Selection of artificial teeth

Paul J. Wehner, D.D.S., KS., Judson C. Hickey, D.D.S., ~&SC.,* and

Carl 0. Boucher, D.D.S.**
Dayton, Ohio, Lexington, KY., and Columbus, Ohio

S election of artificial
widely neglected
teeth for complete
phase of prosthodontics.
and removable partial
Many dentists inappropriately
dentures is a
surrender
this critical biomechanical phase of restorative dentistry to a dental laboratory
technician.
The appearance of complete and removable partial dentures involves creative,
artistic ability which includes the whole person. Preservation of tissues involves
knowledge of all basic sciences. Selection of artificial teeth is intimately related to
both the appearance of the patient and preservation of the residual ridges.
Dental laboratory technicians have not been disciplined in any of the phases of
denture construction that involve appearance and preservation of residual ridges.
However, in many instances, the dental profession has forced these duties upon
them. The all too numerous legal problems with the so-called “denturists” are most
often a consequence of the profession’s failure to assume its full responsibility in
prosthodontic procedures. The delegation of the selection of teeth to laboratory
technicians is a prime example.
The selection of anterior and posterior artificial teeth is a simple procedure,
which is not time-consuming, and which merely requires the development of ex-
perience and confidence. The dentist has many available guides for the selection of
both anterior and posterior teeth. Varied philosophies for the selection of the form
of posterior teeth must be understood and used in relation to the dentist’s concept
of balanced occlusion.

PRE-EXTRACTION AND FACIAL GUIDES

Pre-extraction and facial guides include diagnostic casts, photographs, roent-
genograms, the size and form of the face, the profile and cheek form, the size and

Presented at the Kentucky State Dental Association Meeting, Louisville, Ky.

*Assistant Dean and Professor of Prosthodontics, University of Kentucky College of
Dentistry. Present address: Dean, Medical College of Georgia, Augusta, Ga.
**Professor and Chairman, Division of Prosthodontics, The Ohio State University, College
of Dentistry.
222
Volume
Number
18
3
Selection of artificial teeth 223

form of the cast, observation of the teeth of close relatives, and extracted teeth.
Diagnostic casts are excellent aids in both selecting and arranging anterior teeth.
It is a simple matter to measure the length and width of the anterior teeth and select
artificial teeth that are of comparable size and form. Then, arrangement of the
anterior teeth for appearance becomes a matter of the ability of the dentist to copy
that which is before him.
A photograph of a patient in which the natural anterior teeth are visible is a
great help in the selection of the size, form, and necessary modifications of artificial
teeth (Fig. 1). In addition, an algebraic proportion may be established from the
photograph. The known factors are the interpupillary distance of the patient, the
interpupillary distance on the photograph, and the width or length of the central
incisor on the picture. The unknown factor is the width or length of the natural
central incisor. The proportion is arranged as:
interpupillary distance of patient = x
interpupillary distance on photograph width or length of central incisor on photograph

Roentgenograms can be meaningful guides for the selection of anterior teeth.

Although roentgenograms are subject to elongation and foreshortening, in the ab-
sence of other records they have a value in selecting crown form, width, and length
(Fig. 2). Often roentgenograms can be obtained from the patient’s previous dentist.
Patients appreciate this extra interest and become cognizant that this phase of pros-
thodontics is dentist-oriented.
The size and form of the face have been shown to have a positive relationship
in many instances to the size and form of the teeth.l The form of the patient’s face
is classified as square, tapering, ovoid, or a combination thereof, and anterior teeth

