CHAPTER 13 Arrangement of artificial teeth

Chapter 13
Arrangement of artificial teeth
The contour of the maxillary and mandibular occlusion
rims are adjusted in the stage of jaw relation registration. On
the upper occlusion rim, the midline, the high lip line and the
canine lines are marked. These can be used as guide marks in
setting up of anterior teeth.

Before arrangement of the artificial teeth:

1- The midline and the canine lines are extended on the cast to
preserve a record of them when these marks on the upper
occlusion rim are destroyed during setting up of the teeth.

2- The crest of the upper and lower ridges are marked on the
casts. These marks are transferred to the top of the wax rims.
The posterior teeth especially the lower should be set up on the
crest of the ridge by the aid of these marks.

Center
Center ofofridge
ridge
Posterior
Posterior
Mandibular
Mandibular
1/2
1/2 way
wayup
up Cast
retr Cast
retromolar
omolar

Land
Land Area
Area
Ar ea
Occlusion
Occlusionrim
rim
Center
Center ofofridge
ridge
Anterior
Anterior

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Marking reference lines on the upper and lower casts

Factors that are considered in the arrangement of

teeth:

1- Pattern of Bone Resorption:

The pattern of bone resorption has a great effect on
setting-up of teeth especially the anterior teeth.

a. In The Maxilla:
After extraction of the teeth, resorption of bone occurs
vertically, labially and buccally due to the direction and
inclination of the roots of the teeth and the alveolar process.

b. In The Mandible:

Resorption of bone occurs vertically and lingually.

Consequently with progressive bone resorption, the maxilla
becomes small in size and the mandible becomes wide.

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By understanding the pattern of bone resorption, setting-up

of anterior teeth should be labial to the crest of the ridge to
restore the original position of the natural anterior teeth.

2- Esthetics:

Esthetics should be considered in arrangement of teeth in

such a way to produce appearance and to simulate to great
extent natural teeth.

There are some irregularities frequently preset in natural

teeth, these may be reproduced to improve esthetics.

3- The occlusal plane:

The occlusal plane has a direct relationship with -setting up

of anterior teeth. Anterior teeth should be set up 2 mm below
the upper lip. It also has a role in setting up of posterior teeth
e.g. in fiat lower ridges the occlusal plane is oriented as closely
as possible to the lower ridge.

4- Harmony of the teeth with the contour:

The arrangement of teeth should follow the contour of the

ridges, where they are oval, taper or square. The posterior teeth
are generally set up with their long axis perpendicular to the
ridge.

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5- Interdigitation of teeth:

The Upper and lower posterior teeth should be set up to

have a definite cuspal relation to each other which maintains
their positional and functional relationship. Maximum
interdigitation should be established during setting-up of
posterior teeth.

Factors governing the position of artificial teeth:

I. Anterior Teeth:

Anteroposterior positioning of anterior teeth is

important for esthetics and phonetics because of the support
that teeth give to lips, cheeks and other tissues of the oral
cavity. Therefore it is important to place anterior artificial
teeth in the same position or in a position as close as possible
to that occupied by natural teeth to maintain proper support of
these tissues and natural patient appearance.

The crest of the residual ridges aids in positioning the

artificial teeth if the natural teeth are recently extracted. As
resorption progresses, the crests of the residual ridges do not
remain in their relative position, due to the pattern of alveolar
bone resorption. The incisive papilla is used as a useful
anatomic guide in determining the anteroposterior and
mediolateral position of maxillary anterior teeth, because of
its constant relationship to the natural teeth.

A line drawn on the cast anteroposteriorly bisecting the

midsagital suture, incisive papilla and the labial frenum

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coincide with the midline of the upper dental arch.

Mediolaterally, the central incisors are set on either side of
this line.

Anteroposteriorly, the central incisors are positioned so

that the distance from the center of the incisive papilla to the
labial surface of the central incisors is about 8-10 mm.

II- Posterior Teeth:

Posterior teeth are generally placed to enhance the

stability of the mandibular denture. This is done by arranging
the teeth, so that the mandibular posterior teeth are over, or
slightly lingual to the crest of the mandibular residual ridge.

The retromolar pad is used as a guide in determining the

buccolingual position of posterior teeth, a line drawn from the

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center of the retromolar pad to the canine area, marks the crest
of the mandibular ridge.

I- Arrangement of the anterior teeth:

1. Arranging the maxillary anterior teeth

a. Maxillary central incisors

1. The long axis of the tooth should incline slightly distally.
2. The contact point should coincide with the midline of the
face.
3. The incisal edge should touch the mandibular occlusion
rim.
4. The facial surface of the central incisors should be 5-9
anterior to the center of the incisive papilla.
5. The neck is slightly depressed.

b. Maxillary lateral incisors

1. The long axis should incline slightly distally.
2. The neck is more depressed.
3. The incisal edge of the lateral should be raised
approximately 1 mm from the mandibular occlusion rim.

c. Maxillary canines
1. The incisal edge of the canine should touch the mandibular
occlusion rim.
2. The long axis should be perpendicular or slightly inclined
distally to the occlusal plane. The cervical third of the labial
portion of the canine should incline buccally to achieve some
prominence.

