Textbook of Complete Denture PROSTHODONTI Sarandha D.L. mos Reader Department of Prosthodontics Hasanamba Dental College and Hospital Hassan (Karnataka) Contributing authors Zakir Hussain MDS Department of Prosthodontics Sibar Institute of Dental Sciences Guntur (Andhra Pradesh) Uthkarsh Mps (Oral and Maxillofacial Surgery) Reader Department of Oral and Maxillofacial Surgery Hasanamba Dental College Hassan (Karnataka) JAYPEE BROTHERS MEDICAL PUBLISHERS (P)LTD New DelhiPRINCIPLES OF ARRANGEMENT OF TEETH DEFINITION In Prosthodontics, the term “arrangement” would refer to a procedure of locating, tilting, rotating and spacing arificial tooth/teeth in relation to the plane of reference and to each other with the objective of creating a natural appeal and based on biomechanical requirements of complete denture treatment. PRINCIPLES OF ARRANGEMENT OF MAXILLARY ANTERIOR TEETH 1, General position: The general position of each tooth is such that the imaginary root passes through restored ridge contour of maxillary foundation 2. Relation of tooth to the frontal plane (Fig. 12.1) a. Central incisor should have slight labial inclination. 'b. Lateral incisor reveals a little more/relatively more labial inclination compared to central incisor revealed by cervical depression of the tooth. ©. Canine is located in upright manner with the cervical third of the tooth revealed in a bold manner. FIGURE 12.1: Relative postion of maxillary anterior teeth to frontal plane 3. Relation of tooth to clinical midline (Fig. 12.2): a. Central incisor reveals very slight mesial inclination, b. Lateral incisor shows relatively more mesial inclination than central incisor. ©. Canine is placed in an upright manner. 4, Relation of incisal edge to mid-sagittal plane: a. Central incisor reveals an angle litle less than 90° to the sagittal plane. FIGURE 12.2: Relative position of maxillary anterior teeth to clinical midline b. Lateral incisor reveals an angle of 30° to the sagittal plane. . Canine reveals an angle of 45° to sagittal plane. 5. Relation of incisal edge to occlusal plane (Fig. 12.3): a, Central incisor isin contact with the occlusal plane, b. Lateral incisor remains 0.5-1 mm away from the occlusal plane. ¢. Canine tips remain in contact with the occlusal plane FIGURE 12.3: Relative position of incisal edge of maxillary anterior teeth to occlusal plane APPLICATION OF DENTOGENIC CONCEPT Positioning of the teeth is necessary in further conveying, sex characteristics to a denture. To enable us to simplify and clarify this point we will consider some of the various positions of the six maxillary anterior teeth. Central Incisor ‘The positions of the two central incisors set in perfect symmetry are the starting positions for conventional tooth, setups. By bringing the incisal edge of one central incisor anteriorly, we create a position which is evident but harsh.(4) If we move one of the central incisors from the starting position out at cervical end, leaving the incisal edges together, we can create a harmonious lively position. The more vigorous position is to move one central incisor bodily anterior to the other. Combined rotation of the two central incisors with the distal surface forward with one incisor depressed at the cervical end and the other depressed incisally. These three positions can be treated either very softly or more vigorously. However, the softer positioning would be more favorable for women and the vigorous more favorable for men. Lateral incisors They being generally narrower and shorter than the central incisors are less apparent; however they can impart a quality of softness or hardness to the arrangement by their positions. a, The lateral incisor rotated to show its mesial surface whether slightly overlapping the central incisor or not, gives softness or youthful coquettishness of the smile. . By rotating the lateral incisors mesially the effect of the smile is hardened, Cuspid Teeth The three positions for cuspids adopted are: a. Out at the cervical end, as seen from front. b. Rotated to show the mesial surface. c. Almost vertical as seen from the side. Itis evident that a prominent cuspid eminence gives to the cuspids greater importance and therefore gives to the smile a vigorous appearance more suitable to the masculine sex. Genre Goes ined BONDS W GH baie) t= Central and lateral incisors are placed upright. Canines are mesially tlted-sleeping canines (Fig. 12.4). The mandibular teeth are placed in a mesial relation to the maxillary teeth (Fig. 12.5). There should be a vertical overlap of 2-3 mm and a horizontal overlap of 1-2 mm (Fig. 12.6). ‘TextB00K oF CompLere DENTURE PROSTHODONTICS FIGURE 12.4: Relative position of mandibular anterior teeth to (a) Occlusal plane and midline. (b) Frontal plane FIGURE 12.5: Relative position of maxilary anterior teeth to mandibular anterior teeth Arrangement of Posterior Teeth Itis based on the following principles: 1. General position of teeth 2. Buccopalatal relation. 