2
Fig.

Fig. 1
The photograph provides a means for selecting artificial teeth that are similar in size and
form to the natural teeth. Measurements can be made on the photograph that are useful in
determining the actual size of the natural teeth.
Fig. 2
An indication of the basic size and form of the tooth can often be obtained from observation
of roentgenograms.
224 Wehner, Hickey, and Boucher J. Pros. Dent.
September, 1967

are selected with a form that will harmonize with this face form. Quite logically,
a large tooth would usually appear natural for a large face and a small tooth
for a small face (Fig. 3). Even though the anterior teeth are often dissimilar in
form and size to the outline form of the face,2 this procedure is simple and can be
useful when no positive guides are available.
Since alveolar bone is dependent for its development on the presence and
eruption of teeth, it is logical to assume that at least in a general way the size and
form of the maxillary cast has a relationship to the size and form of the anterior
teeth. However, measurements made directly on edentulous casts are seldom helpful
in selecting anterior teeth because of the uncertainty of the amount of resorption of
the residual ridge. The cast is the only guide that is available to the dental technician

Fig. 3
Left, the size of the tooth is often proportional to the size of the face. Right, in many
instances the form of the tooth is similar to the outline form of the face of the patient.

A:B-3.3:1 v

Fig. 4
Left, the greatest bizygomatic width divided by 16 provides an estimate of the width of the
central incisor. Right, the greatest bizygomatic width divided by 3.3 provides an estimation
of the over-all width of the upper six anterior teeth.
Volume 18 Selection of artificial teeth 225
Number 3

Fig. 5
The plastic face mask can be a useful adjunct in arriving at the length and width of the
central incisor.

for selection of teeth. Surely, dentists should be able to select artificial teeth with all
of the additional guides that are available.

ANTHROPOMETRIC MEASUREMENTS
Certain anthropometric measurements have been found to be useful in selection
of artificial teeth. In a study of 555 dentulous subjects, House and Loop1 found
that the greatest bizygomatic width of the skull divided by 16 gave an estimation
of the width of the upper central incisor, and the bizygomatic width divided by 3.3
gave an estimation of the over-all width of the upper six anterior teeth when carded
flat (Fig. 4). A face-bow may be used as a caliper to determine the bizygomatic
width and then the mathematical computations can be made. Five to 6 mm. must
be added to the number that represents the over-all width of the upper anterior
teeth to indicate this measurement on a curved surface as listed on the mold selec-
tion charts of some manufacturers. A clear plastic form has been developed which,
when centered on the patient’s face, will give an indication of the form of the
patient’s face and the width and length of the central incisor (Fig. 5) .* This deter-
mination is based on a 1 to 16 ratio.

MEASUREMENTS ON OCCLUSION RIMS

A properly contoured upper occlusion rim provides another means of arriving
at the over-all width of the six anterior teeth. The distal surfaces of most natural
upper canines are positioned at the corners of the relaxed mouth. Therefore, marks
placed on the upper rim at the corners of the mouth approximate the location of
these teeth. The rim is removed from the mouth and the distance between the marks
is measured around the labial surface (Fig. 6). Anterior teeth of this width, if ar-
ranged with their labial surface in approximately the same anteroposterior position

*Dentists’ Supply Company, York, Pa.

Fig. 6
Left, a mark is placed on the occlusion rim at the corner of the mouth to indicate the distal
surface of the upper canine. Right, a measurement around the labial surface of a properly
contoured occlusion rim indicates the over-all width of anterior teeth that will be necessary to
fill the projected space.

as the labial surface of the occlusion rim, will occupy a space similar to that of
natural teeth.
Parallel lines extended from the lateral surfaces of the ala of the nose onto
the labial surface of the upper occlusion rim give an estimation of the position
of the middle of the upper canine teeth. The width of the anterior teeth can be
again estimated by the measurement around the labial surface of the upper OC-
elusion rim. A plastic measuring caliper has been designed for this purpose (Fig.
7) .* The caliper indicates the necessary size and suggests possible molds that are
harmonious with the measurement.

