Arrangement of teeth

Lec.5 Dr. Kawan

Salah

Objectives:
1. Clarifying the concepts of occlusion.
2. Reviewing the rules of arrangement for each tooth separately.
3. Clarifying the compensatory curves.

Definition: it is the placement of the teeth on the denture with different

objective in mind which should have certain thing which is the concept of
occlusion which we are going to adapt it during the arrangement of the teeth.
Occlusion: is the contact between the incisal and occlusal surfaces of the
teeth.
For simplicity, we have 2 concepts of occlusion:
1. Non-balanced occlusion (Neuro-centric) concept.
2. Balanced occlusion concept.

1. Neuro-centric concept: it is based on the hypothesis that a plane

surface is always present no curvature, so they try to do the
arrangement without any curvature (compensating curve), and always
those people use flat teeth, and the occlusal plane is parallel to the
ridge.
2. Balanced occlusion concept: in this concept, they try to have a
balanced occlusion which can be defined as an occlusion which gives
a harmonious and simultaneous contact during centric and eccentric
contact, but this contact is within functional limits.
In our school, we use this concept (Balanced occlusion concept). So in
order to develop such occlusion for the patient, we should follow certain
rules:
 First of all, we should think of the postulate that generally we should
arrange the teeth where they grew, the arrangement of teeth is based
on this hypothesis, because patient keeps his natural teeth for a certain
period of time, so the muscles of mastication work in harmony with
this position of teeth (adapt to this position).
We will start with the arrangement of the anterior teeth:

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 I. Arrangement of the anterior teeth:
It begins with the arrangement of the upper anterior teeth. We begin with the
arrangement of the upper central incisor. Ideally, the arrangement of the
anterior teeth should be done by the dentist himself, but when we give this
job to a technician we should give him: correctly oriented bite rim, and
prescribe in detail what we need in the arrangement of teeth.
The arrangement of teeth starts with the upper central incisor. The
arrangement of the upper central incisors is very important.
We should consider each tooth in 3 planes: (Frontal, sagittal, and horizontal
planes).
In the frontal plane, the upper central incisor is perpendicular and the incisal
edge touches the occlusal plane.
In the sagittal plane, the first central incisors have a slight labial inclination
to give support ton the upper lip.
In the horizontal plane, the labial surface of the central incisor should be
located at a distance of 8-10 mm from the center of incisive papillae.

The second tooth is the upper lateral incisor:

In the frontal plane, it has a slight distal inclination or same time
perpendicular depending on the facial form of the patient.
In the sagittal plane, it shows a slight labial inclination.
In the horizontal plane, it gives continuity of the curvature of the teeth.
Then the arrangement of canine:
In the frontal plane, the canine is perpendicular and the cusp tip touches the
occlusal plane.
In the sagittal plane, slight labial inclination or sometimes perpendicular.
The most important point in the arrangement of canine is that the tip of the
canine on both sides, the line passing between them, passes through the
center of the incisive papillae.
Lower central incisor:
In the frontal plane, it is perpendicular.
In the sagittal plane, slight lingual inclination depending on the amount of
resorption, and when we close the articulator we should have what we call it
(over bite) or (the vertical overlap) which means that the upper anterior teeth
covers part of the lower anterior teeth, and this amount depends on several
factors, but generally speaking it should be about 1-2 mm.
[Overbite is the vertical extension of the upper anterior teeth on the lower
anterior teeth when the posterior teeth are in centric occlusion].

