 Day 4 8 6 x Chew better, less move-

ment, more comfortable

5 Days 3 3 3 x Smoother, tighter

was used only as a hinge

3 Days 2 4 3 x Speaks and chews better,

teeth not so high

1 Day 2 3 3 x More comfortable

1 Day 3 4 4 X Smoother, more room,

chew better, talk better
32 Brewer, Reibel, and Nassif J. Pros.Dent.
January. 1%

Table I-Cont’d
L
i No. of !
previous i j Insert
Dentist Patient Age dentures Attitude i’n2;, Impressions I first
Brewer 19 22 2 Pessimistic 3 Individual tray and irre- Zero de
versible hydrocolloid

Brewer 20 33 1 Indifferent 3 Individual tray and irre- .4naton1

versible hydrorolloid

Brewer 21 45 Pessimistic :i Individual tray and irre- Zero dc

versible hydrocolloid

Brewer ‘7‘)
.- 27 Philosophical 1 Stock tray and irrevers- Allatonl
ible hydrocolloid

Brewer 2.7 49 Indifferent 4, Stock tray and irrevers- Zero de

ible hydrocolloid

Brewer 24 44 Indifferent 3 Stock tray and irrevers- Zero de

ible hydrocolloid

Brewer 25 48 2 Optimistic I Stock tray and irrevers- Zero de

ible hydrocolloid

Centric relation. A centric maxillomandibular relation record was made in

wax in the mouth by the tactile method. This was transferred to the articulator.
Centric Check Points* were positioned, and the bases were returned to the mouth
far verification. Corrections were made when necessary, and the process was rc-
peated until we were assured that the correct centric maxillomandibular relation
record had been transferred to the articulator. The centric relation record obtained
on the duplicate denture bases was then checked in the same manner, and at the
same vertical dimension of occlusion. The individual mandibular mounting casts
were used for mounting the duplicate mandibular denture bases.
After the first 15 sets of duplicate dentures had been completed, this pro-
cedure was altered for the dentures to be completed with the zero degree posterior
teeth. These were placed on the articulator by the technician without a face-bow
record. The centric relation record and transfer were then verified by means of
the Centric Check Points.
Tooth arrangement. The teeth were arranged to be esthetically acceptable by
using all available guides, such as pre-extraction casts and photographs, former
dentures and/or partial dentures, ridges and facial form, trial and error.
Anatomic tooth dentures. A protrusive maxillomandibular record relation was
made in accelerated artificial stone. This record was made at a level to allow for
the cusp height, and the condylar guidance on the articulator was adjusted to
accept this record. The lateral condylar guidances were set according to Hanau’s
formula. The teeth were arranged and altered so that complete cross-tooth and
cross-arch balance of the occlusion was achieved. When indicated in the judgment

+Hanau Engineering Co., Buffalo, N. Y.

 Volume 17 Zero degree or anatomic teeth for complete dentures 33
Number 1

Adjustments Preference
Second Alterna-
insertion tion for Ana- Zero Ana- Reasons for
after months tomic degree tomic 0” None preference
1 Week 4 3 2 x

1 Day 1 !A 1 1 x

1 Week 3 2 2 x Prefers from all aspects

8 Days 3 3 4 x Chew better

1 Week 2 2 3 x Just feel better

3 Days 3 0 0 X

1 Day 6 3 4 X Look, feel, work better,

smoother

of the dentist (9 of the dentures), the completed dentures were remounted in each
lateral position by making lateral maxillomandibular relation records in accelerated
artificial stone, and using the articulator as a tripod to locate interferences or in-
adequacies in the occlusion. These were corrected on the articulator.
Zero degree teeth dentures. The anterior teeth were arranged to reproduce,
as closely as possible, the arrangement of the anterior teeth on the dentures with
the anatomic teeth. No alterations were made in vertical or horizontal overlap.
The posterior teeth were not “centralized” but were placed in a similar tongue,
tooth, and cheek relationship as the anatomic teeth had been positioned. The pos-
terior teeth were set on a flat plane without any compensating curve. The articu-
lator was used as a hinge.
Vertical dimension of occlusion. All available guides were used to determine
the correct vertical dimension of occlusion. After the teeth were arranged in wax
on the denture bases, they were inserted in the mouth, and the patient was en-
couraged to talk and read for a five to ten minute period. If too much interocclusal
distance was exhibited, correction was made. If the teeth were pushed out of
place during this test period, this new vertical dimension of occlusion was used.
Denture completion. New casts were poured into the completed denture bases
after the teeth had been arranged, and the teeth were secured in position by the
wax on their lingual surfaces. The labial and buccal surfaces of the denture base
were exposed from the denture border to the teeth. These were flasked and the
eliminated wax was reproduced in cold curing resin. After deflasking, the dentures
were returned to their respective mounting casts and the processing changes were
corrected. The form of the labial and buccal surfaces of the dentures was completed
by brush application of suitably tinted cold-curing resins, and cured in a pressure
pot. Every effort was expended to product similar chal.acter.izatioII for rach ~1
of duplicate dentures,
1~r.s~tio~z. The zero degree tooth dentures were inserted first for 13 of the
patients and the anatomic tooth dentures were inserted first for 12 of them. The
alternate sets of dentures were substituted at intervals that ranged from one day
to six months, and they were changed thereafter at daily, weekly, or rnonthl~~
intervals. In no instance was the patient informed of these substitutions until :t
considerable period of time had eIa.psed. This ranged from one to six months.
depending on the patient and/or the dentist retainability.