DENTOGENIC CONCEPT
The concepts of “dentogenics,” which uses the age, sex, and personality of the
patient, afford additional information to the dentist for selection of anterior teeth.3
It seems likely that a rugged man would have teeth of a different form than a
delicate-appearing young lady. The squareness of form of the tooth indicates mas-
culinity, while more rounded incisal and proximal contours denote femininity (Fig.
8). Small lateral incisors in relation to the central incisors tend to make the ar-
rangement of teeth appear more delicate than central and lateral incisors that are
more nearly the same size.
The dentist still retains the obligation to selection of artificial teeth in this
concept. A prescription written to the dental technician indicating merely the age,
sex, and personality of the patient does not fulfill professional requirements. The
“dentogenic” concept is used in conjunction with other guides to tooth selection so
as to arrive at the best possible situation for the given patient.

PRELIMINARY TRY-IN OF SELECTED TEETH

A comparison of acceptable molds by tentatively arranging the teeth on the
upper occlusion rim or on a tooth selector can give the dentist an early appraisal of

*The Swissedent Corp., Los Angeles, Calif.

Volume 18 Selection of artificial teeth 227
Number 3

Fig. 7
The plastic caliper provides a measurement of the width of the nose which serves as an indi-
cation for a suggested width of the artificial teeth.

Fig. 8
Left, the form of the tooth is compatible with femininity. Right, the form of the tooth is
compatible with masculinity.

the likely appearance of the patient and serve to eliminate undesirable molds (Fig.
9). Special emphasis must be placed on obtaining sufficient width of the upper six
anterior teeth to adequately fill the available space and to allow for the introduc-
tion of irregularities in individual tooth position. Final appraisal must be reserved
for the completed setup on the trial denture bases.

SELECTION OF SHADE OF ARTIFICIAL TEETH

The colors of teeth before extraction, when available, usually are the “shade
of choice” for the artificial teeth. However, the shade must be selected with the
tooth in its normal environment. If no such records are available, the selection of
shade is based primarily on the over-all complexion as modified by the age of the
patient.
The pure solid shades of artificial teeth have been superseded by a series of
blended shades that are provided by most tooth manufacturers. These shades give
a combination of coloring within the same mold that is natural in appearance and
usually eliminates the necessity of combining different shades for the same patient.
The least conspicuous shade for the patient is desirable. A light tooth is cer-
tainly contraindicated for a dark, brown-eyed, brown-haired man who is nearing
fifty years of age. Shades of natural teeth darken with increasing age because of
deposition of secondary dentin, wearing away of enamel, and external staining.
 J. Pros. Dent.
228 Wehner, Hickey, and Boucher September, 1967

Fig. 9
Left, a tentative selection of anterior teeth is arranged on a plastic tooth selector. Right, the
proposed mold is tried in the mouth to observe the size in relation to the face of the patient.

Fig. 10
The shade of the prospective artificial teeth is compared with the shade of the face. The least
conspicuous shade is considered ideal.

This aging feature must be respected in the selection of artificial teeth for edentu-
lous patients insofar as it can complement the complexion, color of the eyes, and
color of the hair.
The source of light must be considered in the selection of shade of artificial
teeth. Artificial light can influence the apparent hue of the tooth and the presence
of shadows affects the brilliance.
We prefer to select the shades of the teeth on a bright day if possible with the
patient located close to the natural light. However, the teeth are also observed in
artificial light; many denture patients are most often seen in this environment.
The best region for comparison of the shade of artificial teeth is the side of the
patient’s face (Fig. 10). In addition, the shade selector is observed under the lip
with the lip relaxed and then under the lip with more tooth exposed and the mouth
Volume 18 Selection of artificial teeth 229
Number 3

open as though the patient were laughing. Placement under the lip serves to com-
plement the previous test along the side of the face.
The “squint test” is of value in differential selection of shades of teeth that
harmonize best with the complexion of the face. The respective shades are held
along the face of the patient. Then the dentist partially closes his eyelids to elimi-
nate light. The shade that disappears from the vision first is the most likely shade
to consider for the patient.
Observing a specific shade of tooth for a great period of time may cause the
color receptors in the eye to accommodate so that a specific hue appears increasingly
appropriate. This phenomenon of “accommodation” can be overcome by looking at
a blue or green background for a short period of time. Then the shade selection in
question can be restudied for acceptability.