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The other thing in the arrangement of the anterior teeth is that we should
have over jet which is the extension of the lower anterior teeth beyond the
upper anterior teeth. This amount we call it (over jet). The amount of over
bit and over jet is guided by several factors. The end result of the
arrangement of the anterior teeth is that we should have:
- Uniform over bite.
- Uniform over jet.
- We should have a normal canine relation, which mean that we should have
the lower canine in the embrasure between the upper lateral incisor and
upper canine.
This is the normal canine relation that should be checked inside the
patient’s mouth before the arrangement of the posterior teeth in order to
evaluate the esthetic and phonetic and correction should be done in order
to respect the age, sex, and personality of the patient. And also we should
do the phonetic examination of this arrangement by asking the patient to
pronounce certain words which contain F and V sound to assess the
arrangement in the frontal and sagittal planes. During the pronunciation
of such words, the incisal edges of the upper incisors should touch the
vermilion lines of the lower lip (vermilion line is the line which separates
between the dry and moist part of the lower lip).
When we feel a correct arrangement of the anterior teeth, then we go to
the articulator and do the adjustment of the inclination of incisal guidance
or insisal table. This adjustment of the incisal table will give us the
inclination of the incisal guidance. The inclination of the incisal guidance
depends on the amount of over bite and over jet, so when we get the
correct inclination of our incisal guidance we go into the arrangement of
the posterior teeth.
The arrangement of the posterior teeth depends on the correct
arrangement of the anterior teeth because we should draw a line on the
lower bite rime which extends from the tip of the lower canine and the
middle of the retromolar pad. The central grooves of the occlusal surfaces
of the lower posterior teeth should pass through this line in order to give
a direct concentration of occlusal force on the lower residual ridge.
For the arrangement of the lower posterior teeth we should begin with the
arrangement of the lower 1st premolar, 2nd premolar, and during this
arrangement we should begin to give what we call it the compensatory
curve, so we begin to give the compensatory curve which in the natural
dentition we call it (the curve of spee) which is a curve in the sagittal
plane of the natural dentition. It begins at the tip of the canine and
continues to the anterior border of the ramus of the mandible. The

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 arrangement of the teeth or the level of the occlusal plane should never
pass the lower 2/3 of the height of the retromolar pad because it will
affect the stability of the denture.
The arrangement of the upper posterior teeth begins with the arrangement
of upper 1st molars. We begin to give a normal molar relation, i.e. the
mesio-buccal cusp of the upper molars is in the buccal groove in the
lower molars. This is a very important relation because the artificial teeth
are designed to work on these two relations which are the canine and
molar relation.
Another curve in the frontal plane in the natural dentition which we call it
(Monson’s) or (Willson’s) curve which is in the frontal plane (in the
artificial teeth we call it 2nd compensatory curve). This curve comes from
the theory of sphear. In this theory, they think that the incisal and the
occlusal surface of teeth touch a sphere of 10 mm diameter with the
center situated near the glabella.
So in the arrangement of the artificial teeth we should give this correctly,
i.e. the buccal cusps should be higher than the lingual cusps.
These curves are done to obtain balanced occlusion. These curvatures
will give simultaneous contact during the protrusive and during the
lateral movement.
The curve which is equal to the curve of spee will give simultaneous
contact during the protrusive movement, and the other curve which is
equal to Monson’s curve will give simultaneous contact during the lateral
movement on the working side and balancing side.
To obtain this we should have certain factors listed by Hanau:
1. Inclination of the condylar guidance.
2. Inclination of the incisal guidance.
3. Orientation of the occlusal plane.
4. Inclination of the cusps.
5. The prominence of the compensatory curve.
So we should consider these 5 factors to have a balanced occlusion in
protrusive and lateral movement.
The condylar guidance is fixed in our articulator, but we have adjustable
incisal guidance. In other articulators, we should adjust this condylar
guidance. This is based (in the Hanau articulator) on the (Christinson’s
phenomenon): when we protrude our mandible to have an edge-edge
relation of the upper and lower incisors we will have a space between the
upper and lower molars.
These 2 factors (condylar and incisal guidance) are fixed i.e. related to
the patient and are result of muscle and ligaments. The other 3 factors are

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changeable we can change them to have the end result which is the
balanced occlusion which is the simultaneous contact between the upper
and lower teeth during the centric and eccentric contact within the
functional limit.

We have two eccentric occlusions and relations in complete denture:

 Protrusive occlusion, in which we should have a contact between the
incisal edges of the upper and lower incisors, and between the mesial
slop of the lower posterior teeth with the distal slops of the upper
posterior teeth.
 Lateral movement, here we have 2 point:
1- Contact or occlusion on the working side.
2- Contacts or occlusion on the balancing side.
The direction to words which the mandible moves is the working
side.