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3. Distal aspect of the canine should coincide with the crest of

the ridge.

Relations and inclinations of maxillary anterior teeth.

Line connecting cusp tips is perpendicular to midline.

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2. Arranging the mandibular anterior teeth

In denture fabrication the mandibular incisors should not

touch the maxillary incisors in centric relation.

a. Mandibular central incisors

1. The long axis of the mandibular central incisor should be
set perpendicular to the occlusal plane.
2. Set the mandibular central incisors so that the maxillary
incisors cover them, 1 mm vertically.
3. The contact point of mandibular incisors should coincide
with the midline of the maxillary teeth.

b. Mandibular lateral incisors

1. The long axis of the mandibular incisor should be slightly
inclined distally at the cervical portion of the tooth.
2. The occlusal height should be the same as the central
incisors.

c. Mandibular canines
1. The long axis of the mandibular canine is nearly
perpendicular to the occlusal plane with a slight distal
inclination.
2. The tip of the canine should be at the same occlusal height
as the mandibular central and lateral incisors.
3. When properly arranged, the long axis of the maxillary
canine will coincide with the distal surface of the mandibular
canine, when viewed from the buccal.

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N.B.
Anterior teeth are set to follow the arch form of the
patient's residual ridges. The incisal edges of the anterior
teeth should be set to correspond to the shape of the arch.

Relations and inclinations of mandibular anterior teeth.

Arranged upper and lower anterior teeth.

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PROCEDURE:

1. A window is cut in the upper rim immediately left to the

midline slightly wider than the central incisor. A small
piece of softened wax is added, the upper left central
incisor is attached to the wax according to the rules.

2. The upper left lateral and cuspid are positioned according to

the rules. By the same technique the right central lateral and
cuspid are set-up.

3. The labial segment of the lower wax rim is removed and the
lower anterior teeth are set-up as the rules.

The upper anterior teeth should overlap the lower in

vertical and horizontal directions. A minimal vertical overlap
and a reasonable horizontal overlap are desirable; this will
avoid a locked condition of the anterior teeth.

Horizontal and vertical overlap

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After setting up the anterior teeth, the following points

should be checked:

• The incisal edges of the maxillary central incisors are

generally parallel with the incisal plane.

• The incisal edges of the maxillary laterals are usually one or

two mm higher than the central incisors. They should be
depressed gingivally.

• The maxillary cuspids are usually set-up in a

vertical position or their necks are slightly shifted to the
distal. They are prominent at their necks and depressed at
their incisal edges.

• The incisal edges of the mandibular centrals and laterals are

usually parallel with the incisal plane.

• The mandibular cuspids are usually prominent at their necks

and depressed at the incisal edges.

• The cuspid relations: The distal incline of the lower cuspid

should be in vertical alignment with the tip of the cusp of the
upper cuspid.

• In case of using a semi-adjustable articulator the incisal table

is adjusted as follow:

The centric lock screw and the adjusting screw of the

incisal guide table are loosened. The inclination of the incisal

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table is adjusted by tilting it upward and downward while

moving the upper member of the articulator about 3 mm to
each side and 2 mm backward. When the incisal edges of the
anterior teeth just pass over each other without interference and
the incisal pin remains on the incisal table tighten the adjusting
screw of the incisal table. Slight adjustment of one or few teeth
may be necessary to fulfill this condition and the centric lock
screw is tightened.

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II- Arrangement of the posterior teeth:

Arranging the maxillary posterior teeth:

a. Place the maxillary first premolar with its long axis at right
angles to the occlusal plane. The buccal and lingual cusps
should contact the metal occlusal plane.

b. Place the maxillary second premolar in like manner. Buccal

and palatal cusps contact the metal occlusal plane. Align the
buccal surfaces of the premolars and the canine with the edge
of metal or plastic occlusal plane template.

c. The mesiolingual cusp of the maxillary first molar touch the

occlusal plane. The distobuccal cusp is raised about 1/2 mm
and the distolingual cusp is raised about 1/2 to 3/4 mm above
the occlusal plane.

d. All of the cusps of the second molar are raised from the
occlusal plane following the position of the first molar.

Relation of maxillary posterior teeth to occlusal plane.

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Relation of buccal surfaces with the canine.

Arranging the mandibular posterior teeth:

In centric occlusion, the buccal cusps of the mandibular

teeth fit into the central fossae of the maxillary teeth while the
lingual cusps of the maxillary teeth fit into the central fossae of
the mandibular teeth. This position establishes the proper
buccal overjet.

1st Bicuspid: Space available for it depends upon

anterior relationship. If necessary mesiodistal width may be
reduced on mesial contact point. Buccal cusp touches mesial
marginal ridge of upper 1st bicuspid.
2nd Bicuspid: Buccal cusp touches distal marginal ridge of 1st
bicuspid and mesial marginal ridge of 2nd bicuspid. Lingual
cusp rests lingually and between maxillary1st bicuspid and 2nd
bicuspid.

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1st Molar: Mesiobuccal groove is under the mesiobuccal

cusp of maxillary 1St molar . Fossae are in contact with the
lingual cusps of the maxillary molar.

2nd Molar: Same relative condition as for first molar.

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