SELECTION OF POSTERIOR TEETH

The form of posterior teeth may be one of the most important aspects of
preservation of residual ridges for the edentulous patients. Selection and placement
of posterior teeth is based on a knowledge of anatomy, histology, physiology, pa-
thology, and biomechanics. The nature of the mucosa and submucosa, the form
and relationship of the residual ridges, the general systemic condition of the patient,
the tone of the mandibular musculature, esthetic factors, and past patient experi-
ences can all relate to the size, form, and number of artificial posterior teeth that
may be used on the denture bases. The dentist is solely responsible for the selection
of the posterior teeth as he alone possesses the necessary information required in
this regard.
The available interarch space is a controlling factor in the occlusogingival

Fig. 11
The interarch space can be determined after the casts are mounted on the articulator and is
used as a guide for determining the occlusogingival length of the artificial teeth.
 J. Pros. Dent.
230 Wehner, Hickey, and Boucher September, 1967

length of posterior teeth (Fig. 11). Long posterior teeth are generally more esthetic
in appearance than are shorter teeth (Fig. 12).
The extent of the occlusal table in the mandibular dental arch should not be
carried farther posteriorly than the region at which the residual ridge turns upward
to make its ascent to the retromolar pad (Fig. 13). When posterior teeth are ar-
ranged over steep inclines of the residual ridge, the resultant forces of mastication
or other tooth contacts will likely tend to displace the dentures from their sup-
porting structures. Teeth are not arranged over the retromolar pad because the
histologic makeup of the tissue that forms this anatomic entity are not of a nature
that will support stresses that develop from near or actual tooth contact. Therefore,
for many patients only three posterior teeth are used on each side of the denture.
For other patients, narrower but longer posterior teeth are used to reduce the mesio-
distal length of the occlusal table.
The buccolingual width of the posterior teeth is an important factor in denture
stability. Relatively narrow teeth in a buccolingual direction are indicated to en-

Fig. 12
Left, the posterior teeth are too short in relation to the length of the anterior teeth. This dis-
similarity in size detracts from the over-all appearance of the dentures. Right, the posterior
teeth are favorable in relation to the length of the anterior teeth and provide a more natural
appearing complete denture.

Fig. 13
The line extending buccally from the crest of the residual ridge indicates the most posterior
extent for placement of posterior teeth. This line serves as a guide to the technician in place-
ment of posterior teeth.
Volume 18 Selection of artificial teeth 231
Number 3

hance the development of the correct form of the polished surfaces of the denture.
A wide posterior tooth will not allow the buccal and lingual flanges to slope away
from the occlusal surface so as to permit surrounding tissues to function around the
denture base and actually aid in the stability of the denture (Fig. 14). Narrow
occlusal surfaces with proper escapeways for food are also thought to direct less
stress during function to supporting structures than would similarly placed teeth
with wider occlusal tables.
The over-all length of posterior teeth is measured in millimeters from the mesial
surface of the first premolar to the distal surface of the second molar. A measure-
ment of the mandibular cast from the approximate position of the canines to the
beginning of the upward turn of the residual ridge toward the retromolar pad indi-
cates the appropriate mesiodistal length of the posterior teeth. If the measurement
is less than the length of the smallest posterior teeth, elimination of a premolar of
a larger mold is often the choice to meet the required length of the occlusal table.