3. Relation to clinical midline 4, Relation to occlusal plane. Itis governed by mean crest line. All the mandibular posterior teeth should be located in a position, so that ‘mesiodistal grooves or central grooves of all teeth joined together should coincide with average crest line of, mandibular foundation,PRinciPLes oF ARRANGEMENT OF TEETH FIGURE 12.6: Relative position of maxillary anterior teeth to mandibular anterior teeth. (A) Overbite (B) Overet Maxillary First Premolar It should be placed upright with the tip of buccal cusp contacting the occlusal plane. Palatal cusp is rudimentary/ nonfunctional (Fig. 12.7), Maxillary Second Premolar It should be placed upright with buccal and palatal cusp tip contacting the occlusal plane (Fig. 12.7). Maxillary First Molar It is inclined buccally in buccopalatal relation and inclined buccodistally in clinical midline relation with the mesiopalatal cusp in contact with occlusal plane (Fig. 12.7), Maxillary Second Molar It is inclined buccally in buccopalatal relation inclined. distally in clinical midline relation. None of the cusps contact the occlusal plane (Fig. 12.7) The mandibular teeth are placed in a mesial relation tothe maxillary teeth. The maxillary teeth should overlap the mandibular teeth and the mesio-buccal cusp of the ‘maxillary first molar should coincide with the mesiobuccal groove of the mandibular first molar, which forms the key of occlusion (Figs 12.8 and 12.9). FIGURE 12.7: Relative position of maxillary posterior teeth to (A) Occlusal plane, (B) Clinical midline. (C) Frontal plane FIGURE 12.8: Relative position of mandibular posterior teeth to maxilary posterior teeth Compensating Curves It is a biomechanical requirement. It compensates for the lateral and posterior space created on protrusive and, lateral excursions for the stability and harmony of dentures 1, Lateral curve: It is called the Monson's curve (Fig, 12.9) 2, Antero-posterior curve: It is called the curve of Spee (Fig. 12.9)FIGURE 12.9: Relation of maxillary posterior teeth to mandibular posterior teeth with compensating curves. (A) Antero-posterior ‘curve, (B) Lateral curve Arrangement of Noncuspal Teeth It is indicated in cases of malrelated jaws, crossbites, resorbed ridges and uncontrolled jaw movements for ‘whom itis difficult to obtain a valid centric relation record. The mid crestal line of the lower ridge is marked over the mandibular occlusal rim, The maxillary teeth are arranged such that their centers lie approximately over the line scribed on the mandibular occlusal rim. The mandibular teeth are then arranged to occlude with the maxillary teeth. In normal jaw relation, there will be buccal overjet of the upper teeth. However, in some situations in which there is a small upper arch and a large lower arch, it is possible to position the posterior teeth in an end-end occlusal surface relationship. ‘Additionally if the upper and lower space available for arranging teeth antero-posteriorly is mismatched, it is possible to arrange premolars to oppose molars, since there is no interdigitation of cusps. ‘TexTB00K oF ComPLeTE DENTURE PROSTHODONTICS It is advisable when using O"posterior teeth to select ‘or modify the canines so that they tend to have a blunt incisal edge rather than a pointed one, Usually, optimal contact and/embrasure between a canine and a O'premolar can be obtained more easily with a somewhat blunted canine than with a pointed one, It is important to pay special attention to see that there is good occlusal contact in the set up when viewed from different aspects, especially the lingual aspect. FIGURE 12.10: Arrangement of non-cuspal teeth (A) Flat ‘occlusal plane (B) Balancing ramp (C) With compensating Arrangement of Teeth in Abnormal Ridge Mandibular Retrusion Anterior teeth ‘The management of such situations can be attempted in any of the following ways: 1. If the retrusion is not too extreme, the simplest way is to select the lower anterior teeth of a narrower mesiodistal width and try to achieve the normal canine relationship. 2. If esthetics permits, a litle crowding of the lower anterior teeth by overlapping may solve the problem well 3. Another solution, which is effective at times, is creating slight spaces between the upper anterior teeth to attain normal canine relations, However, such a procedure is estheticaly limited 4, In situations where the discrepancy is not too great, grinding of the distal surface of lower canine is sufficient to restore the normal canine relationship.