RESULTS
The patients were from 20 to Xl years of age. l’cn of them were in their
twenties, six in their thirties, and nine in their forties. Four of them had no pm-
vious denture experience. Seven had one previous set of dentures, eight had had
two previous sets of dentures, and four had three previous sets. One had six pre-
vious sets and one had eight (Table I).
The psychologic attitudes of 4 of the patients were optimistic, of 8 were philo-
sophic, of 6 were pessimistic, and of 7 were indifferent. The prognosis had indi-
cated that 8 of the patients were in Class 1 (easiest to treat), 7 were in Class 2,
7 were in Class 3, and 3 were in Class 4 (most difficult to treat). In other words.
we had a reasonable cross-section of what we would find in an average practice.
except for the very aged.
Only two of the patients realized or suspected that they had two sets of clen-
turcs prior to being told. One of these noticed a chipped tooth-- -a lateral incisor-.
on one of the dentures, and the other noticed a difference in the feel of t.he rugat:
to his tongue. Many of them did not believe that they had two sets of dentures even
when they were told.
After the patients had been informed that they had two sets of dentures, tlit*
dentures were changed weekly, when possible, and the patient was asked for his
preference, and the reasons for the preference
During both of these periods, before and after the patients’ knowledge of the
two sets of dentures, records were maintained of the adjustments that were necrs-
sary. From zero to eight adjustments were necessary, averaging three per set of
dentures. These were usually the result of over-extension, or of denture border
sharpness, and; in all instances, similar areas in each of a set of duplicate dentures
were involved.
The first patient, immediately after insertion of his second set of dentures
(dentures with the zero degree teeth), reported to the neuropsychiatric service and
was evacuated to the United States for psychiatric treatment. If we had stopped
here. we could have assumed that zero degree teeth drive people mad. The second
patient was no problem. He did not wear either set of dentures. ‘l‘he remaining
23 patients were all happy and pleased with the appearance, comfort, and function
of their dentures. Of these: 2 preferred the anatomic teeth, 11 preferred the zero
degree teeth, and 10 had no preference. These conclusions were reached by the
patients after 6 weeks to 23 months of alternation of the dentures.
Volume 17 Zero degree or anatomic teeth for complete dentures 35
Number 1

REASONS FOR PREFERENCE

One patient preferred the anatomic teeth because he thought they looked
better, and the other because he felt he could chew better. Those that preferred the
zero degree teeth gave the following reasons: (1) “More room in the mouth,”
(2) “Smoother to the tongue,” (3) “Feel better,” (4) “Look better,” (5) “Chew
better.”
Those who had no preference said “I can’t tell the difference, I don’t see how
you can,” or, “Since you have told me I know I have two sets and when you change
them there is a difference. But after a short time I can’t tell which set I am
wearing.”

COMMENT
The fact that ten of the patients could not tell the difference or had no
preference even after they were informed they had two sets of dentures should
successfully refute any hasty conclusion that perhaps the occlusion was not ade-
quately perfected when the anatomic teeth were used.
Until this experiment we had always made complete dentures using anatomic
teeth. We thought that zero degree teeth were an inferior substitute. We were
wrong. True, we cannot predict the effect of zero degree teeth on the tissues, but
we cannot do this for anatomic teeth either.
It is evident that we have been doing many things that are unnecessary. We
are now confident that we can, when using zero degree teeth, dispense with the
face-bow and the adjustable articulator for complete denture construction.
We cannot, in our practice, justify the expenditure of the time and effort
needed to arrange anatomic teeth when zero degree teeth are equally accepted or
preferred by patients.
VETERANS ADMINISTRATION HOSPITAL
50 IRVING ST., N.W.
WASHINGTON, D. C. 20422

1121 WEST MICHIGAN ST.

INDIANAPOLIS, IND. 46202

305 w. 12TH. AVE.

COI~UMBU~, OH10 43210