PORCELAIN OR PLASTIC ARTIFICIAL POSTERIOR TEETH

Plastic posterior teeth, unfortunately, wear away faster than porcelain teeth
and tend to stain readily for certain patients. For these reasons, we use porcelain
artificial posterior teeth except in selected situations.
Plastic teeth are employed when they oppose natural teeth or those whose
occlusal surfaces have been restored with gold. This procedure eliminates the possi-
bility of the artificial tooth causing unnecessary abrasion on the natural or metallic
occlusal surfaces of the opposing teeth.
Plastic artificial posterior teeth are also used when the interarch space is slight
and the tooth must be reduced excessively in length occlusogingivally. The chemical
combination that occurs between the acrylic resin of the denture base and that of
resin teeth eliminates the probability of the tooth breaking away from the denture
base. In addition, the plastic tooth is indicated when a great reduction in the mesio-
distal width or form is necessary so that the tooth can be shaped to fit small spaces
for esthetic purposes, or be placed in contact with retainers for removable partial
dentures.

Fig. 14
Left, the buccolingual width of the posterior teeth prevents the external form of the denture
base from being shaped correctly. Right, the buccolingual width of the posterior teeth is such
that the external form of the denture base can be shaped in harmony with the surrounding
tissues.
232 Wehner, Hickey, and Boucher J. Pros. Dent.
September, 1967

Acrylic resin posterior teeth should never be used in combination with porcelain
anterior teeth. The rate of wear of resin teeth in relation to that of the porcelain
teeth is such that excessive forces from opposing tooth contact will eventually be
developed in the anterior part of the mouth. The supporting structures for the
dentures are usually least able to withstand increased stresses in this region.

FORM OF ARTIFICIAL POSTERIOR TEETH

Both porcelain and plastic artificial teeth are manufactured in a variety of
cuspal forms. The commonly used forms are those with 33, 20, or 0’ cuspal inclina-
tions. The steepness of the cusp is measured as the angle formed by the incline of
the mesiobuccal cusp of the lower first molar with the horizontal plane.
The maximum opportunity for a fully balanced occlusion is offered by 33’
posterior teeth. However, the final effective height of the cusp depends upon the
horizontal and lateral condylar guidance inclinations and the incisal guidance. The
incisal guidance is a function of the horizontal and vertical overlap of the anterior
teeth. We attempt to maintain as shallow an incisal guidance as is compatible with
esthetics so that balanced occlusion can be developed with as little cusp height as
possible. No controlled research has shown that anatomic teeth cause more changes
of supporting tissues or patient discomfort than other forms of posterior teeth.
The semianatomic 20’ tooth is wider buccolingually than the 33’ tooth. The
20’ tooth has the disadvantages of a cusp tooth without the advantages of a flat
tooth. This tooth provides less cusp height with which to develop balancing contacts
in eccentric positions than the 33’ tooth.
The nonanatomic tooth is advisable when the only record made from the pa-
tient is a centric relation record and no effort is directed to establish a balanced
occlusion. Nonanatomic teeth are also effective when it is difficult or impossible to
precisely establish jaw relation records from the patient or in the presence of ab-
normal jaw relationships.

SUMMARY
The selection of both anterior and posterior artificial teeth for removable
restorations is the responsibility of the dentist. Many of the guides that only the
dentist has available to aid in selection of artificial teeth were described. Each
dentist must develop the necessary experience and confidence that is required for
proper biomechanical selection of artificial teeth.

References
1. House, M. M., and Loop, J. L.: Form and Color Harmony in the Dental Art, Monograph,
(.
Whittier, Calif., 1939, M. M. House.
2. French, F. A.: The Selection and Arrangement of the Anterior Teeth in Prosthetic Den-
tures, J. PROS. DENT. 1: 587-593, 1951.
3. Frush, J. P., and Fisher, R. D.: Dentogenics: Its Practical Application, J. PROS. DENT.
9: 914-921, 1959.

1010 FIDELITY BLDG. MEDICAL COLLEGE OF GEORGIA COLLEGE OF DENTISTRY

DAYTON, OHIO 45402 SCHOOL OF DENTISTRY THE OHIO STATE UNIVERSITY
AUGUSTA, GA. 30902 325 WEST 12~13 AVE.
COLUMBUS, OHIO 43210